Howard W. French
As he watched his country flail early in the COVID-19 pandemic, the Nobel laureate economist Paul Romer argued that only by taking a dramatic, concerted step, carried out simultaneously nationwide, would the United States be able to stop the spread of the virus and contain its spiraling costs.
At the time, in April 2020, Romer said that the United States should commit an estimated $100 billion dollars to a crash national testing program that would allow the quarantining of people who were positive and thereby stop the spread of the pathogen to others. This, he argued, was a pittance compared to the $2 trillion the government had already committed by then to a series of ill-coordinated pandemic response measures that seemed ever-doomed to remain at least one step behind the virus.
An awful lot has changed since the time of Romer’s proposal, not least the idea that the coronavirus can be effectively combatted in a single country, unless it is a rare nation like China, which combines a strongly authoritarian government, formidable systems of surveillance and enforcement, and no public sphere in which anyone can loudly object to infringements on personal freedoms.
Since then, the rest of the world has veered through wave after wave of the pandemic, with infection levels rising and falling in different rhythms across disparate regions—and every moment of relief and relaxation followed by another spike in infections, hospitalizations and deaths.
With the latest emergence of a new variant of concern, in which global attention has been hastily bracketed on Southern Africa, it is time to revisit the main gist of Romer’s thesis and its corollary: Only by taking truly systematic action will the spread of this virus be broken, and as dramatic as the costs of an all-at-once approach might look at first glance, they are immeasurably cheaper in public health, social and economic terms than any more improvised or piecemeal approach might be.
An updated Romer approach would not be focused on testing, but rather on vaccinations. And to be truly cost effective, a new vaccine campaign should be truly global, meaning rolled out as close to simultaneously as possible worldwide, leaving no region or national population unvaccinated. In fact, from the moment effective vaccines started being delivered almost a year ago, the world has known that this is the only way that the COVID-19 pandemic will be mastered. But as the satisfaction over the newfound sensation of freedom from grave risk spread in the West last summer, rich countries lost all sense of urgency toward providing affordable and, where need be, free vaccines to the rest of the world.
This spirit was captured inadvertently in a message tweeted by the U.S. State Department recently, in which Washington fairly bragged about its generosity toward global public health needs. With no intended irony, it said, “The United States is making good on our commitment to provide COVID vaccines to the world. To date we have provided more than 80 million Covid-19 doses and more than $1.9 billion in Covid-related assistance to African countries, with no strings attached.”
To be truly cost effective, a new vaccine campaign should be truly global and rolled out as close to simultaneously as possible worldwide.
As it happened, this tweet was issued on the very eve of the news that the potentially dangerous new version of the virus, since named the omicron variant, had been isolated in South Africa. The new variant contains over 50 mutations, including many to its spike protein, the element of the virus thought to be most critical to transmission, and its incidence has been found to be rising quickly in South Africa.
The world’s woeful initial response could not have been more predictable. Having done little to provide vaccines to the African continent, rich countries reflexively slapped on travel restrictions, hoping to contain the new variant there and let Africans stew in their own misery. It didn’t take long for such a classically offensive approach toward Africa and Africans, treating them as a dispensable appendage of the “international community,” to reveal its prejudice and absurdity. Within another day or two, cases of the new variant were turning up in many rich countries, including among people who had no obvious direct connection to Africa, via travel or otherwise. Since then, in fact, Dutch authorities say they have traced cases of infection with the omicron variant that predate its identification in South Africa.
In the end, though, it is fitting that omicron was discovered in Africa, even though it is still premature to conclude that it evolved there, as some media instantly began asserting. If the United States, the world’s largest manufacturer of vaccines has only provided 80 million doses to a continent numbering 1.4 billion people, it stands to reason that no matter how well COVID-19 is contained in places like Western Europe, Israel, Canada or the U.S. itself—and in many of these places it has not been well contained—a large reservoir of human hosts remains for the virus to keep evolving until it has eventually outstripped the vaccines designed to protect against it.
According to the Financial Times, the number of people in high-income countries who have received two doses of approved vaccines is nearly twice the number of people who have received just a single dose in low-income countries. Meanwhile, 66 percent of the population in G-7 countries has been vaccinated twice, while in Africa, that number stands at just 6 percent. In fact, South Africa is a bit of an outlier on its continent, with about 35 percent of its population vaccinated, far higher than almost anywhere else in Africa.
This brings us back to Romer. The United States, China, Russia and Europe should join forces urgently to put in place a truly global crash vaccine program. As China opened its annual summit with African countries on economic and political ties this week, President Xi Jinping made a big splash by saying that Beijing would supply a billion doses to Africa in 2022, more than half of them for free. This is encouraging news, even though economically advanced countries—including Washington, Brussels and Moscow—have made big promises about donating vaccines before as part of their ongoing global image and propaganda sweepstakes, only to leave them badly unfulfilled.
In order for a Romer-like plan around global vaccination to succeed, national rivalries must be temporarily set aside. Technology will need to be shared, including much more deeply with the so-called developing world. And through emergency measures, limits will have to be placed on the profit margins of the companies that developed the leading vaccines, almost always with some form of rich government support, whether direct or indirect.
The vaccines rolled out so far have proven to be among the most lucrative pharmaceutical products in history. It is time now for a less profit-oriented approach. Covering costs and stepping up manufacturing, even by licensing rivals, is necessary in order to contain the mounting public health and economic catastrophe that the virus is wreaking. If ever there was a chance to show humanity’s better side, here it is.
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