Can We Control Covid Without Controlling Capitalism?

By Mike Koetting September 2, 2021

With the announcement that a third shot (or second for J & J recipients) may be desirable as a booster—arguably running ahead of the science on the issue–many Americans are already jockeying to get one. Understandable. I expect I will get one soon myself. We all want to avoid Covid and the delta variant is scary.

But, at the same time, we also need to consider context. And the key contextual fact is this: unless the virus is brought under control on a global basis, there will continue to be waves of deadly variants. There will be some regardless. The only absolute is the lack of absolutes. But we are talking about speed, size and odds, things that make a big difference in how world-wide reality plays out.

This is not a newsflash. We’ve known the global nature of the problem since the beginning. That was one of the arguments for sharing the genomic code so widely. But after the rich nations got vaccinated, we stopped acting like that…or, more accurately, we continued to recognize the importance of that concept by giving away many doses of vaccine, but nowhere enough to meet need. Just over 1% of the population in the world’s poorest countries have been vaccinated. To meet global need would require suspending the usual capitalist order. That hasn’t happened.

While it is certainly true that the existing facilities could not meet this need, there are options for expanding that capacity. For multiple reasons, it is probably not as simple as the loudest advocates suggest. But “greater complexity” is not at the same as “impossible”. Various vaccines are manufactured all over the world in partnership agreements. As early as March, the former director of chemistry for Moderna said that with blueprints and advice, the world is full of factories that could be manufacturing in four months at most. That is opposed to the current rate of production, which will not have many countries even starting vaccination campaigns until 2023.

The Biden administration recognized this issue and in May, to the surprise of many observers, urged the World Trade Organization to grant a waiver of intellectual property rules which would force Pfizer/BioNTech and Moderna to let others manufacture their vaccine. For this to have the desired effect, it would probably also be necessary to use the Defense Production Act to force Pfizer/BioNTech and Moderna to actually transfer applicable technology to places that might be capable of producing the vaccine. They would still get royalties for these products, but they would lose the ability to control pricing and volume. Pharma, of course, went ballistic.

Since May, two things have happened. Well…one thing didn’t happen and one thing did.

What didn’t happen is the WTO actually issuing a waiver. It is being blocked by Germany and the EU. And as near as can be readily seen, the Biden administration isn’t doing anything about that: it didn’t even come up in the recent Biden-Merkel summit. At this point, it’s hard to know whether Biden was serious about this in the first place or was just posturing.

What did happen is that both Pfizer/BioNTech and Moderna raised their vaccine prices. This appears consistent with their stated strategy that they will make the real money on longer term demand, specifically the sale of booster shots in countries that can afford the high prices. These increases—which are obviously driven by market power rather than incurring new costs of innovation—will be on top of terrific, and growing, profits in both companies from the vaccine.


The most obvious take-away is that Big Pharma, indeed all mega industries, still wield power. No surprise.

But the way this is playing out puts an usually sharp focus on the implications of how we have given one concept of our economy a greater priority than human needs.

In April, Mihir Swarup Sharma, a columnist with Bloomberg, described the production and distribution of the vaccine as an existential challenge for capitalism.

This isn’t about inequality, which we always knew capitalism could create. It’s about inefficiency, which capitalism is supposed to avoid. When it comes to desperately needed COVID-19 vaccines, capacity is being wasted and innovation isn’t benefiting everyone. Twelve billion vaccine doses could be produced this year, if all current projections are aggregated. But we’re nowhere close to that in actuality. And the doses that are available have largely been gobbled up by rich countries.

We have a system that used the challenge of a world-wide crisis to virtually create magic in the form of vaccines developed in record time. This is an awe-inspiring achievement. No one begrudges substantial rewards for the people and institutions who made this happen. But now Pharma is using its leverage to extract mega profits. There is no magic in this; only raw power.

There is a serious chance this will be self-defeating. In the short run, if we don’t take the next step, even the world’s elite nations might not be able to protect ourselves against the variants that will get spawned in the un-vaccinated nations of the world. Of course, depending on your level of cynicism, you might even imagine that the ongoing wave of variants strengthens Pharma’s prospects for a permanent demand for boosters.

In the longer term, it is hard to imagine that the poorer nations of the world will be indefinitely acquiescent to the notion that preserving intellectual property rights to insure that capitalist Pharma can reap super-rewards is necessary. Yes, this was a stupendous achievement, but it was achieved (and back-stopped) with substantial governmental supports. Why should these circumstances allow people who are already rich beyond imagination, get even richer still by standing in the way of vaccines for the poor countries? If that’s somehow offered as an imperative for capitalism, global support for capitalism will decay at an ever-increasing rate.

Indeed, if capital can’t control its appetite for profits, erosion of support may be a necessary development. In The Ministry for the Future, Kim Stanley Robinson says economic systems are simply the measurement of quantified ethics and power. As an explanatory statement, that sounds about right. And, thus, we might consider carefully if the system of uncontrolled profits represents the ethics we really want to pass on to future generations.

We will of course get the booster. But, as suggested by Yoo Jung Kim, a practicing Chicago physician, we should at least feel uncomfortable about it.

We bear some degree of individual responsibility toward our unknown brethren thousands of miles away, however small or indirect. We may never get to know them, but don’t they also deserve a chance to avoid the worst effects of COVID-19?….The booster will buy those of us in the United States some more time and keep many of us safe from the delta variant, but it is not a cure to the pandemic. We can’t solve this on our own, and to help ourselves, we must help others.

Looking across the world, one can see many other problems that can only be solved by helping, really working with, others. We don’t want to destroy those aspects of capitalism that create the magic of innovations. But as the question of vaccine makes clear, our economic system needs recalibrating if we want to have a different set of ethics than “winner take all.” That system runs the risk of making all the rest of us losers.


And One More Thing

My last blog spotlighted water shortages along the Colorado River. A week after I posted, The Atlantic Monthly had a really sobering article (“The Well-Fixer’s Warning”) by Mark Arax on water shortages in the almond growing country along the San Joaquin River in the central California valley. The article was essentially an interview with a guy who maintained irrigation systems in that area. The well-fixer’s warning wasn’t based on academic modeling about future problems; it was a sophisticated, on-ground the assessment of how the water supply was, literally, drying up. Every year now, the water being drawn out for the orchards was greater than the water going in and the aquifer was collapsing. By his evidence, it would be necessary to reduce water usage by 1/6 to maintain the aquifer. He was skeptical of that happening because no one wanted to give up the profits they were making now.

Who is representing the future in this scenario?

Author: mkbhhw

Mike Koetting’s career has been in health care policy and administration. But it has always been on the fringes of politics. His first job out of graduate school was conducting an evaluation of the Illinois Medicaid program for the Illinois Legislative Budget Office. In the following 40 years, he has been a health care provider, a researcher, a teacher, a regulator, a consultant and a payor. The biggest part of his career was 24 years as Vice President of Planning for the University of Chicago Medical Center. He retired from there in 2008, but in 2010 was asked to implement the ACA Medicaid expansion in Illinois, which kept him busy for another 5 years.

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