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Rula Khalaf, editor of the Financial Times, picks her favorite stories in this weekly newsletter.
The writer is a contributing editor for the FT and writes the Chartbook newsletter
In a world of multiple crises, where intersecting problems exacerbate each other and where there are few easy gains, it is crucial that we recognize truly clear policy options. Vaccines are one such investment. Since the 1960s, global vaccination campaigns have eradicated smallpox, suppressed polio, and contained measles. Modest public health spending has saved tens of millions of lives, reduced disease rates, and allowed children around the world to develop into adults capable of living healthy, productive lives.
After years of development, 2023 will see the approval of a second vaccine against malaria, a scourge that causes more than 600,000 deaths annually. A recent study on a vaccine for Streptococcus A, the pathogen that causes 600,000 deaths and 600 million cases of pharyngitis annually, estimates that an investment of less than $60 billion would yield benefits exceeding $1.6 trillion.
Even more impressive is the success achieved against coronavirus disease 2019 (COVID-19), with fully approved vaccines deployed in less than one year. Although we have failed to provide it to many of the world's poorest people, it has saved the lives of at least 14 million people. The restart of the global economy has generated trillions in additional output.
The ability to deploy a vaccine in the middle of a pandemic opened a new chapter in medical history. At a summit hosted by the UK government and the Coalition for Epidemic Preparedness Innovations (Cepi) in March 2022, a new goal of having safe and effective vaccines ready within just 100 days of the next outbreak was announced.
This will take some work. Covid vaccines could be developed so quickly thanks to years of research on the Mers and SARS viruses. To prepare for the next attack, we must compile inventories of potentially dangerous strains and tighten global surveillance. We can try to predict which pathogens are most likely to cause an animal mutation. Above all, we can start working now in the early stages of developing vaccines for serious diseases we already know about.
Of course, this will cost money. But compared to other major investments, scientific discoveries come cheap. Advancing at least one vaccine against the 11 pandemic infectious diseases into Phase 2 trials would cost less than $8.5 billion. In her book Disease X, science writer Kate Kelland estimates that $50 billion would cover the cost of creating a comprehensive vaccine library.
It is unrealistic to expect funding to come from the private sector. The work is expensive, high-risk, and the returns are uncertain. Philanthropy and public-private partnerships may succeed. But ultimately it is governments that must foot the bill. Unfortunately, in public policy, pandemic preparedness is too often relegated to cash-starved development agency budgets or squeezed into strained health budgets. Where this spending properly belongs is under the banner of industrial policy and national security.
Biotechnology is one of the most promising areas for future economic growth, combining research, high-tech manufacturing and service sector work. As the International Monetary Fund has declared: “Vaccine policy is economic policy.” Preparedness to confront epidemics belongs to national security because there is no more serious threat to the population. A far greater proportion of the UK died from Covid between 2020 and 2023 (225,000 out of 67 million) than German bombs killed in World War II (70,000 out of 50 million).
The annual defense budget of just one of the largest European countries would be sufficient to cover the costs of a comprehensive global pandemic preparedness programme. The money spent on just one of the UK's vaunted aircraft carriers was enough to make the world safe against the dreaded Ebola and Marburg viruses.
Not only is the cost-benefit ratio unbeatable, but failure to make this spending means disaster. In any given year, the risk of a Covid-level global pandemic with 20 million excess deaths is thought to be around 2 per cent. We will be lucky if we avoid another major pandemic in the coming decades. What's more, due to population growth and urbanization, the risk of zoonotic mutations is steadily increasing. Climate change exacerbates this effect.
There is now a consensus that we must engage in trillions of investments to mitigate and adapt to climate change, transforming our energy infrastructure and way of life. But for most countries, you have to go further in climate scenarios to generate an event as severe in terms of loss of life and economic cost as Covid. Measured by the cost of lives saved, vaccines are much cheaper, more direct and more effective than climate policy.
This is not to play global public health against climate policy. We can't choose our challenges. But what we can do is reduce the overburden, which in 2020 threatened to overwhelm the decision-making capacity of our societies and our political processes. As Kelland points out: “…while pandemics are inevitable, pandemics are a choice.” If we fail to invest the modest sums needed to give us a fighting chance against major life-threatening diseases, it will not be fate that drives us into chaos, but expediency. Narrow subjectivism and collective myopia.
