Arjun Jayadev & Achal Prabhala: The Imperative of Access to Drugs

INET Senior Economist Arjun Jayadev and Shuttleworth Foundation fellow Achal Prabhala talk to Rob Johnson about the global need for access to affordable pharmaceuticals, especially in India and the rest of the developing world.


Rob Johnson:

I’m here today with Arjun Jayadev, who, I’m pleased to say, is a senior economist at INET and a professor of economics at the Azim Premji University in Bangalore, India. We’re also here with Achal Prabhala, who is a fellow at the Shuttleworth Foundation and the head of the Axis IBSA Project there in India. Thank you both, gentlemen, I’ve read your articles in Mint, Live Mint, I’ve read your articles in the Project Syndicate. I feel like you’re dealing with very, very important problems, and my audience and I are very, very curious about your insights regarding India. You’re both based in India, and I thank you for joining us. We need to shed light on all the places that are important in the world.

Arjun Jayadev:

Thank you, Rob.

Achal Prabhala:

Thank you, Rob.

Rob Johnson:

So here we are at the end of May, 28th of May. We have this global pandemic. It is hard to be jovial or humorous about such a thing, but I do make the joke that precisely at the time that all humans are asked to wear a mask, we are unmasking the flaws in the economic and social organization paradigm that we’ve lived by for the last 40 years. How do each of you experience this violent and dreadful tragedy, and what do you see? What do see that is being down well, that gives you encouragement, what do you see as missing that you would recommend? What creates fear within your spirit when you see dreadful things taking place?

I’ll ask each of you, let’s start with Arjun. How do you see the pandemic and the challenge that it presents?

Arjun Jayadev:

Thanks, Rob. I like the phrasing “unmasking of the paradigms that we’ve lived in.” They say that this particular virus exposes the weaknesses that already exist in the human body, but that’s true as much of the body politic. I think across the world, we’re seeing tearing along familiar fault lines. My experience in India has been that this has really exposed some of the really horrendous fault lines that we’ve seen in India. Specifically, on the way that we have dual tracks of life and death in this country.

I suppose this is the case all over the world, but the way that we have, our responses and our general sense of responsibility, civic duty, seem to be completely divergent in the pandemic by virtue of making sure that everybody under threat has exposed, really, this underbelly. So just for example, we’re now in India in the 68th day of lockdown, and we’ve seen possibly the most horrendous internal migration that has been there since we had Partition. Day after day, we see horror stories about people having to walk home, and walk home meaning 1,200 kilometers, they get in trains, trains get lost. It’s both a huge amount of malevolence and incompetence when it comes to the poor. The rich are hiding for the moment, and we can’t hide very much longer, so we’re going to see that play out in the next few weeks and months.

So I think that there are many, many things that we can explore for further, but just by way of putting the broad canvas, I think it has exposed this dual track, and our response thus far has not been promising with respect to handling this in a collective way, which really, we have to be.

Rob Johnson:

Achal, how abour yourself? How do you see what’s on the horizon? Where do we have to address things, and where are we lacking?

Achal Prabhala:

Thank you, Rob. Much like Arjun, I live in India, we both live in Bangalore in south India, which is relatively prosperous city with relatively young demographic. The thing that’s been possibly the most heartbreaking in the last three months has been to see not, unfortunately, what’s happening directly around the coronavirus pandemic, but to see the thousands, hundreds of thousands of people who have no safety net whatsoever, who are completely at the mercy of a daily wage, who are being denied that daily wage, who are being denied food, who are being denied basic shelter in the places that they work in, making these treks back home, starving along the way, some of them dying along the way.

It’s impossible to watch without bursting into tears. It is a horrendous tragedy, and what it underscores is the callousness of the Indian state. We do have welfare programs; the BJP, the party that’s in power in India, despite being a politically right-wing party, cannot undo the welfare schemes that were put in place prior to their rule. We have a few, not enough, welfare schemes in place around basic employment, around food security. Very few of those are accessible to migrant workers when they’re away from their villages, their homes, their states. And it has exposed the absurd callousness by which the Indian state machinery creates people who are literally at the bottom of the economic ladder in this country. And I think that’s been extremely hard to watch.

But what’s also been hard to watch is how the BJP and the ruling party has brought every pre-existing prejudice that it has had over the last several decades of its existence, somehow into the pandemic. Very early on in the pandemic, the BJP targeted a group of Muslims scholars who met in Delhi and identified and then shamed them publicly as being somehow … as somehow creating a super-spreader event for COVID-19. And that quickly turned into the country’s pre-existing prejudices and turned those prejudices on, which meant that in the first few weeks of our response to the pandemic, the country was mainly interested in blaming a very small group of Muslim scholars who were among several other people who had been inadvertently caught up in the mass chaos that the pandemic response created.

And so I’m almost stupefied, but almost admiring of how the BJP has managed to bring every fault of its from the past few decades into the pandemic, completely distracting us from the essential work that needs to be done, not just to crest the wave of the coronavirus, but to address all of the underlying problems that it’s exposed in the way that we treat the most vulnerable people in this country. So it’s been difficult to watch.

Rob Johnson:

Wow. Arjun, the two of you wrote an article recently about what you might call the … the “dilemmas” might be a nice way of saying it, but potential damage of allowing intellectual property right in the pharmaceutical industry to prevent a broad-based response to the pandemic providing vaccines and other medicines. You compare that to the flu vaccine and to Jonas Salk. Describe to me, and to our audience, what is it that you are seeing as what you might call the failing of the current system?

Arjun Jayadev:

Thanks, Rob. Yes, so just as background to this, Achal and I have known each other for decades, and we went our own separate ways and did many things; I did economics, Achal did law. Many years ago, we came back and found we had a common interest in trying to understand how we should think about this intellectual property system, specifically with regard to the question of medicine. We’ve been working on it on and off ever since … sometimes with Joe Stiglitz, who is my post-doc advisor.

By way of background, I think it’s important to understand that the intellectual property regime is not a natural, God-given thing, but something that is created explicitly in the last 20-30 years in order to push particular advantages that richer countries have, specifically within the pharmaceutical industry. It’s been an extremely destructive system globally, in terms purely of lives, but also in terms of destroying countries’ indigenous capacity to respond to public health emergencies and so on.

India has a particular interesting history in all of this, because India, in 1970, actually banned any intellectual property rights in medicines. And as a result, we had an indigenous industry of generic medicines, which has its own quite incredible history. Because of the country’s generic industry, southern African countries and South Africa in particular, and actually, we’ll probably have a lot more to say about this, was able to benefit from much lower prices. So we’ve been spending a lot of time on this.

But stepping back a bit, Rob, I think the really interesting thing is that throughout the history of public health and medicine, there have been many, many innovations and many, many things that people have done without the requirement for and use of intellectual property. Of course, the classic example is Jonas Salk, but there have been many, many things that people have done which have been supported publicly, through things like the National Chief of Health or through universities, which have then been taken up by private companies and been … the knowledge commons have therefore been enclosed. And this has become an extremely destructive system globally.

So we’ve been writing many, many responses to this, including what you can do differently. We’re not, of course, the only ones; there have been many thoughts around this: advanced market commitments, rises over patents, making clinical trials publicly funded, for example, Dean Baker has written a lot about these kind of things. But I think what is interesting for us as economists and lawyers is that we have all these interesting ways in which people are actually doing innovative things which does not involve patents and intellectual property rights, and that we ought to be supporting these kind of endeavors far more than we are. And that was the motivation for writing [inaudible 00:12:46]. Achal may have something more to say about that.

Rob Johnson:

Sure, Achal?

Achal Prabhala:

Yeah, certainly I do. Look, I’ve worked as an activist now for about 18 years, and I’ve been working on access to medicine since then. I began getting interested in it at exactly the time that the AIDS crisis in the developing world spurred and actually created the access to medicines movement. At the turn of the century, or the millennium, there was the confluence of two things that created both tragic circumstances as well as wonderful activism that has had far-reaching effects into the present day, which was the creation of the WTO in the late 1990s, and a certain formalization of global intellectual property rights that were tied to the trade regime and trading rules, and therefore given a set of teeth that bit much harder than they’d ever done before.

But that confluence consisted of two things: not just the globalization of trade, but also the emergence of countries in sub-Saharan Africa, South Africa, for instance, especially South Africa, as being the global centers of the HIV/AIDS epidemic. We thought of that as being something that was restricted to Europe and North America in the 1980s because of what we heard, but by the 1990s, it had shifted to countries that were far poorer.

What they found is they were in an acute crisis of affordability, this was a very strange situation. There were cures, in the sense that there were drugs to treat HIV/AIDS, to turn it from a death sentence into a chronic condition like diabetes, so something unremarkable. From being the cause of so much hysteria, HIV and AIDS has suddenly become, had the potential to become something unremarkable. Except that it couldn’t quite be that way in South Africa because the drugs cost $10,000 a year at the time, and for poor countries with per capita incomes that were seven times lower than that, it was obviously unaffordable, either for individuals or for the state to do anything with that solution.

And this seemed particularly unjust and a particularly cruel metaphor for a kind of emerging neo-liberal economics at that time, that you had a cure, you simply couldn’t afford it. And that’s how I started off doing this work. The AIDS activists of the time, by the way, did really create the template that then worked to solve access to medicines across a range of diseases, from cancer to hepatitis C. It moved from being a third-world activist cause into becoming a first-world concern. I worked on a campaign in the U.K. to gain access to drugs for cystic fibrosis. During the Democratic primary campaign, there was not a day that went by when Bernie Sanders or Elizabeth Warren did not talk about measures to rein in drug pricing.

And all of that, actually, the template for this activism and the spotlight on these unjustified and frequently just outrightly unjust private monopolies that pharmaceutical companies held on life-saving medicines, the template for that activism really did come from South Africa in the early aughts.

I think one of the things that’s been welcome for me in the coronavirus pandemic is that, in the past, we used to think of access as an afterthought. The focus was always on getting a drug, a cure, a treatment or a vaccine out. And then the idea was, let’s think about how to get access to this vaccine for poor people.

Let’s think about how to get access to this vaccine for poor people. So with AIDS drugs, it took 10 years after the AIDS drugs were developed for them to reach the places that they were needed the most. We have cases with vaccines, such as the pneumococcal conjugate vaccine, which is a very effective vaccine against pneumonia, which has seemingly taking an infinite bank to get to India because we simply can’t afford it even today. And so there are 127,000 deaths a year from a lack of vaccination to this completely preventable disease.

So what’s happening in this pandemic is that many of the people who are thinking about this, both at the WHO and elsewhere, activists such as myself are thinking about this together. We’re thinking about developing treatments and vaccines, as well as how to have access to them at the same time. And it’s for a couple of reasons. I think one, this is universal in a way that AIDS was not, or that pneumonia is not, or that another major public health problem like tuberculosis is not. And it’s forcing us to understand that the health of each of us is directly connected to the health of all of us and access therefore, is an integral part of the solution.

Even a nationalist solution necessarily needs to build in global access to whatever cures that emerge for COVID-19 in order for it to work and so that’s a welcome change. I think that what we’re trying to do now is to see how we can effectively apply the lessons from 40 years of human history, lessons that were hard and tragic, battles that were hard fought and won on the bodies of people who succumbed to these diseases, how we can apply those lessons in a way where we don’t treat this as an anomaly.

I think that there is a danger in treating the coronavirus pandemic as an anomaly to which the response is also an anomaly. After which, we then go back to doing things as usual. And I think that to the extent that I think there are two problems here. I think that the first problem is in terms of our access to medicines and vaccines, to be able to carve out an effective solution to exit this pandemic wherever they emerge. But I think that the second problem here is to not treat this situation as anomalous and to treat it as a part of a historical continuum, which we must learn from, in order to change some of the structures we have to respond to pandemics like this, so that we can have a different future rather than the same old past.

Rob Johnson:

Yeah. Yeah. Well, I think you guys have made a very clear argument and it’s fascinating. Achal, you work in South Africa, India and Brazil from my understanding, is that right?

Achal Prabhala:

I do. Yes, that’s right. I work in all three countries. Yes.

Rob Johnson:

And in Brazil, my closest friend from my graduate school years and an INET board member is Arminio Fraga, the former central bank governor. And the sense that I get from he and his family members is that things are very, very dire in Brazil right now that this is a very, very daunting challenge to the fabric of their social organization.

Achal Prabhala:

I think that Brazil has had a compounded tragedy upon tragedy over the last couple of years. They’ve had a very, very contested and difficult election. They had a whole series of austerity measures even prior to the election that hobbled the state’s ability to respond to poverty and inequality in the country, which were … I do think, however one evaluates the reign of the workers’ party, the key focus of more than a decade, from the late 1990s until 2013 or 14. And I think that this particular crisis, I’ve been writing a little bit around the Brazilian response to the coronavirus pandemic and I work with several colleagues there. I think that the human tragedy of this is unfolding in ways that we don’t even understand.

When I was working on a couple of pieces about two and a half weeks ago, the death toll stood at 5,000 people. And today, just in that very short space of time, since we wrote the piece, the death tone is over 25,000. The number of doctors, in fact, it is going up the number of medical personnel infected and moderately infected with the coronavirus is going up. The social fabric of the country is being torn apart, not in the least by the destructive encouragement of Jair Bolsonaro, the President of Brazil.

For Brazilians to simply somehow ignore this pandemic and to let it pass and to continue to indulge in his favorite pastime, which he sees as being key to his survival, which is economic activity to keep the economy going at the cost of our … Now it seems clearly, thousands and thousands of lives. So I think that the tragedy is go to unfold in ways that we don’t even understand. But I want to point out in the context of Brazil, something that I think people don’t fully understand is that the classification of the country as a middle income, as an upper middle income country, in fact has hurt it immeasurably.

And you look at the economic demographics of Brazil. Brazil is a country with a majority of poor people and a minority of rich people. And the truth is that for all kinds of purposes of charity and concessions made by pharmaceutical companies around the world, it’s middle income countries, those countries that are unfortunately rife with income inequality, typically Latin American countries, some countries in the former Soviet Union, north African countries, that are in the worst position possible. So if I may, there’s an example with one of the first treatments that was approved by the US Food and Drug Administration to treat the coronavirus pandemic, which is, I think an illustrative example of how access initiatives failed and particularly fail countries like Brazil.

So Remdesivir is an antiviral drug that was approved by the USFDA. It’s not a hugely important drug in itself, but it’s a drug that holds potential for further research, as well as for use in combination with other drugs and so there are multiple trials along the way. Remdesivir is the monopoly property of Gilead Pharmaceutical, multinational giant, which has several patents in force for the next 20 years. Gilead announced an access agreement. They signed deals with five Indian companies to produce the drug and export it to 127 of the poorest countries in the world. And that got a lot of press.

What didn’t get a lot of press is that Gilead excludes about half the world or 4 billion people from its access agreement, every rich country and every middle income country. So there’s not a single country in Latin America that can get access to this drug at a discounted price. The Brazilian health system, which is trained, which has had its budgets frozen, effectively for the last five or six years, has to face a bill of $4,500 for a 10 day course of Remdesivir when, and should they want to use this. While Gilead itself, without having sold yet a single pill, a single vial of Remdesivir has seen its market capitalization increased by several billions of dollars in the last two months. While at the same time, donating its entire stockpile of Remdesivir to the US government for use in the pandemic for free, right? So it’s allowed the poorest countries in the world to make it with zero royalty. It is donating its stockpiles of Remdesivir to the richest country in the world for absolutely nothing and it’s charging an absurd price to every single country in between.

Rob Johnson:

What a mess. And how would I say, those who choose to deify the marketplace had better start asking questions with outcomes like that. That’s just not humanly justified in any way, shape or form. Let me shift the focus now. You both live in India and let’s talk about, when I imagine a place like America using its fiscal capacity or Great Britain, there’s just a tremendous, you might call, possibility or capability to respond to a disaster. In a place like India, where you have high incidents of many diseases before and unrelated to the Coronavirus, and you have lots of poverty and you’re at a different stage of development. The question I ask is, how can you mobilize the resources? How can you devote the resources? How can you acquire the resources to embrace this challenge, given its severity and what is warranted for the humanity of India?

Arjun Jayadev:

So, Rob, I think this is a great question, just to link up to what we had spoken about before. I think it’s an interesting thing that the three, maybe outstanding authoritarian, I think there’s Trump, Bolsonaro, and Modi have all been found wanting, with respect to responses. And I’d like to say a little bit about India’s overall response on the fiscal front. Really, what we’ve seen in India is just a complete inadequacy of responses by the central government. And it extends quite extensively for the fiscal response.

About two weeks ago, Modi was on television with one of his 8:00 PM addresses, which of course fills most of us with fear because we have no idea what’s going to happen. And he announced, quite grandiosely, that India was going to undertake a 10% of GDP stimulus. And everyone was pleased because clearly India has been going through very bad year, even prior to the pandemic and the pandemic wiping out about $5 billion a day of activity. We don’t have a social safety net, et cetera, so people are excited about this 10% of GDP figure. And then the next day or two, when the details came out, it became clear that this was nothing of before, that in fact, they were counting all kinds of things like the central bank support, contingent liability support that had already been promised earlier. The support that was promised to the farmers as well was part of this supposed new package.

And when it came down to finally, where the amounts that were actually been pledged, it was things like maybe somewhere between 0.7 to 1% of GDP. So there was a clear inadequacy and lack of capacity to think creatively on government. Having said that, there is the genuine question, do you have resources that we can count on? There’s two or three things that India does have, which it’s not really using.

I wrote a piece on how India can finance some of its required fiscal stimulus. So obviously, we are going to have to think of some level of monetization of the deficit, and that has been something that has been taboo. But I think increasingly, we’re going to have to just face up to that. There are particular sorts of simple things that we ought to be doing. Cutting interest rates now will mean that our debt to GDP ratios are much more stable in the medium term. And while it’s happened, it’s happened very inadequately at the moment.

Then there are very simple things. There are many ways in which the government, should they have had the capacity and the bureaucratic capacity, to quite easily shift a certain percentage of GDP into this essential activity that we need, but we have not been able to pull that off. And so it really is striking as to how the safe governments are now being needed to reform. Some of them have better capacity and are able to respond, both in the resource front and really on the administrative front where others are not. So overall, it is a mess, but it’s a mess of governance as much as it is a mess with actually capacity.

Rob Johnson:

And Achal, how do you, how do you feel, what you might call, we’re in a globalized world and things are organized as a nation state. How do you see whether it’s related to issues of climate or multi-lateral engagement, the development of India in relation to the disease, in relation to the needs, and what you might call the retrenchment of a multiple multilateral concern? How does, how does India fare in this context?

Achal Prabhala:

So I think that there’s a lot there. And so perhaps we can start by, maybe I can unpack that by starting with what I think are the contradictions of India as coronavirus pandemic response. When we think of countries in Europe, especially with well functioning, well funded health systems, with what I would describe only as an overall stability. I think that it’s a fragile stability because I’ve been working recently on cases where many rich country governments, like the UK’s NHS for instance, cannot afford some of the new drugs that are coming to market around cancers and diseases like cystic fibrosis.

So it’s a fragile and not quite, not quite certain stability, but there is evidence that there’s a well functioning system that by and large, takes care of the public health needs of its population. We don’t have that in India. And I think that one of the most tragic contradictions of India’s outsize response to the coronavirus pandemic is the question that Arjun and I tried to ask in our article for Mint which is a major financial newspaper in the country, which is how-

… which is a major financial newspaper in the country, which is how is it that we have been able to sit on, completely overlook, and accept what really is an unacceptable rate of completely preventable deaths. We’re talking about 1500 children a day in infant mortality due to a lack of vaccinations. We’re talking about 1200 people a day who die due to tuberculosis. We’re talking about the millions, literally this number is in the millions, who die as a result of complications, usually respiratory, connected to the disastrous apocalyptic air quality in many parts of this country. Arjun and I are lucky to live in a city, Bangalore, which actually does not have the same kind of industrial base or the farming base and therefore not the same kind of horrendous air quality that many parts of northern India get.

But we’re never the less affected by it and we see it affecting our country long before the coronavirus pandemic. And so one of the contradictions has been a simple statistic, which is that more people die in one day of tuberculosis and the lack of vaccinations than have died in the last three months due to the coronavirus pandemic. And yet we haven’t done anything close to that. We’ve spent up, or lost, up to $5 billion a day in our lockdown due to decreased economic activity. We’ve spent an enormous amount of money coordinating very, very complex state and federal institutions to enforce and maintain this lockdown. And we’ve done all of that for a pandemic which, I think, we are responding to primarily because it affects the rich.

Now this is not an argument for us not to respond to the pandemic. And I think we wanted to be clear about what we were trying to say as well. I think we support the government’s response to the pandemic. We don’t support the abject lack of planning that left millions of people destitute and dead as a result of it. But we support the effort that is being made in this pandemic. We just want to very clearly point out the glaring contradictions in this response. And in terms of motivation, we are hard pressed to think of any reason other than that tuberculosis, bad air quality, these are things that primarily kill poor people. Of course rich people are affected by air quality as well, but the way they’re affected is that they have to cut short their evening walks in the park while wearing N95 masks and go back to their homes that are powered by very, very expensive air conditioners and air purifiers, of which there is a booming market in this country.

Tuberculosis is an infectious disease. It very rarely affects rich because rich people don’t live around people who have TB. The way that TB has played out in the world over the last few decades is that it has been completely eradicated in many western countries, as a result of which many parts of Europe and the United States, you don’t even take the vaccines against TB that we take. The BCG vaccine. We continue to take the vaccine here, but the way it works in India is that between the rich and the poor, it’s like the difference between Switzerland and a much poorer country in terms of how TB affects us. It’s a huge part of the life of the modern Indian state, life and death from TB. And it’s no part of the life of rich people within this country. And as a result of which it’s also almost no part of our fiscal response, our investment in curing and solving this disease. So that is a glaring contradiction.

At the same time I think we can effectively use what’s happening in the coronavirus pandemic to address those issues because they do form a part of the broader vulnerability that will make the pandemic worse in general. And it’s part of a larger group of health factors that I think could possibly get some attention now, given that we are now paying attention to public health, for whatever reason, even the fact that it’s rich people who are involved and vulnerable in this situation. So that, I think, to me, is the most important way in which we can use the pandemic to pay attention to the product issue that the pandemic addresses, which is public health in India and other poor countries with similar situations. Because we’re not the only country where people are dying of diseases that can be cured, that we can invest in cures for, at much higher rates than the coronavirus pandemic.

And so I think that this applies not just to us, but to many, many parts of Asia, Africa and some parts of Latin America. I have a friend and a colleague called Astra Taylor, who was talking about this in relation to the unmasking of the paradigm that you were talking about right at the outset of this conversation. And she had a typically wise and witty thing to say, which is, there are so many rules we see being dismantled or ignored in order to combat and exit from the pandemic. And it does make you wonder as to what those rules were for when they were there. If we have to ignore them in order to exit the pandemic, why did we need them in the first place? And, for me, I think the most important way in which that witticism manifests itself here is in terms of intellectual property. Later today I’m going to be part of a WHO event to formally launch a WHO COVID-19 technology pool for, not just treatments and vaccines, but also diagnostics.

Because again, since this is a new coronavirus, even things like testing kits and protective equipment come with intellectual property monopolies around them. Every pharmaceutical company CEO opposes this, but is having a hard time saying that publicly because suddenly now it’s not poor people in India are saying we need access to medicines. It’s not poor people in a township outside Johannesburg who are asking for access to medicines. It’s all those who need access to medicines. It’s the British cabinet, it’s the leaderships of countries like Spain and Canada and so on. There’s very, very rich, I just have to say, rich white people are really affected by the coronavirus pandemic and care just as much about access to medicines and treatments as the poor people who were asking for it 20 years ago were in India and South Africa.

And so pharmaceutical companies can’t be as callous as they were. So all of them are now saying we’re not go to profit off this pandemic. Ignoring the fact that they have actually already profited off this pandemic. There was a lot of attention paid to the increase in market capitalization of digital service firms, including Amazon and many of the media companies. I think less attention has been paid to the ways in which the only other industry that’s genuinely come out of this better is the pharmaceutical industry, which has seen overall an enormous rise in market capitalization when you take the top six or eight companies. So despite the fact that they’d already profited off the pandemic, they’re all saying that they’re not going to.

At the same time, none of them have formally announced any renunciation of the very strictly enforced intellectual property monopolies that they wield. They oppose the WHO COVID-19 technology pool, which would be a place where all monopoly ownership of anything that can get us out of this pandemic will be pooled in order that pretty much anyone can then make those things. Whether it’s a vaccine or a drug or a test kit. Now it is really astonishing and I think that somebody should talk to them publicly and more seriously about this to be able to put them to the test, because either you’re profiting from this or you’re not. And if you’re profiting from this, then you should face the consequences of it. And if you’re not profiting from it, we should have a formal arrangement by which you can say so.

And if we’re not going to be enforcing intellectual property monopolies in a pandemic as a necessary precondition to exit the pandemic, then I would love to know why we have to enforce those monopolies in order to do everything else we do, which is survive cancer, which is survive hepatitis C, which is survive cystic fibrosis, survive tuberculosis, or any other disease that we die off.

Rob Johnson:

Yeah, yeah. It’s almost as if, Arjun you correct me if I get the economics wrong, but the inelasticity of demand of a person who is ill allows predators to exploit. And we just can’t have a system like this. There something, how would I say, more important than the inspiration for profit at stake here. And I sense everybody feels it across the whole spectrum of health challenges and other things that are of essence. Let me turn now, many of the guests who have been on this podcast talk about climate as the thing that was haunting before the pandemic and, fingers cross, after the vaccine and the other potential mitigating influences and remedies have been created, on the horizon, in a 10 to 15 year horizon, not much longer, there’s a long gestation transformation of the very structure of energy so that mankind can survive.

And the reason I bring that to the table with the two of you is, first, there’s quite a division among my guests between whether the climate initiative, which was gathering momentum prior to the pandemic, will be spurred on by, what we’ve called tonight, the unmasking. Or will it be, what you might call, diminished in intensity because we’ve used fiscal capacity at a very large level to fight the pandemic, because global cooperation is breaking down, particularly between the United States and China, and because people are exhausted and the idea of a large transformation is daunting and maybe they want to be quiet for a while before they embrace the next challenge.

On the other side of that, what you might call a macro Keynesian, might see a national and global program of energy transformation as a new source of aggregate demand and recovery and employment. And so I don’t know how you see this, but one thing I do know is every climate expert or leader that I have interviewed feels that the fulcrum of what will matter is how the intersection between development of India, given the scale of the size of the country, and transformation of energy in India, at the margin they consider that the most important project, and obviously given the level of development in India, it’s a very, very, very hard thing to imagine them doing the public good for the world on their own, without multilateral assistance. So with all of that context, how do you see the horizon? These are the energy transformation addressing climate in the country of India. Arjun, why don’t you start?

Arjun Jayadev:

Sure. So Rob, it’s an interesting thing. We’ve had the plague, if you will, the pandemic. Last week we had a cyclone that came in through and really one of the most powerful cyclones we’ve had, flooded and destroyed one of India’s major cities, Calcutta. And now we have locusts which are coming in from Africa. So these are the so called biblical plagues, the locust, flood plagues. And in some ways maybe, as someone said, they’re just symptoms of ecosystem collapse. We just keep repeating these as some sort of collective memory of last warning cries of some sort of collapsing civilization. Sometimes I think that all of these come together as one agent, this is what people have been worried about. So with India in this context, in the context of climate change, obviously there are two competing camp.

One which says that, I think rightly and justly, India should not be made to pay for fact that the carbon bank has been thieved and taken away by the west and maybe China to an extent. And there is, of course, the other camp, which is also right which says that any sort of development plan cannot be innocent of climate change. And in India, we know that there is absolutely no way that development plans can ignore climate change. And therefore, I think there is a concerted effort among scientists and so on to think of different ways of doing this, which of course will mean technological transfers, a different sort of financing and so on.

I’d like to say a little bit though about the whole question about the financing of this transition and the worry about this full capacity. It’s true that we will have spent money on the pandemic, but I don’t see the number itself, let’s say debt to GDP ratios grow by 20%, 50%. And I’m not sure exactly what the number is. What is the main concern that people have? I think the main concern that people have is that it will, in some way, use up the real resources that we have and create inflation. A friend one said this, better the economy run hot than the planet. And I feel like that is true. That we have to try to make sure that all our resources are maximized. At the current moment I don’t see that to be a problem post the pandemic of resource unavailability. Real resource unavailability. There are going to be people who are unemployed. There are going to be people and systems which have to be rethought. And so I actually see it as an opportunity globally, and of course as well as in India, to rethink our ways. So you said your guests have two competing views, the view that this is actually an opportunity to think creatively and effectively about the climate, which must happen if we’re going to survive as a species.

Rob Johnson:

Achal, how do you see this challenge?

Achal Prabhala:

I would say similarly to Arjun, but with some conditions attached. And let me just explain what I mean. I have been a public health activist, and I think that there are some ways in which, in a country like India, even despite the global conversation around climate change, it can seem like a both distant thing, and a thing that is far away in the future.

For me, I think that there’s a way in which we have dire immediate effects of energy consumption that are costing human lives. And I think that air pollution is one of the most vivid examples of how that’s affecting us.

I think the condition that I was going to talk about was to be able to cast efforts at future climate change prevention and containment, to cast that conversation as a question of saving human life. But not in the future, but in the present. One of the consequences of countries like China and India, deciding that they must do their own bit around carbon depletion to catch up with three or four centuries of work in the richer countries in the world, has been the fact that it is, certainly while helping their economies grow, has been costing enormous human lives within these countries as well. And I think that we don’t pay enough attention to that fact. We don’t publicize or examine the number of millions of people in India that are being mostly affected by our energy consumption.

And I think that a very, very good way to start, without necessarily even using the term climate change, would be a public health authority that is designated to save human lives in India, that come at the cost of air pollution and bad air quality in the country. The recognitions that we can design it on that, the rules that we could put in place to combat that, whether it’s incentivizing electric vehicles, whether it’s creating massive new investments and infrastructure for public transport would go a long way in terms of our larger, longer fight against climate change.

But I do think that casting these plans, I think for it to be politically feasible either for the government or even expedient for any government, this one, or even a more left leaning one to undertake, I think to use the cost in immediate human lives in the present day as the best justification to start implementing these programs is a really good one. It would make sense at every level possible. And it’s one that I’d support enormously, and I think would make sense to every voter in this country. And I’m surprised that we haven’t started implementing programs that use human life as a basis to address climate change.

Rob Johnson:

Yeah. Well, what do you see in the world … You look at this tension between the United States and China, and our capacity for having a collaborative global system is, how we say, it appears to me to be at risk. But I know that in India’s relationship with China, there are some other complexities. And I’m curious how you see the prospects for India in light of the breakdown of the relationship between the United States and China. Do either of you see, how would I say, a dreadful scenario that relates to that? Or is that not such a concern for people in India?

Achal Prabhala:

I could start with perhaps at the very moment, India and China are engaged in a territorial standoff. So in the middle of the coronavirus pandemic, Indian soldiers and Chinese soldiers are beating each other up and shooting at each other in one remote corner of India over contested territory. There’s a long standing territorial dispute, which is just too slow burning to even care about. But they’re in the middle of doing that right now.

Indian media is awash with what I can only term as completely delusional articles, which suggest somehow that the Indian government is going to turn India into a manufacturing base that will take advantage of the United States and the world’s anger against China, and its perceived inability to manufacture now because of the coronavirus pandemic, which is complete nonsense and has been described as such, I think, by anyone with a working mind.

I think that the larger question of multilateral cooperation that you brought up, Rob, I think is very important. The piece that Arjun and Joe and I wrote together in a project syndicate talks about the flu shot that we all take. So this is the shot that Americans take every year, that not as many Indians take every year, but it’s available to us to take every year. The newest version of that vaccine is called a quadrivalent vaccine. So it targets, I think, four different strains of the influenza virus.

That shot, that is manufactured by hundreds of companies around the world, because there’s no monopoly on it, is produced through collaborative research that takes place every day through national monitoring laboratories in 110 countries around the world. And it’s based out of a center, a very little known center at the WHO. It’s called the GISRS, the Global Influenza Surveillance and Response System in the WHO.

So what they do is they monitor all these flu strains. And then twice a year at the opening of the flu season in the Northern hemisphere and in the Southern hemisphere, they issue recommendations as to what strains should be included in that year’s flu shot. And obviously the flu shot, as we know, is not something that eliminates your susceptibility to influenza. It merely reduces it by a substantial extent, to the extent that it is recommended by health systems almost everywhere in the world.

So what the WHO does is that it uses international cooperation, a vast network of international cooperation to analyze on an ongoing basis of flu data, and uses that to create an open source formula that anyone can apply and produce. Now, no country government is bound to follow the WHO’s recommendations, but invariably, every one of them does, including the Center for Disease Control in the United States.

This is the model of multilateral cooperation that we have had. And incidentally, one other curious factor about the flu vaccine is that, of course, the very first strains of the flu vaccine were developed by the very same Jonas Salk, who gave us the polio vaccine, and who of course memorably said to Ed Morrow in an interview when asked why he didn’t patent it and have a monopoly on the polio vaccine said, “I never thought of it. It was a people’s vaccine. Can you patent the sun?” Which brings a tear to my eye, even after all these years.

So the model of multilateral cooperation, it’s not even a fantasy that we have to imagine. And I think that’s the point we were trying to make in that piece. This is how one important part of the world already works. This is how it has worked since 1973, in fact, right? And it has done a lot of good in the world. It works. There’s a system in place to do it. We could replicate that and build on that, use that as a model for not just flu vaccines, but for pretty much every other form of disease research and development that the world needs. We don’t actually need to follow the model where every aspect of research is then divested with no responsibility to a private corporation to bring to market.

So we have a system in the world that works. It’s an important multilateral system. It has to work. And to the extent that the coronavirus pandemic increases multilateral cooperation, despite the United States’ recalcitrance to do so, I think that could be one of the best outcomes of this. Not only the fact that each of us is individually interconnected in terms of our health affecting the other, but the fact that the more that countries cooperate in this interdependence and in this mutual feeling of solidarity, the better results we will come to, whether it’s containing a pandemic or curing it.

Rob Johnson:

Arjun, any thought?

Arjun Jayadev:

You know, the question about where India will be with respect to the global changes that are going on, yes, it is interesting India’s relationship with China has always been fraught since the sixties, at least. And it’s seen itself as a rival, though it’s never a really, I think, measured up to that in the economics here.

It’s hard to say, Rob. This is a world in which I think we are certainly seeing a move to greater nationalism, and a certain belief that the nation state has to be strengthened, and that you see across the world. So you have these contradictory impulses. We do understand that the world requires global cooperation. Many of the responses have been very national and nationalistic, India. The new word that is being bandied about is self-reliant in India, which is of course hearkening back to 30, 40, 50 years ago.

So it’s hard to say where India will end up in all of this, whether at the end of 16, 18 months, we’ll actually try to be much more reliant on our own supply chains, or whether we’ll return to the earlier world with respect to gaining manufacturing.

So I wish I had more clarity on this, but I do think that’s an axis in which a lot will depend on the way we go forward. And my hope, as I have evidenced in that article with Achal and Joe, is that we actually think of the good parts about global integration and try to promote those as opposed to going back to nationalism, which is narrow, inefficient, and probably Indian self-destruction.

Rob Johnson:

Okay. Well, I want to thank you both. We’ve explored a lot of terrain in the issue space. Your deep dives in the realm of healthcare in the systems that we’ve created, incentives or disincentives to the protection of health in the context of India are all very important dimensions for those affiliated and interested in an institute for new economic thinking, to understand and to explore.

I hope that both of you will come back and see me again in a few months time, because I think this is a work in progress. I think you are both quite a bit ahead of the curve. But there’ll be new stimulants. There’ll be new turns in the road. And I guess for right now, I want to thank you for steering our minds tonight, but I do hope to see you again soon.

Achal Prabhala:

Thank you Rob.

Arjun Jayadev:

Thank you very much, Rob, and thanks for everything.

Rob Johnson:

Thank you. We’ll be in touch and we’ll be back together before too much time passes. Good night.

Achal Prabhala:

It was a pleasure.

About the Host

ROB JOHNSON serves as President of the Institute for New Economic Thinking.

Johnson is an international investor and consultant to investment funds on issues of portfolio strategy. He recently served on the United Nations Commission of Experts on International Monetary Reform under the Chairmanship of Joseph Stiglitz.


About the Guests

ARJUN JAYADEV is Professor of Economics at Azim Premji University. He works on issues of Macroeconomics, Finance and Distribution. His research has appeared in several leading journals as well as in popular outlets. He is also a consultant to the Institute for New Economic Thinking where he is deputy director of the Political Economy of Distribution Program and helps oversee the partnership between Azim Premji University and INET.

ACHAL PRABHALA is a fellow at the Shuttleworth Foundation and coordinator of the accessibsa project, which campaigns for access to medicines in India, Brazil, and South Africa.