Transcription

• COVID-19: Vaccine Inequity (Anil Deolalikar & Bruce Link)

  Introduction: Welcome to policy chats, the official podcast of the School of Public Policy at the University of California, Riverside. I'm your host, Maddie Bunting. Join me and my classmates. as we learn about potential policy solutions for today's biggest societal challenges. Joining us today is UCR SPP founding Dean, Anil Deolalikar and Distinguished Professor of Public Policy and sociology, Bruce Link. My fellow classmate, Kevin Karami and I chatted with them about international COVID-19 vaccine distribution. 

   

  Maddie Bunting: Dean Deolalikar, you are the founding dean of the UCR School of Public Policy since February 2013 and a professor of economics at UC Riverside since 2003. You also serve as the Chair of the Board of Directors of the University of California Global Health Institute. Dr. Link, you are a Distinguished Professor of Public Policy and Sociology at UC Riverside. Your interests are centered on topics in psychiatric and social epidemiology. Thank you both for joining us today.  

   

  Bruce Link: Thank you. 

   

  Anil Deolalikar: Our pleasure and and at least to my thank you for that generous introduction and my credentials sound more impressive than they really are. 

   

  Maddie Bunting: I didn't even include the half of them! But jumping right in it, we have such an important topic to cover today. Our world and data currently lists out the share of people who have received at least one dose of the vaccine in low-income countries is just 1%. And lower middle-income countries are listed at only 11.8%. On the other hand, high-income countries have administered at least windows to over 47% of heir populations. There seems to be a major disparity there any thoughts on how this came to be, to have such a large percentage difference?

   

  Anil Deolalikar: It's clear what is happening. I mean, eventually it's all a question about resources. And the rich countries of the world had the resources to buy up lots of advanced quantities by up in advance a huge quantities, of vaccine even before they were produced. And so they booked, you know, pretty much most of the supply that was going to be coming out. They were quick and the United States was particularly quick. And this is credit to them for having, had the foresight to buy up some of these quantities of the vaccine in advance even before it was proven. Because they had the resources to do so. And so now you have a situation where, I believe a third to a half of all the currently available vaccines and continue produce vaccines in the world are under the control of the rich countries who constitute less than 12 or 13 percent of the world's population. So it's a question of resources and resource allocation. Bruce? 

   

  Bruce Link: Yes. This is something I study all the time, is how do we create inequalities in health. We’r remarkably adept at doing it. It keeps happening. And so every time something new happens, we discover something new or a new threat comes. In the way I think that people, nation-states, communities deploy their flexible resources, I call them flexible resources because they can be used no matter what the situation is. If it's the onset of a pandemic, it's the discovery of a new vaccine. They have these resources and then Anil mentioned these, that they deploy in that circumstance. And when they do that, they create an inequality. And that's the inequality you just told us about. So the interesting thing is that that keeps happening. And it's happened with chronic diseases where disparities have been developed around those. And now it's happened around this very novel coronavirus. There are inequalities in how it went through the population. And now there's inequalities and how the distribution of the vaccines as is common. So basically we're creating a new connection between having resources and health. And this is what I've, my whole career is kinda focused on. But one thing that's really interesting and important about this one is that when people with more resources use those resources and get a better situation for themselves, often, it doesn't come back to pinch them. They just get a better situation with respect to where they're situated, with respect to pollutants, to the diesel trucks go by their house or someone else's house. There there get getting that benefit doesn't hurt them. But this time, look out. Because if we don't take care of the whole world, this time, it's going to come back and pinch us. And so my, one of my interesting hopes is it that we might learn something from this. Because I think really in every instance it does come back to pinch us in one way or another, the inequality. And then we bet better off if there was less inequality. But in this instance, it's really obvious. And if we screw up, if we don't take it really seriously and do the best we can to reduce these inequalities. It's going to hurt us because new variants you'll come back are vaccines will wear off and they'll be there for us. It'll be killing the old folks in our, in our context.

   

  Anil Deolalikar: I think that's a very important point that Professor Link highlighted which economists call externalities and you negative externalities here. So health and especially communicable diseases are not something that you can keep in one corner of the world. Whatever happens in Africa or China or India, as we saw that this was the case with the coronavirus. It spreads very quickly around the world. And so these, this is one place where the inequality is going to come back to bite us in the rich world. So I think we should be especially concerned of this. And by the way, another area where you sort of see this playing out, professor Link didn’t mention this explicitly, but it's there and I think it's sort of the next big disaster calamity that the world is going to face is global warming. I mean, we have had global warming because of the cumulative impact of economic development in, throughout the world, but especially in the rich world. The rich world historically has contributed a large share of global warming. And now what countries are going to be affected most by global warming? It's really going to be the poor countries that are going to pay the price. So inequality literally spans across every dimension of life as being hosted on Earth. Thanks. 

   

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  Kevin Karami: Thank you both for such insightful answers. I think that was really interesting to hear. Both the equity portion of the question, but then also the economics portion. So my next question, and it's kind of in the same vein, more specific. So as of July fourth, India has over 280 million people with just one dose of the vaccine, but only 63 million with both doses meaningfully vaccinated. You know, your opinion, does this indicate that they're just simply in the earlier stages of vaccine rollouts? Or does this potentially indicate that there may be concerns or issues with getting it administering the second dose since the difference between the amount of people with the first particularly vaccinated. 

   

  Anil Deolalikar: Well since I probably am a little bit more familiar with the Indian situation, has taken on first crack at that. India is sort of an ironical, India’s situation is somewhat ironic because India happens to be the world's largest vaccine producer. And the largest vaccine manufacturing company in the world is based in India. And in fact, in the fall of last year, they had contracted with AstraZeneca and they had a licensing arrangement with them where they were going to produce over a billion or 2 billion doses of vaccine. And India was actually slated to supply much of the, most of the vaccines that we're going to be included in this program called cutscene, global program to supply vaccines to poor countries at subsidized rates. And so India was going to be the center of production and then India was going to actually supply a lot of the vaccines to the rest of the world and they had begun doing that. But then the second wave hit India in March, April of this year. And it was especially severe. And so India had to pull back and we need on some of its commitments to go vaccine, the global vaccine distribution agency based in Switzerland. And so India has in some ways made a mess of things. On the other hand, all those vaccines were, were pulled back, but they weren't deployed properly even within India. And so the vaccine rollout in India is also bad. And, and again, this highlights an important aspect of how we come back. Or pandemics in general. You need good leadership. We saw what poor leadership did to the United States through much of the pandemic in 2020. At least luckily, there was some foresight in, in planning for the vaccines and subsidizing the companies that develop new vaccines and buying up some in advance supplies of vaccines, the US to some leadership. And thanks to that, we are where we are. But in India. And the leadership did not anticipate the second wave at all. And they, they were behaving as if they had the, the widest prematurely and celebrating that India had emerged with a very low COVID count and very few COVID deaths. And then of course, when the second wave it India very hard in April May, they have been scrambling to get the vaccination roll out going within India. So some of it is actually related to just poor mismanagement. It's not that India doesn't have access to vaccines. They do have the largest producer of vaccines right there in India. But it's just been total mismanagement unfortunately. Professor Link?

   

  Bruce Link: Such a great response. I have two things I'd say, given the facts you gave us. One thing is it makes me think about how important something I would call coming through school of public health, public health infrastructure is. And then whatever you see these facts that run counter to what would be rational, reasonable, about how a rollout should. You want to look at what's the nature of the public health infrastructure that should be responding to this. And it's like, it's like a signal that there's something live. And it's a very unlikely that it's off just for this 1 thing. It's likely that you need more developed. So the inequalities in distribution by race, ethnicity, and socioeconomic status of the vaccine in our country also suggests this problem with public health infrastructure. And the other thing that makes me think is, you know, we think about medicine as being in the body kind of what this fact in all the other facts that are coming out with respect to this pandemic is just how social, social, how much social sciences bear on health outcomes. Because it's not, it's not the snout, people's bodies, not the syringes. It's the getting those materials to people and having them be willing and accepting. And that's a very social process. So we should always keep that in mind.

   

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  Maddie Bunting: Thank you both for your responses. I didn't not know India was producing or had the largest production of vaccines. So that, that is a very interesting facet of what we're talking about.

   

  Anil Deolalikar: The behavior or demand side of vaccine acceptance is, is very important. And the US, we are seeing this very rapid vaccine rollout and the vaccination rates sort of increased dramatically between January and April. But after that they have stalled because now the supply problem is no longer there. There's enough supplies of vaccines available, but there are lots of people who in India, you are at such an early stage of the vaccine rollout that demand is right now not the problem. The problem is supply. There's just not enough vaccine supplies. To make available to everyone. But at some point in India doing ones go get 60, 70 percent vaccine coverage, you are going to see some of these problems come in. 

   

  Maddie Bunting: Thank you. And yes, I do think as the rest of the world becomes her vaccinated, that conversation will be interesting. I do have a bit of an ethical question. I suppose. Many members of the World Trade Organization, including the United States, previously blocked a push by dozens of developing countries to waive patent rights and effort to boost production of COVID-19 vaccines for poor nations. If we could ask what even our patent rights for those who may not know. And what does this mean for the international community that we, we waited until the next question may lead to the G7 meeting. When, when they agreed, you know, to to give it a billion vaccine doses away. But I guess this goes back to the first question. We hoarded the resources and assistance before distributing them. Any, any thoughts on the patent right argument and why it happened this way? 

   

  Anil Deolalikar: This is actually Professor Link’s, the ethical issues surrounding intellectual property rights. And so I am going to let him start this time. 

   

  Bruce Link: Well, I don't know. I mean, I don't know that much about that in particular, but thinking about it through an ethical lens, I mean, I don't think we can come up with a, It'd be interesting to go through each one of the people that I taught their work during my ethics class. And so Anil and I just had an exchange about it. A very famous person who delved into ethical issues was Amartya Sen his approach was very practical. You have a situation. You don't want to, you don't have overall principles, but you'd go to the situation, try to figure out the best thing  in that particular situation given the circumstance that exists there. And so but then the way I think about it is whether or not there's another philosopher, an ethicist is, name is Peter Singer's at Princeton University who make it just draws out really quickly that if that our common humanity is so important. And then putting ourselves ahead because we happen to live in the United States is just from an ethical standpoint, he would really pinch us with how wrong that. And, you know, it's hard not to do that. But if you take his point of view, you would be, you would have to tell my students when we talk about him, He makes you sit on a sharp fence. You want to do this, you want to do that. And it's really, you just have to look at these issues. So there I would hope that those kinds of ethical thoughts that people might have would push them towards pressuring our governments to be more, more likely to be generous with our large asked. And maybe that happened a little bit, so maybe that is a good, good thing. 

  Anil Deolalikar: What if I may add to that? I mean, the whole issue of intellectual property rights. Basically the idea of argument that some people have been making is that the United States and the rich countries where most of the pharmaceutical companies that came up with a vaccine that are located should temporarily relax the patent rights associated with the vaccines that were developed against COVID. Now, that's sort of a tricky argument because of course, the pharmaceutical companies, as you would expect, would be very much against this idea. There is also the issue that patent rights, copyrights do spur innovation. And one reason why companies like Pfizer and Moderna, aspirins any god came up so quickly. I mean, this is historically unprecedented that we had a vaccine from sort of the conceptus change to the manufacturing stage on one, you within one year, including three-stage clinical trials, is unprecedented, normally takes at least 45 years for vaccines to be rolled out. And one reason why this happened was, of course, the existence of laws, healthy diets, and patent rights. Accompanies that came up with the vaccines stood to gain a lot in terms of their profits, in terms of their shareholder value. And so if you take that away even temporarily, does it actually reduce the incentive to innovate in the longer run? And that's sort of the debate that's been going on. But, but I would say there is a practical issue here that just sort of relaxing the lights wouldn't really solve the problem becomes us in the, in the poor countries that are very few countries. In the poor world. There are, in the developing world, there are very few countries that have the capacity to actually manufacture these magazines in a big way. Even if they got the intellectual property rights to these vaccines, the supply chain logistics issues are too complicated. Probably you'll have a couple of countries like India and China and Thailand that probably might be able to scale up production of vaccines. But countries in Africa and many countries in Latin America, I have no ability to sort of manufacturer hundreds of millions or billions of doses that quickly. So I think just relaxing the intellectual property rights for a limited period would probably not have done very much unless the pharmaceutical companies also contributed their manufacturing know-how and skills to developing countries. That's my take on it. That sometimes I believe the patent right issue is exaggerated. The importance of that tissue is exaggerated that we sort of need really the old, you need a whole set of infrastructure to actually manufacture these vaccines. And much of that is lacking in the poor countries. 

   

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  Anil Deolalikar: I want to ask Professor Link a question. And this comes back to the point you made earlier and which we started the issue of resources. The rich countries have resources. They have resources that they can deploy quickly at short notice to deal with emergencies. And so they will always be well-positioned to deal with any calamities or emergencies that arise. And poor countries will always be at the back of the tube. Given that a lot of these equity questions are related to the source resources. I would like to sort of ask Professor Link what might be possible ways in which we could alleviate these kinds of equity issues? Should we just rely on the generosity of the rich? Should we rely on the generosity of some rich billionaires in the rich countries like Bill Gates and Warren Buffett to do what is needed in global health. How do we rectify these health disparities in some more sustainable way rather than just depend on the generosity of the rich countries? 

   

  Bruce Link: Yeah, Well, that's such a complicated, difficult question. And my thought about it because it comes up all the time you might give my spiel is I called it earlier, but I call fundamental causes. It's the idea that people deploy their resources to gain a health advantage. And so I wanted to do about that. So I mean, the things that, that are important, you can go from really broad. Like we have systems and probably Anil you know these better than that I do that influence the distribution of resources at an inequality between nations. And, you know, we often don't think about those. It's important to health. But then, you know, when something like this happens, we see that the old math they really are. And those can be either better or worse in terms of how the money flows, in how much inequality there is. So we have some leverage there in terms of policies that might kind of integral influence inequality. The other thing is, I think you need to do something in every which way possibly can, because if you don't, this problem is either worse or better. So if Bill Gates does something. It's not going to make it go away, but it might make it a little less bad. And you just need to do everything you possibly can at every level. To try to minimize this, well, sometimes people get discouraged because there's so much inequality. What are we gonna do about that? Well, my answer is always, you just do everything you possibly can. But that really the fundamental thing is the, what is it that produces the inequality between nations and other systems that are alterable, that there would be people who could agree were fair, that that would reduce that. 

   

  Anil Deolalikar: Yeah. I think that's a great point. And at least within the country bear, you can sort of deploy these systems or rules of the game as it were. Because governments can be a force of men, can be a force for the disparities that arise from differential resources. And governments can do something about that. Through social welfare programs, through targeted health programs, or for the poor. But when it comes to international disparities, it's much more difficult because we don't have an international, we don't have, we do have a United Nations, we do have global alliances. But they have very little teeth to them. They have very little enforcement teeth to them. So how do you make everyone abide by the international agencies you can't. So I think the international sort of disparity situation is much more difficult to handle in a dress. Because of the absence of international authority that can impose some of these rules. Level playing field conditions on different governments. 

   

  Bruce Link: Yeah, absolutely.

   

  Maddie Bunting: Absolutely. Well, I learned so much. I just wanted to thank you so much both for coming on this conversation, having both of you together to bounce ideas off of each other. And, and as Kevin said earlier, we got to such a holistic view of the international vaccine distribution and relations in general. And that it's very complicated and so much more than to consider that maybe the average person does myself included. So thank you for participating, but yes, just thank you both. This is such a wonderful conversation. 

   

  Bruce Link: Thank you. Thanks for inviting us. 

   

  Anil Deolalikar: Thanks Maddie and Kevin.

  
  Outro: This podcast is a production of the UC Riverside School of Public Policy. Our theme music was produced by C Codaine. I'm Maddie Bunting, till next time.