The Covid 19 pandemic is once again at an inflection point– with cases now falling sharply in most of the world. The current pandemic may be coming under control, but after millions of preventable deaths, this is very far from a success story and it is as good a time as any to take a hard look at our failings, especially with regard to our management of knowledge
Across the world, the number of Covid infections are declining: the United States numbers are finally falling after the Delta variant sent it soaring in the late summer; India-perhaps the hardest hit country in the world where cases peaked at more than 400,000 a day in early May, is now reporting just over 20,000 cases daily, the equivalent of 5,000 a day in the United States. Similar declines can be seen in countries around the world.
This drop worldwide is due to a combination of both the spread of vaccines and, perhaps more importantly, natural immunity arising out of many infections. According to a New York Times article, for example, the number of infections in India as of early May was likely close to 540 million, when the official count was just 27 million. Since the pandemic was still in full force in the country at the time, an extrapolation would imply 750 to 800 million infections, close to 60 percent of the country’s population.
While such widespread infections might help to contain the pandemic, it came with a horrible human cost. While the official number of deaths is around 450,000, researchers have estimated likely death tolls in the range of 1.6 million to almost 6 million in urban areas along according to one study. There is a similar story throughout the developing world, where the actual number of infections and deaths hugely exceed the already devastating official statistics.
That this death toll has occurred, even when the world is (rightly) celebrating the rapid development of effective vaccines, means that we have failed badly in getting these vaccines distributed widely around the world. Crucially, this has been a failure of political will, not the lack of capacity to produce and distribute vaccines.
A key feature has been our treatment of knowledge around the development and production of vaccines and medicines more generally. Given the continuing cost of the pandemic globally, enlightened policy should aim to maximize production and dissemination of vaccines and medicines. Instead, we have seen egregious attempts to limit dissemination.
A year ago, South Africa and India proposed a resolution at the World Trade Organization to suspend patents and other intellectual property claims for vaccines, tests, and treatments for the duration of the pandemic. Since that time, the rich countries have been engaged in a filibuster to block any action.
The pharmaceutical industry also claims that the developing world lacks the sophisticated manufacturing facilities needed to produce the Covid vaccines. This is not true, as India, Brazil, South Africa, and several other developing countries have modern facilities that can be used to produce vaccines.
Clearly, for some of the newer technologies (such as mRNA vaccines), such facilities were not immediately available, but getting such facilities up and running by now would almost certainly have been possible had action been taken quickly on the resolution last October. For some of the older technologies, which include highly effective non-mRNA vaccines, capacities exist, but patent protection and the need for licensing limits production even today
IP protections also pose problems beyond vaccines. As new technologies are developed that combat Covid (Merck’s Molnupiravir antiviral is an example), our current system of patent protection will continue to limit access more than is necessary, even with potential licensing agreements. In such cases patents are the only thing standing in the way—the ability to make these life saving drugs already exists in many parts of the world and doing away with restrictions will make them available across the globe much more cheaply.
Patents though are only one part of the problem. Access to technology remains just as critical. The TRIPS provisions of the WTO were designed to limit the spread of technology to the developing world. The India-South Africa resolution was intended to get around these restrictions, but as was widely noted, much of the necessary technology was protected by industrial secrets, not patents. That would mean that suspending patents by itself, would be of little benefit in spreading production.
Trade secrets have an amorphous protection under law, and maximizing production and distribution requires taking this head on. South Korea back in July announced that they have the capacity to manufacture a billion mRNA vaccines almost immediately, but had not found a firm willing to share their manufacturing knowhow. As three researchers pointed out in August, however, the US could invoke its Defense Production Act (which it has already done in the pandemic) and compel the transfer of technology and knowhow. In addition, it could do so unilaterally.
An additional remedy would be to prevent non-disclosure agreements (NDA) at least in technologies largely funded by the public sector. NDAs protect industrial secrets by threatening any employee who discloses information with serious lawsuits. If NDAs are banned as an anti-competitive practice, the threats from companies against former employees, to protect their secrets, would be meaningless.
In general, and in a global health emergency in particular we should be looking to share technology as widely as possible, not locking it up behind patent monopolies and other protections. A worldwide pandemic should have been an occasion for the world’s scientists, including those from China and Russia, to work collectively to confront a common problem.
The cost has not just been borne by the developing world. By allowing the pandemic to spread largely unchecked in the developing world, we gave it the opportunity to mutate into more vaccine resistant forms that will continue to reverberate in the months and years to come. The Delta variant developed in India last December.
We may never know if a more rapid rollout of vaccines and widespread testing could have contained it before it spread around the world, but the human and economic costs of this spread have been enormous. Also, the US and other wealthy countries continue to feel the economic impact of the spread in the developing world. Factory shutdowns in places like Vietnam and Malaysia have been a major factor in supply chain difficulties that are now macroeconomic concerns. Making knowledge available, much more easily deployable, and widely shared is not simply a moral imperative, but is in the overall self-interest of everyone, everywhere.
This column first appeared on CEPR.