CareTalk Podcast – Should the US Vaccinate the World?

John and David weigh in on whether or not the USA should step in and help vaccinate the rest of the world against COVID.

David Williams:

Well, John, the U.S. has plenty of vaccines. Should we make sure the world has enough too?

John Driscoll:

Absolutely. But it’s easier said than done.

David Williams:

Well, let’s say it at least. Welcome to Care Talk, your weekly home for incisive debate about healthcare, business, and policy. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix.

David Williams:

Well, John, we’ve got a nice morality question here for you today. The U.S. now has enough vaccines, but there’s a lot of places in the world that have a 1% or 2% rate of vaccination. Is that the U.S.’s job to make sure that everybody has a vaccine?

John Driscoll:

Well, obviously, if we’ve got the technology, we’ve got the distribution, we’ve got the supply now is the time we should lead morally and not leave the rest of the world behind. I mean, I think it’s obvious, David.

David Williams:

Yeah. John, there’s a bunch of arguments that are used. I mean, the moral one will go right to there. Yeah, it makes me feel good. Self-interest you could say, “Well, if the virus is spreading elsewhere and there’s these variants, eventually, maybe they’re going to get around to the vaccine, or maybe we won’t be able to do business with people if their economies come to a halt.” Plus, maybe we want to compete with China and Russia.

John Driscoll:

Sorry, are you giving the arguments in favor of my position? Because I’d like to expound on that. Or are you going to somehow take the immoral stance that you started?

David Williams:

Well, John, I’ll take the immoral stance. Sure, it’s good to go and make sure everybody has a vaccine, but if you do that, there’s a few things that happen. First of all, you’re going to get in the way of the free market, which can help to solve this problem in the first place.

John Driscoll:

What? The free market? Oh, I’m sorry, are we talking about the pharmaceutical market? The monopolistic, highly regulated, costs going up all the time pharmacy market that you have great issues with in other podcasts, but suddenly you’re going to suggest a free market exists when the government protects the profits? I mean, what are you talking about?

David Williams:

All right, John. Just giving you a little red meat, John, to chew on and throw you off. But listen, all the time here we’re talking about social determinants of health, reducing inequality in the U.S., improving health equity, so I think we should focus on that. Otherwise, we’re going to go to India and make sure that actually everybody has a place to live and clean water and good roads and all infrastructure so that we address their social determinants of health without addressing them here? I mean, I think that’s one of the problems.

John Driscoll:

Oh, slow down the truck of nonsense. I mean, just stop it. I mean, the longer this pandemic goes on, and without vaccines it will go longer, the more mutations we will see and the greater risk, not just for those places where the pandemic is running without vaccinations, but even for us. Even in the narrowly defined, perversely narrowly defined self-interest that you expound, what we’re talking about here will protect us. There’s three great reasons here, David. The first honestly is enlightened self-interest. The virus is already mutating into more dangerous forms in Brazil and more virulent forms in Britain. And that British strain has infected Vietnam, and in Vietnam, they’re seeing a combo version of Brazil plus Britain that is quite dangerous. It hasn’t jumped the barrier or the protections that we have with the current vaccines, but it will continue to mutate at scale until we have tamed this beast.

Secondly, this pandemic, if it continues to run with the level of vaccination that currently exists, particularly outside of the west, you’re looking at a $9 trillion economic loss. That’s going to be at least a trillion that’s going to affect us. We’re protecting your health, David, we’re protecting your financial health, and finally, this is an opportunity and a risk for U.S. power. I mean, China ran ahead of us with its vaccine diplomacy. Our brand has been damaged by Trump.

David Williams:

John, there’s a couple of things. First of all, the vaccines are so effective right now that it doesn’t really matter if others get vaccinated or not. And yeah, there’s a concern about the virus mutating, but it’s had a lot of chance to mutate. It hasn’t jumped around the vaccine yet, and it may not. On Brazil-

John Driscoll:

There is no virologist on this show who will agree with the notion that the current vaccines protect you from any foreseeable mutation in the future.

David Williams:

Yeah. Good, John. Well, it’s good you pointed out there’s no virologist on this show. Now turning to Brazil, as we’ve said in previous episodes, they’ve had terrible management, and they screwed up. Now, it turns out that they reopened their economy anyway and it’s growing. Now let’s get to the point about competition with China and Russia. Now there, I agree.

John Driscoll:

What about that example of the community in Northern Brazil where they took a city and they actually immunized all, I think it’s 40,000-ish, residents and the death and illness by COVID dropped by 95%. Brazil’s still getting beaten up. They bet it on herd immunity, which means herd pain and suffering. Now they’ve got new variants. I mean, I don’t think Brazil is a model of success.

David Williams:

Well, I don’t think we’re going to help them by getting them vaccines. Now, competition with China and Russia is another matter. Now here, you’re right. We were slow to get out of the gates because our prior leader didn’t do a good job on that. But there’s a couple of things that have happened. First of all, there’s plenty of suspicion on the Chinese government, and rightfully so, for potentially covering up what happened in their lab. So in any case, there’s concern abouts the culpability of the Chinese government for the virus getting loose. And secondly, their vaccine suck compared to ours. You want an American vaccine. You want an mRNA vaccine, whether American or claimed [crosstalk 00:05:49]

John Driscoll:

Excuse me, excuse me. Would those be the vaccines you don’t want to share?

David Williams:

No, we’ll share them. Let them buy them up. Cash on the barrel head, John.

John Driscoll:

This is a time for generosity of spirit and for enlightened self-interest. We should be investing our assets in getting more of the vaccine supply to areas of the world that need it. And frankly, I would be well open to opening up the patents so that where countries can actually assemble the materials and get it manufactured, we should empower the rest of the world. This pandemic may feel like it’s gone away in the U.S. It’s raging in other parts of the world. David, you’re betting against the virus, and that has been a losing bet for the last year.

David Williams:

So, John, let’s let’s move away from the moral grounds and maybe you’ll get off your high horse and down onto the ground and we can talk about distribution, where the rubber meets the road, or in the case of, I don’t know, some places that don’t have rubber tires, I guess, they use wooden wheels or something like that on the dirt roads. But let’s talk about actually doing a distribution. So I actually think there was discussion about we should be distributing the doses now before everybody in the U.S. is vaccinated. I think it’s actually a moot point at this point. Everybody who wants a vaccine can get one either if we distribute them. And I do think that we want to consider how we actually distribute the vaccines. And I actually do think, John, this is going to surprise you, I actually think that COVAX, which is a public private partnership and a multinational effort is actually the way to go.

John Driscoll:

Wow, you’re actually showing some respect for an international institution that actually requires more than just U.S. provincialism to perform.

David Williams:

Thank you, John. I’m going to take that as a compliment. So the post-World War Two order has served us very well with a lot of organizations that the U.S. really helped to set up, starting with the United Nations and many international agencies, World Health Organization, and so on that we abandoned largely under the previous regime here. Now, COVAX is an opportunity to create a new organization with American leadership, do something good, and actually outflank China and Russia in that regard. There is no way COVAX could be successful up until this point. They couldn’t compete when there is a really limited supply, but they can do a good job of distributing vaccines where it’s needed for your noble and moral public health orientation as opposed to just who’s your buddy and an ally that you’re going to give vaccine to.

John Driscoll:

It is practical, it’s political, and it makes sense.

David Williams:

So John, the other thing is, I was going to decry that there’s not that many foundations involved in it, because it was the Bill and Melinda Gates Foundation. But I guess now it’s going to be the Bill Foundation and the Melinda Foundation. So that’s two.

John Driscoll:

Stop with the snide remarks for those people who actually predicted that we were not preparing for the big one. And let’s acknowledge that exponential growth is something that’s really hard for humans to get, as is the complexity of the viral spread. I think, David, anything we can do to contain this and cure it through vaccines we should be doing. It should be a national priority to solve this international problem. And I’m glad that even someone who’s as an America First-er like yourself can get behind COVAX because you think it will help America, because it will.

David Williams:

So, John, I know you’d like to throw in some of your little pet projects there like breaking patents. You break my patent, I’m going to break your patent. And then we’ll see who’s happy.

John Driscoll:

We don’t have patents. During a period of emergencies, you’ve got to break a little glass. This is not a time when people should be standing, we can make it time limited, standing on the patent treaty to prevent countries from taking control of their own healthcare destinies. I mean, I thought you were supportive of independent entrepreneurial [crosstalk 00:09:56].

David Williams:

Yeah. It’s like government henchmen going around and going to snatch my patent. Now, true enough. There’s actually a U.S. government patent on mRNA, which Moderna hasn’t licensed, and I understand they could be sued for patent infringement. There’s no virologist and there’s no patent attorney on this show either. Nonetheless, John, I think that, that patent breaking is a red herring and the real bottlenecks have to do with [crosstalk 00:10:17].

John Driscoll:

By the way, what is a red herring? Have you ever had a herring that was red? I have not. That’s a distraction. You’re creating a distraction with a word that’s a distraction.

David Williams:

It’s like a meta something. I don’t know what. But John, okay, whatever type of herring it may be, it’s like a pickled herring, but the problem is not the patents. The problem is that even if you broke your patents, do you still have a shortage of know-how, supplies, distribution?

John Driscoll:

We’ve opened them. We’re opening the patents. We’re not breaking. Why use that violent language? We’re permitting others to build the tools, to embrace the tools, to actually build their own medicine. Are you seriously standing in the way of healers trying to make their own medicine so they can save lives in their countries?

David Williams:

Well, John, when you put it like that, I will say that my 18 year old son decided, he had a choice between the Moderna and the Pfizer vaccine or one of your nonsense, probably Sinovac or something too, but he decided he’s going to get Moderna, because he wants to support local businesses. That’s what he took away from the pandemic. I don’t know, John. But let’s talk about the future since we don’t seem to agree about the present or the past. How do we prevent future crises? Or maybe this is the end of crises and this’ll be the last one and we’re all set.

John Driscoll:

The challenge with the United States government is that we are extremely good at dealing with any problem as long as it’s right in front of us and we have a hard time preparing for the opportunities or the challenges farther out. And I think the lesson here is, gosh, since the Bush administration, there’s a wonderful book out Michael Lewis wrote about premonition, which is all about the preparation, which was difficult and required independent entrepreneurs within government during the George Bush administration, and it evens goes back to reference the Swine Flu near pandemic during the Ford administration. And it points out that when you’re preparing for large unpredictable problems, people will criticize you before the problem, or if you avoid it and they’ll basically hang you politically if you can’t actually solve the problem that you were potentially unprepared to fund the solution for prior.

And I think the lesson here is that we need a FEMA for healthcare and for health and biological safety. What the pandemic really represents is a fundamental I think restructuring, if we look at it the right way of our view, of what risks are. We take the risk of nation states attacking us quite seriously of terrorists, independent actors, and just like after 9/11, we changed the way we thought about independent actors taking action against the United States and our citizens. We need to look at the pandemic as activating a different vector of threat, biological, and we need to prepare for it and react with longterm solutions in the same way that we dealt with terrorism post-9/11.

David Williams:

John, I’m glad you pointed back to some of those examples from earlier administrations, because I do think that they are apropos. In addition, you’ve seen good responses to diseases that have emerged like with AIDS. Bush did a good job with the PEPFAR Program and that included making sure that generic medications were available and that there was the mechanism not just to produce them or break patents, as you will, but also to actually distribute them, to monitor, to make sure you weren’t having new resistance emerging. We can do it. And some of the technologies that have come along as part of this pandemic, with the mRNA in particular and some approaches to make more universal vaccines, to use information technology to do a better job with public health surveillance and to build up something like COVAX give me hope that we could actually get there and establish a new regime, I don’t want to say a New World Order, that is based on public health and security. And if I may be so bold, that perhaps this will even eventually lead to joint action on climate change.

John Driscoll:

Now you’re just trying to pull us into yet another Care Talk episode, but I think the big difference between all of the preparation that happened and what we would do next time if we were to think about it is whether it’s PPE or supply chain or the capacity to distribute, it’s not just having the plan and the solution at hand, but being able to turn it on at scale, which means we’ll be carrying as a country a little bit more infrastructure that maybe we can make dual use. But what we have to prepare for is the ability to turn on that public health infrastructure and supply in a crisis within 30 to 60 days. What we proved this time is a plan without infrastructure and supplies will fail.

David Williams:

Well, John, it sounds like you’re ready, I’m ready I guess, to pull us into the next episode of Care Talks. So for now, why don’t I push us out of this episode by saying, that’s it for yet another edition of Care Talk. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix, and David’s still wrong.