Quick Take: Challenges of vaccine production & distribution

Ian Bremmer's Quick Take:

Hi, everybody. Ian Bremmer here, back in the office in New York City. And I've got my Christmas scarf going, it feels... It's the time of the holidays, get your trees, decorate, right? I usually have a little tree trimming party, which means everybody else comes and trims the tree with me. Not this year, but nonetheless, soon to be, Merry Christmas to everybody and lots to talk about.

I guess, biggest thing on my mind right now is the rollout of these vaccines. I mean, on the one hand it's I know it's challenging the push and pull of the United States right now being in the teeth of the worst of the pandemic in terms of cases, in terms of hospitalizations, and even now in terms of deaths. And that's with mortality rates significantly lower than they were six months ago, but the case level has been so explosive that the death rates are still higher than they were at the earlier peak back in the spring. And given where hospitalizations now are and given where cases are certainly going to be, those numbers are going to keep going up. So, on the one hand we're looking at maybe half a million total dead by the time we get to end of January, February, and the next couple of months are going to be really, really hard.

On the other hand, we are now also looking at people getting vaccinated, we're looking at real solutions. And those solutions come first and foremost to the people that are by far the most vulnerable. Now, usually you would be focused on how quickly can everybody get this vaccine, but I do think it's important because this disease hits so much worse a relatively small piece of the population, the very old and those with serious pre-existing conditions, and particularly when those two groups collide. And those are precisely the people along with first responders and hospitals that are going to be getting the vaccines first.

So, I mean, irrespective of difficulties in rollout, irrespective in fake news around anti-vaxxer sentiment, we're going to see within two months a very, very significant reduction in the mortality rate of this disease, because the people that are most vulnerable are suddenly going to be vaccinated. And they'll only get some immunity immediately, they'll need to get that second course, the booster shot, which gets them up to 95% and that takes a few weeks after the first shot, but still, that's a very positive outcome.

Having said that, in terms of getting the country and getting the world back up and running there is an enormous degree of uncertainty around what happens next year on how quickly we're going to be able to roll out the vaccine. I just saw from Secretary of Health and Human Services, Azar, an expectation that most people in the US are going to be able to be vaccinated by second quarter. I agree that that is possible, it is the best-case scenario, it is absolutely not something you want to do bet on right now, and there are a few reasons for it.

The first is that we have no idea how difficult it is going to be to produce and roll out this vaccine, these vaccines that we're using Pfizer and Moderna. These are the two that everyone in the US will want to take, they're the two that have the highest degree of efficiency. But they're also the two with the very difficult infrastructure requirements, the serious cold chain requirements, in the case of Pfizer, also a need to dilute the vaccine on site before it's given to patients and that requires specialized labor which is already stretched.

So you've got significant infrastructure needs. You're also talking about producing at massive scale vaccines using technologies that have never been produced before. I mean, Pfizer's produced a lot of vaccines, they've been around for a long, long time, they're a big, big pharmaceutical company, global pharmaceutical company, but no one's ever produced an mRNA vaccine before. Moderna has never produced anything before, they've been around for 10 years, this is their first commercial product. So I mean, everything has to go right to get it out there by April.

And when you hear people talking about side effects, some of those are I'm sure going to be exaggerated, some of those side effects we don't necessarily know at scale yet. I spoke with a friend of mine who's on the Coronavirus Task Force for Biden, he took both courses of the Moderna vaccine and after the booster shot, he was out for three days with a heavy fever and wasn't able to go to work. And I can imagine a lot of people thinking they take the first shot, and they say, "Ah, I didn't feel great after that first shot, I don't really need to take the second shot, nevermind." And then suddenly you don't have 95% effective effectiveness, you have 50 or 60% effectiveness and it's a radically different story in terms of getting the vaccines out there. Then there's also huge difference between if 80% of the people say they'll take it, and if only 60% do. And anti-vax sentiment in the United States is reasonably high and there's going to be massive disinformation that's going to be put out in an unprecedented polarization of social media in the United States right now.

I mean, when a majority of Republicans think the election was stolen, how many people are going to think that this vaccine is unsafe or that one of the vaccines is unsafe and then decide they want to take the other one, but it's not available for everybody. I mean, there are a lot of things that can go wrong, can go wrong around information, can go wrong around manufacturing, can go wrong around distribution.

And then you've got the global side of this, which is also really interesting. One of the things we don't know is how long your immunity lasts once you've taken both courses of these vaccines, is it six months to 12 months? Is it 18 months? We have no idea. The United States has ordered an enormous amount of these vaccines, and if we knew that the vaccines were going to last for a year or two years, there would be a significant willingness after the US produces to start exporting a lot of that vaccine to other countries. On the other hand, if you've got problems in your manufacturing, in your distribution and/or if there's real uncertainty around how long your immunity lasts, the United States and other countries are going to want to stockpile a lot more of the vaccine than they otherwise would, which means they're not going to be exporting it to other countries.

You know who will be exporting it to other countries? China. They're doing a lot of producing, their vaccine isn't as good, but it doesn't require the cold chain, just basic refrigeration. And also, they don't need a lot of vaccines for China itself, at least not near term, because they've got massive surveillance capabilities and quarantine capabilities, they can demand that of their population. They'll give it to the frontline workers, but most Chinese people don't necessarily need the vaccine if you've already hammered down the virus, right? I mean, it's like New Zealand, for example. It's like Australia today, for example. Which means China's going to be engaging and exporting all of these vaccines internationally, whether the US can or will is an uncertainty right now, that's a massive difference between those two countries and potentially leads to big, big conflict between the United States and China and the issue that is the most important next year, which is how are we doing on vaccines? It matters to getting our economies restarted, it matters to unemployment, it matters to growth, and it matters to geopolitics.

A lot of uncertainty here, we hope for the best-case scenario, it is a real scenario, it is plausible. I mean, the United States did a good job on the economics in 2020 until very recently, did a lousy job on the healthcare response to coronavirus in terms of masking and PPE and all of the rest. But so far has done a very good job, some of the world's best in terms of vaccine development. Now we have to see for 2021, how the United States is going to do on vaccine production and distribution, and as of right now, we don't know. That level of uncertainty is probably greater than any near-term issue I can imagine that we knew about it, but we just didn't know how well it was going to work, the impact that's going to have on so many factors in the US and globally is just massive, something we'll be paying an enormous attention to and rooting for quite a bit over the coming months.

So that's enough for me for now, hope you guys are well, stay safe and avoid people.

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