Why the Shortage of Medical Supplies?
Economics Environment healthcare News Politics Science
By Stephen Shenfield April 11, 2020 No Comments 33 Min Read
One key feature of the coronavirus crisis is the grave shortages of medical supplies. Respiratory and surgical masks, gloves, gowns, and other personal protective equipment (PPE); ventilators, X-ray machines, and other medical devices; the various components of testing kits; even sedatives. The list goes on and on. And many things not yet in short supply will be soon.
Anyone at all familiar with capitalist dogma regarding the wonders of the 'free market' must surely find these shortages surprising. After all, it is a much-celebrated virtue of this market that it balances supply and demand and satisfies consumer demand (true, only within the limits of what consumers can afford). Shortages are associated not with capitalism but with the sole recognized alternative of the pseudo-socialist Soviet-type 'command economy.'
The shortages of medical supplies have many causes. Some are intrinsic to the capitalist system. Others are not. Examples of causes that do not flow from the nature of capitalism as a system are the corruption and/or ignorance of specific politicians such as US president Donald Trump and British prime minister Boris Johnson. A country may have honest and well-informed public officials while still being part of world capitalism. This investigation focuses mainly on causes that are closely connected with the nature of capitalism.
Admittedly, it is sometimes difficult to draw a firm line between what is intrinsic to capitalism and what is not. For instance, whether governments maintain and replenish national and subnational stockpiles of medical goods for use in emergencies is a matter of policy. As such it is not fully predetermined by the nature of capitalism. However, spending lots of money for a purpose as unprofitable as preparing for future contingencies does go against the spirit of capitalism, so neglect of stockpiling requirements does have some connection with the nature of capitalism. This helps explain why the federal government of the United States has failed to replenish the national stockpile while the State of California abandoned its own stockpile.
I begin with a discussion of the main systemic causes that underlie shortages of existing medical goods or impede the creation and wide use of new products to assist in the fight against COVID-19 (Section 1). Then I present three case studies, focusing on specific products as follows:
Section 2. Respiratory face masks (respirators) – the single most essential item of PPE
Section 3. Ventilators – 'breathing machines' to intubate patients at risk of suffocation
Section 4. Vaccines
Section 1: Systemic Causes
In organizing future output of a product, the capitalist faces a degree of uncertainty. He has some knowledge of current demand for the product, but cannot be sure how much demand there will be for it at the time when it reaches the market. He may find himself saddled with a surplus that he cannot sell at a profit. In deciding whether to fund development of a new product, he faces even more uncertainty: he does not know when it will be ready for sale or even whether a usable product will emerge at all.
During the initial stage of a newly emerging epidemic (not yet a pandemic) uncertainty about future demand for medical supplies is especially great. Perhaps the epidemic will remain localized and gradually fizzle out. Perhaps it will spread rapidly, only to dissipate equally rapidly with the arrival of spring. Then demand will rise sharply but disappear before he can produce, distribute, and sell the products to satisfy it.
Besides fear of ending up with a surplus that cannot be sold at a profit, the capitalist may have other reasons to be concerned about possible costs of trying to satisfy rising demand. As we shall see in the next section, a company that specializes in the production of face masks for use by workers in industry and construction may fear that it will be sued by new medical customers who are dissatisfied with its product. It may be willing to sell to such customers only if it is freed from legal liability.
Note that the capitalist does not consider how he can best contribute to the treatment of patients or to the fight against the epidemic. As a capitalist he has to operate by the rules of the capitalist system. He cannot behave as a socially responsible human being. However devastating the epidemic may become, it cannot alter that. What he cares about is his 'bottom line.'
That said, there is still the matter of the capitalist's attitude toward risk. Is he more concerned about capturing possible gains if higher demand is sustained or about avoiding possible losses if higher demand proves short-lived? Recent decades have seen a shift in business practice toward giving priority to the avoidance of possible losses. This shift has been associated with adoption of the so-called 'just-in-time' principle.
The shift toward more cautious decision making began in Japan in the 1970s, when the Toyota company adopted at its manufacturing plants the practice that came to be known as 'just-in-time' or 'lean' manufacturing or the Toyota Production System. Since then this practice has spread throughout the world. The basic idea is to save on space, labor, and other costs associated with storage by producing only to satisfy demand definitely known to exist, or even only to meet orders already in hand. Maintaining production capacity or inventory to cope with possible rises in demand above this level is considered wasteful.
Charles Johnson, president of the International Safety Equipment Association, has been quoted as saying:
Manufacturers don't carry inventory. If you do, you are less competitive. They produce what they need to satisfy orders. That's what has happened to global manufacturing.
'Just in time' now prevails at all links of the supply chain. Retail outlets place orders with their suppliers 'just in time.' So do hospitals. As a result, reserves no longer exist anywhere in the system.
When demand suddenly leaps upward, as it does for medical supplies during a pandemic, 'just-in-time' ensures that there will be no spare production capacity or inventory to help satisfy the increased demand. With sufficient investment it is still possible greatly to expand output, but this inevitably takes time – and in an emergency, by definition, time is short.
A rational system of production for use would enable society to maintain reserve production capacity and inventory of essential goods adequate for foreseeable contingencies. Of course, not everything that can happen is foreseeable and mistakes of judgement will always be possible.
Globalization is a significant cause of the current shortages. It has led to extreme geographical concentration in the production of many goods. Specialized products especially are often available only from a single producer in a single country – and that country is rarely the United States. Thus the coronavirus test initially recommended by the Centers for Disease Control required the use of a genetic analysis kit available only from the diagnostic firm Qiagen in Germany and nasopharyngeal swabs (inserted into a nasal passage to get a sample for testing) available only from Copan, a company whose manufacturing plant is in northern Italy – a region itself hard hit by the pandemic. Unsurprisingly, clinics in the United States have been able to obtain supplies from these companies only after long delay, if at all.
However, the United States is dependent for medical supplies mainly on imports from China. Factories in China, even if owned by American corporations, suspended exports in order to meet rising domestic demand as the epidemic spread within the country. Later exports of some goods resumed, though at much higher prices. A commentator in the congressional magazine The Hill writes:
Right now, only China has the potential production scale to meet the soaring demand in the United States and elsewhere for such vital products as medical-protective equipment, pharmaceuticals, electronics, and household essentials. It is imperative for our country and the world that we encourage the rapid recovery of Chinese production capacity. Particularly, we need China to ramp up output quickly in areas of most-critical need, such as sophisticated protective gear for doctors and nurses and pharmaceuticals/medicines for patients and households.
Stockpiles
The Strategic National Stockpile (SNS), originally called the National Pharmaceutical Stockpile, was established in 1998 on the initiative of President Clinton. Its contents are stored at 12 secret locations in different parts of the country. A stock of protective equipment was added to the stockpile in 2006 but it was depleted during the influenza epidemic of 2009 and has not been replenished to any significant extent. Much of the equipment released from the stockpile during the current pandemic was found to be in disrepair.
The SNS has been exhausted since about April 8. Its contents were not distributed with a view to maximizing their impact. States with relatively mild outbreaks received disproportionately large amounts at the expense of 'hotspots' like New York and Chicago (here). Requests from states with Republican governors – Florida, for instance – were met more fully and more promptly than requests from states with Democratic governors.
Some states had stockpiles of their own. They too are now exhausted. California used to have a very substantial stockpile, established in 2006 under Governor Arnold Schwarzenegger at a cost of $200 million and containing 51 million N95 respirators, 2,400 portable ventilators, 3,700,000 courses of anti-viral medications, and three 200-bed well-equipped mobile hospitals. It was scrapped in 2011 by Governor Jerry Brown as part of cuts to reduce the state's deficit (here).
Especially important are new products, like an effective drug or vaccine, that might radically change the situation for the better, but only if made widely available as soon as technically possible. Unfortunately, this is not in the interest of the producing company. The way for it to maximize its profit is to take out a patent on any new product and exploit to the full the monopoly position that the patent gives it for a certain number of years. That means delaying the start of large-scale production and then charging an exorbitant price.[1]
As we shall see in Section 4, considerations of likely profitability have a negative impact even at the stage of research and development of a new drug or vaccine, especially when funds are sought for the conduct of clinical trials.
Patents also impede independent attempts to replicate or repair ventilators and other medical equipment.
Section 2: Respiratory Face Masks
Here is how two hospital workers describe the current shortage of the protective face masks known as 'N95 respirators' (so called because they supposedly filter at least 95% of airborne particles):
Dr. Michael Pappas, resident physician at a hospital in New York City:
Under normal circumstances you could be fired for re-using a single N95 mask throughout the day. You are supposed to dispose of your mask after dealing with one patient and use another for the next patient, to ensure that you do not contaminate that patient or yourself. But currently our hospital is asking healthcare workers to use only one N95 mask each day. And that's actually a better situation than in most New York City hospitals, which give staff one N95 mask that they're supposed to carry around in a paper bag and use for an entire week.[2]
Maria Louviaux, RN, of the California Nurses Association:
At our hospital nurses and all frontline staff are not allowed to wear our N95 respirators. Respirators are actually under lock and key. In some cases, security needs to be called up to release our personal protective equipment. In other cases, a respirator needs to be signed out. But we do not have easy access to N95 respirators or to surgical masks. We're not allowed to wear masks of any kind unless certain criteria are met throughout the hospital.
Once we are finally issued an N95 respirator, it has to be used continuously as we go from one patient to another. We have to re-use it repeatedly until it is compromised by soiling, wetting, or loss of integrity. And that violates the rules set by the FDA for its use.[3]
In South Korea, by contrast, even ordinary citizens walk about wearing KF94 masks, which are almost the same as the N95 respirators that are in such short supply even for hospital staff in the United States.[4]
The April 2 issue of The Washington Post featured an investigation of why production of protective respiratory masks has not increased early enough and fast enough to meet the need generated by the pandemic. The main manufacturer of such masks in the United States is 3M, a company with headquarters in Minnesota and factories in South Dakota and Nebraska.
Under normal circumstances, however, the bulk of the face masks produced by 3M are of a type intended for use by workers in industry and construction, not by medical personnel. Most production of masks for medical use had been relocated to China in order to reduce costs, but in mid-February China stopped exporting the masks, reserving them for domestic use. So globalization has played an important part in creating the shortage.
Industrial and medical masks are designed differently. Medical masks contain more material, providing added protection against splashes. Industrial masks are not tested for fluid penetration. The two types are also subject to different regulations set by different agencies. 3M has been reluctant to switch its production line from industrial to medical masks, as this would require retooling – and then a second retooling to switch back again after the pandemic. But the company was also reluctant to supply its industrial masks to medical customers, fearing that it might be sued.
What to do? It was at this point that Arthur Caplan, Professor of Bioethics at New York University School of Medicine, offered 3M and other manufacturers of medical supplies some unsolicited advice:
Don't talk to your lawyers if you're making masks or gowns or ventilators. See where the need is and get moving as fast as you can.
But 3M paid the good professor no heed. Why hire lawyers if you can't consult them? Not until March 22, after the FDA had approved medical use of industrial masks and legislation had passed waiving legal liability, did 3M finally conclude that its continued profitability was no longer in doubt and announce a rapid expansion of output.
Will socialism be any better than capitalism in this respect? Will people in a socialist society be able to 'see where the need is and get moving as fast as they can'? True, they won't have to worry about lawsuits, but they will face other obstacles to prompt action if they have saddled themselves with a complicated, unwieldy, and overcentralized decision-making system. That is why it is so important not just to abolish capitalism but to design a flexible and sufficiently decentralized system of democratic decision-making for socialism.
Another major factor underlying the dire shortage of face masks is the 'just in time' principle, followed not only by manufacturers producing only to satisfy orders but also by hospitals with a policy of not buying supplies in advance. To quote Dr. Pappas again:
Instead of buying supplies in advance, many hospitals … waited to see if the pandemic actually hit or not, because buying supplies in advance would be an extra cost for hospitals if the pandemic never hit. So they didn't buy supplies, they didn't prepare, and now we're seeing what we're seeing.
Finally, what of the Strategic National Stockpile?
This emergency stock of masks was depleted during the influenza epidemic of 2009, when 85 million N95 respirators were distributed. It was never replenished to any significant extent despite repeated warnings and requests from healthcare groups.
Section 3: Ventilators
Over the coming months, hundreds of thousands of people in the United States are going to come down with severe forms of COVID-19 infection. How many will pull through and how many will die of 'respiratory failure' – that is, suffocation – will depend crucially on the availability of ventilators in the intensive care units of hospitals. There are only 62,000 ventilators in service across the country, many of which are being used for non-coronavirus patients. A recent survey found that even acute-care hospitals have on average only eleven 'full-feature' ventilators. Unless they very soon acquire many tens of thousands more of the machines, hospitals will be overwhelmed as the pandemic spreads. By the time you read this article, some may already be overwhelmed.
In a desperate attempt to mitigate the disaster, hospital staff are preparing to link up each of their ventilators to four patients. A video posted on YouTube shows them how to do it. As the instructor admits, this is an 'off-label use' of machines designed to serve one patient at a time. I cannot help wondering how well it will work.
Go For It, Auto Execs!
Initially Trump took the orthodox 'neo-liberal' view that there was no reason for government to get involved. 'Unfettered free enterprise' could be trusted to rise to the occasion. However, he ended up brokering a deal for a joint venture between General Motors and Ventec Life Systems. General Motors would retool a car parts plant in Kokomo, Indiana as a ventilator production facility using Ventec's technology. A government order for 80,000 ventilators was to be fulfilled in just two months. Trump's enthusiasm was unbounded. 'Go for it auto execs,' he tweeted excitedly on March 22, 'let's see how good you are?'
Then suddenly it was announced that the deal was off. Officials in the Administration were unhappy about the cost – over a billion dollars, a large part of which had to be paid upfront to cover the cost of retooling. True, it worked out at only $13,000 per ventilator, which would seem good value for money, considering that these machines usually sell within the range $25–50,000. 'But for Chrissake', lamented officials at the Federal Emergency Management Agency, 'for that money we could buy eighteen F-35 fighter jets!' And if you think I made that up for ironic effect then you are wrong. They really find it distasteful to spend large sums of government money for the benefit of ordinary people.
An interdepartmental working group was set up to investigate the matter under the wise guidance of Clown Prince Jared Kushner (who was admitted to college only after his dad paid a hefty bribe – I mean 'donation'). The GM-Ventec project remains on the table, but another dozen or so other proposals are also under consideration. The target of 80,000 ventilators was whittled down to 20,000 and then to 7,500 – so a plan to more than double the number of machines was transformed into a scheme to increase that number by just 12%.
You see, some officials are worried that too many ventilators may be ordered. What are they to do with the surplus?
Give the guy credit where it is due. Trump must have started to get impatient, because on March 27 he issued the following statement:
Today, I signed a Presidential Memorandum directing the Secretary of Health and Human Services to use any and all authority available under the Defense Production Act to require General Motors to accept, perform, and prioritize Federal contracts for ventilators. Our negotiations with General Motors regarding its ability to supply ventilators have been productive, but our fight against the virus is too urgent to allow the give-and-take of the contracting process to continue to run its normal course. General Motors was wasting time. Today's action will help ensure the quick production of ventilators that will save American lives.
The Defense Production Act of 1950 authorizes the President to require businesses to sign contracts and fulfill orders deemed necessary for defense, but it has also been invoked occasionally in non-military emergencies. Democrats in Congress were urging him to invoke it in the current crisis. Trump was under pressure from corporate CEOs and the Chamber of Commerce not to do so.
Trump then fired off tweets to General Motors and Ford, which was working on its own plan to adapt car parts for ventilators, declaring that they 'MUST START MAKING VENTILATORS NOW!!!!!!' (yes, in capital letters and followed by six exclamation points).
It seems that this 'very stable genius' – as Trump has described himself – momentarily forgot how capitalism works, even though most of the time he understands this very well. How else could he fondly imagine that a few presidential exclamation points might induce a corporation to set aside considerations of profitability in order to satisfy a human need, however urgent?
As of this writing (April 10), no new facility for the production of ventilators is yet in operation in the United States.
An Even Harsher Light
But there is another aspect to this problem – one that casts the functioning of capitalism in an even harsher light.
While American hospitals have only 62,000 ventilators in service, they have in storage a very large number – estimates run as high as 100,000 – of ventilators that might be brought back into use if repaired. It is true that older models may not be reliable, but repairs could bring enough machines back into use to save many people. Hospitals, however, are unable to have ventilators repaired due to restrictions imposed by the manufacturers (Siemens, Philips, General Electric Healthcare, Medtronic, Ventec Life Systems, Hamilton Medical), who also fight legislative challenges to their repair monopoly.[5]
First of all, purchasers of ventilators and independent technicians are denied access to the documentation and software required for repairs. Second, unauthorized attempts to repair a ventilator are blocked by special 'anti-repair software.' Third, a hospital that hires a technician who manages to overcome these obstacles and repair a ventilator may be sued by the manufacturer.
In Brescia, a city in the north Italian region of Lombardy, a technical expert used a 3D printer to produce 110 special valves needed to repair ventilators at a local hospital. It cost him just 1 euro for each valve, as compared with the price of 10,000 euros charged by the manufacturer of the ventilators, Intersurgical. He gave his valves to the hospital for free, thereby saving at least ten lives. However, he faced a threat of legal action for infringing Intersurgical's patent and therefore decided not to provide the same service to other hospitals (here).
Of course, it is not only medical equipment manufacturers who deliberately try to prevent repair of their products. Manufacturers of computers, tractors, and many other devices do exactly the same thing. It is one of the ways by which they artificially shorten the service life of their products with a view to 'persuading' consumers to buy new ones. The phenomenon is known as built-in obsolescence. It is a normal feature of capitalism and a major source of the enormous waste generated by that system.
A waste of labor, a waste of resources, and – as in this case – a waste of human life.
Oases and Hotspots
The prospects of the pandemic in the United States vary widely from one place to another, depending on the timing and strength of the response from city and state governments. At one extreme are places like Seattle and the San Francisco – Bay Area where strong measures were adopted at an early stage and have shown good results, comparable with those achieved by South Korea and Hong Kong. Here the pandemic is already on the wane; numbers infected are relatively low; hospitals have coped well.
However, such 'oases' are few and far between. More typical are the many areas where measures, though in effect by late March, began only after significant delay. These include such cities as New York, Chicago, Detroit, Atlanta, Miami, and New Orleans. In quite a few of these 'hotspots' hospitals are already in crisis.
Even worse are likely outcomes in areas where adequate measures had still not been taken in early April. Most but not all such areas are in the Southern 'bible belt.' Here, for instance, religious services are still being held – sometimes for the explicit purpose of vanquishing the virus by prayer or exorcism.
For the time being, however, media attention has focused on the plight of New York City.
New York Appeals for Help
At a press conference on March 28, Andrew M. Cuomo, governor of New York State, stated that according to projections New York State was going to need 30,000–40,000 more ventilators by May 1. The Clown Prince responded that according to his projections New York did not need so many, though Dr. Anthony S. Fauci, MD, the immunologist who serves on the White House Coronavirus Task Force, said that he saw no reason to doubt Cuomo's estimate. The Clown Prince urged Trump to 'push back' against Cuomo.
Where were the additional ventilators to come from?
Can they be purchased? The trouble is that high demand and short supply have created a seller's market with sky-high prices. The situation is exacerbated by the lack of coordination at the national level, which forces state governments to bid against one another and against the Federal Emergency Management Agency (here).
The Strategic National Stockpile is supposed to supplement local medical supplies during a public health emergency. And federal authorities have sent New York State 400 ventilators from this source – 200 earmarked for New York City and 200 for the rest of the state. 'What am I going to do with 400 ventilators when I need 30,000?' asked Cuomo. Not to mention that many have parts missing and do not work. It is unfortunate that New York State has a Democratic governor, as only Republican governors like Florida's Ron DeSantis get their requests met quickly and in full by the Trump Administration (here).
At a press conference on April 4, Governor Cuomo announced that 1,000 ventilators would be arriving by air later that day – a donation 'facilitated' by the Chinese government. The State of Oregon, now itself over the hump of the pandemic, is giving New York another 140 ventilators.[6]
China, Oregon, and the federal authorities, taken together, are sending New York 1,540 ventilators, just 4—5% of the number needed.
According to recent reports, New York was going to run out of ventilators on April 8 (and Louisiana on April 9).
Who Will Be Left To Die?
So it seems that hospitals in New York – and other places – are going to be overwhelmed – meaning, in particular, that they are going to run out of ventilators. What happens then? Who will be hooked up to a ventilator? Who will be left to die?
According to a TV talk show broadcast from New York on April 3, these life-and-death decisions will be based on ratings that combine three factors:
age of the patient (younger people have priority)
the patient's state of health prior to infection (people otherwise in good health have priority)
health insurance status (people with 'good' insurance or able to pay for themselves; people with less 'good' insurance; people who are uninsured)
Those with the highest ratings get a ventilator all to themselves; those with the lowest ratings are left to die; those in the middle share a ventilator with other patients.
In other words, a class system has been devised – as befits a class society.
In Production at Last?
Meanwhile, what progress is there with new production projects like those described above?
On April 5 Tesla posted the first YouTube video about their ventilator prototype, made using electric car parts – a project reportedly initiated at the request of New York City mayor Bill de Blasio.[7] However, the design is new and untested.
Parallel to the General Motors—Ventec project, Ford is working with General Electric and plans to start production on April 20 at its Rawsonville Assembly Plant in Ypsilanti, Michigan. Ford promises to deliver 50,000 ventilators within three months. I don't know how realistic this timetable is. Time will tell. But even if the promise is fulfilled these ventilators will arrive too late for many. With a prompter response to the start of the pandemic, many if not all of them would already be saving lives.
Section 4: Vaccines
There would seem to be good prospects for a safe and effective vaccine against the SARS-CoV-2 coronavirus.
First, numerous teams of scientists are working in parallel, applying diverse approaches to the problem. According to an interview on March 21 with Dr. Stanley Plotkin, inventor of the rubella vaccine, at least forty possible vaccines were already under development at that date (here). By April 8 the number had risen to 115 (surveyed here). Besides European and North American biotech companies, Chinese, Indian, and Japanese companies are now in the race. China alone is developing nine potential vaccines.
In addition, the Oslo-based Coalition for Epidemic Preparedness Innovations is funding several research efforts by non-commercial organizations.[8] Non-commercial projects are of special value, because they are not bound by the commercial secrecy that impedes cooperation among scientists working for different companies.
The Boston-based company Moderna has already begun a first-phase clinical trial of an RNA vaccine – a new type – on human subjects (here).
Second, the evidence so far indicates that the virus is slow to mutate. Genetic differences among the strains that have emerged in different countries are slight. This greatly simplifies the task. Any vaccines developed to protect against the virus in its current forms will probably remain potent for a considerable period.
Third, the SARS-CoV-2 virus is new but by no means completely new. It bears some similarity to other coronaviruses and especially – as the label given it indicates – to the SARS-CoV-1 coronavirus of 2002—2003, and also to the MERS coronavirus of 2012—2014. This family resemblance to viruses that have already been studied facilitates the search for a vaccine.[9]
Squandered Advantage
However, much of the advantage that this family resemblance could have given was squandered when research into SARS-CoV-1 and MERS was discontinued after the corresponding epidemics ended. In particular, Dr. Maria Elena Bottazzi and her team at Baylor College of Medicine and Texas Children's Hospital Center for Vaccine Development developed early vaccines against SARS-CoV-1 and MERS but in 2016 were unable to obtain funding to conduct clinical trials. Such trials that would have given a head start to current work on a SARS-CoV-2 vaccine. Researchers would already have some idea of how humans react to one class of possible vaccines against members of the SARS family of coronaviruses.[10]
Why then was 'no one interested' in funding trials of these vaccines? Here is what virologist Dr. Hakim Djaballah, head of the Pasteur Institute Korea, has to say about it:
There is no more threat, so everybody forgets about it… The best comparison is with the Ebola virus in Africa. The only reason we got a vaccine for Ebola is because Ebola decided to leave the continent of Africa and started infecting people in Europe and America. So those people started getting worried about the spread of Ebola on their own soil. And that was the push for government funding to get those vaccines made. Companies will not make vaccines if there is no one to buy them. They make them only when governments are in crisis. So those governments write and sign the checks and hand over the money. But those governments have not seen a vaccine for SARS-CoV-1 yet. And there hasn't been a push for it. Now perhaps they will try something, but I'm not holding my breath.[11]
No money for research to guard against future contingencies like reappearance of an old pathogen or emergence of a new one belonging to the same family as an old one. No money to fight even a current epidemic so long as only poor countries are affected. No money to preserve and strengthen research capacities in order to be in the best possible position to meet future challenges. There is no commercial justification for any of these things.
This is the narrow focus of capitalist society. Profit-oriented decision makers see no palpable advantage in contributing to a broadly conceived and future-oriented research program, although it is precisely such a program that humanity needs in its present predicament. To quote another scientist:
We need coordinated research, worldwide, on virus illnesses, to be prepared for the next mutation. It will be impossible to cover all possible variants, but we would be much closer to a new mutation than we are now.[12]
This makes good sense. A socialist world community would surely do it that way. But is such a high degree of global coordination feasible in a world of competing producers and rival nation-states?
Delay, Delay
The time needed from the start of research on a new vaccine until it is marketed is commonly estimated as 12—18 months, although many commentators say that it could easily take two years and some give an upper limit of three years or even longer. Dr. Plotkin recalls that 'it took at least five years before a vaccine [for rubella] was on the market' and adds: 'We cannot afford to have that kind of delay in an emergency like this one.' He urges companies to 'go into superaction' immediately, with a view to having a vaccine available in the event of a second wave of the pandemic next winter – that is, within about 8 months.
One major reason why the process takes so long is the number and duration of the clinical trials required to get a vaccine licensed by regulatory agencies like the US Food and Drug Administration. The official purpose of licensing is to ensure the safety and efficacy of drugs and vaccines. In practice, the FDA was long ago 'captured' by the companies it is supposed to regulate, with most of the scientists who sit on its advisory committees dependent on those companies.[13] FDA decisions therefore tend to reflect the interests of the companies that have the most political clout at the time.
Monopolization and Extortion
Another recommendation made by Dr. Plotkin is that the FDA should license not one but several vaccines against SARS-CoV-2, 'because if we need millions of doses a single manufacturer will not be able to make enough for the world.' This too makes good sense. Or at least it would if production were carried on to satisfy human needs. However, we live under a global system in which production is for profit.
How then does a company that develops and produces vaccines act in order to maximize its profit? It seeks to monopolize the market for a vaccine against a specific disease by ensuring that its vaccine – and its vaccine alone! – is licensed. Then it applies for a patent on its vaccine – another significant cause of delay. Monopolization sets the scene for extortion. The company sells its vaccine at an exorbitant price that makes it unaffordable to most of those who need it.
How many times this has happened in the past! A few years ago, for instance, the Joint Committee on Vaccination and Immunization, one of the committees that advises the British National Health Service, recommended that a new vaccine against Meningitis B manufactured by Novartis NOT be made available to all children in the UK, even though this terrible disease afflicts 1,870 people per year. It was 'highly unlikely to be cost effective' – in other words, it was too expensive.[14] And this in a country that for over seven decades now has had what "progressive" Americans politicians call 'Medicare for All'! Vaccines against the scourge of viral hepatitis are likewise too expensive for large-scale use.[15]
Indeed, there has already been an attempt to monopolize a future SARS-CoV-2 vaccine – one that does not yet even exist. In mid-March, the German press reported that the Trump Administration was trying to secure exclusive rights to any vaccine created by the German pharmaceutical company CureVac. Research and development would then be moved to the United States and the vaccine made available only in the United States (here).
[1] For a discussion of patents, with other examples of the harm done by them in the medical field, see here.
[2] Interviewed on April 7 by The Real News.
[4] Professor Kim Woo-joo of Korea University Guro Hospital, interviewed on March 27 by The Korea Times.
[5] They do this both directly and through their lobbying group, AdvaMed. See Jason Koebler, 'Hospitals Need to Repair Ventilators. Manufacturers Are Making That Impossible,' Vice, March 18.
[6] See here. It is not clear who in China is actually footing the bill.
[7] See here. There were soon several videos on YouTube about Tesla's ventilator.
[8] Seven projects as of April 10. See here.
[9] See the article by researchers at La Jolla Institute for Immunology in the March 16 online issue of Cell, Host and Microbe.
[10] See here. For a detailed assessment and references to articles by members of the Bottazzi team, see comments by pharmaceutical engineer Christopher C. VanLang on the question-and-answer website quora.com.
[11] In an interview with The Korea Times.
[12] Physicist Cees J.M. Lanting on the question-and-answer website quora.com.
[13] This includes scientists directly employed by companies, scientists working for them on contract, and the many university scientists who depend on corporate money to fund their research. In fact, there are so few genuinely independent scientists that the FDA would be unable to rely mainly on them even if its leading officials wished to do so.
[14] 10% of victims die, while many survivors become deaf or blind or have to have limbs amputated (The Independent, July 24, 2013; Daily Mail, August 24, 2013).
[15] Vaccines exist for types A and B of this disease: see here. For a discussion of the availability of vaccines in underdeveloped countries, see here.
Tags just in time/masks/patents/respirators/shortages/stockpiles/vaccines/ventilators
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