Interview
Why we still don’t have vaccines that could save millions | Rachel Glennerster
- A universal COVID-19 vaccine is projected to generate $1.5 to $2.6 trillion in value for the U.S. compared to variant-specific boosters, with an estimated implementation cost of $6.4 billion to cover half the population via an advanced market commitment.
- Market failures currently prevent the development of vaccines for tuberculosis, strep A, and hepatitis C despite scientific achievability, with predictions that none will exist within five years absent market shaping interventions.
- The probability of a new pandemic occurring annually is estimated at one in 50, with the likelihood of a subsequent event potentially twice as severe as COVID-19 increasing over time.
- Climate change is expected to drive a collapse in crop yields in Sub-Saharan Africa by 2098, potentially reducing productivity by 28%, while tipping points for temperature thresholds in African crops are approaching.
- An "explosion" in air conditioning usage is anticipated in low- and middle-income countries due to rising wealth and climate change, with cooling currently accounting for 4% of global emissions, necessitating pull mechanisms for efficient units.
- The Market Shaping Accelerator will determine which of seven selected projects advance in the next couple of months, though final confirmation of projects moving to full implementation requires many more months.
- Successful implementation could establish a template for pull mechanisms to be used for other diseases and technologies over the next 10, 15, or 20 years, potentially creating a global movement of evaluators and designers.
- An advanced market commitment for pneumococcal vaccines resulted in immunizing 150 million children and saving 700,000 lives five years faster than the rotavirus vaccine, serving as a precedent for future malaria or similar initiatives.
- Early childhood intervention programs are predicted to have huge long-term impacts on earnings decades later, whereas providing inputs like computers or textbooks without strategic design fails to improve learning outcomes.
- Future pull mechanisms for generic drug repurposing may utilize usage-based rewards in high-income countries with centralized data, while low-income countries might require prize models due to data system limitations.
- Pull mechanisms for clean air conditioning could involve subsidizing existing efficient units or funding new technology, though the latter may remain subsidy-dependent due to cost structures.
- Economic modeling suggests that accelerating vaccine development by 12 hours would have been cost-effective relative to the $12 billion Operation Warp Speed expenditure.
- Political resistance poses a risk to adoption, as policymakers often prefer near-term, credit-claiming solutions over long-term structural reforms required for pull mechanisms.
- Large firms are expected to invest in universal vaccines only if a significant, profitable market exists, as they cannot currently charge prices reflecting social value during a pandemic.
- A universal flu vaccine is predicted not to be developed without intervention due to high costs and the inability to charge socially valuable prices during pandemics, despite its potential to protect against future major outbreaks.
- Without pull mechanisms, innovation for climate-resilient sorghum crops will not occur due to ineffective market systems regarding seed reuse, and similar gaps exist for malaria vaccine history where earlier intervention would have saved lives.
- The development of climate-resilient crops is threatened as current temperatures approach thresholds where productivity suddenly collapses, a phenomenon observed gradually increasing with warm days before sharp failure.
- A universal COVID-19 vaccine could provide multi-year protection without annual boosters and be stockpiled or distributed rapidly before the next wave, assuming approval and distribution assumptions hold.
- Future simulations for universal vaccine value assume new dangerous waves occur at an average observed rate, while the probability of such events is expected to "stack up" over time.
- Middle-income countries faced significant economic losses in the past by failing to borrow earlier for vaccine manufacturing, a risk that could be mitigated by improved financing mechanisms.
- In the next five years, a large segment of India's population is expected to purchase air conditioners, highlighting the immediate scale of demand relevant to climate and cooling policy.