How testing market fails during a pandemic

What Caused the COVID-19 Testing Deficit?

The evidence of market failure during this pandemic is everywhere. Shortages, excessive prices, unavailable capacity...It is a clear example of mismatch between demand and supply. The question is, Can we do it otherwise?. In this article there are some hints for resource allocation for testing activities.

Globally, the development of diagnostics has long been left to markets, many of which are highly specialized. But while there are diagnostics markets for major infectious and non-infectious diseases, and even neglected tropical diseases, there is none for pandemic diseases.
Governments can of course counteract market deficiencies, but the commonly used mechanisms still require a trace level of demand, which does not exist for pandemic-disease diagnostics until the brink of an outbreak. And national governments, subject as they are to political and ideological constraints, cannot be relied upon always to create markets with the same swiftness demonstrated by South Korea. Reactive market creation is therefore not the way forward.
Instead, national governments should support the creation of a global coordinating platform for pandemic preparedness. Such a platform can take the lead in raising and pooling capital to channel toward rapid development, production, and distribution of diagnostics for pandemic diseases.
The blueprint for such a platform already exists. The Coalition for Epidemic Preparedness Innovations (CEPI) is a coordinating mechanism focused on advancing vaccine development and facilitating clinical validation, mass-scale manufacturing, and stockpiling. By reducing uncertainty and minimizing disruptions, CEPI makes vaccine markets more secure, accessible, and dynamic.
CEPI relies on both traditional financing (large grants from governments and foundations) and innovative financing (the returns from instruments like the International Finance Facility for Immunization, or IFFIm). In the event of an outbreak, CEPI uses instruments like Advanced Market Commitments (AMCs) or volume guarantees – which can be structured through mechanisms like the Global Health Investment Fund and InnovFin, or as conditional pledges to IFFIm and Gavi, the Vaccine Alliance – to enable it to scale up production quickly.
This blueprint can easily be replicated for diagnostics. All that is needed is a specialized entity – an institution or initiative that couples research and development with market access. 

Health vs. wealth in a pandemic

HEALTH VS. WEALTH? PUBLIC HEALTH POLICIES AND THE ECONOMY DURING
COVID-19

A NBER paper says:

A pandemic can impact an economy in many ways: reductions in people’s willingness
to work, dislocations in consumption patterns and lower consumption, added stress on the financial system, and greater uncertainty leading to lower investment. These are
respectively referred to as (labor) supply shocks, demand shocks, financial shocks and
uncertainty shocks. Connected economies and epidemiological communities also move in synch. Even a healthy economy, or an economy that has not mandated a shutdown, may feel the impact of external events. With the exception of the 1918 influenza, recent
pandemics have neither had as large of a global impact, nor has there been as much real
time data available to empirically assess the economic and public health impact of NPIs.
We study outcomes during the Covid-19 pandemic.
We have three main results. First, our analysis shows NPIs may have been effective
in slowing the growth rate of confirmed cases of Covid-19 but not in decreasing the growth rate of cumulative mortality. Second, we find evidence of spillovers. NPIs may have impacts on other jurisdictions. Finally, there is little evidence that NPIs are associated with larger declines in local economic activity than in places without NPIs.

Against patents for the current pandemic

Patents vs. the Pandemic

Imagine a world in which a global network of medical professionals monitored for emerging strains of a contagious virus, periodically updated an established formula for vaccinating against it, and then made that information available to companies and countries around the world. Moreover, imagine if this work were done without any intellectual-property (IP) considerations, and without pharmaceutical monopolies exploiting a desperate public to maximize their profits.
This may sound like a utopian fantasy, but it is actually a description of how the flu vaccine has been produced for the past 50 years. Through the World Health Organization’s Global Influenza Surveillance and Response System, experts from around the world convene twice a year to analyze and discuss the latest data on emerging flu strains, and to decide which strains should be included in each year’s vaccine.

This is exactly what Nobel prize David Stiglitz says in his op-ed in Project Syndicate. Absolutely agree.

For too long, we have bought into the myth that today’s IP regime is necessary. The proven success of GISRS and other applications of “open science” shows that it is not. With the COVID-19 death toll rising, we should question the wisdom and morality of a system that silently condemns millions of human beings to suffering and death every year.
It’s time for a new approach. Academics and policymakers have already come forward with many promising proposals for generating socially useful – rather than merely profitable – pharmaceutical innovation. There has never been a better time to start putting these ideas into practice.

Hopper

Austerity is not for nowadays

Austerity When It Works and When It Doesn’t

If somebody want to know what happens with austerity policies, then this is the book to read.

The term “austerity” indicates a policy of sizeable reduction of government
deficits and stabilization of government debt achieved by means
of spending cuts or tax increases, or both. This book examines the costs
of austerity in terms of lost output, what types of austerity policies can
achieve the stated goals at the lowest costs, and the electoral effects for
governments implementing these policies.
Why Austerity?
If governments followed adequate fiscal policies most of the time, we
would almost never need austerity. Economic theory and good practice
suggest that a government should run deficits during recessions—when
tax revenues are low and government spending is high as a result of
the working of fiscal stabilizers such as unemployment subsidies—and
during periods of temporarily high spending needs, say because of a natural
calamity or a war.

PS. Alberto Alessina passed away recently.

Surveillance, censorship and manipulation (using covid as excuse)

The Information Trade. How Big Tech Conquers Countries, Challenges Our Rights, and Transforms Our World

What does google know about you?. Right now they have developed a new API with Apple to control citizen location and contacts. This is the perfect tool for the end of privacy with the excuse of a pandemic.

In a recent book, all these strategies are clearly explained, specially how they defeat the democracy.

WE’RE IN A WORLD STILL DOMINATED BY NATION-STATES, BUT INCREASINGLY influenced by the actions of net states. Nation-states continue to own the physical territories within their borders, but net states wield significant power both within and across country space, guiding events that affect us both on an individual and on a global level. Therefore, we need to get smart about what net state power really looks like, and quick.
One country that’s excelling in its efforts to do so is Denmark. In 2017, it opened a door that has the potential to radically alter our existing geopolitical order: it appointed a new ambassador to capital-T Tech itself. Ambassador Casper Klynge is the world’s first-ever tech ambassador. His mandate: to establish diplomatic relations between Copenhagen and Tech. And what exactly that looks like is all fresh territory, yet to be discovered. Fittingly, his office operates as a virtual embassy, with three physical manifestations: one in his home base of Copenhagen and two in the most powerful tech hubs on Earth—Silicon Valley, California, and Beijing, China.

And the film, The creepy line, adds more concern on the same issue.

The role of testing while waiting for a cure and a vaccine

Testing for COVID-19: A way to lift confinement restrictions

HORIZONTE COVID-19: CLAVES PARA LA REINCORPORACIÓN AL TRABAJO

Vaccines for all

How to Develop a COVID-19 Vaccine for All

Messages from Mazzucato and Torreele:

The first, critical step is to adopt a mission-oriented approach that focuses both public and private investments on achieving a clearly defined common goal: developing an effective COVID-19 vaccine(s) that can be produced at global scale rapidly and made universally available for free. Realizing this aim will require firm rules regarding intellectual property (IP), pricing, and manufacturing, designed and enforced in ways that value international collaboration and solidarity, rather than competition between countries.

Second, to maximize the impact on public health, the innovation ecosystem must be steered to use collective intelligence to accelerate advances. Science and medical innovation thrives and progresses when researchers exchange and share knowledge openly, enabling them to build upon one another’s successes and failures in real time.

Third, countries must take the lead in building and buttressing manufacturingcapabilities, particularly in the developing world. While an effective COVID-19 vaccine probably will not be available for another 12-18 months, a concerted effort is needed now to put in place the public and private capacity and infrastructure needed to produce rapidly the billions of doses that will be required.

Because we don’t know yet which vaccine will prove most effective, we may need to invest in a range of assets and technologies. This poses a technological and financial risk that can be overcome only with the help of entrepreneurial states backed by collective, public-interest-driven financing, such as from national and regional development banks, the World Bank, and philanthropic foundations.

Finally, conditions for ensuring global, equitable, and affordable access must be built into any vaccine-development program from the start. This would allow public investments to be structured less like a handout or simple market-fixer, and more like a proactive market-shaper, driven by public objectives.

PS. Masks, tests, treatments, vaccines – why we need a global approach to fighting Covid-19 now
Bill Gates dixit:

 I’m a big believer in capitalism – but some markets simply don’t function properly in a pandemic, and the market for lifesaving supplies is an obvious example. The private sector has an important role to play, but if our strategy for fighting Covid-19 devolves into a bidding war among countries, this disease will kill many more people than it has to.

Edward Hopper. Cape Cod Morning, 1950. Smithsonian American Art Museum

What we're up against

Biography of Resistance
The Epic Battle Between People and Pathogens

Great book for nowadays.

Antimicrobial resistance does have a future, one that is going to affect the way we get to live and die. The potential doomsday scenario of tens of millions dead annually is real, but so are the hopeful developments of the last few years. On the technical side, there is promise in vaccines and phage therapies. On the economic front, ideas are being proposed that incentivize pharmaceutical companies to commit themselves to research and development.3 There is a new sense of urgency within the WHO to improve surveillance and empower all countries, rich and poor, large and small. 

 Bacteria will continue to do what they have done since the dawn of life—evolve, adapt, and get ready for the next battle for survival. Our actions are helping them acquire a better arsenal at a faster rate than they probably would have on their own. But despite the challenges and frustrations, in the hundreds of interviews that I conducted for this book, there was a sense of optimism about the future. That optimism stems from a belief in human ingenuity, the vast reserves of natural treasures that are untapped, and the power of coming together. That optimism is also predicated on two things: a commitment to peace, and a desire to care for all people—everywhere.

This is the index:

 Chapter 1: What We’re Up Against
Chapter 2: Fifty Million Dead
Chapter 3: Time and Space
Chapter 4: Friends in Far Places
Chapter 5: Near the Seed Vault
Chapter 6: Keys to Karachi
Chapter 7: War and Peace
Chapter 8: From the Phages of History
Chapter 9: Sulfa and the War
Chapter 10: Mold Juice
Chapter 11: Tablets from Tears
Chapter 12: The New Pandemic
Chapter 13: The Man in the Blue Mustang
Chapter 14: Honeymoon
Chapter 15: Mating Bacteria
Chapter 16: S Is for Soviet
Chapter 17: The Navy Boys
Chapter 18: From Animals to Humans
Chapter 19: The Norwegian Salmon
Chapter 20: Closer to Sydney Than to Perth
Chapter 21: A Classless Problem
Chapter 22: The Stubborn Wounds of War
Chapter 23: Counting the Dead
Chapter 24: Clues in the Sewage
Chapter 25: X Is for Extensive
Chapter 26: Too Much or Too Little?
Chapter 27: Visa Not Required
Chapter 28: The Dry Pipeline
Chapter 29: New Ways to Do Old Business
Chapter 30: A Three-Hundred-Year-Old Idea
Chapter 31: Spoonful of Sugar
Chapter 32: Conflict Inside the Cells
Chapter 33: Security or Service?
Chapter 34: One World, One Health
Chapter 35: Bankers, Doctors, and Diplomats
Epilogue

Behavioral response to the virus

Using Behavioural Science to Help Fight the Coronavirus

Main topics of the paper:

(1) Evidence on handwashing shows that education and information are not enough. Placing hand sanitisers and colourful signage in central locations (e.g. directly beyond doors, canteen entrances, the middle of entrance halls and lift lobbies) increases use substantially. All organisations and public buildings could adopt this cheap and effective practice.

(2) By contrast, we lack direct evidence on reducing face touching. Articulating new norms of acceptable behaviour (as for sneezing and coughing) and keeping tissues within arm’s reach could help.

(3) Isolation is likely to cause some distress and mental health problems, requiring additional services. Preparedness, through activating social networks, making concrete isolation plans, and becoming familiar with the process, helps. These supports are
important, as some people may try to avoid necessary isolation.

(4) Public-spirited behaviour is most likely when there is clear and frequent communication, strong group identity, and social disapproval for those who don’t comply. This has implications for language, leadership and day-to-day social interaction.

(5) Authorities often overestimate the risk of panic, but undesirable behaviours to watch out for are panic buying of key supplies. Communicating the social unacceptability of both could be part of a collective strategy.  

(6) Evidence links crisis communication to behaviour change. As well as speed, honesty and credibility, effective communication involves empathy and promoting useful individual actions and decisions. Using multiple platforms and tailoring message to
subgroups are beneficial too.

(7) Risk perceptions are easily biased. Highlighting single cases or using emotive language will increase bias. Risk is probably best communicated through numbers, with ranges to describe uncertainty, emphasizing that numbers in the middle are more likely. Stating a maximum, e.g. “up to X thousand”, will bias public perception. 

Pandemic socialism

Pandemic Socialism

Great article

By introducing a uniquely disruptive shock to both supply and demand, the COVID-19 pandemic has upended longstanding ideological debates almost overnight. Suddenly, far-reaching state intervention in the economy has become necessary to save market capitalism, which is unlikely to emerge unchanged.

You may agree or not. But it is a fact.

CRISPR Diagnostics (for COVID-19)

CRISPR–Cas12-based detection of SARS-CoV-2

Applied technologies for detection of COVID are basically PCR molecular assays and immunoassays. However, CRISPR developments are entering into diagnostics and you may find the first example in Nature.

We report development of a rapid (<40 accurate="" and="" as12-based="" assay="" br="" crispr="" detection="" easy-to-implement="" extracts.="" flow="" for="" from="" lateral="" min="" of="" respiratory="" rna="" sars-cov-2="" swab="">We validated our method using contrived reference samples and clinical samples from patients in the United States, including 36 patients with COVID-19 infection and 42 patients with other viral respiratory infections. Our CRISPR-based DETECTR assay provides a visual and faster alternative to the US Centers for Disease Control and Prevention SARS-CoV-2 real-time RT–PCR assay, with 95% positive predictive agreement and 100% negative predictive agreement.

The role of CRISPR in diagnostics tests is going to increase.

Daido Moriyama 

Back to work

NATIONAL COVID-19 TESTING ACTION PLAN

Some papers:
Rockefeller Foundation has issued a document of interest about testing and going back to work.
AEI document here.
Center for American Progress document here.
Duke University here.
Harvard University here.
Johns Hopkins University here.

How coronavirus affects the body

From FT The medical mysteries of coronavirus

A known unknown

Coronavirus and the Limits of Economics
Why standard economic theories have no answers for this kind of crisis

You'll find an interesting article in FP

Economists have long made the distinction between uncertainty and risk. Uncertainty is typically understood as involving outcomes that cannot straightforwardly be assigned a probability, unlike risk. Economics offers limited resources to understand how to make decisions in the presence of fundamental uncertainty. But a still deeper form of uncertainty is one in which the possible outcomes cannot easily be anticipated at all. Such a wildly unpredictable outcome has come to be popularly known in recent years as a black swan event.

 The coronavirus pandemic might at first appear to have been such a black swan event, but that claim does not withstand scrutiny: The possibility of such a threat was long recognized by experts. This recognition led to scenarios being discussed at the highest levels of governments. The possibility of a pandemic was therefore a “known unknown” rather than an “unknown unknown.”

Consider that an economy cannot be separated from society: It is socially embedded. The notion that the economy can be analyzed independently of the public health, political, or social processes—often promoted by the dominant tradition in economics and reflected in general equilibrium theory—is shown by the pandemic to be not merely fragile but false.

PS D Rumsfeld stated:

Reports that say that something hasn't happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don't know we don't know. And if one looks throughout the history of our country and other free countries, it is the latter category that tend to be the difficult ones.

Galeria Marlborough