Vaccine economics

【首文】疫苗经济学

A bigger dose

加大剂量

The world is not spending anywhere near enough on a coronavirus vaccine

全球在新冠疫苗上的支出还远远不够

CONSIDER THE following thought experiment. If you fail to eat a pizza within an hour, you will die from hunger. What do you do? Most people would immediately order a pizza—and not just one Margherita, but lots of them, from several different parlours. In order to maximise the chances that at least one pizzeria got you what you needed in time, you would not care that some of the pizza would be sure to go to waste.

来做一个思维实验：如果你不能在一小时内吃到一份披萨，就会饿死。你会怎么做？大多数人会立马下单——而且不只点一份玛格丽特披萨，而是从几家不同的店点很多份。你想要最大限度地增加机会，争取至少有一家披萨店能及时把你需要的东西送到，所以不会在意有些披萨肯定会被浪费掉。

The world is hungry for a vaccine against covid-19. So far about 700,000 deaths have been recorded from the disease, and the total is increasing at a rate of roughly 40,000 a week. If you also include unrecorded deaths, the actual numbers are much higher. Meanwhile, the global economy is experiencing its sharpest contraction since the Great Depression, of perhaps 8% of GDP in the first half of 2020.

全世界亟需一种能对抗新冠肺炎的疫苗。截至目前大约已录得70万人死于这种疾病，而且这个数字还在以每周约四万人的速度增长。如果把未被记录的死亡人数也计算在内，实际数字还要高得多。与此同时，全球经济正在经历自大萧条以来最剧烈的收缩，2020年上半年GDP可能收缩8%。

In the face of this catastrophe, scientists look likely to produce a vaccine much faster than almost anyone could have predicted at the start of the pandemic. Yet global efforts to manufacture and distribute vaccines do not measure up. A mere $10bn or so has been devoted to the cause—the equivalent of ordering one pizza, rather than the several that are needed.

面对这场灾难，科学家们研发出疫苗的速度看起来很可能大大快于几乎所有人在疫情刚开始时的预测。然而，全球在制造和分配疫苗上所做的努力达不到预期。截至目前大约只有100亿美元被投入到这项工作中——这就相当于只订了一份披萨，而不是所需的好几份。

The figures are murky, but on a rough estimate the world has bought about 4bn doses of covid-19 vaccines for delivery by the end of next year, which is in theory enough to give half the planet one dose. In practice, however, far fewer people will secure protection from the disease. Some of the vaccines in production will fail to get regulatory approval, and a potential candidate that reaches a large-scale clinical trial—as several have—still has a 20% chance of failure. Others will be approved but may not provide full protection. They may not be suited to the elderly, for instance, or they may stop people dying from covid-19 but not from passing it to others. Other vaccines will require more than one dose in order to be effective. Because of these contingencies, even those countries, such as Britain and America, that have bought more than two doses for each of their citizens have still not bought enough.

相关数字并不确切，但据粗略估计，全球已订购了约40亿剂新冠疫苗，等待明年年底前交付。理论上，这足够让世界一半的人口接种一剂疫苗。但实际上，能得到保护的人远远没有这么多。部分生产中的疫苗将无法获得监管机构的批准，而已开展大规模临床试验的候选疫苗（已有若干进入此阶段）仍有20%的失败几率。其他一些将会获批，但可能无法提供全面的保护。例如，它们可能不适合老年人，或者它们也许能避免人们死于新冠，却不能阻止他们传染他人。其他疫苗将需要注射一剂以上才能起效。由于这类可能性，即使是英、美等已为每个公民购买两剂以上疫苗的国家，购买的量也还是不够。

Instead of seeing unproven vaccines as an extravagance, the world needs to think of them as an insurance policy. Research suggests that if ten or more vaccines are in development, there is a 90% chance of finding one which works. Once one of these candidates proves to be effective, billions of doses will need to be distributed quickly. But it is impossible to know in advance which candidate will succeed. Governments should therefore help pharmaceutical firms produce vast quantities of a range of different vaccines—ideally, numbering tens of billions of doses in all—long before regulatory approval is or is not granted. The winning vaccine could thus start to get to people quickly, even as doses of failed vaccines might be thrown away unused.

世界不应将效用未经证实的疫苗视作奢侈，而需要视之为一种保险。研究表明，如果有十种或更多的疫苗正在研发中，就有90%的机会找到一种有效的疫苗。一旦这些候选疫苗中有一种被证明有效，就需要将数十亿剂疫苗迅速分发出去。但是，由于无法提前知道哪种候选疫苗会成功，政府应该在监管机构做出批准或不予批准的决定前，早早帮助制药公司大量生产一系列不同的疫苗——最好是能总共生产出数百亿剂。这样一来，就可以在第一时间启动向人们派发胜出的疫苗，尽管那些失败的疫苗可能会被丢弃不用。

That may seem deliberately and needlessly lavish. Yet even boosting vaccine funding tenfold to $100bn or more, in line with the most ambitious proposals, pales in comparison with the $7trn which governments across the world have spent or pledged since the pandemic began in order to preserve incomes and jobs. The real extravagance would be to wait until a successful vaccine candidate emerges before rushing to boost production. In terms of the economic output that is saved, to say nothing of lives, it would make sense for the world to spend as much as $200bn on bringing forward an effective covid-19 vaccine by just one week.

这看起来也许像蓄意且不必要的铺张。然而，即使按照最雄心勃勃的提议将疫苗研发资金增加10倍至1000亿美元或更多，相比疫情爆发以来各国政府为保收入和就业而支出或承诺支出的七万亿美元，仍是小巫见大巫。真正的奢侈是等到一个成功的候选疫苗出现后，才着急忙慌地提高产量。且不说人命，单就被保住的经济产出看，世界就算花2000亿美元在仅仅一周内研制出一种有效的新冠疫苗也仍是合理的。

For some, the prospect of such a heavy investment raises fears of “vaccine nationalism”, in which rich countries outspend poor ones in an attempt to corner the market for their citizens. The world as a whole can wring the most benefit out of limited supplies of vaccine by pooling resources and allocating doses on the basis of need—health-care workers first, vulnerable people next, and so forth. Around 80 countries are interested in such a deal. Unfortunately, however, politicians in some countries with manufacturing capacity are likely to put their own people first. One way to minimise the international scramble over who gets vaccines and when is to maximise supplies up front and to spread manufacturing capacity. Vaccines for the poorest countries would need to be subsidised, perhaps through GAVI, the alliance that already pays for other vaccines there.

如此巨额投资的前景引发了一些人对“疫苗民族主义”的担忧，即富国比穷国投入更多，以求垄断市场来让本国民众受益。世界作为一个整体，可以从有限的疫苗供给中“挤出”最大的益处，方法是汇集资源并按需分配疫苗——首先是医护人员，然后是弱势人群，诸如此类。大约有80个国家对这样的方案感兴趣。但遗憾的是，一些有疫苗生产能力的国家的政客很可能会把本国人民放在第一位。要使国际上对谁能获得以及何时获得疫苗的争执最小化，一个方法是最大限度地增加预先供应，并扩散生产能力。提供给最贫穷国家的疫苗将需要补贴，这或许可以通过全球疫苗免疫联盟（GAVI）来实现，这个组织已经在为穷国使用的其他疫苗买单。

The idea of deliberately overproducing something does not sit easily with politicians, especially in a world where there are so many claims on public funds. Faced with a large manufacturing capacity that turns out to be useless, politicians risk being accused of having wasted money—as the British government was when the emergency hospitals it had built early in the pandemic were not needed. Yet politicians must be rational. You buy insurance before you know what will happen, not after. ■

故意过度生产某样东西的想法不太容易为政客所接受，尤其是在一个对公共基金的索求如此之多的世界里。一旦大规模的生产能力到头来毫无用处，政客就有可能被指斥白白浪费钱——就像英国政府在疫情早期建了临时医院，结果却没派上用场一样。但政客们必须要理性明智。你并不是在知道了会发生什么之后才去买保险的。