I think every word of Matthew Yglesias’s post on Omicron, Omar Bradley, and why the hell aren’t we investing in pandemic prevention is brilliant. I think it is publicly available (I didn’t pay) and advise just clicking the link.
For those who ignored the above advice, I would like to focus on two main points
First he argues that we should invest in the capacity to make large amounts of vaccines against currently unkown viruses. This includes massive investment in efforts to produce a broad spectrum vaccine, but also just making sure that we don’t again end up with a vaccine but without the capacity to rapidly make 15 billion doses. As Yglesias notes, the cost benefit calculation is absurd.
We want enough infrastructure in place that we can start churning out a billion doses of any new vaccine within a month.
We need huge amounts of excess capacity in vaccine manufacturing, and someone has to pay for that. You could do it with explicit subsidy or you could do it with windfall profits when the vaccines are needed. But right now, on both vaccines and antivirals, we just can’t make them quickly enough to unlock the full potential of the underlying science, and it would be worth spending tons of money to be able to do so. For context, Pfizer is anticipating about 36 billion in vaccine revenue in 2021. If handing them 10 times that revenue made it possible to triple vaccine production, it would be money well spent.
He also explains why this, which obviously should happen, obviously won’t happen. First no private firm will invest in capacity which might generate hundreds of billions in profits but which will probably generate zero revenue. It might be in the interests of shareholders with diversified portfollios, but any CEO who does that can only be motivated by being sick of the job and would just cut out the middle man and retire.
Second Congress won’t fund it. We know that as funding for pandemic preparedness, proposed during an pandemic, was cut from $65 billion to $2.7 billion . It is fairly likely that this will be money for things which won’t be needed. In the less than 50% chance that it is funding for things which will be desperately needed, no one will get close to proportional credit for preventing something horrible that ended up not happening (because it was prevented). There are not and there will never be proper incentives to deal with tail risk. Such is life, or, for the past two years death.
Notice how the modest operation warp speed grants are controversial (there must be some reason why so much anger is directed at Moderna compared to Pfizer). Second notice how angry people get about windfall profits. It’s not the money — it’s the sense of unfairness. So trillions for partial remediation of side effects but not hundreds of billions to including tens of billions of profits for a lucky corporation which has the cure.
Yglesias’s other point is that current agencies are also a mess. For institutional reasons, they are small c conservative during a crisis. Also their funding “is a bunch of budgetary silos with almost no flexibility.” This is the natural steady state of organizations (maybe especially public organizations).
I have further thoughts on slightly less key points.
Intelletual property I really like this
“You hear a lot about patent protection from left-wing types, but I think that’s a case of starting with a general view (patent protections for medications are bad for poor countries) and then strong-arming it to apply to a case where it doesn’t really fit. The signature symptom of an IP-induced deadweight loss is that the product is available, but poor people can’t get it because the market price is too high. That was the situation with AIDS medications in the late-1990s, and it’s a very real issue in the world. But mRNA vaccines ae genuinely scarce.
As noted before, I strongly agree. The fact that Moderna has promised not to enforce the patents during the pandemic has remarkably no effect at all (that I have been able to detect) on the discussion of patent protection by left-wing types.
I’m pretty sure I have complained about the FDA more than enough already. It appears in the post in say “we’re in the annoying wait-and-see period during which experts fully expect the drugs to be approved by the FDA, but they have not yet been approved. As has consistently been the case throughout this crisis, there are questions about why the FDA can’t do a review of this kind on a more rapid basis given the urgency of the situation. ” Also “We were too slow to roll out tests.”