/ 14 May 2021

No vaccine superheroes or supervillains: Fix the system

A Man Carrying A Picture Of Bill Gates Protesting During A
Superhero or supervillian? That’s the wrong question, writes Phillip Machanick. The right question is: How it is that philanthropist Bill Gates can have so much influence over world health? Photo: Marcos del Mazo/LightRocket/Getty Images

Vaccines are an area of confusion and disinformation. Bill Gates is a superhero; Bill Gates is a supervillain. Vaccines will solve the Covid-19 pandemic instantly; they will make it worse.

As with many debates in absolutes, the true position is too complex to express in a simplistic extreme.

Had the Gates Foundation not made the intervention that it did, it’s likely that we would be even further behind on vaccines than we are. But Gates’s insistence that patent protection is no obstacle to rolling out vaccines faster and the staunch resistance of developed countries other than the United States to the Trips — the World Health Organisation (WHO) Agreement on Trade-Related Aspects of Intellectual Property Rights — waiver proposal underscores the way Big Pharma happily socialise their risks but refuse to socialise the consequential benefits.

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A large part of the research and development cost of pharmaceutical companies is covered by government-funded research, none more so than the Covid-19 vaccines. Many projects were funded on the expectation that some would fail but that as many as possible had to go ahead as fast as possible to ensure delivery. 

What was missing from that funding model was that governments should have owned the resulting intellectual property and that part of the development process should have been gearing up alternative sources. There are claims that there are production-ready factories standing idle; whether this is true or not, the past year could have been spent identifying and scaling up capacity.

Is Gates a superhero or a supervillain? That’s the wrong question. The right question is: How is it that one person can have so much influence over world health?

That his foundation is a bigger contributor to the WHO than most governments is scandalous. Why should governments, who represent the interests of the whole of society, abdicate their public health role to wealthy philanthropists?

Gates filters his perceptions of right and wrong through the interests of big business. Gates is not a socialist. He made his money by predatory business practices. 

Given all that, his role in public health is not all that bad. The fiasco of sluggish vaccine roll-out and the fight over the Trips waiver is a natural consequence of this policy failure.

This is the backdrop to a huge disinformation campaign that aims at discrediting vaccines, ironically supported by many who also oppose measures to contain the virus such as lockdowns and masking.

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Failures of public policy, including the excessive influence of Big Pharma, has rightly fuelled suspicion of Big Pharma but has given the anti-vax campaign undue influence. An investigation of the drivers behind this campaign is long overdue — some for example have been promoting their own remedies or even alternative vaccines, usually with scant evidence of efficacy.

One argument relates to the role of vaccines in more contagious variants. In the United Kingdom, which has had more than one extra-contagious variant, the rapid roll-out of vaccines has steadily suppressed growth in infections. Yet some point to countries such as India and Brazil, where rapid surges have followed vaccination, ignoring the fact that vaccination in those countries is extremely slow. There is no evidence for the claim that vaccination drives a trend towards more contagious variants. 

The SARS-CoV-2 virus is much slower at mutating than the flu virus; we only see rapid mutation when a lot of it is in circulation. Vaccination reduces the amount of virus and hence the probability of mutation. Also encouraging is convergent evolution: similar variants have appeared independently in different parts of the world, indicating that the virus has limited options for developing more contagious variants. 

Another part of vaccine mythology is reading raw data on adverse events without looking at the wider context. A meme on social media is about the number of children and babies who’ve had severe adverse events but this group has not been vaccinated. The US Vaccine Adverse Event Reporting System system has a report of a one-year-old who died of a self-inflicted gunshot wound. 

Not all adverse effects are so clearly bogus; the real issue is interpreting them. If, for example, someone dies four days after being vaccinated, did the vaccine cause that? Such deaths should be investigated. But if you tell me that the standard for a vaccine is that no one should die within four days of being vaccinated, I would get vaccinated every three days and live forever.

As with interpreting reported Covid-19 deaths, adverse events should be interpreted versus a baseline of “normal”. With no sense of irony, many who try to claim that all Covid-19 deaths result from other causes also attribute every post-vaccination adverse event to the vaccine. 

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For Covid-19, we have robust excess deaths statistics in many countries that show far more people have died than did in a year without the virus and that the official Covid-19 toll is an undercount. For vaccines, deaths are no higher than normal; a small number of rare complications has shown up and those need special attention. 

A case in point is the rare form of clotting associated with both the Oxford-AstraZeneca and Johnson & Johnson vaccines; another is rare instances of anaphylactic shock. But all of these have a much lower probability of serious harm than contracting the disease. This is what adverse event monitoring is supposed to do and it is working.

So where are we now?

We should be pushing hard not only on the Trips waiver but on fixing the underlying system. Governments should put much more money into the WHO, Big Pharma should have a contractual obligation to society to share benefits of publicly-funded research and alternative sourcing of vaccines should be sped up. 

We need a robust public education programme on vaccines. And we need an investigation of the motivation of the anti-vax campaign, which has been allowed to flourish for far too long under the guise of protected free speech.