Mariana Mazzucato and Els Torreele say the pandemic creates an opportunity to develop a new, public-interest-based approach to health innovation

Mariana Mazzucato and Els Torreele say the pandemic creates an opportunity to develop a new, public-interest-based approach to health innovation

By Mariana Mazzucato and Els Torreele

In the early weeks of 2020, it started to dawn on people that COVID-19 could be the long-dreaded but expected “Disease X” – a global pandemic caused by an unknown virus. Three months later, the majority of the world’s population is in lockdown, and it is clear that we are only as healthy as our neighbors – locally, nationally, and internationally.

Strong health systems, adequate testing capacity, and an effective, universally available vaccine will be key to protecting societies from COVID-19. But ensuring that no one is left behind requires not just unprecedented collective investment, but also a very different approach.

Researchers at universities and companies around the world are racing to develop a vaccine. And current progress is encouraging: 73 vaccine candidates are actively being explored or are in preclinical development, while five already have entered clinical trials.

These massive efforts are possible only because of substantial public investment, including by the US National Institutes of Health and the Coalition for Epidemic Preparedness Innovations (CEPI). The latter, a publicly funded non-profit organisation, was established after the 2014-16 West African Ebola epidemic to drive research and development of vaccines that could be deployed during disease outbreaks.

CEPI has so far received an extra $765 million of a targeted $2 billion in funding for COVID-19 vaccine development from multiple governments. The Biomedical Advanced Research and Development Authority, part of the US Department of Health and Human Services, has invested substantially in vaccine-development projects with Johnson & Johnson ($450 million) and Moderna ($483 million). And the European Union intends to mobilise further public funding to tackle the pandemic at an online pledging conference on May 4.

But investment alone is not enough. To succeed, the entire vaccine-innovation process, from R&D to access, must be governed by clear and transparent rules of engagement based on public-interest goals and metrics. That, in turn, will require a clear alignment between global and national public interests.

The first, critical step is to adopt a mission-oriented approach that focuses both public and private investments on achieving a clearly defined common goal: developing an effective COVID-19 vaccine(s) that can be produced at global scale rapidly and made universally available for free. Realising this aim will require firm rules regarding intellectual property (IP), pricing, and manufacturing, designed and enforced in ways that value international collaboration and solidarity, rather than competition between countries.

Second, to maximise the impact on public health, the innovation ecosystem must be steered to use collective intelligence to accelerate advances. Science and medical innovation thrives and progresses when researchers exchange and share knowledge openly, enabling them to build upon one another’s successes and failures in real time.

But today’s proprietary science does not follow that model. Instead, it promotes secretive competition, prioritises regulatory approval in wealthy countries over wide availability and global public-health impact, and erects barriers to technological diffusion. And, although voluntary IP pools like the one that Costa Rica has proposed to the World Health Organisation can be helpful, they risk being ineffective as long as private, for-profit companies are allowed to retain control over critical technologies and data – even when these were generated with public investments.

Moreover, collective steering is vital in order to select and pursue the most promising potential vaccines. Otherwise, marketing authorisation may go to the best-resourced candidate rather than the most suitable one.

Third, countries must take the lead in building and buttressing manufacturing capabilities, particularly in the developing world. While an effective COVID-19 vaccine probably will not be available for another 12-18 months, a concerted effort is needed now to put in place the public and private capacity and infrastructure needed to produce rapidly the billions of doses that will be required.

Because we don’t know yet which vaccine will prove most effective, we may need to invest in a range of assets and technologies. This poses a technological and financial risk that can be overcome only with the help of entrepreneurial states backed by collective, public-interest-driven financing, such as from national and regional development banks, the World Bank, and philanthropic foundations.

Finally, conditions for ensuring global, equitable, and affordable access must be built into any vaccine-development program from the start. This would allow public investments to be structured less like a handout or simple market-fixer, and more like a proactive market-shaper, driven by public objectives.

Pricing of COVID-19 vaccines should reflect both the substantial public contribution to their development and the urgency and magnitude of the global health crisis. We must go beyond statements of principle and generic pledges, and introduce concrete conditions that enable vaccines to be free at the point of use. Policymakers should also consider using compulsory licensing to allow countries to make the best use of the available tools and technologies.

Crucially, we need collective procurement mechanisms that ensure fair allocation and equitable global access to the new vaccines as they become available. The overriding goal must be to prevent advanced economies from monopolising the global supply or crowding out demand from poorer countries.

The COVID-19 crisis rules out a business-as-usual approach. As countries mobilise collectively against the pandemic through calls for a global alliance, pledging conferences, G20 meetings, and the upcoming annual World Health Assembly, we cannot afford to miss this chance. These collective efforts must include clear and enforceable rules of engagement that commit all partners to an end-to-end approach to health innovation based on the public interest: an effective COVID-19 vaccine that can be rapidly made available to all for free.

Developing an effective and universally available COVID-19 vaccine is one of the most critical missions of our lifetime. Above all, it is a litmus test of whether global public-private cooperation, touted by policymakers as the key to success, will maximise the supply of public goods or the share of private profits.


Mariana Mazzucato is Professor of the Economics of Innovation and Public Value and Director of the UCL Institute for Innovation & Public Purpose (IIPP). She is the author of The Value of Everything: Making and Taking in the Global Economy.  Els Torreele is Executive Director of the Médecins Sans Frontières Access Campaign. Copyright: Project Syndicate, 2020, and published here with permission.

We welcome your comments below. If you are not already registered, please register to comment.

Remember we welcome robust, respectful and insightful debate. We don't welcome abusive or defamatory comments and will de-register those repeatedly making such comments. Our current comment policy is here.

28 Comments

will the Vaccine only be for the vulnerable? Because I don't like vaccines, I need my tetanus etc but never flu vaccines.
It's going to be a mission to try and vaccinate everyone.

Why do we need a vaccine? All the evidence now points to the IFR of Covid-19 being the same as the flu or about 0.1%. All the antibody tests done in the USA, Germany and Italy show that there are at least five times as many infected as cases reported (and maybe 80 times as many). If New Zealand has 8,000 infected and only 8 deaths ACTUALLY CAUSED by Covid19 our IFR is also about 0.1%.

The Australian and Swedish experiments, with no lockdowns, have not resulted in "thousands of deaths" as our PM claimed. In fact, Australia has a lower IFR than us.

We cannot eliminate this virus and therefore herd immunity is the only option. Doctor's appointments have plunged 90% and cancer is going undiscovered.

No vaccine to SARS was ever found, except one that was dangerous. What we need to do, I believe, is face scientific fact; this virus is about as dangerous as a wet wipe.

Australia had lockdowns and some more than us, their government said dont need to but the state governments over ruled them and imposed lockdowns, i have family over there who have been in lockdown before us, they just did not call it lockdown they called it home confinement
this from Queensland
https://www.abc.net.au/news/2020-04-03/coronavirus-queensland-home-confi...

On the whole it is reported that Oz still has around 90% business still operating.
NSW policy was vulnerable isolated as much as possible, business could operate but you can't sit down and stay to eat your food for example.

that is rubbish , ask someone over there, they had similar rules to us just a lot of wombats didnt follow them
https://www.legislation.nsw.gov.au/_emergency/Public%20Health%20(COVID-19%20Restrictions%20on%20Gathering%20and%20Movement)%20Order%202020.pdf
Explanatory note The object of this Order is to give certain Ministerial directions to deal with the public health risk of COVID-19 and its possible consequences. In particular, this Order directs that a person must not, without reasonable excuse, leave the person's place ofresidence. Examples of a reasonable excuse include leaving for reasons involving
(a) obtaining food or other goods and services, or
(b) travelling for the purposes of work or education if the person cannot do it at home, or
( c) exercise, or (d) medical or caring reasons. In addition, this Order directs that a person must not participate in a gathering in a public place of more than 2 persons. Exceptions include
(a) gatherings of members of the same household, and (b) gatherings essential for work or education. Section 10 of the Public Health Act 20 IO creates an offence if an individual fails to comply with a direction with a maximum penalty of imprisonment for 6 months or a fine of up to $ 11 ,000 (or both) plus a further $5,500 fine each day the offence continues. Corporations that fail to comply with a direction are liable to a fine of $55,000 and $27,500 each day the offence continues.

Yep, I have multiple family in NSW and have talked with them most weeks, do you ?

"Since the lockdown, cumulative per capita cases have grown at a greater rate in New Zealand compared to most Australian states (Figure 1). Infected cases have progressively declined for the last three weeks in Australia. Australia has had a much looser definition of lockdown, with 90% of the economy continuing to operate, compared to about 50% here"
http://www.covidplanb.co.nz/our-posts/data-gives-hope-for-quick-end-to-l...

Yep, I have multiple family in NSW and have talked with them most weeks, do you ?

"Since the lockdown, cumulative per capita cases have grown at a greater rate in New Zealand compared to most Australian states (Figure 1). Infected cases have progressively declined for the last three weeks in Australia. Australia has had a much looser definition of lockdown, with 90% of the economy continuing to operate, compared to about 50% here"
http://www.covidplanb.co.nz/our-posts/data-gives-hope-for-quick-end-to-l...

i talk to people in all the states daily, NSW has clusters still growing. there is a growing cluster in cairns the rest are like NZ fine,
as for the figures you need to compare apples with apples and only count our positive tests like aussie do
so we have had 1124 cases and 19 deaths they are at 6729 and 85 deaths.
we have had slightly higher deaths per cases
https://www.smh.com.au/national/covid-19-data-centre-coronavirus-by-the-...

here is how your Swedish experiment went
data published by the official Swedish statistics office and other available figures in an attempt to answer that question. The answer is not encouraging: We found that the country recorded a record number of excess deaths in the first three weeks of April.
In the 21 days before April 19, 7,169 people died — 1,843 more people compared to the average number of deaths during the same weeks between 2015 and 2019. That’s the equivalent of a 34.5% increase.

Rubbish, Mr Sunchap, with respect
Belgium CFR=15%, so go square the circle

With respect, the new antibody tests are showing the IFR is often 50 times the CFR:https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1. Why go and report your "case" when you have no symptoms? New York did them and found IFR was five times CFR.

I think Jacinta is refusing to do these tests, as she knows asymptomatic transmission is so high.

The difference between 0.1% and 15% is 150X; there is probably somewhere in the middle you could pick.
I just think that it would be rather unusual to see refrigerator trucks full of bodies now and not in the flu season if the CFR was anything like the same......Nor would 5 million /11million have fled Wuhan....at the start.
BTW the PM is Jacinda, and your suggestion that she is refusing to test untenable.
Reliable antibody testing is not available here, and is dubious elsewhere.

Belgium: cases 46,000, deaths, 7,000. Tests per million - 16,000, low as. 15% death rate. Same for France - tests per million 7,000, hopeless = 14% death rate. On the other hand Germany tests 24,000 per million, death rate = 3.9%. Throw in some serology studies from New York:
https://www.nytimes.com/2020/04/21/health/coronavirus-antibodies-califor...
It's everywhere - mostly asymptomatic, mostly mild. Knocks off the old and infirm like a boss flu. Those are the stats.

More Belgium - recent test shows antibodies in 4% of population. Population of Belgium = 11.5m. 4% = 460,000. 7,000 deaths from 460,000 cases. 0.01 case fatality.
https://www.brusselstimes.com/all-news/belgium-all-news/108088/coronavir...

Flu vaccine is rated by CDC as 60% effective but ranges from 19% to max 60%.
So don't hold your breath a rushed one will be any better or not have side affects.

Before you let any person inject anything into your body, do your own research and make an informed decision. I’m sorry, but it’s not for me !

I'm with you Homer, I won't take a vaccine since they're not prepared to tell me what's in it. Groceries are taken by mouth and yet all ingredients must be listed in the packets yet something intended to be injected directly into your bloodstream is allowed to be secret.

Obviously you have forgotten history, before vaccines, many people DIED from many diseases, the most frightening was polio, it used to ravage NZ from time to time with terrible results. Even today people still die from flu and most are not vaccinated who die of it. Those vaccines you do not like have spared you and your family of such anguish.

J & J are already ramping up to produce massive amounts when they have one
https://www.massdevice.com/how-johnson-johnson-is-expanding-manufacturin...

Or more talcum powder

if they can make a billion vaccines and make 5$ of each one might cover the damages from the talcum powder, which they are still making and selling

There are only 27 diseases that we have vaccines for. 27. Let's not hold our breath waiting for a 28th.

https://www.bloomberg.com/news/articles/2020-04-28/virus-is-here-to-stay...

Well worth a read. Basically, many scientists, not only from China, saying we have a new seasonal illness and we’ll have to learn to live with it.

Yes, that article is very interesting. NZ scientists (from Auckland Uni and AUT) also supported terminating this lockdown but the Herald refused to publish their "PlanB". Strangely enough they published the views of some scientists opposing PlanB a few days later...

These press-titutes should hang their heads for their shameless propagandising. The Herald claimed claimed today that the world was "admiring" our efforts to eradicate this bug. Probably laughing in my opinion. Not one epidemiologist believes eradication is possible and we are destroying our tourism sector which employs 300,000 people.

And for what reason? The Swedish experiment resulted in a death rate per capita one fifth that of the UK. In a year's time, the Swedish death rate will probably equal that of it's Nordic neighbours when the bug recurs there because they lack herd immunity.

Japan also has a death rate similar to ours with no lockdown and linear regression studies now indicate the lockdown had no effect in the US on reducing the IFR.

I believe continuing with this lockdown for another four weeks is almost criminal negligence. The death rate in New York state is 0.1% :https://youtu.be/ndL0uSmKTQU. If the death rate in the "worst hit" place in the western world is the same as the flu, why are we continuing with it here - with an even lower death rate? We don't do it for the flu.

Children are being molested and beaten up by parents locked down with them. Domestic violence is up 20%. This collective madness must stop.

Nice ideal academic ideas, sadly for far too long we've been given our public health care mandate into vested interest, too deep now to claw back up. A bit like asking FAA not to be cosy with Boeing, Airbus with EU regulators, FDA with pharmaceutical industries, World countries with their every needs from China.
Please, check as who is the biggest for UN WHO funds country contribution? Should we all voted to change?

The WHO have said there's no evidence that those who have recovered from the virus will have immunity to it. The WHO aren't exactly a reliable sourse but if those who are infected (and survive) don't develop immunity it's hard to think how an effective vaccine will be possible.

The SARS1 infected developed immunity and many think this will happen with SARS2 as it is very similar. Do we need immunity if less dangerous than the flu? The death rate in California, Spain and New York state (and therefore almost certainly NZ) is less than that of the flu: https://youtu.be/ndL0uSmKTQU

Why are we quarantining the healthy? This has never been done. Even the Romans 2,000 years ago quarantined the lepers. They did not quarantine the healthy. This decision was made without evidence and has been proven to be wrong.

They have backtracked on that claim. The length of immunity is unclear.