The potential for global cooperation when it comes to COVID-19 vaccine distribution
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Fareed Zakaria, host of CNN’s “GPS,” has a new book out in a few weeks called “Ten Lessons for a Post-Pandemic World.” Zakaria spoke with “Marketplace Morning Report” host David Brancaccio about the challenge of vaccinating the world against COVID-19.
The following is an edited transcript of their conversation.
David Brancaccio: You’ve been thinking about how the world will work after the pandemic. How do you think the distribution of vaccine and deciding who gets it earlier, who gets it later, might play out given the direction of the world as you see it?
Fareed Zakaria: Well, there are two levels at which your question operates. The first is at the level of truly global issues, which is to say, which countries will get it. And, without any question, it is going to be the rich world that will get it first. And those countries will make sure that their population gets access to it first. What we should be trying to do is ask ourselves, “what is the most efficient way for this vaccine to be effective?” So it should be sent to those countries where you have the greatest hot spots. A global pandemic needs a global response.
Brancaccio: What are your thoughts about multilateralism and cooperation at this moment in history and moving forward?
Zakaria: So the extraordinary thing about COVID-19 is that it is truly a global pandemic, which shows us how everything is connected, how we are all interdependent. And yet, the effect of this pandemic has been to make us more narrow, more nationalistic, more selfish. That feeling is real. I think we all feel that anxiety, that hunkering down, that sense of protecting yourself. But the point I make in my book is that the only way to get to an efficient outcome, to actually solve this problem, is to cooperate. You see a window of this with the European Union. When COVID-19 hit, European countries closed their borders, even to one another. The Italians started blaming the Germans, the Germans started blaming the Italians. But very soon, because of good leadership, they realized that the only durable solution was to cooperate more, not less. And so what is happening as a result of this pandemic, is you are seeing a stronger European Union. You are seeing greater cooperation. We should be doing that globally. Right now we have, in very important countries, the United States and China being the most important ones, a kind of wave of nationalism, a wave of populism. But I do believe that people will come to their senses and realize this is a global issue. You can’t solve it locally. You need to figure out what are the most important hot spots that need to be vaccinated first. In other words, you need to have a scientific basis to figure out what is the solution here, and that solution is going to be one that requires international cooperation. We’ve only gotten as far as we’ve gotten because of a lot of international cooperation. When the United States needed supplies in those critical months of March and April, where did we go? We got them from the rest of the world, including by the way, China. When you look at how far we have moved scientifically, why is that? It’s because scientists around the world are cooperating 24/7, with no concern about nationalism. A lot of this nationalism is nice rhetoric, but the actual work is being done by a lot of global cooperation.
Brancaccio: And an interesting lesson in history here, that you point out in the book. There was a particularly intense moment in the Cold War. I mean, 1958 for heaven’s sake, the U.S. joined with its archenemy the Soviet Union to work together to wipe out smallpox around the world.
Zakaria: It’s an extraordinary moment. In 1958, the World Health Organization, a version of it is getting together. And the Soviets propose that the United States and the Soviet Union join together to rid the world of smallpox. The Americans are initially hesitant, but then they decide to sign on, and then they cooperate fully. And with international cooperation, what ends up happening is that the two superpowers of the age — and, remember, there is a real prospect of nuclear war, there is a real prospect of every crisis escalating into something catastrophic. And yet, the two countries decide that it’s important to show the world that they can cooperate. And the result, by the way, was very efficient, effective cooperation. The most extraordinary thing about the eradication of smallpox around the world is that the story is less about the science, though that is important. Of course, it’s more about the extraordinary efficiency and cooperation internationally spearheaded by the U.S. and the Soviet Union that allowed it to happen. It’s a wonderful story of how cooperation actually ended up getting everybody to a better place than they would have been without it.
Brancaccio: Now, let’s talk about the other part of my leading first question, which is, what do we know about the distribution of an eventual COVID vaccine? We talked globally, but within the United States, there’s a major public policy question about who gets it first — who gets it at all, really.
Zakaria: So, one of the 10 lessons in my book is, it is not the quantity of government that matters, but the quality of government. And one of the things we have realized in this pandemic, is that the United States has a dysfunctional government at every level, particularly regarding public health. Whether it’s the federal, state or local. We can blame Donald Trump all we want, and God knows he deserves blame. But let’s be honest, the CDC failed in sending out faulty test kits. The FDA failed in not allowing private labs to do the testing. The Department of HHS failed in not setting up some kind of national testing framework. Federal, state, local governments all have, in some way or the other, been incompetent and ineffective compared with their counterparts in other rich countries. There is simply no getting away from the fact that the United States has demonstrated that its government is not able to perform the basic duties that are required in an emergency. Now, when you look at something like the vaccines, what worries me is that we will see a similar scenario as we saw with testing. The two parts of the American testing fiasco that are worth pointing out are, one, the people who are getting it most easily were not the people who needed it: frontline workers, health care workers. It was basically people who were rich and well-connected. What you needed, in order to eradicate the hot spots, was to have the frontline workers, the people who are in some way exposed, or likely to be exposed to the virus, be tested.
The second thing we realized was that the — because of the bizarre way in which we fund health care — the companies that were doing the testing had no incentive to provide the results quickly. Which means they’re essentially ineffective. Because if you don’t get the results within about 48 hours, you might as well not get them. If we have a similar rollout in the vaccine, where it ends up first going to rich people, it ends getting to people too late or there’s some kind of form of faulty equipment, I worry a great deal about it. There is one compensating factor. We’ve done it before, we do it with the flu vaccine. So it’s quite possible that these are fears that will be exaggerated. We know how to do the flu vaccine. But looking at the testing fiasco, I feel concerned enough that I think we need to over-plan and over-prepare for the actual physical distribution of the vaccine in America. First, so it goes to the right people in the right sequential order, and second, so that we make sure that it gets to people fast enough that you do achieve that herd immunity that you’re looking for.
Brancaccio: Do you think we ever get to the stage, after pandemic, where we look at that hard question that you pose about how ineffective the machinery of government was? Not just a report that points the finger at certain officials, but sort of structural change to making government and policymaking officials and these bureaucracies more effective?
Zakaria: I hope so. And the most important aspect of this is recognizing that we failed. You know, one of the things I point out in the book is that the countries that have done well over the last 30 or 40 years are countries that looked around the world, asked themselves, “why are other people doing things better than we are? And how do we copy them?” A lot of these countries by the way, the East Asian countries in particular, copied America. They looked at a lot of things America was doing right and they adopted best practices. So, in a sense, there was a time when the world was learning from America. Right now, I think America needs to learn from the world. We have to ask ourselves, why is it that Taiwan, with the same rough population as New York state has, as of this recording, something like eight deaths? What is New York? At 35,000? Why is it that places like Seoul and Taipei and Hong Kong, with crowded subway systems in densely populated cities, somehow have COVID deaths on a per capita basis that are astronomically lower than the United States? Why is it Germany has one-fourth the per capita deaths that the United States has? A lot of it is just the way in which we handle government.
I talk in the book about the history of good government and why the United States has always resisted that, because of all kinds of fears about big government. But it’s not really about big versus small. Taiwan, Hong Kong, South Korea have small governments, but they’re effective. They’re trusted. They know how to deploy resources well. In health care, we have a particular problem, which is we have the world’s most complicated, dysfunctional health care system. We spend three times as much on health care per capita as Taiwan does, for example. We get worse outcomes and we have unequal, and in fact, limited access for a lot of people. And it turns out that having large parts of the population that do not have access to health care and live in fear that they don’t have access is terrible from a public health point of view. Because you need to have access to the entire population, you need those people to be willing to come in to get tested, vaccinated without worrying about cost. You need to be able to have all that information collated very efficiently. Taiwan does that all. It has a single-payer system with one health card. I’m not advocating any particular system, but I’m saying if the entire population does not have access, if it lives in fear of costs, and things like that, and therefore won’t come forward, to get tested, to get vaccinated, you have a public health disaster. Because the nature of a public health emergency is if anyone is infected, no one is safe. And that means you need some kind of universal system.
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