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The author of this article is a contributing editor of the Financial Times and writes the Chartbook newsletter
In a crisis-ridden world, where problems intersect and deepen their complexity and there are few easy-hanging fruit, it is all the more important to recognize those policy choices that are truly obvious. Vaccines are one such investment. Since the 1960s, global vaccination campaigns have eradicated smallpox, virtually eliminated polio and brought measles under control. Modest public health spending has saved countless lives, reduced morbidity, and allowed children around the world to grow into healthy adults who can contribute to society.
After years of development, a second malaria vaccine was approved in 2023 (malaria kills more than 600,000 people every year). A recent study of a Streptococcus A vaccine calculated that an investment of less than $60 billion would yield more than $1.6 trillion. Group A Streptococcus is a pathogen responsible for 600,000 deaths and 600 million cases of strep throat each year.
What is even more amazing is the success of the new crown vaccine. In less than a year, the vaccine that completed all certifications was put into use. Although we have failed to deliver these vaccines to many of the world’s poorest people, they have saved at least 14 million lives. The world economy has restarted, creating trillions of dollars in additional output.
Being able to put a vaccine into service during a pandemic opens a new chapter in the history of medicine. A summit co-hosted by the British government and the Coalition for Epidemic Preparedness Innovations (CEPI) in March 2022 announced a new goal to have a safe and effective vaccine ready within 100 days of the next outbreak.
This requires some effort. The COVID-19 vaccine can be developed so quickly because it is based on years of research on the Middle East respiratory syndrome (Mers) virus and the severe acute respiratory syndrome (Sars) virus. To prepare for the next outbreak, we must compile a list of potentially dangerous strains and strengthen global surveillance. We can try to predict which pathogens are most likely to trigger zoonotic mutations. Best of all, we can start working now on the early stages of vaccine development for dangerous diseases we already know about.
Of course, this costs money. But investing in scientific breakthroughs is inexpensive compared to other major investments. It would cost less than $8.5 billion to advance at least one vaccine against 11 prevalent infectious diseases into Phase 2 trials. In her book “Disease X,” science writer Kate Kelland estimated the cost of building a complete vaccine arsenal at $50 billion.
It is unrealistic to expect the private sector to contribute. The work was too expensive, the risks too high, and the rewards too uncertain. Funding from philanthropy and public-private partnerships may work. But ultimately it is the government that should foot the bill for this work. Unfortunately, in public policy, epidemic prevention often has to be spent from cash-strapped development agency budgets or tight health budgets, while it is appropriate to spend it from industrial policy and national security budgets.
Biotechnology is one of the brightest areas for future economic growth, combining research, high-tech manufacturing and service industry jobs. As the International Monetary Fund (IMF) declares: “Vaccine policy is economic policy.” Epidemic prevention is a matter of national security because it is the most serious threat to the population. Between 2020 and 2023, the proportion of people in the UK who died from COVID-19 (225,000 out of 67 million people) was much higher than the proportion of people who died from German bombings during World War II (70,000 out of 50 million people).
The annual defense budget of a larger European country is enough to pay for a comprehensive global anti-epidemic programme. The money spent on one of Britain’s proud aircraft carriers would be enough to protect the world from the horrific threats of Ebola and Marburg.
Not only is this spending unbeatable in terms of cost-effectiveness, but not making it is inviting disaster. The risk of a COVID-19-level global pandemic resulting in 20 million additional deaths in any given year is thought to be about 2%. We will be lucky if we avoid another pandemic in the coming decades. What’s more, the risk of zoonotic mutations is steadily increasing due to population growth and urbanization. Climate change is exacerbating this effect.
The consensus now is that we must invest trillions of dollars in mitigating and adapting to climate change, transforming our energy infrastructure and way of life. But for most countries, only climate scenarios of considerable severity will cost more lives and economic costs than COVID-19. Measured by the cost of a human life saved, vaccines are much cheaper, more immediate, and more effective than climate policy.
This is not to pit global public health against climate policy. We don’t get to choose what challenges we respond to. But what we can do is reduce the load that exceeds our capacity, which in 2020 nearly left our social and political processes unable to make decisions. As Kellan said: “…while epidemics are inevitable, pandemics are a choice.” If we fail to invest the small amounts of money necessary to give us a chance at fighting a big, deadly disease, then it is not destiny but a narrow understanding of self-interest and collective shortsightedness that will put us in chaos.
Translator/He Li
2024-04-01 12:05:59
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