Owning Up to Mistakes and Pandemic Deaths

June 07, 2023

John Kerry got the start to his political career when he testified to Congress about the Vietnam War as an anti-war veteran, and asked, “How do you ask a man to be the last man to die for a mistake?” The point, of course, was that we were still sending soldiers to Vietnam to fight and risk dying in a war that was widely recognized to be pointless. Rather than just owning up to the mistake, we continued the killing.

We might ask the same question about the U.S. trade embargo against Cuba and our government’s efforts to prevent Cuba from playing a positive role in stemming the pandemic. As my friend Achal Prabhala pointed out in a Washington Post column (co-authored with Vitor Ido), Cuba had developed two effective Covid vaccines by the summer of 2021. Rather than taking advantage of this innovation, and attempting to share the vaccine widely, the United States did everything it could to discourage its use in developing countries that were still struggling to get the vaccines produced by the United States and Europe.

There are two issues here. The first is straightforward. We have had a trade embargo on Cuba since 1962. The embargo was ostensibly imposed because of Fidel Castro’s human rights violations and his failure to hold democratic elections.

Few people took these claims seriously, since the United States at the time had strong ties to many countries with worse human rights records and no pretense of being democratic. However, the idea was that if we cut off Cuba from trade, not only with the United States but also with our allies, the economic pain would force the regime to buckle. Either Castro would be overthrown, or he would be forced to come running to the United States with his tail between his legs.

Well, it has been more than six decades now, and neither has happened. The government that Castro put in place when he overthrew a U.S.-backed dictator, is still there. And, it is not begging the U.S. for forgiveness. In other words, we might say the embargo has been a failed policy.

The embargo has undoubtedly crippled Cuba’s economy, inflicting hardship on its people. It has made it difficult for the country to get a wide range of items since in principle it applies not only to goods from the US but also items produced in third countries that contain U.S. components. As a result, everything from computers to spare parts for old US-made cars are much harder to find in Cuba than would otherwise be the case.

And now we are seeing the fallout from the embargo spread to vaccines that potentially could have saved millions of lives in developing countries. Our political leaders would apparently rather see people die than allow Cuba to get some of the credit for saving them.

The crisis created by the pandemic, and the potential benefits from the Cuban vaccines, would have been a great opportunity to own up to the mistake and acknowledge that the embargo was not serving its ostensible purpose. It is not going to lead to the collapse of the regime or get it to play nice with Washington. But ending the embargo is still not on the policy agenda in Washington.

Just to be clear, ending the embargo would not mean endorsing Cuba’s human rights record or political system. The United States trades and has close relations with many countries that have abysmal human rights records and no pretenses of being democracies.

Saudi Arabia would top the list here. Women are officially second-class citizens and homosexuality is a crime, which can be punished with long prison terms, and even death. The country is still operated as a hereditary monarchy, and its leaders routinely have opponents imprisoned and/or killed. Yet, the country does hundreds of billions of dollars of business yearly with the United States and its allies. Obviously, democracy and human rights have not been a big issue here.

There are many other countries that have extensive economic and political ties to the U.S. despite abysmal human rights records and the lack of a functioning democracy. Ending the embargo with Cuba does not mean endorsing its practices in these areas, it just means acknowledging that the embargo has done nothing to change them for the better in 60 years and is not likely to do so going forward.

Ending the embargo will improve the situation for millions of Cubans. It is also likely to reduce the number of Cubans trying to enter the United States, for those concerned about such things.

Dealing with Pandemics as Though Human Life Mattered

The response of the United States and other wealthy countries to the pandemic was truly shameful. It would have been in everyone’s interest, including our own, to freely transfer the technology developed to deal with the pandemic, especially the vaccines. We should have made it a top priority to get the world vaccinated as quickly as possible and not allow government-granted patent monopolies, or other forms of intellectual property, to get in the way.  

As has been widely noted, the government paid for developing the Moderna vaccine. While the company had spent considerable money over the years developing mRNA technology, the government paid roughly $450 million to Moderna for developing a Covid vaccine and then paid a comparable amount for phase 3 clinical trials.

There is no story of Moderna needing to be rewarded for risk. If it turned out that the vaccine was not approved, it would have already been paid for its work. It risked nothing. As a result of both paying for the development of the vaccine and then giving the company control over its distribution, we created five Moderna billionaires.

What would have been the harm if the government had insisted that Moderna’s technology be freely shared with the world, meaning that no patent monopolies or other protections would apply, nor would non-disclosure agreements be binding for its employees? If Moderna’s engineers wanted to go around the world assisting other countries in producing the vaccine, they would be free to do so. (Presumably, they could be well-paid for this work.)

For those getting misty-eyed over Moderna’s lost profits in this scenario, we could even compensate them for missing out on this potential pandemic gold mine. We would just do it after the fact. And, if Moderna didn’t think the offered compensation was adequate, they could go to court and make their case for a larger amount. The point is to get out the technology needed to deal with the pandemic as quickly as possible and worry about how much money everyone gets later.

Ideally, we would have international cooperation in this effort. It was in everyone’s interest to contain the pandemic as quickly as possible. If we had made every possible effort to vaccinate the world, we might have prevented the development of the Delta strain and almost certainly could have avoided the Omicron strain. Millions of lives could have been saved, and hundreds of millions of infections prevented.

Instead of filibustering, along with other wealthy countries, the India-South Africa WTO resolution to freely share technology during the pandemic, the U.S. could have pushed efforts to share not only its own vaccines, but also the vaccines developed in Europe, Russia, China, India, and even Cuba. The goal should have been to vaccinate the world, not to score ideological points.

Would all these countries have joined the effort?  We can’t know for sure, but we know that the U.S. never tried a push in this direction.

Thankfully, the Covid pandemic is largely contained now, but that makes it a good time to set a different course for the next pandemic and for public health more generally. Rather than seeking to bottle up healthcare technology with patent monopolies and related protections, we should look to have it freely shared.  

We can start on this path by taking advantage of the technology that is already available. That means facilitating not only the use of the vaccines developed by Cuba but also other low-cost vaccines. In particular, two researchers at Baylor College of Medicine and Texas Children’s Hospital, Peter Hotez, and Maria Elena Bottari, developed an open-source vaccine, Corbevax, that has already been used by over 100 million people in India and Indonesia.

If the Biden administration sponsored a clinical trial here, so that it could be approved by the FDA, it would lead to its use in many other countries. Unlike the vaccines developed in the U.S. and Europe, Corbevax is cheap. It costs less than $2 a shot in India. This makes it, like the Cuban vaccines, very affordable for people in developing countries.

It would also save a huge amount of money for people here. Instead of paying Pfizer or Moderna $110-$130 for your next booster, a shot of Corbevax would almost certainly cost less than $5. If we are talking about over 100 million boosters a year, the savings would come to more than $10 billion.   

It would be a huge step forward for both public health and U.S. foreign policy if we could begin down the road of freely sharing healthcare technology rather than trying to bottle it up so that a small number of people can get very rich. The whole world shares an interest in preventing the spread of pandemics. This is an area where we should be able to work together for the benefit of humanity.


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