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First100-030121
A vaccination in India, where much more needs to be done for global coverage
It’s March 1, 2021 and welcome to First 100. You can sign up to have First 100 delivered to your email by clicking here.
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The Chief
This was the best weekend for America in a year, hands down. We recorded over 2.4 million vaccinations each day, for starters, bringing us to 15 percent of the population with at least one dose. Plus, the Johnson & Johnson vaccine got emergency use authorization approved on Saturday. The company has lagged on manufacturing but there’s about 4 million doses ready to ship immediately, and a promised 100 million by the end of June. And as a one-shot dose, it’s worth two doses of Pfizer and Moderna’s vaccines.
This unlocks whatever supply problems could have emerged. It’s now pretty clear that the U.S. will have more than enough vaccine to cover every adult by late spring or early summer. I’ve seen some concern that every adult won’t want a shot, and blaming thrown at poor media or government communication about the wonder drugs these vaccines truly are. One thing that’s getting lost is the significant amount of natural immunity in the population. From Youyang Gu’s projections, about 94 million Americans have immunity through past infection; that’s over one-quarter of the population. You need to add that to the immunity numbers to see the whole picture. There’s some overlap—I personally think those previously infected should wait to get the vaccine—but not that much.
The point is that to get back to normal, you can combine that one-quarter with the roughly 50 percent of the county who we know is going to get the vaccine when offered. Together that’s in the ballpark of 75 percent, the low end of immunity needed for normality. All “I am not a demographer” caveats apply, but I don’t think you need to convince that many people to take the vaccine, and an actual campaign aimed at convincing, combined with a healthier country with fewer infections and no lasting side effects, should do the trick.
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In short, that’s not what I’m worried about. I’m worried that in the near term we’ve stubbornly plateaued at about 70,000 new infections per day, and that cases rose slightly in the last week. But more vaccinations in vulnerable populations will get those hospitalization numbers down, as they have in the nursing home population. Hospitalizations are now below the two other peaks of the pandemic and falling, and as they fall, so will deaths. States may reopen but the whole point of closure was to prevent hospital systems from being overwhelmed; as long as those most likely to be hospitalized get the shots, that’s unlikely to happen. (We need more internet navigators!)
Yes, there are variants in California and New York City, which appear to be somewhat more transmissible. But the fact that the California variant was sifting through the population for months means that it’s not exactly a new factor. And everything we know so far is that these variants are still extinguished by the vaccine. Anyway, Moderna and Pfizer are already pushing science ahead of mutations by testing boosters for the variants we know.
We can both say that social distancing helped slow the spread this winter (among other things it prevented the flu season from happening at all, saving roughly 50,000 lives) and that things will be back to normal by summer. Those are not in conflict; they’re the impressions you get from the facts on the ground. Based on what we know, the U.S. is on the path to beat the pandemic.
I’m worried about what we don’t know.
The various mutations have come from relatively developed countries. There are certainly countries in the world not doing genetic screening to see if the virus has mutated. That these mutations all hit between the fall and winter suggests that COVID-19 is highly mutatable after 9 months or so of spread. We’re only seeing the part we can see; there are other mutations out there, and as long as the virus exists, more will proliferate. Only eradication will stop the mutations.
So far, we’ve been incredibly fortunate that the variants are not so destructive that they render vaccines useless. But nobody wants to get to that point. And the only way to be sure is to vaccinate as many people with what we know works, not just in America but around the globe. We should know by now that pandemics spread globally; that’s what makes them pandemics.
And while we have no supply problem domestically, we don’t have enough supply to cover the world. At the same time, the for-profit pharmaceutical manufacturers see the developing world as a vaccine profit opportunity. Pfizer has been reportedly “bullying” Latin American countries over access to the vaccine. It could be years until the whole world is covered—2024, by one measure of the current trajectory. That’s a risk we shouldn’t take.
Since October, poor countries have demanded a waiver to an international trade agreement (Trade-Related Aspects of Intellectual Property Rights, or TRIPS) to suspend patent protections and allow unfettered access to vaccine formulas and technology, as well as treatments and tests. One hundred nations are now in support of this waiver. The U.S. has joined several rich countries, homes to pharmaceutical giants, in blocking this request. It’s one of the biggest decisions of the Biden presidency. Biden has given $4 billion to COVAX, the global initiative to vaccinate the world, and Janet Yellen has asked for more rich country support. But money isn’t the problem; it’s supply.
There is no question that mRNA is a complex process involving long lead times. Opponents of the waiver argue that producers in other countries don’t have the capacity to replicate them. But they’ve been saying this for five months, wasting all that time that could have been spent on the problem. The leading manufacturers went from no vaccine to millions of doses in eight months. Plus, as Dean Baker writes, if Pfizer and Moderna directly shared their expertise, for pay, then complexity becomes less of a barrier. And other manufacturers are already involved in supply.
As for the length of time, nobody expects a genie-blink and millions of doses. If the waiver leads to a full global array vaccines in 2023 or sooner it’s ahead of the game. Pfizer keeps announcing ways to speed up its production process, by the way, despite these claims that there are physical limits to acceleration.
Finally, more than just mRNA vaccines are effective. Johnson & Johnson and AstraZeneca are having serious manufacturing capacity problems on less complicated vaccines, and while India has made some AstraZeneca doses, there’s available capacity throughout the world. (Finally, using other countries to make treatments, tests, low-dose syringes and everything else that can beat the virus comes along with this waiver too.)
Biden’s U.S. trade representative Katherine Tai needs to support the TRIPS waiver. Claims that this would ruin cooperation from drug companies that have the right to make a profit are nonsense; public money was used to create the Moderna and Pfizer vaccines (Pfizer denies this but its partner BioNTech took money from the German government). The vaccine development should crash the entire patent-based system for prescription drugs; direct funding support is faster and more effective. But we funded the research and gave out the patents anyway.
The only way we will truly end the pandemic is by engaging the world to assist in supply. It’s unconscionable to spend another day arguing about this.
What Day of Biden’s Presidency Is It?
Day 41.
Today I Learned
- Here’s my final shift on Left, Right & Center on KCRW, from last Friday. (KCRW)
- The plan that would have taxed big companies that paid low wages is dead. It wouldn’t have worked to mimic a higher minimum wage anyway. (Washington Post)
- Biden didn’t directly support the Alabama union vote at an Amazon warehouse, but you can’t come away from that video not knowing his position. (AL.com)
- Lisa Murkowski is meeting with Neera Tanden today, in the last chance for Tanden’s OMB nomination. (CNN)
- The insane order to overturn the federal eviction moratorium is under appeal. (Politico)
- Biden is planning an announcement today on Saudi Arabia, after taking serious criticism for letting the kingdom off the hook for the death of Jamal Khashoggi. (Reuters)
- Nuclear deal talks with Iran are off for now. (New York Times)
- Possible breakthrough on a global deal on corporate taxes. (Wall Street Journal)
