The greatest argument in favor of regulated markets is that they manage production better than any other system. Done properly, regulated market capitalism is supposed to match supply and demand, and provide the right incentives. Productive capacity is built, not wasted. Buyers and sellers are connected. Innovation thrives and benefits everyone.
But, right now, that’s not the case. 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.
Can more be produced? In many developing nations, pharmaceutical manufacturing capacity is being under-utilized. One Bangladeshi company says it could churn out 600 to 800 million doses annually if granted the appropriate licenses and know-how. Even if that’s an overestimate, too many such factories stand idle, waiting for a nod from regulators and patent-holders. The 41 members of the Developing Countries Vaccine Manufacturers Network alone produce between three and four billion shots of other vaccines every year.
It isn’t surprising, therefore, that multiple countries have demanded intellectual property rights essentially be suspended for the duration of the pandemic for Covid-related drugs and vaccines. That sounds like a tempting — even satisfying — solution. But, as my colleague David Fickling has pointed out, if getting new vaccines out the door was as simple as ignoring IPR rules, then we would see developing countries doing just that by issuing what are called “compulsory licenses.” They haven’t.
True, some countries may fear retaliation if they issue such licenses; a broad IPR waiver would get around that problem. But the larger issue is that something as complex as a Covid-19 vaccine cannot be easily reverse-engineered. Simply telling companies they’re free to try won’t do much good.
In other words, we need Big Pharma to cooperate and license its technology to as many manufacturers at possible. Somewhat to my surprise, the vaccine industry seems already to be working unusually hard at this. While the usual timeline for technology transfer is years, one study looked at over 70 such outsourcing and partnership deals during the pandemic and found that the typical time between the transfer and the start of manufacturing had shrunk to six months.
But the disincentives for Big Pharma to expand production even further are considerable. It isn’t that all of them are greedy capitalists worried that they’ll lose a bit of cash, in spite of what you may have read in that angry post on Facebook. Some have, after all, agreed to give up on profit-making while the pandemic rages — so it’s in their interest to ensure that Covid-19 switches from pandemic to endemic as soon as possible.
More likely, the binding constraint is that they’re already really stretched internally; every new licensee that they sign up would add another location they’d need to carefully scrutinize to ensure that it meets good manufacturing practices. As Rajeev Venkayya of Takeda Vaccines Inc. argued on Twitter, “every aspect of vaccine manufacturing is tightly controlled,” “70% of manufacturing time is spent on quality control,” and “all of these challenges carry over to manufacturing partnerships for capacity expansion.”
Even so, these can’t be seen as insurmountable obstacles, not when the situation is so dire. Several prominent figures associated with global public health and the World Health Organization issued an appeal last month in the British Medical Journal for companies to “voluntarily step up with licensing and share their knowledge with multiple producers — moving from a limited set of contract manufacturers to a coordinated effort with multiple producers.”
If that is to happen, governments will have to help. Rich-country governments should, in particular, consider how to pay for the renovation and expansion of facilities in the developing world to prepare them to make vaccines under license. Developing-country governments should strengthen their own commitment to regulation and to intellectual property, in order to ensure that their own manufacturers look attractive as licensing partners.
If both sides don’t meet this challenge, then across the world people are going to wonder if a system that leads to wasted capacity and market failure even during a global pandemic is all it’s cracked up to be. Global trading rules, basic respect for intellectual property and much else hangs in the balance. Unless we can scale up our response soon, capitalism’s reputation could take a bigger hit in 2021 than 2008, or 1929.