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Biden Finally Agrees that Pandemics are Global

Help to India on the way. Plus: movement on health care

Over one million Indians have contracted coronavirus in the past three days. Eighty-two hundred and three have died. Those are just the official cases and almost certainly an undercount; the crematoria are working so consistently in some cities that the furnaces are melting. The official numbers, given population patterns, are just now peaking above where the U.S. is at today. However, it’s likely cases are concentrated in the urban centers, it’s likelier that this represents a fraction of those afflicted, and the health system available to all Indians is in worse shape than ours.

The outbreak comes on the heels of a mass gathering of hundreds of thousands for Maha Kumbh, a Hindu religious festival, and other large events. However India got there and however Prime Narendra Modi might be responsible, in a pandemic and a connected world what happens across continents will likely wind up on our shores, in mutations and variants that just might not be covered by the current suite of vaccines. So it’s an imperative to vaccinate the entire world, and we won’t be safe from crisis until that happens.

Yet the United States had put an export ban on raw materials needed to create some of the vaccines. The country is sitting on 30 million AstraZeneca doses (although they were made at that extremely troubled Baltimore factory) that it’s unlikely to use. And India’s health system is in desperate need of basic supplies, like oxygen.

The first time the State Department was asked about this, on Friday, its spokesperson first said it was a question for the U.S. trade representative (not really), and then when pressed noted that the “United States first and foremost is engaged in an ambitious and effective and, so far, successful effort to vaccinate the American people.” So India, you get nothing until we get ours. He closed by flipping the script and saying it was in the interest of the world to see Americans get vaccinated. Then isn’t the converse true? And if you can help India get vaccinated without affecting the U.S. program at all, wouldn’t you do it?

It took all of 48 hours for the White House to recognize how bad this looked. In discussions between the two countries’ national security advisors Sunday, the U.S. committed to sending “specific raw material urgently required for Indian manufacture of the Covishield vaccine” to India. (Covishield is the brand name for AstraZeneca’s vaccine, incidentally.) We’re also sending therapeutic drugs, testing kits, ventilators, and PPE; are “pursuing options” for oxygen supplies; and helping to fund India vaccine manufacturer to “produce at least 1 billion doses… by the end of 2022.”

OK, this is about a bare minimum start, even if you cast aside the pledges coming in too late. The end of 2022 is a long way off and a billion doses (you need two for Covishield) won’t cover half the Indian population. Covishield, again, is the same as AstraZeneca, and yet those fully formed AstraZeneca doses aren’t being shipped out.

Longer term, and if we’re talking about the end of 2022 we’re talking longer term, the U.S. still hasn’t joined the world in recommending the elimination of intellectual property protections on COVID-related therapies and vaccines, known as a TRIPS waiver. (TRIPS stands for Trade-Related Aspects of Intellectual Property, which is actually TRAIP, so I don’t know.) Pharma lobbyists (in association with lover of IP barriers Bill Gates) have been making the same point for 10 months, that waiving IP wouldn’t do anything of value because it takes too long to add manufacturing capacity. First of, if waiving TRIPS won’t do anything, why has an army of lobbyists been deployed to prevent it? Second, BioNTech, Pfizer’s partner, bought a German plant in Marburg that had no experience with mRNA and brought it to production in six months. The “it’ll take too long” talking point has wasted lives, and the best day to end that is today.

The wacky new talking point, unleashed in the Financial Times, is that waiving IP might allow CHINA AND RUSSIA to… cure cancer. Seriously, that’s the claim. I’m supposed to be so nationalist that I don’t want to lose a curing-cancer race to a foreign country. If this is all they’ve got, there really is no justification other than profit.

Here’s the part of this that’s worth monitoring: U.S. trade representative Katherine Tai has put the TRIPS waiver under review, meeting with stakeholders and making statements leaning in the direction of the waiver at a WTO meeting. This led to “one vaccine maker to complain to White House officials” about Tai.

There’s something hilarious in pharma CEOs calling mom and dad at the White House because Katherine Tai was being mean and threatening their cash cow. But looking closer, it seems that the pharma lobby believes that the White House runs trade policy rather than the U.S. trade representative. This is something we’ve been concerned about. USTR recently nominated a top deputy to run the critical China portfolio who has no experience with trade or China. It felt like a demotion for USTR; note that the call to India was with national security advisor Jake Sullivan, not Tai. A White House bigfooting of a fairly progressive trade rep has implications that go well beyond vaccine IP; this bears watching.

On Friday it appeared that Biden would announce his American Families Plan with no provision on a critical hardship for American families, health care. This spurred some rapid response, both from the “expand Medicare” movement led by Sen. Bernie Sanders (I-VT) and close to 20 other Senate Democrats, and the “expand the Affordable Care Act” movement led by a couple dozen freshman and sophomore House Democrats.

Sure enough, by the weekend, it was floated that the plan now includes $200 billion to extend insurance exchange subsidies, so nobody has to pay more than 8.5 percent in income for an insurance premium. This was passed in the American Rescue Plan but only for two years. A measure to lower the price of prescription drugs, however, appears to still be on the sidelines.

Once again the White House proves itself malleable on policy, though it has taken a side in the “improve private health care vs. improve public health care” debate. But so much of this remains theoretical. Emperor-king Joe Manchin wants to limit the bill to “conventional infrastructure” and involve Republicans, and if he wants that, we’re headed for a final package that’s about one-seventh the size of the Jobs and Families plans. Making plans is nice, but it might just be pushing paper.

The Shuttered Venue Operator Grants application portal is supposed to reopen today; initially it was Saturday, so we’re already one delay in. (SBA, Twitter)
Meanwhile, rental assistance is another minefield that isn’t actually getting out to beneficiaries. (New York Times)
Biden approval holding steady at a couple points above his share of the two-party vote in 2020. There just aren’t many persuadables anymore. (Axios)
“The Biden administration changed its story on refugees 6 times in 3 weeks.” (Washington Post)
Shutdown process beginning in Afghanistan. (Associated Press)
Outdoor mask guidance is going to be relaxed; if you’re distanced and outdoors, you don’t need it. (CNBC)
The women of Bears Ears national monument pleading for restoration suggests that the administration’s action on Day One isn’t a done deal. (New York Times)
Biden acknowledges the Armenian genocide. (Yahoo News)