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The World Trade Organization (WTO) Director General (DG) is holding a "Third Way" COVID-19 vaccine confab in Geneva on April 14th that at best is a distraction from an effective initiative that falls squarely within the WTO's actual remit.
The World Trade Organization (WTO) Director General (DG) is holding a "Third Way" COVID-19 vaccine confab in Geneva on April 14th that at best is a distraction from an effective initiative that falls squarely within the WTO's actual remit. That would be a temporary COVID-19 waiver of patent, copyright, industrial design and undisclosed information terms of the WTO Trade Related Aspects of Intellectual Property (TRIPS) agreement, to the extent they hinder the "prevention, treatment and control" of the COVID-19 pandemic.
By design, what the WTO DG has dubbed the "Third Way" is unlikely to help bolster COVID-19 vaccine or treatment supplies because it leaves the same few pharmaceutical firms in total control of supply. Relying on contract manufacturing and voluntary licensing is the approach that has led to massive shortages with a few firms controlling if, where and when supply will be manufactured and can be sold or distributed and at what price. Horrifyingly, the world is not expected to reach herd immunity until 2024 under this regime.
The WTO DG has said that current annual global COVID vaccine production capacity is 3.5 billion doses. But between 10-16 billion are needed to reach herd immunity, assuming 70% of population vaccination levels and some vaccines being two-shot regimes. There is no option but to create significantly more production capacity, especially given the prospect that these will not be one-time shots but perhaps needed on an ongoing basis if, like flu vaccines, they must be repeated or if booster shots have to be given.
The role of the WTO and its DG should be to facilitate negotiations among WTO member nations to fix the problem that is caused by existing WTO rules on intellectual property. Many health and vaccine-specific agencies already have initiatives underway that have failed to coax vaccine originator firms to license or otherwise share their technology. And, not one firm has participated in the World Health Organization's voluntary COVID-19 Technology Access Pool (C-TAP). Various global and even national agencies are better suited than the WTO to play matchmaker between originators and prospective manufacturers.
But missed connections are not the issue: Until policies change so vaccine originating firms do not have total control over production, such as a WTO TRIPS waiver and related government actions to pressure for tech transfers, supplies of vaccines and treatments will remain short. Many qualified firms in developing nations have sought licenses or contract manufacturing deals. Instead of agreeing to boost global production, vaccine originators have used their IP monopolies to effectively block production to supply markets they consider unprofitable. Their focus is not on global access. Consider Pfizer's investor relations VP's recent announcement that the firm will shift production next year to boosters for sale to rich nations at higher prices.
Had the TRIPS waiver of some WTO Trade Related Aspects of Intellectual Property (TRIPS) been agreed when proposed last year, perhaps more than 27% of people in low- and middle- income countries (LMICs) would be projected to get vaccines in 2021. Instead, few will have access until 2022. Many will wait until 2024. The pandemic will rage largely unmitigated among more than three quarters of the world's population.
A temporary TRIPS waiver can make sure "trade" rules are not an obstacle to countries' efforts to protect their residents' health and crush the pandemic. Indeed, the agreement establishing the WTO does not provide authority for the DG to broker deals between private firms. This activity is simply outside of its mandate.
In contrast, negotiating waivers of the obligations contained in WTO agreements due to the development of exceptional circumstances is an explicitly authorized function of the organization. If the COVID-19 pandemic does not constitute such exceptional circumstances, it is unclear what would qualify as such.
Today more than 100 WTO members support the waiver and consider it critical to boost worldwide production of COVID vaccines, treatments and diagnostic tests. Many hoped that the arrival of new WTO DG, economist Ngozi Okonjo-Iweala, might move countries currently blocking the waiver. Because South Africa introduced it and the WTO Africa Group supports it unanimously, some WTO members and activists worldwide hoped that the first African WTO DG could help facilitate progress. However, Okonjo-Iweala did not endorse the waiver. Instead, she diverted attention away from it by suggesting a "third way" that is more of what has failed.
Namely, corporations determine where and how much vaccines and other drugs are produced through highly restrictive voluntary licenses and contract manufacturing arrangements, with the monopoly-holding firms deciding if, how much, where and under what terms chosen partners may produce. One example of what the WTO DG proposes is South African firm Aspen's contract manufacturing arrangement with Johnson & Johnson (J&J). According to South Africa's WTO Counselor, for many months 91% of doses produced in South Africa had to be sent for sale in Europe, while only 9% could be used in South Africa.
Many pharmaceutical industry interests oppose the waiver and have a litany of arguments intended to redirect attention away from the core problem of their monopoly control over supply. They claim developing country firms cannot make these vaccines, even as they make limited contracts for such firms to do so. They claim that IP barriers are not a real obstacle to greater production. If IP was not an obstacle, manufacturers all over the world would already have begun to organize more production to fill the chasm between supply and demand. Instead, there are a limited number of market-segmented contract manufacturing arrangements, as determined by developers who restrict access to the technology. Moderna declined to partner with a qualified Bangladeshi vaccine maker while other firms report never getting any response to their inquiries. Just in Africa, "Biovac and Aspen in South Africa, Institute Pasteur in Senegal, and Vacsera in Egypt could rapidly retool factories to make mRNA vaccines," notes a group of medicine-production experts in a recent Foreign Policy article. Indeed, while COVID-19 shone a spotlight on the mRNA platform, for two decades researchers around the world have attempted to harness it for vaccines and therapies. A former Moderna director of chemistry revealed that with enough technology transfer and knowhow-sharing, a modern factory should be able to get mRNA vaccine production online in three to four months. The result of the originators' unwillingness to partner is a huge gap between needed global supply and the production levels that vaccine developers deem useful for their business strategy, which is focused mostly on selling at higher prices to rich and upper-middle-income countries.
Failure to enact a waiver in the face of this unprecedented health and economic crisis could be the final blow that dooms the WTO. The existential and intensifying crisis that has wracked the WTO in recent years is in no small part a consequence of the organization getting involved in or being used to dealing with issues clearly outside of its mandate. And the WTO's increasing irrelevance is related to the body not succeeding in managing problems and concerns that are directly in its remit.
The "third way" approach would double down on the same mistakes. By not prioritizing the negotiation of waiver language agreeable to all WTO member countries and desperately needed to address THE priority concern of many, the organization will become more irrelevant, while also alienating 100-plus countries that support the TRIPS waiver. If the new DG pulls the WTO -- an organization devised to negotiate and administer rules -- into instead pretending to become an international deal broker, it will only amplify concerns about the WTO staff and structures overstepping the authorities provided by member countries.
The way forward at the WTO is clear. Existing WTO rules are obstacles to scaling up global production and thus facilitating more equitable distribution of affordable, safe and effective COVID-19 vaccines, treatments and tests. Eliminating these obstacles is not the final step to greater production, but the first, so there is no time to waste. The DG's priority should be to pave a quick path to countries engaging in text-based negotiations on a waiver. If some WTO member countries have specific concerns with the waiver that South Africa and India have proposed, then the way forward is to offer changes to that proposal. Facilitating negotiations among WTO members to fix a problem caused by existing WTO rules, by preparing a waiver text that can be approved by all at the WTO General Council, is precisely the role of the DG and the WTO.
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"They want to cut and privatize Social Security and take away our young people's futures," said Democratic Rep. Pramila Jayapal.
Former Vice President Mike Pence, a possible 2024 presidential candidate, has voiced support for a Social Security privatization scheme that the George W. Bush administration unsuccessfully pushed nearly two decades ago.
In a closed-door event Thursday hosted by the National Association of Wholesale-Distributors, a corporate trade group, Pence said he believes that "the day could come when we can replace the New Deal with a better deal, literally give younger Americans the ability to take a portion of their Social Security withholdings and put that into a private savings account that the government would oversee."
"I mean, a very simple fund that could generate 2% would give the average American twice what they're going to get back on their Social Security today. And it could save the government money doing it," Pence said, according to video footage obtained by the Democratic-aligned group American Bridge 21st Century.
\u201cMike Pence calls for privatizing Social Security for young people as a way to cut spending on public benefits. "We could replace the New Deal with a better deal," he told a conference of business executives.\u201d— More Perfect Union (@More Perfect Union) 1675466552
Experts have forcefully rejected the notion that private savings accounts of the kind Pence endorsed—which would allow workers to divert a portion of their payroll tax contributions into private investment accounts—would be more beneficial than Social Security's guaranteed benefits, as the former vice president suggested.
"The popular argument that Social Security privatization would provide higher returns for all current and future workers is misleading, because it ignores transition costs and differences across programs in the allocation of aggregate and household risk," Olivia Mitchell, John Geanakopolos, and Stephen Zeldes—economists sympathetic to the idea of privatization—wrote in a 2000 paper.
Experts have also said private accounts would not, as Pence put it, "save the government money."
In 2005, analysts with the Center on Budget and Policy Priorities (CBPP) estimated that a privatization plan put forth by former Sen. John Sununu (R-N.H.) and former Rep. Paul Ryan (R-Wis.) would "create $85.8 trillion in additional debt (equal to 93.7% of GDP) by 2050" while not boosting Social Security's long-term solvency—something Republicans claim they want to do.
"Creation of a system of private accounts would not change the amount of revenue coming into the federal government, but it would increase government spending, because the federal government would be making regular payments into the private accounts," the CBPP analysts explained. "These payments would represent new government spending. This increase in spending, unaccompanied by an increase in revenues, would widen annual deficits."
Despite the myriad drawbacks of private accounts as a partial or full-scale alternative to Social Security, Republicans have continued to promote them.
Last year, the Republican Study Committee—a panel that Pence chaired during the Bush administration—released a budget proposal that urged lawmakers to "consider legislative options that allow employers and employees to reduce their payroll tax liability and use those savings to invest in private retirement options."
Pence's remarks Thursday came as the White House and House Republicans are locked in a high-stakes standoff over the debt ceiling, which the GOP does not want to raise without also inflicting steep cuts to federal spending.
"Republicans keeping saying the quiet part out loud: They want to cut and privatize Social Security and take away our young people's futures," Rep. Pramila Jayapal (D-Wash.), chair of the Congressional Progressive Caucus, tweeted late Saturday. "Democrats will never let this happen."
"Doctors' sense of our complicity in putting profits over people has grown more difficult to ignore."
A U.S. physician took to the op-ed pages of The New York Times on Sunday to offer a scathing condemnation of the country's for-profit healthcare system and his profession's historical complicity in campaigns against universal coverage.
"Doctors have long diagnosed many of our sickest patients with 'demoralization syndrome,' a condition commonly associated with terminal illness that's characterized by a sense of helplessness and loss of purpose," wrote Eric Reinhart, a physician at Northwestern University. "American physicians are now increasingly suffering from a similar condition, except our demoralization is not a reaction to a medical condition, but rather to the diseased systems for which we work."
"The United States is the only large high-income nation that doesn't provide universal healthcare to its citizens," Reinhart continued. "Instead, it maintains a lucrative system of for-profit medicine. For decades, at least tens of thousands of preventable deaths have occurred each year because healthcare here is so expensive."
The coronavirus pandemic accelerated that trend and spotlighted the fatal dysfunction of the nation's healthcare system, which is dominated by a handful of massive corporations whose primary goal is profit, not the delivery of care.
According to one peer-reviewed study published last year in the Proceedings of the National Academy of Sciences, a universal single-payer healthcare system could have prevented more than 338,000 Covid-19 deaths in the U.S. from the beginning of the crisis through mid-March 2022.
"In the wake of this generational catastrophe, many healthcare workers have been left shaken," Reinhart wrote Sunday. "One report estimated that in 2021 alone, about 117,000 physicians left the workforce, while fewer than 40,000 joined it. This has worsened a chronic physician shortage, leaving many hospitals and clinics struggling. And the situation is set to get worse. One in five doctors says he or she plans to leave practice in the coming years."
"To try to explain this phenomenon, many people have leaned on a term from pop psychology for the consequences of overwork: burnout. Nearly two-thirds of physicians report they are experiencing its symptoms," he added.
But for Reinhart, the explanation lies more in "our dwindling faith in the systems for which we work" than in the "grueling conditions we practice under."
What has been identified as occupational burnout is a symptom of a deeper collapse. We are witnessing the slow death of American medical ideology.
It's revealing to look at the crisis among healthcare workers as at least in part a crisis of ideology—that is, a belief system made up of interlinking political, moral, and cultural narratives upon which we depend to make sense of our social world. Faith in the traditional stories American medicine has told about itself, stories that have long sustained what should have been an unsustainable system, is now dissolving.
During the pandemic, physicians have witnessed our hospitals nearly fall apart as a result of underinvestment in public health systems and uneven distribution of medical infrastructure. Long-ignored inequalities in the standard of care available to rich and poor Americans became front-page news as bodies were stacked in empty hospital rooms and makeshift morgues. Many healthcare workers have been traumatized by the futility of their attempts to stem recurrent waves of death, with nearly one-fifth of physicians reporting they knew a colleague who had considered, attempted, or died by suicide during the first year of the pandemic alone.
Although deaths from Covid have slowed, the disillusionment among health workers has only increased. Recent exposés have further laid bare the structural perversity of our institutions. For instance, according to an investigation in The New York Times, ostensibly nonprofit charity hospitals have illegally saddled poor patients with debt for receiving care to which they were entitled without cost and have exploited tax incentives meant to promote care for poor communities to turn large profits. Hospitals are deliberately understaffing themselves and undercutting patient care while sitting on billions of dollars in cash reserves.
Acknowledging that "little of this is new," Reinhart wrote that "doctors' sense of our complicity in putting profits over people has grown more difficult to ignore."
"From at least the 1930s through today, doctors have organized efforts to ward off the specter of 'socialized medicine,'" he wrote. "We have repeatedly defended health care as a business venture against the threat that it might become a public institution oriented around rights rather than revenue."
Confronting and beginning to solve the myriad crises of the U.S. healthcare system will "require uncomfortable reflection and bold action," Reinhart argued, and "any illusion that medicine and politics are, or should be, separate spheres has been crushed under the weight of over 1.1 million Americans killed by a pandemic that was in many ways a preventable disaster."
"Doctors can no longer be passive witnesses to these harms," he concluded. "We have a responsibility to use our collective power to insist on changes: for universal healthcare and paid sick leave but also investments in community health worker programs and essential housing and social welfare systems... Regardless of whether we act through unions or other means, the fact remains that until doctors join together to call for a fundamental reorganization of our medical system, our work won’t do what we promised it would do, nor will it prioritize the people we claim to prioritize."
Reinhart's op-ed came as the prospects for legislative action to transform the U.S. healthcare system appear as distant as ever, despite broad public support for a government guarantee of universal coverage.
With the for-profit status quo deeply entrenched—preserved by armies of industry lobbyists and members of Congress who do their bidding—the consequences are becoming increasingly dire, with tens of millions uninsured or underinsured and one health crisis away from financial ruin.
In a study released last month, the Commonwealth Fund found that "the U.S. has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates" among rich countries, even as it spends far more on healthcare than comparable nations both on a per-person basis and as a share of gross domestic product.
"Not only is the U.S. the only country we studied that does not have universal health coverage," the study added, "but its health system can seem designed to discourage people from using services."
China's Ministry of Foreign Affairs said the U.S. military's move, ordered by President Joe Biden, "seriously violates international convention."
"The Chinese side clearly requested that the U.S. appropriately deal with this in a calm, professional, and restrained manner," the ministry said, again dismissing the Pentagon's claim that the high-altitude balloon was part of a surveillance operation aimed at monitoring sensitive military sites.
"For the United States to insist on using armed force is clearly an excessive reaction that seriously violates international convention," the ministry continued, invoking force majeure, which under international law refers to unforeseen circumstances that are beyond a state's control. China has claimed the balloon was a civilian weather research aircraft that was blown way off course by unexpected winds.
"China will resolutely defend the legitimate rights and interests of the enterprise involved, and retains the right to respond further," the ministry concluded.
War hawks in the Republican Party, including former President Donald Trump, predictably reacted with hysteria to the Pentagon's Thursday announcement that it detected the balloon over the state of Montana.
"President Biden should stop coddling and appeasing the Chinese communists. Bring the balloon down now and exploit its tech package, which could be an intelligence bonanza," said Sen. Tom Cotton (R-Ark.), one of the most vocal warmongers in Congress. "And President Biden and Secretary Austin need to answer if this was detected over Alaskan airspace. If so, why didn't we bring it down there? If not, why not? As usual, the Chinese Communists' provocations have been met with weakness and hand-wringing."
An unnamed Pentagon official said Saturday that this latest incident is one of several times a Chinese balloon has been detected in U.S. airspace in recent years. The other balloons were not shot down.
"[People's Republic of China] government surveillance balloons transited the continental United States briefly at least three times during the prior administration and once that we know of at the beginning of this administration, but never for this duration of time," the official said in a briefing with reporters.
Tensions between the U.S. and China have risen sharply in recent months, largely over Taiwan. The Biden administration recently announced that it is expanding the U.S. military's footprint in the Philippines, a move widely characterized as a message to China.
As The New York Timesreported Thursday, "A greater U.S. military presence in the Philippines would... make rapid American troop movement to the Taiwan Strait much easier. The archipelago of the Philippines lies in an arc south of Taiwan, and the bases there would be critical launch and resupply points in a war with China. The Philippines' northernmost island of Itbayat is less than 100 miles from Taiwan."
Rep. Michael McCaul (R-Texas) said late last month that the odds of a U.S. war with China within the next two years are "very high," echoing the assessment of the head of the Air Mobility Command.
Far from promoting diplomatic talks with China, Republicans in Congress appear bent on ratcheting up tensions further—and some Democrats are joining them. Last month, with overwhelming bipartisan support, House Republicans established the Select Committee on the Strategic Competition Between the United States and the Chinese Communist Party.
Upon her appointment to the panel on Thursday, Rep. Mikie Sherrill (D-N.J.) called the Chinese Communist Party "a threat to our democracy and way of life" and said the select committee represents the "best opportunity to accomplish real results for Americans and respond to China's aggression."
Rep. Mike Gallagher (R-Wis.), the chair of the select committee, has said the panel's goal is to help the U.S. "win this new Cold War" with China.
Nearly two dozen House progressives issued a statement last month opposing the formation of the committee, saying the U.S. "can and must work towards our economic and strategic competitiveness goals without 'a new Cold War' and without the repression, discrimination, hate, fear, degeneration of our political institutions, and violations of civil rights that such a 'Cold War' may entail."