Mariana Mazzucato, et al. examine the deeper systemic problems lurking behind recent biomedical progress toward defeating COVID-19

Mariana Mazzucato, et al. examine the deeper systemic problems lurking behind recent biomedical progress toward defeating COVID-19

By Mariana Mazzucato, Henry Lishi Li, and Els Torreele*

Recent announcements of demonstrated efficacy in COVID-19 vaccine trials have brought hope that a return to normality is in sight. The preliminary data for Pfizer/BioNTech and Moderna’s novel mRNA vaccines are highly encouraging, suggesting that their approval for emergency use is forthcoming. And more recent news of effectiveness (albeit at a slightly lower rate) in a vaccine from AstraZeneca and the University of Oxford has fueled optimism that even more breakthroughs are on their way.

In theory, the arrival of a safe and effective vaccine would represent the beginning of the end of the COVID-19 pandemic. In reality, we are not even at the end of the beginning of delivering what is needed: a “people’s vaccine” that is equitably distributed and made freely available to all who need it.

To be sure, the work to create vaccines in a matter of months deserves praise. Humanity has made a monumental technological leap forward. But the springboard was decades of massive public investment in research and development.

Most of the leading vaccine candidates prime the immune system’s defenses against the viral “spike protein,” an approach made possible through years of research at the US National Institutes of Health. More immediately, BioNTech has received $445 million from the German government, and Moderna has received $1 million from the Coalition for Epidemic Preparedness Innovations and more than $1 billion from the US Biomedical Advanced Research and Development Authority and the US Defense Advanced Research Projects Agency. The AstraZeneca-Oxford vaccine has received more than £1 billion ($1.3 billion) of public funding.

But for technological advances to translate into Health for All, innovations that are created collectively should be governed in the public interest, not for private profit. This is especially true when it comes to developing, manufacturing, and distributing a vaccine in the context of a pandemic.

No country acting alone can resolve this crisis. That is why we need vaccines that are universally and freely available. And yet, the current innovation system prioritizes the interests of high-income countries over those of everyone else, and profits over public health.

The first step toward a people’s vaccine is to ensure full transparency of the clinical-trial results, which would enable independent and timely assessments of safety and efficacy. The publication of scanty, preliminary data through corporate press releases is meant for financial markets, not the public-health community. This practice sets a bad precedent. While pharmaceutical share prices surge, health professionals and the public are left second-guessing the reported results. As more details about the flaws in clinical trial design and implementation for the AstraZeneca-Oxford vaccine emerge, so do the calls for open science and immediate sharing of protocols and results.

In addition, critical questions about the leading vaccine candidates remain unanswered. Responding to political and economic pressure in high-income countries, pharmaceutical companies are rushing their vaccine candidates across the finish line. Accordingly, they have designed their phase-three clinical trials to deliver the quickest possible positive read-out, rather than addressing more relevant questions such as whether the vaccine prevents infection or just protects against the disease. It also is unclear how long the protection will last; whether a given vaccine works equally well in young and old people, or in people with co-morbidities; and how the top candidates compare to one another (critical for designing effective vaccination strategies).

Moreover, national interests – especially those of developed countries – remain the dominant factor in vaccine rollout. While the international purchase and distribution platform COVAX represents a momentous step forward, its impact is being offset by massive bilateral advance-purchase agreements by rich countries that can afford to bet on multiple vaccines. For example, high-income countries have already bought close to 80% of the Pfizer/BioNTech and Moderna vaccine doses that will be available within the first year.

All told, rich countries have laid claim to 3.8 billion doses from different vaccine makers, compared to 3.2 billion (which includes around 700 million doses for COVAX) for the rest of the world combined. In other words, high-income countries have pre-ordered enough doses to cover their populations several times over, leaving the rest of the world with potentially too few to cover even their most at-risk communities.

At the same time, because the vaccine race is focused primarily on Western markets, some candidates are scarcely viable outside of a developed-country context. The Pfizer/BioNTech vaccine must be kept at -70ºC, which is colder than an Antarctic winter. Distributing this vaccine will create costly and complex logistical challenges, especially for low- and middle-income countries. Although other candidates – such as the AstraZeneca-Oxford vaccine – are stable at higher temperatures, it is notable that such glaring features of market discrimination are built into the first product to reach the approval stage.

Beyond national interest lurks the problem of even narrower private interests, which stem from an over-financialized biopharmaceutical innovation model. The business model for future vaccine development is already being sized up now that the pandemic has revealed the potential windfall for investors. But while they benefit from sky-rocketing stock pricessoaring capital gains, and dumping a company’s shares the same day it announces promising preliminary results in a clinical trial, delivering a people’s vaccine has become an afterthought.

The COVID-19 crisis is a perfect test of whether a more public-health-oriented approach to innovation and production will prevail in the years ahead. While Pfizer is sticking with the model of maximizing shareholder value, AstraZeneca has at least pledged not to profit from its vaccine “during the pandemic.” Yet, despite all the public investment that underwrote these innovations, the process will remain opaque, leaving one to wonder if AstraZeneca is actually ready to prioritize public health over profit and offer its vaccine at cost.

While the recent vaccine news has brought hope, it also has exposed the pharmaceutical industry’s broken business model, casting doubt on the prospects of delivering a people’s vaccine and achieving Health for All. Business as usual may allow us to scrape by in this crisis. But there is a better way to do things. Before the next pandemic arrives, we must recognize vaccines as global health commons, and start to reorient the innovation system toward symbiotic public-private partnerships governed in the public interest.  


Mariana Mazzucato, Professor of the Economics of Innovation and Public Value at University College London, is Founding Director of the UCL Institute for Innovation and Public Purpose and the author of The Value of Everything: Making and Taking in the Global Economy and The Entrepreneurial State: Debunking Public vs. Private Sector Myths. Henry Lishi Li is a research fellow in health innovation at the UCL Institute for Innovation and Public Purpose. Els Torreele is a visiting policy fellow at the UCL Institute for Innovation and Public Purpose. Copyright: Project Syndicate, 2020, and published here with permission.

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52 Comments

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"But for technological advances to translate into Health for All, innovations that are created collectively should be governed in the public interest, not for private profit."

"No country acting alone can resolve this crisis."

Why is the solution always socialism and world government? No thank you. Socialism is a bad idea in theory and worse when put into practice. Free market innovation and a diversity of approaches to crises are better than a single poorly led approach. The WHO was telling us not to wear masks and even that COVID wasn't human transmissable not long ago..

The profit motive drives the innovation and the innovation comes from the wealthy countries (hint - it's why they are wealthy). No amount of policy making or other governmenting is going to make North Korea a hub of innovation. What might work is opening up their markets and allowing capatilism to thrive (check SK, they're doing ok).

What is it with you weirdos obsessed with the socialist boogeyman. Nowhere in this piece did she advocate for full on socialism at all, she merely said that in this instance because the medicines are being created through public funds that it should be them who gets the benefit. Calm down and read the article properly next time.

The headline was good - the best.

Just what the content had to do with the headline, though, I don't know.

Shouldn’t the public funds be conditional on a specific outcome such as a cheap vaccine? Do they just dish it out without conditions?

Regretfully, I did read all of the drivel.

"They" do get the benefit, they get the vaccine. Where does this end - should all companies that recieve public funds in exchange for goods and services be required to return the "benefit" and not ust the goods and services as paid for? There's a word for that you know...

You just don't get it do you.
Two legs bad, 4 legs better, except in reverse.

What a stupid response. A collection of misassumptions, a falsehood about covid transmissibility and the inevitable North Korea strawman.

If you remember, the government let a whole lot of perceived risky but necessary businesses carry on their trade right through Covid level 4. They refused to let non necessary, but perfectly safe businesses run. Because the government response to Covid was philosophy driven as much as health driven. Which reminds me, why were there practically zero Covid deaths caused by keeping these necessary businesses open, when the anecdotal evidence I have been given is that their Covid precautions were a silly joke, and impossible to implement?

I suspect a lot of the drastic lock-down actions have been more about enacting the much discussed "great reset" and less about health. I'm not suggesting COVID was created by this motivation, more that it was an opportunity to be leveraged. Bill gates and the like were salivating at the opportunity to introduce this great change for a "fairer"and more "sustainable" capitalism. Watch any of his recent interviews and you can see he's giddy about everything that's happening.

It's hilarious to me that we have Prince Charles lecturing us on this great reset and the need for a more equitable capitalism. His mum's face is on a good chunk of the world's money supply! Perhaps he can personally lead the charge by sacrificying some of his vast accomodations and fortune.

Or we could just stop PCR testing, open the borders, get back to normal, and the "pandemic" would be over tomorrow.

And watch the deaths start racking up in the new year. Charming.

What you're on about? do you think those essential workers such as rubbish collectors, front line student both med/nurses, nurses, lab workers being paid enough by govt. subsidy? - all have multiple rental places? if the economic can be tweaked at will to benefit a few (hardly any of those essential workers), so the argument start to make sense, to just let go open up the border, business as usual and see when the tweak is from that point. OR if our frontline healthcare workers, decided now nationwide to strike. Nothing that govt & RBNZ can do about it. But yea, the tickle effect is not yet there.

Pat - you're factually, scientifically, medically and just generally utterly wrong. Give it a rest.

Yes yes yes - the empirical data is wrong. Nobel laurates like Michael Levitt are wrong. Oxford Harvard & Stanford university professors are wrong. Respected NZ doctors are wrong. They guy who invented the PCR test is wrong. The former Chief Scientific Officer at Pfizer Mike Yeadon is wrong. The American CDC and WHO are wrong. I'm a scientist and I'm wrong too. I'm just so glad we've got the Herald and people like Wiles to tell us all what's right.

Can understand you fully FP, we're at front line healthcare workers even to the specialist level.. just basically felt the same too. Buying time, flattening the curve.. then to we're crushed the bugs.. all along the beauty of subsidy & bail out everywhere, our rental is up receiving bail out, but not our pay. We're ready with minimal preparation as compare to OZ, EU & USA.. but alas, just plain lucky due to strict border measure... no significant preparation dribbling into the DHBs... specially if we're talking about 'staffing issue' - it's just a matter of time now, and when it does. .we already over & out.

Pat - you're a consipiracy theorist. I would try and engage but it would be useless. Covid is real. The pandemic is real. Opening the borders will cause havoc in NZ right now. End of story.

Ad hominem. Opening the border would result in something akin to a slightly worse than usual flu season, that's what the empirical data from Europe shows. We could've mitigated the risk by opening during the summer months to be out of phase with the normal flu season. We could've instigated rules to protect the elderly for example by mandating that the sick not be allowed to return to retirement villages. High dose Vitamin D could be also provided to the vulnerable. These are pragmatic sensible measures that could've avoided the catastrophic economic damage caused by the isolationist measures that the government currently has in place.

You're having a laugh Pat.

.. looks like he's humiliating you with facts and reason to me.

hard to be humiliated by rubbish.

More "it's just the flu” nonsense. Opening the border would stuff the economy and lead to the unnecessay deaths of thousands of Kiwis. French Polynesia opened up to tourism at the end of July, now they have the 4th highest prevalence in the world, ICU is full, and the tourists don't come in any numbrs to make a difference.
There is no evidence Vit D supplementation makes any difference to covid mortality or hospitalisation, despite the fact that Vit D deficiency is associated with higher mortality for a number of illnesses including covid.

On the contrary, there is very compelling evidence. have a look for yourself https://c19vitamind.com/ (also look at ivermectin)

The first cohort study showing how vitamin d3 affects susceptibility to COVID 19 is complete. (SEE HERE). Results show that people who were vitamin d3 deficient (serum less than 20 ng/ml) were 1.77 times more likely to contract COVID19.

The first randomised double blind study showing how vitamin D3 affects people with COVID19 is complete (SEE HERE). This study is mind blowing! Vitamin D3 gave better results than anybody could have possibly imagined. The study is based on 76 patients in Spain admitted to hospital with COVID19. 50 patients were given a vitamin d3 prodrug at a high dose of 0.532 mg (21280 IU). Of the 50 patients given vitamin D only 1 required ICU admission, while of the remaining 26 patients NOT given vitamin D 13 required ICU admission!

It’s worth noting that Sweden has mandatory vitamin d3 fortification in butter, milk (3-5 ug/L) cooking oil (0.2 ug/g) etc. According to the literature an ideal target blood serum concentration is ~50 ng/mL which corresponds to an oral daily dosing of 4000 IU/day (or 100 ug/day).

What a load of socialist dribble.
Where does she think the money comes from to develop such a vaccine in record time? What about the value of the vaccine to stave off an even worse economic outcome.
The vaccine for the most part will be provided to the public for free.
The Gates foundation and others have provided billions of dollars of free vaccines to third world countries.

Where does she think the money comes from to develop such a vaccine in record time?

Public funding. Did you not read the article?

The vaccine for the most part will be provided to the public for free.

No, governments will use taxpayers money to buy the vaccines to distribute to their population.

The article is suggesting that there should be no profit involved in this payment, which is the case for the Oxford one - a non-profit vaccine sold at $3 per dose. Pfizer's vaccine is for-profit and costs $40 per dose.

What’s wrong with profit?

Maybe consider the behaviour.... governments aren’t paying for the vaccine, just for supply rights.
Not for profit like the Auckland council.... that brings real performance.

M

11
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The whole debacle has been a transparent re-write of the chicken little story. Hyper-sensationalism by rabid media has driven the meek into a flap of biblical proportions with largely irrelevant statistics based on cherry picked and distorted data with flat out ridiculous control methods touted by the excitable talking heads. The age old teachings that mankind is the centre of all things, that all else is ours to command must and shall bend to our will is completely swallowed by the fawning and faithful masses. But the truth is out there, some of it common knowledge. No, we do not have a medical solution for all conditions, many fatal, that may affect humans. Vaccines are like so many other medical interventions, they may or may not work for any individual. Mutations may render them impotent and eventually something will arise to which humans cannot respond well enough to protect ourselves, covid-19 just joins that list. I look forward to the honest studies of the vaccine roll out, clearly an opportunity for the medical science community to clearly show the real effects, beneficial or otherwise, of vaccination on a large population. NZ was lucky enough to be a low traffic cul-de-sac that shut the doors early, no great command decisions there, just had to disregard the bleating of those likely to make less profit. Managing the future re-opening will be the real test.

"Managing the future re-opening will be the real test". Easy to ride the tiger, especially when one is catapulted onto it's back. But the Dismount, that's a whole different story.....

My ex wife was into horses. I never managed to learn to ride, but I got to the point from practice where I could fall off with some skill and grace. Of course the early attempts were less than graceful, but they paved the way.

Did she nag?

I think the vaccines are remarkably cheap considering their value. For example $1000 a head would be $5 billion for NZ - a tiny fraction of what Covid has cost the government let alone the entire country. They could have easily charged that much.

I think they'll need the other $950 per head to get it into everyone.

Vaccine, vaccine, vaccine... how many smart peoples in this interest.co.nz asking about simple questions regarding this recent vaccine news? - how, many pregnant female that has been tested with this new/trial vaccine, in every gestational period? - is there any data out there yet? for the baby that born after mum receiving trial vaccine during pregnancy, immuno compromise patient and dozens more conditions, how about them? - is this going to be the death/banning of Antivaxx movement? - Enjoy, but watch out this December..

Pregnant women have not been tested and are not getting the vaccines yet. Pregnant women are rarely, if ever, given any vaccine for any disease. I imagine those who are pregnant at this time will simply have to remain careful until delivery.

Weighing up the small risk of being infected with covid and the miniscule risk of serious complications vs. the guaranteed "serious hangover" and furher unknown risks due to the rushed testing, I'll take my chances with COVID! Maybe in a couple of years i'll get the jab if all goes well.

I expect by then it will be all but mandatory, required for travel etc.

Take the vaccine if you have the opportunity and have no contraindication to having it.
It is not wise to risk an infection with an IFR of 0.7% and a hospitalisation rate of 10-20%. The last 2 deaths in NZ were in individuals uder the age of 60.
10-30% of covid survivors suffer long term health complications, although a lot is still unknown, and “naturally” acquired immunity may not prevent future infection.

Here's the rub. In order to start mass production early and compress the trials, companies had to pre-sell vaccines to governments willing to pay for them without a guaranteed outcome. The people of those nations who ultimately pay the price bought in on the proviso that they got the cure.

Don't overthink it..

Unfortunately, Interest co nz readers comments seem to be getting a lot more Trumpian since the election.
This is a pity. Lots more remarks by folk with anti-State anything , anti-tax, Jacinda hating and semi-conspiratorial doubters. Anything remotely welfare oriented is "socialist" just like Biden (not). Might be time to cease bothering on here, since v few people seem to be interested in rational critical thinking and its much easier to get a like by being dismissive or getting into personal interactions not in fact connected to the matter of an article.

I agree, there's lot of uninformed extremist drivel here. I’ve always valued your contributions but it might be reasonable for the owners of interest.co.nz to consider permanantly suspending all commentary now, most of it has no merit.

Hope some people will read the highlighted ref in the article to the BMJ which asked a lot of useful questions we should have answers to.

Yip & heaps of unanswered/bypassed queries, akh the peril of know too much (sigh).. wish we don't spend those years on this modern professional healthcare, less is better in this case.

Covid can be defeated by Ivermectin, we do not have to wait and have the expense of vaccines to open up the country.
Ivermectin is an anti-parasitic medicine and now has been proven to offer a highly potent real-world, anti-viral, and anti-inflammatory properties against SARS-CoV-2 and COVID-19.
https://www.youtube.com/watch?v=z5-S49EqCJ8
https://ivmmeta.com/
https://osf.io/wx3zn/

That second link is brilliant! Ivermectin looks interesting too. What an amazing world we're living in where we can be one click away from data like that.

Interest - you really need to stop these conspiracy hoax comments from people like Pat - it's dangerous allowing them. https://www.health.govt.nz/news-media/news-items/caution-about-laborator...

Your govt.nz reference is way out of date, the extensive references that FP commented upon conclude that Ivermectin is an effective treatment for COVID-19. The probability that an ineffective treatment generated results as positive as the 22 studies to date is estimated to be 1 in 4 million (p = 0.00000024). Early treatment is most successful, with an estimated reduction of 90% in the effect measured using a random effects meta-analysis, RR 0.10 [0.03-0.38].

Hi dcnbwz I see you joined interest 6 months ago and, I hope you're not too offended when I say this but, you seem to post a mixture of ad hominem, straw man arguments, and emotive virtue signaling. Now you're appealing to interest.co.nz to have my opinion silenced despite the fact that back up my arguments with high quality peer reviewed literature, and contextual debates with experts in the field.

I know COVID is an emotive subject. We all have loved ones and nobody wants them to die. What a lot of people, including me, worry about is that the direction NZ is taking will result in far more deaths due to economic depravation than COVID ever would've caused. There's mounting evidence that COVID isn't much worse that the flu for the vast majority, and is probably less dangerous than the flu for people under 70. There's value debate and having differing opinions, and that's why I like interest. I often learn a lot from the articles and from reading peoples posts. If you're rebutting an argument I've made then I certainly welcome that, but please do so in a meaningful way, with data and scientific papers. Cheers.

Emotive virtue signaling - what does that even mean? I certainly back science, medicine and fact. Opening the borders would cause untold economic damage at the moment. It has to happen at some point, but it can be managed in a way that is both sustainable economically and medically, based with strong science and backed with vaccination and tight border controls. When those factors align the time will be right.

What concerns me is the argument that covid is no more dangerous than the flu and that touting things like ivomectin, a parasite treatment, as a cure are being presented as fact, when that is clearly not the case.

A quick google, less than two seconds:
https://www.jhsph.edu/covid-19/articles/no-covid-19-is-not-the-flu.html
https://www.medpagetoday.com/infectiousdisease/covid19/86176

Long term it may be the case that covid becomes another cold or flu, with all that entails, but right now? It's deadly.

That's better quality debate thanks. Nobody is saying COVID is the flu, what we're saying, and what the CDC is saying! is that the infection fatality rate is ~0.02% for under 70 year olds, and that is less than the seasonal flu! Obviously for the elderly the situation is different. If you look at the euromomo website you see excess deaths in Europe stratified by age and country. You see a spike for COVID that isn't that much worse than the normal flu season. Yes it's worse but is the response in NZ proportional to that threat?. You mentioned New York which had a huge excess death, and that's true. A likely reason is that the governor of New York Anderew Cuomo mandated that sick elderly people be returned to rest homes. That was awful infection control, and we need to learn from that and do the opposite.

We know more that we did 6 months ago regarding treatments and preventative measures. Medicines like Vitamin D3, Zinc, and Ivermectin are relatively inexpensive and are the leading treatments according to the latest scientific research. The second link Peri posted contains almost real-time updated trials meta analyses with p-values to measure statistical significance. That's not quack stuff.

When you add it all up, the low IFR, the treatments available, the infection control that we could instigate, then the logical person concludes that there's no reason why we should have quarantine hotels and travel restrictions, and certainly not over summer. This thing is not Ebola! The "cure" that the government is applying is orders of magnitude worse than the disease. What about the unintended consequences of what the government is doing. If enough airlines go out of business then that could raise the price of air travel and cripple tourism in NZ for the next decade.

The public interest would be to save the taxpayers as much payment of old people's pensions as possible. The private profit motive is to keep these old sick people alive as long as possible!

This was writen in 2014.. 19th December.... Nothing has changed except the Date.

I shall repeat...for all to see.

by Alter Ego | 19th Dec 14, 8:30am

These Aussie banks can use all their dividends and invest in the heaviest element mining, known to man. It is an Aussie trait we have to invest in, after ALL.,

-----------
Heaviest Element yet Known to Science: (Gv)

Lawrence Livermore Laboratories has discovered the heaviest element yet known to science. The new element, Governmentium (Gv), has one neutron, 25 assistant neutrons, 88 deputy neutrons, and 198 assistant deputy neutrons, giving it an atomic mass of 312.

These 312 particles are held together by forces called morons, which are surrounded by vast quantities of lepton-like particles called peons.

Since Governmentium has no electrons, it is inert; however, it can be detected, because it impedes every reaction with which it comes into contact. A tiny amount of Governmentium can cause a reaction that would normally take less than a second, to take from 4 days to 4 years to complete.

Governmentium has a normal half-life of 2- 6 years. It does not decay, but instead undergoes a reorganization in which a portion of the assistant neutrons and deputy neutrons exchange places.

In fact, Governmentium's mass will actually increase over time, since each reorganization will cause more morons to become neutrons, forming isodopes.

This characteristic of morons promotion leads some scientists to believe that Governmentium is formed whenever morons reach a critical concentration. This hypothetical quantity is referred to as critical morass.

When catalyzed with money, Governmentium becomes Administratium, an element that radiates just as much energy as Governmentium since it has half as many peons but twice as many morons.

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The last Friday before Christma, we really need to inject a little humour into our lives. Because....Banking and Govt are leeches on mans productivity. And getting more like blood suckers everyday. Christmas is not all about Houses and Investment in trivial presents., to keep the parasites in play, truth be told. But it is the time, when the businesses and banks rub their hands and are hopefully in the black to pay the bills on the vast overheads we have built into our over commercialised lives. First the funnies, then the reality. We are forever in their debt.
Plus taxes, naturally.
Have A Merry Christmas. Keep spending.
Santa.

That's brilliant, my fav is "critical morass" Neutrons held together by morons. lol I wonder what the toxicity of this element is? We need more laughter these days.