Making vaccines for the world.

Vaccinating the world is, needless to emphasize, a complicated problem. It has technological, economic, social and political aspects that aren’t easily solved. As studies suggest that there is a huge supply-demand gap in vaccine delivery, we must know that this quagmire will not be resolved without system wide changes.

It indeed has surprised the world that the Joe Biden administration is batting for waiving the patents in a bid to make vaccines available to everyone across the globe. But we also know that this is not going to work unless there is enough technology transfer. Without tech transfer and hand holding, it is nigh impossible for ordinary pharmaceutical companies to make these complex vaccines. In this scenario, we may break down this issue into a few simpler problems and see where we stand.

  1. The “demand” of vaccines is not static. Depending upon the evolution of new variants and resurgence of waves due to waning of immune response, already inoculated populations may need booster shots and reformulated vaccines.
  2. Supply chain of vaccine delivery is not present in most of the poorer countries.
  3. The vaccine distribution through the Covax initiative (for poorer countries) pales in comparison with those acquired by wealthy countries of North America and Europe who have deep pockets.
  4. Governments across the world like India, have failed to anticipate deadly recurring waves. These need hazard mapping and aggressive inoculation of vulnerable areas giving priority to those with comorbidities.
  5. There is no centralised database of systems through which lesser known pharmaceutical companies can coordinate together and produce enough vaccines for the world.
  6. The rules that protect Intellectual Property are in favour of big pharmaceutical companies due to their intense lobbying. These are under the assumption that without this, the investment in R&D will slow down. But there are no inbuilt clauses or effective mechanisms to make them work for humanity in cases of extreme danger like the crises we have now.
  7. The failure of organisations like WTO that work on consensus. That we cannot create a solution even with the US onboard shows the extent of the problem.
  8. Even the support of the US without any scheme for tech transfer could be seen as just a means to virtue signal without actually delivering anything. After all, what is the value of your commitment if you cannot deliver?
  9. Technological questions - which “platforms” are better suited for quick vaccine research delivery, cheap to manufacture and deliver? Do we have international collaboration of research to make sure that this happens? What are the impediments to such a collaboration in terms of politics, laws and economics?

The COVID-19 is only a particular case at hand. Last two years have exposed various epidemiological models that have been known for a long time. The COVID-19 has a particular curve, which we see now. With a different hibernation period (time between contracting infection and showing symptoms, but the patient can spread the disease), proportion of asymptomatic cases and replication number (number of people infected by a patient), we could have more dangerous viruses or variants. What will we do then?

These questions make a few things hauntingly clear. That the global leadership or governance systems are inadequate to solve for a great contagion is out there in the open for all to see. There needs to be a fundamental rethinking in the way societies and nations interact. The question of universal human solidarity should be reiterated on a daily basis. This is intertwined with the local politics of all the nations. That people across the globe were sold a brand of exclusionary politics in the last decade has an impact on current failure is undeniable. But to put all the blame on them is unfair. The system was already broken. Now we should look at what needs to be done, practically.

At this point, it is imperative that we should have global systems that can mobilize all resources available to humanity. We should realise that this is not a firefighting mission, but there needs to be consistent effort and planning to make this happen. Every facet of our policy should consider this. From IP laws to buildings and education systems, the need to build capacity with this in mind should be drilled in.

It is under this light that we should consider the great global systems of research and information/wisdom dissemination should be evaluated. There should be an unimpeded and fast flow of information. Thinking minds across the globe have a means to collaborate. Even when we can argue that they are already connected by the internet, we should know that the amount of capital investment and local ecosystem support they get is varying. Also, a stellar mind from IISc Bangalore cannot collaborate with someone in Harvard or Tsinghua without a direct political will to systems that allow them to do that.

This applies equally to the vaccine manufacturing capacity that companies in India, Pakistan, Bangladesh and Senegal hold. For them to effectively contribute to the global effort, there should be built in mechanisms to first survey them and establish the terms through which they interact. While a “global” rule of law is missing and it is still hard for us to enforce contracts, sure there can be sane commercial understanding that makes sense. The support of respective governments can be mobilised only through consistent multilateral engagements that are democratic and equitable. Here we see that a complete overhaul of the United Nations led international order is moot. This could be a longshot, but this has made clear that nations like India should not attach themselves with the most powerful nations in defending the existing world order. It should create, nurture and lead a separate bloc that doesn’t buy into the ethical systems, ideals and beliefs that has created the present world order.

Sure, this is a complex problem to tackle. For example, India doesn’t yet have the comprehensive scientific and technical prowess to lead such a bloc. We cannot expect the powerful west to give up their hegemony either. We may need to create durable multilateral groupings that also act as “technological super nations.” We already have BRICS like groupings that tend to create an alternate financial paradigm. But technological cooperation is still very much limited. From space to biotechnology to agri-tech and edu-tech, these nations should pool their resources together. This way, they could build up shared capacity that will protect their people in times of crisis.

This of course assumes political will from an enlightened leadership in the developing countries. To what extent this can be done is still an open question. But that shouldn’t discourage us. Our sustained interaction with local political systems play a role in the way we fight the contagions that will attack humanity. COVID-19 is only the beginning.

To sum up, we need the following:

  1. Technological unity across the globe with supersystems and ‘supernations’ where there is a will to build, nurture and sustain these systems of fighting.
  2. The world order should be rule based and only the weak and meek have an incentive to change it. So they should organise and mount a political, economic and technological response to the developed world.
  3. The interim period should focus on getting the developed world on board because letting the virus rage across the globe will create more variants which may jeopardize their own populations. There is no guarantee that current vaccines will protect against a future pathogen or a deadly later wave.
  4. The future is in transnational collaboration being decoupled from local political exigencies. Every political system across the globe should have inherent mechanisms to avoid this. In the case of India, this decoupling should be argued passionately in public and their approval must be taken. This should be taken up as a broad political programme.
  5. The vaccine production capacity across the globe should be surveyed and streamlined. The UN and its agencies should draft a plan and get it approved by the nations immediately.
  6. Patent waiving should accompany immediate technology transfer. Technology transfer should be comprehensive with new courses in universities, transnational industry academia partnership, supporting raw material sourcing, business process sharing, manufacturing support. It should be a two way process with the big pharma also gaining something out of it, even when we make them lose many of their unfair privileges.

N.B : I realise that some of the suggestions and formulations are a bit quixotic. But I have included the more practical and immediate ones too. After all, what is a plan without fragments of dreams blended into it?

Written on May 20, 2021