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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
The writer is an FT contributing editor and writes the Chartbook newsletter
In a world of polycrisis, in which intersecting problems compound each other and there are few easy wins, it is all the more important to recognise those policy choices that are truly obvious. Vaccines are one such investment. Since the 1960s, global vaccination campaigns have eradicated smallpox, suppressed polio and contained measles. Modest expenditures on public health have saved tens of millions of lives, reduced morbidity and allowed children around the world to develop into adults capable of living healthy and productive lives.
After years of development, 2023 saw the approval of a second vaccine for malaria, a scourge which causes more than 600,000 deaths annually. A recent study on a vaccine for Strep A, a pathogen that causes 600,000 deaths and 600mn cases of pharyngitis annually, calculates that an investment of less than $60bn would deliver benefits in excess of $1.6tn.
Even more spectacular is the success that was achieved against Covid-19, with fully certified vaccines deployed within less than one year. Even though we failed to provide them to many of the world’s poorest people, they saved at least 14mn lives. Restarting the world’s economy generated trillions in additional output.
Being able to deploy a vaccine mid-pandemic opened a new chapter in medical history. At a summit co-hosted by the UK government and the Coalition for Epidemic Preparedness Innovations (Cepi) in March 2022, a new goal was announced of having safe and effective vaccines ready within just 100 days of the next epidemic outbreak.
That will take some doing. Covid vaccines could be developed so quickly because of years of research on the Mers and Sars viruses. To prepare for the next onslaught we must compile inventories of potentially dangerous strains and tighten global surveillance. We can try to predict which pathogens are most likely to provoke zoonotic mutation. Above all, we can start work now on the early stages of vaccine development for the dangerous diseases we already know.
Of course, this will cost money. But compared with other major investments, scientific breakthroughs come cheap. To push at least one vaccine against the 11 epidemic infectious diseases to phase 2 trials has been costed at less than $8.5bn. In her book Disease X, the science writer Kate Kelland estimates that $50bn would pay for a comprehensive vaccine library.
To expect that funding to come from the private sector is unrealistic. The work is too expensive and high risk and the returns too uncertain. Philanthropy and public-private partnerships may work. But ultimately it is governments that should foot the bill. Unfortunately, in public policy, pandemic preparedness is all too often relegated to the cash-starved budgets of development agencies or squeezed into strained health budgets. Where such spending properly belongs is under the flag of industrial policy and national security.
Biotech is one of the most promising areas of future economic growth, combining research, high-tech manufacturing and service sector work. As the IMF declared: “vaccine policy is economic policy.” And pandemic preparedness belongs under national security because there is no more serious threat to a population. A far larger percentage of the UK died of Covid between 2020 and 2023 (225,000 out of 67mn) than were killed by German bombs in the second world war (70,000 out of 50mn).
The annual defence budget of just one of the larger European countries would suffice to pay for a comprehensive global pandemic preparedness programme. The money lavished on just one of the UK’s vainglorious aircraft carriers was enough to have made the world safe against both the ghastly Ebola and Marburg viruses.
Not only is the cost-benefit ratio unbeatable, but not to undertake this spending is to court disaster. In any given year, the risk of a Covid-level global pandemic with 20mn excess deaths is thought to be about 2 per cent. We will be lucky if we avoid another major pandemic in the coming decades. All the more so, because due to population growth and urbanisation, the risk of zoonotic mutation is steadily increasing. Climate change is compounding that effect.
There is now a consensus that we must engage in investments running into the trillions to mitigate and adapt to climate change, transforming our energy infrastructure and our way of life. But for most countries you have to go very far out in the climate scenarios to generate an event as severe in terms of loss of life and economic cost as Covid. Measured by cost of a life saved, vaccines are far cheaper, more direct and fast acting than climate policy.
This is not to play off global public health against climate policy. We cannot pick our challenges. But what we can do is to reduce the overload, which in 2020 threatened to overwhelm the decision-making capacity of our societies and our political processes. As Kelland remarks: “ . . . while epidemics are inevitable, pandemics are a choice”. If we fail to invest the modest amounts necessary to give us a fighting chance against major life-threatening diseases, it is not fate that consigns us to chaos, but narrow self-interest and collective short-sightedness.
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