The role of global governance in a pandemic

Challenges of Global Governance Amidst the COVID-19 Pandemic

COVID-19: Public Health Is a Question of National Security

Three critical points in a document of the Council of Foreign Relations:

Transparency and Knowledge Sharing
The primary flaw in the COVID-19 response has been the opacity in knowledge sharing. China is the first country to claim to have successfully flattened the curve. Research suggests that China’s nonpharmaceutical interventions, such as travel bans, social distancing, isolation, and contact tracing, wereeffective in containing the outbreak.

Strengthening Global Mechanisms
During health crises, the world looks to the primary global health agency, the World Health Organization (WHO), for guidance. Surprisingly, the WHO’s response to COVID-19 was lacking. Although the body had once warned that caution and vigilance were necessary against any future Sudden Acute Respiratory Syndrome (SARS)-like disease, it ignored this advice in late 2019 when managing the mysterious pneumonia in Wuhan, China. For months, it failed to recommend travel restrictions or bans.  

Capacity Building
COVID-19 has rendered some of the better health systems in the world inoperable. A country’s first line of defense is the capability of its health system to detect and control contagious diseases. Underinvestment in preparedness and reliance on treatment rather than a preemptive response has proven costly in terms of lives and dollarspportunity to tackle the pandemic was missed, raising questions about the WHO’s credibility. 

Juan Correa

How epidemic-macroeconomic models of pandemic create uncertainty

Dealing with Covid-19: understanding the policy choices

A model is as good as its assumptions!. This is obvious and the application requires good data. Both issues, assumptions and data are the reasons why many models doesn't fit in this pandemic. Bad assumptions and bad data give bad conclusions. Have a look at this paper and in p.5 you'll find the different health and economic impact of models under different assumptions. So different that require a clever explanation if somebody wants to use them to take a decision.

VSL-based and SIR-macro models have helped to inform policy decisions in the early stages of the Covid-19 pandemic. However, the existing models are subject to a number of caveats, particularly relating to the uncertainty of their underlying epidemiological projections and stylised economic foundations.

 Juan Genovés

Can capitalism be reimagined? (3)

The future of capitalism

Martin Wolf said that this book was one of his main references. And I agree, it contains many well structured messages. Specially, it links economics with politics, quite a difficult issue:

 Our political systems are democratic, but the details of their architecture have increasingly inclined them to polarization. Most of our voting systems favour the two largest parties. So, the menu of choice facing voters depends upon what these two parties offer. The key dangerous step has been that, in the name of greater democracy, in many countries the major political parties have empowered their members to elect their leaders. This has replaced a system in which the leader of a party was drawn from among its most experienced people, and often chosen by its elected representatives.

Leaders can promote new narratives, but the decline of trust in political leaders has inverted authority; people pay more attention to those at the hub of their social networks than to the talking heads on the television. The networks, however, have become self-contained echo-chambers and so we even lack the common space in which to communicate. This is enormously damaging because participation in a common network constitutes the common knowledge that we all hear the same narratives.

 Reduced to a sentence, shared identity becomes the foundation for far-sighted reciprocity. Societies that succeed in building such belief systems work better than those based on either individualism or any of the revivalist ideologies. Individualist societies forfeit the vast potential of public goods. The revivalist ideologies are each based on hatred of some other part of society and are culs-de-sac to conflict. In a healthy society, those who become successful have been reared into acceptance of that web of reciprocal obligations.

 In contrast to the Utilitarian vision of autonomous individuals, each generating utility from their own consumption, and counting equally in the great moral arithmetic of total utility, the atoms of a real society are relationships. In contrast to the psychopathic selfishness of economic man restrained by the Platonic guardians of social paternalism, normal people recognize that relationships bring obligations, and that meeting them is central to our sense of purpose in life. The toxic combination of Platonic Guardians and economic man that has dominated public policy has inexorably stripped people of moral responsibility, shifting obligations to the paternalist state. In a bizarre parody of medieval religion, ordinary people are cast as sinners who need to be ruled by exceptional people – the moral meritocracy.

He is in favour of inclusive politics. Me too. Definitely, capitalism can be reimagined.

Stop Covid with CRISPR Diagnostics (2)

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

Mammoth Biosciences (a firm founded by Jennifer Doudna) has partenered with GSK to commercialise a CRISPR Covid test. Therefore, there are right now two firms in the race: Sherlock and Mammoth.
The paper in Nature explains the details:

Here we report the development and initial validation of a CRISPR–Cas12-based assay9 for detection of SARS-CoV-2 from extracted patient sample RNA, called SARS-CoV-2 DNA Endonuclease-Targeted CRISPR Trans Reporter (DETECTR). This assay performs simultaneous reverse transcription and isothermal amplification using loop-mediated amplification (RT–LAMP)14 for RNA extracted from nasopharyngeal or oropharyngeal swabs in universal transport medium (UTM), followed by Cas12 detection of predefined coronavirus sequences, after which cleavage of a reporter molecule confirms detection of the virus. We first designed primers targeting the E (envelope) and N (nucleoprotein) genes of SARS-CoV-2 (Fig. 1a). The primers amplify regions that overlap the World Health Organization (WHO) assay (E gene region) and US CDC assay (N2 region in the N gene)6,15, but are modified to meet design requirements for LAMP. We did not target the N1 and N3 regions used by the US CDC assay, as these regions lacked suitable protospacer adjacent motif sites for the Cas12 guide RNAs (gRNAs). Next, we designed Cas12 gRNAs to detect three SARS-like coronaviruses (SARS-CoV-2 (accession NC_045512), bat SARS-like coronavirus (bat-SL-CoVZC45, accession MG772933) and SARS-CoV (accession NC_004718)) in the E gene and specifically detect only SARS-CoV-2 in the N gene (Supplementary Fig. 1). This design is similar to those used by the WHO and US CDC assays, which use multiple amplicons with probes that are either specific to SARS-CoV-2 or are capable of identifying related SARS-like coronaviruses.

Edward Hopper 

After all these years, a new pandemic and the same behavioral biases

Using social and behavioural science to support COVID-19 pandemic response

This is the best paper as far as I know on behavioral biases in the current pandemic. The conclusion says:

Over 100 years ago, Science magazine published a paper on lessons from the Spanish Flu pandemic. The paper argued that three main factors stand in the way of prevention: (i) people do not appreciate the risks they run, (ii) it goes against human nature for people to shut themselves up in rigid isolation as a means of protecting others, and (iii) people often unconsciously act as a continuing danger to themselves and others. Our paper provides some insights from the past century of work on related issues in the social and behavioural sciences that may help public health officials mitigate the impact of the current pandemic. Specifically, we discussed research on threat perception, social context, science communication, aligning individual and collective interests, leadership, and stress and coping. 

A century ago paper:  Soper, G. A. The lessons of the pandemic. Science 49, 501–506 (1919).

First, public indifference. People do not appreciate the risks they run. The great complexity and range in severity of the respiratory infections confuse and hide the danger. The infections vary from the common cold to pneumonia. They are not all separate entities by any means. An attack which begins as a coryza or rhinitis may develop into a pharyngitis, tonsilitis, laryngitis, bronchitis or pneumonia. The gravity increases with the progress toward the lungs. The infection sometimes seems to begin in the chest, sometimes in the throat, sometimes in the head. It may stop where it started or pass through several phases. This is the story of the common cold. It is generally more discomforting than dangerous. Most people get well without skillful treatment, or indeed any great interference with business. No specific virus is known to produce it.

Searching for a vaccine and a drug in the surreal and accelerated world of Covid-19 research

What Is the World Doing to Create a COVID-19 Vaccine?

Building the critical path for COVID-19 therapeutics

How to Discover Antiviral Drugs Quickly

The world needs Covid-19 vaccines. It may also be overestimating their power

From CFR:

Public officials worldwide have stressed that the pandemic likely will not end until there is an effective vaccine. Even after a vaccine is approved, however, there remains the tremendous challenge of producing enough of it for the world’s population. An estimated one billion doses would need to be manufactured just to vaccinate workers in health care and other essential industries globally, and that is if only a single dose is required for each person.
This task has both motivated countries to prepare for large-scale production, as well as pitted them against one another amid fears of a potentially limited vaccine supply. While Brazil, China, and India all have large vaccine industries, they also have among the largest populations, and they could reserve their vaccine supplies for their own citizens before opening them up to others. Some countries are seeking to strike monopoly agreements with vaccine manufacturers to avoid domestic shortages. Experts including CFR’s Bollyky have warned that bidding wars over a vaccine will lead to inequitable distribution and, ultimately, fail to eliminate the risk of new outbreaks.
Moreover, amid these extraordinary efforts to secure a vaccine, scientists are still investigating how this new coronavirus behaves and trying to answer the many questions people have about the risk it poses and how protected they will be. This includes how effective a vaccine will be against a mutating coronavirus, though researchers point out that mutations do not necessarily mean different strains of the virus or changes in its infectiousness or lethality. Uncovering such details about the virus, they say, will only help in the development of a successful vaccine.

From NEJM:

 So, what is happening now? The laborious, decade-long, classic pathway for the discovery and approval of new drugs could hardly be less well suited to the present pandemic. Repurposing existing drugs offers a potentially rapid mechanism to deployment, since the safety profiles are known. Therefore, a preliminary report of a supercomputer-driven ensemble docking study of a repurposing compound database to the viral S protein was published on a preprint server in mid-February, with 8000 compounds ranked according to the calculated binding affinity to the receptor-binding domain of the S protein.3 Top-ranked compounds from the original S-protein virtual screen are being tested for activity against the live virus. The results will inform future calculations in a speedy, iterative process.

Counterfeit medicines: the time to act is now

Trade in Counterfeit Pharmaceutical Products
Coronavirus (COVID-19) and the global trade in fake pharmaceuticals

OECD has released an iluminating report about counterfeit medicines around the world. And my surprise was:

Commenting specifically on manufacturing, Table 4.5 indicates that China arrested the largest number of individuals engaged in the manufacture of counterfeit medicines. It was followed by Spain, the United States, India, Pakistan and Indonesia. Note that almost all of these countries (except the United States and Spain) were identified as potential producers of counterfeit pharmaceuticals in the methodology developed by OECD/EUIPO and described in the previous section .

The second method for determining the main producing economies of fake pharmaceuticals and the key transit points involves using PSI data. Through liaison   contacts, member reports and open source reports, PSI has documented the arrest of 2253 people involved in counterfeiting, diversion or theft of pharmaceutical drugs worldwide during 2018. 

Table 4.5. Top ten countries for the number of arrests of individuals engaged in manufacturing counterfeit medicines, 2018

Economy

Number of arrests

China

233

Spain

52

United States

48

India

38

Pakistan

10

Indonesia

10

Canada

7

Colombia

6

Egypt

1

Source: PSI data.

As you can see, Spain is the second country in the world. Nothing to add.

Can capitalism be reimagined? (2)

Capitalism at Risk: Rethinking the Role of Business

Ten years after its first release, a new and updated edition of this book is available. Let me say that the book by Rebecca Henderson is better than this one. Anyway, this is an additional reference to take into account.

WHAT, THEN, should be done about the challenges facing market capitalism? And what, specifically, is the role of business in this effort? In our conversations, we heard answers reflecting a spectrum of views. Although executives in our forums did not use our terminology, their positions clustered into four broad categories that we term business as bystander, business as activist, business as innovator, and business as usual.

Ten years after, the same views...(?)

Assessing the government job on COVID-19

The citizens voice has said that several governments are doing a poor job in front of covid-19. Japan, Spain and France are the worst.  In the case of Spain there are clear reasons behind such opinion (please see below).

A picture is worth a thousand words

Germline editing: fasten seat belts

The Case for Remedial Germline Editing—The Long-term View

We conclude that so long as heritable genome editing interventions are consistent with the welfare of the future person and with social justice and solidarity, they do not contravene any categorical moral prohibition.
Nuffield Council on Bioethics (2018)

This statement changed the existing bioethics view on genome editing. From then, the door is open and nobody knows exactly what does it mean.

In this article, the authors open the possibilities without knowing exactly its implications:

 Two technologies under consideration to tackle this challenge are preimplantation genetic diagnosis (PGD) and remedial germline editing (RGE). Preimplantation genetic diagnosis is an established diagnostic technique, widely deployed today to identify a genetic defect in embryos created through in vitro fertilization, with the goal of transferring only embryos lacking the defect to the mother’s uterus. Remedial germline editing is a novel therapeutic paradigm that has has yet to be applied in the clinic to correct a heritable deleterious mutation in a fertilized egg. We predict that, in time, safe and efficacious RGE will eclipse PGD, the relative shortcomings of which are becoming increasingly apparent.

The final reports of the International Commission on the Clinical Use of Human Germline Genome Editing and the World Health Organization’s Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing are due later this year.
Meanwhile, take care!

The next future

Choices for the “New Normal”

A short article writen by Don Berwick sheds light on the main topics for the next future:

• The Speed of Learning
• The Value of Standards
• Protecting the Workforce
• Virtual Care
• Preparedness for Threats
• Inequity

Fate will not create the new normal; choices will. Will humankind meet its needs—not just pandemic needs—at the tempo the COVID-19–related morbidity and mortality demand? Will science and fact gain the high ground in guiding resources and behaviors? Will solidarity endure? Will compassion and respect be restored for the people—all the people—who make life agreeable and civilization feasible, including a guarantee of decent livelihoods and security for everyone? Will the frenzied world of commerce take a breath and let technology help simplify work without so much harm to the planet and without so much stress on everyone? And will society take a break from its obsessive focus on near-term gratification to prepare for threats ahead?

Ps. Video in JAMA Network

CRISPR, a big leap for mankind

Human Nature



You may find it now on Netflix

Can capitalism be reimagined?

Reimagining Capitalism in a World on Fire

A new book says that reimagining is possible. Rebecca Henderson is a well known reference for her studies on pharmaceutical innovation for decades. Beyond pharma, she is recognised by her works on innovation in general. Now, she has released a book on Reimagining Capitalism and this may sound a huge goal. Rebecca provides clear hints about what can be done, and says:

I spend a good chunk of my time now working with business people who are thinking of doing things differently. They can see the need for change. They can even see a way forward. But they hesitate. They are busy. They don’t feel like doing it today. It sometimes seems as if I’m still at the bottom of that ladder, looking up, waiting for others to take the risk of acting in new and sometimes uncomfortable ways. But I am hopeful. I know three things.
First, I know that this is what change feels like. Challenging the status quo is difficult—and often cold and lonely. We shouldn’t be surprised that the interests that pushed climate denialism for many years are now pushing the idea that there’s nothing we can do. That’s how powerful incumbents always react to the prospect of change.
Second, I am sure it can be done. We have the technology and the resources to fix the problems we face. Humans are infinitely resourceful. If we decide to rebuild our institutions, build a completely circular economy, and halt the damage we are causing to the natural world, we can. In the course of World War II, the Russians moved their entire economy more than a thousand miles to the east—in less than a year. A hundred years ago, the idea that women or people with black or brown skin were just as valuable as white men would have seemed absurd. We’re still fighting that battle, but you can see that we’re going to win.
Last, I am convinced that we have a secret weapon. I spent twenty years of my life working with firms that were trying to transform themselves. I learned that having the right strategy was important, and that redesigning the organization was also critical. But mostly I learned that these were necessary but not sufficient conditions. The firms that mastered change were those that had a reason to do so: the ones that had a purpose greater than simply maximizing profits. People who believe that their work has a meaning beyond themselves can accomplish amazing things, and we have the opportunity to mobilize shared purpose at a global scale.

 The titles of the chapters speak by themselves. You'll get the flavour of a great book, and a personal message (in chapter 8). And don't miss chapter 4 on Aetna CEO and the purpose of the firm.

1 “WHEN THE FACTS CHANGE, I CHANGE MY MIND. WHAT DO YOU DO, SIR?”
Shareholder Value as Yesterday’s Idea
2 REIMAGINING CAPITALISM IN PRACTICE
Welcome to the World’s Most Important Conversation
3 THE BUSINESS CASE FOR REIMAGINING CAPITALISM
Reducing Risk, Increasing Demand, Cutting Costs
4 DEEPLY ROOTED COMMON VALUES
Revolutionizing the Purpose of the Firm
5 REWIRING FINANCE
Learning to Love the Long Term
6 BETWEEN A ROCK AND A HARD PLACE
 Learning to Cooperate
7 PROTECTING WHAT HAS MADE US RICH AND FREE
 Markets, Politics, and the Future of the Capitalist System
8 PEBBLES IN AN AVALANCHE OF CHANGE
 Finding Your Own Path Toward Changing the World

QALYs and COVID

Revisiting the Economic Cost of Flattening the Curve

The Incidental economist blog provides information regarding QALY in the current pandemic. Forget the cost per QALY (so difficult to estimate in my opinion) and take only the 6,4 QALYs per death avoided.

It updates previous estimates and says:

The table below summarizes the previous calculations and current updates. Our revisited analysis shows that, as the shutdown continues, the cost per QALY gained increases exponentially due to the exponential growth in the total cost of both forgone productivity and business failure.

We previously emphasized that a key challenge in making calculations of this type is the uncertainty around the data inputs. Six weeks later, this still holds true, particularly for the range of QALY losses without a shutdown, i.e. the predicted corona-related deaths in the absence of intervention.

One interesting aspect of this analysis is that as time goes on, the cost per QALY gained will become higher and higher. This is because the net gains will diminish — the lives saved remains constant, but the offsetting life years lost due to other factors increase — while the costs increase exponentially. The key number that remains unknown is the relationship between the length of the lockdown and the number of lives lost.
In our first post, we concluded that the shutdown would meet conventional standards of cost effectiveness only if the deaths avoided was on the high end of the possible range and the costs on the low end — an outcome that seemed unlikely. Revisiting the issue, it is now clear that the cost per QALY gained from the shutdown will be outside the conventional range of acceptability even at the high end of deaths avoided. How far outside the range the shutdown policy will ultimately prove to be is unknown.