Editor's Note: Below is a brief excerpt from a complimentary Health Policy Unplugged note written by our Health Policy analyst Emily Evans. Click HERE to learn more about Emily's research process and the analysis subscribers receive.
One thing we do know is that plagues, now known as pandemics which does sound a bit less biblical, is that the most consistently reported impact through time is labor disruption and, with it, supply constraints.
Whether labor disruptions are due to mortality, as was the case when 20-30% of Europe succumbed to the Bubonic Plague, or during and after the Spanish Flu when wartime production needs compounded high death rates especially among young men, the status quo in productive activities is rarely restored afterwards.
The U.S. scientific establishment's emphasis on COVID-19 vaccines to the short and intermediate detriment of preventive and therapeutic responses was a departure from historical practice.
At least since the advent of modern medicine, therapies have usually advanced ahead of vaccines. Of course, for decades the hope for vaccines was always far into the future and waiting for them was considered foolhardy.
More recently, however, even as the prospect of an HIV/AIDS vaccine remains viable (today more than ever), the therapies and prophylactics like Anti-virals and PrePA have gone a long way to bring the disease under control.
With COVID-19, many therapies were rightly dismissed as nutty, like Hydroxychloroquine. Others, with a mixed but still promising record like GILD's Remdesivir were excused by the WHO and others (something that may be corrected if their new data holds up.) REGN's mAb therapy has, as recently as late August, been described as experimental by Kaiser Health News, among others. Technically accurate as mAb is being marketed under an EUA but generally misleading since that is the same authority under which vaccines were initially marketed.
With little ramp in production of therapies - which may change soon with the White House's announcement of a new order of REGN's mAb - those parts of the world that cannot or won't access the vaccine are left without much in the way of alternatives.
Four or five decades ago before the advent of globalization, inoculating the world may have been desirable but it would not have been quite the economic imperative it is today.
Of the 54 Lower Middle Income countries, as classified by international organizations like WHO, two, India and Vietnam, are in the top 15 countries importing to the U.S. critical materials like pharmaceuticals and protective equipment.
That ranking underestimates their role in U.S. economic activity as exports from, certainly India, and probably Vietnam, can make intermediate stops in a high income country like Ireland and do not appear in the Census Bureau's trade data.
Despite a clear economic interest in keeping the people of India and Vietnam healthy so that predictable labor disruptions can be limited, there appears to be little interest in doing so.
According to the most recent COVAX data about 28% of the people in Vietnam and 43% of the people of India have received their first course. For the second course, the gap is wide; 6% in Vietnam and 14% in India.
The U.S. and the European Union created a take force to address vaccination rates and therapies but just got around this week to finalizing their mission even though vaccines have been shipped since earlier in the year.
Maybe things will be different this time; the labor supply in the manufacturing countries of the world will just snap back into place and supply chains will be restored in quick order. Seems like history argues for a different outcome.