COVID-19: Follow the money

“Follow the money” is a frequently provided advice to those who are in search of a deeper understanding. When we follow the money in pandemic earnings models, we can obtain some relevant?insights into COVID policies.?

Comparing endemic and pandemic earnings models

In order to make things not too complex, let's say that in an endemic situation, health efforts and earnings models are predominantly geared towards keeping people healthy, maintaining or strengthening their natural immune systems. When disease strikes, most issues can be cured with proven, low-cost, generic medicines, with hardly any side-effects.?

From personal trainers, to dietitians, to vitamin and generic drug providers and beyond, the market for endemic health services consists of many competing suppliers, resulting in overall low(er) prices and low(er) margins.

In pandemic situations, health efforts and earning models are more geared towards combatting diseases. With pandemic dynamics, there are only a few suppliers, operating with both global volumes and stellar margins. Reports of Merck's molnupiravir's cost price and sales price is a case in point, with sales prices that are a factor 30-40 of its estimated cost price.

Given the enormous global sales volumes and extreme margins, pharmaceutical profits on COVID are likely to be in the hundreds of billion of dollars. That's no small amount and is likely to mobilise a lot of efforts to protect and enhance this profit base. I'll focus on two efforts that maintain and extend that profit base.

1. Keeping belief in the pandemic and medicinal use

The longer we stay engaged with the idea that we are in a pandemic, the more likely it is that we will support pandemic earnings models.?

Over-reporting on COVID in the media, is one way to extend (belief in) the pandemic.

Here in Singapore, where I currently live, we are also (almost continuously) confronted with dengue fever threats. With some degrees of freedom, the case count and health impact of dengue and COVID are within comparable ranges.

What really is different, is that there is no specific treatment for dengue. In other words there is no significant earnings model to dengue. Nonetheless, measures against dengue's proliferation can be taken and are very much worth to be communicated.

The current distribution of messaging and media attention between COVID and dengue relates closer to earning model differences between the two than to health impact differences.

Beyond media attention, spreading messages of fear, introducing (threats of) punishment, suggesting it is dangerous to meet others, forcing tests to keep the reported case numbers up, it all will help to prolong (the perception and severity of) the pandemic. Of course, such messaging is expected to go hand in hand with promoting medicine use, which (long term) effects are not to be questioned, preferably including as much societal cohorts as possible, even those who may be less in need like the younger or more healthy in the population.

The best way to achieve broad medicinal use, is to apply “one-size-fits-all” policies with as few as possible exceptions. Almost everywhere, serological proof of having (stronger) natural immunity from past infections, is not allowed in order to obtain a societal risk status, which, as we can see, doesn't even exist and is superseded by a vaccination status instead. Pressure to enforce use, by excluding the non-users in social activities, events and travel, can also be appreciated from an earnings model perspective.

This one-size-fits-all-enforcement approach increasingly confronts doctors and scientists with moral dilemma's. Many express their concerns in a common declaration that sheds light on the situation.

Of course, the promotion of repeat medicinal use, such as boosters, also serves the interests of pandemic earnings models.

2. Discrediting low-cost alternative generic medicines

Another effort to sustain COVID's pandemic profit pool is to block, discourage and discredit alternative medicines, especially generic, low-cost alternatives, while promoting new medicines that are in experimental phases.

During COVID, we have seen science at its ugliest, with a mass retraction of papers from scientists and doctors with decades long flawless track records, who suddenly became outcasts because they preferred to repurpose well known existing and low cost generic medicines for fighting COVID.

Many scientists and influencers who preferred different treatment methods with repurposed generic medicines have been forced out of (social) media, scientific, medical and policy committees, whereas supporters of new experimental drugs have been given a fairly free and uncontested hand in managing matters.

By and large, benefits of new medicines have been over-reported and side-effects have been underreported.

It is remarkable that after decades of successful administration, physicians in the Netherlands suddenly are no longer allowed to prescribe Ivermectine to (COVID) patients, running the risk of paying a fine of 150 thousand euros.

In India, with close to 1.4 billion citizens, pharmaceutical interests were “less successful” in top-down-curbing the use of generic medicines in fighting COVID. With many bottom up initiatives, the country fought COVID predominantly with generic drugs with quite some remarkable results. Of course, because of?interests, results have been widely discredited and find little absorption in foreign media.

Whatever is the right approach (I am an economist after all), this information war is coming at considerable costs to global health.

Concluding remarks

It is tempting to cry foul and start pointing fingers to individuals, organisations and government institutions. That is neither going to solve things fundamentally nor sustainably. Most involved individuals are probably not even aware that they are subconsciously subject to the dynamics of pandemic earning models.

What really may be addressed systemically are perverse earnings models, because as long as they exist, we will reward perverse behaviour and can only expect it to happen.