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Vaccine in Brazil: when everything wrong threatens to go right

by ace

PixxlTeufel / Pixabay

Throughout the 1950-1960s, Jay Forrester developed a methodology to try to model interactions within dynamic systems, which made history. He was a professor at MIT’s business and business school and wanted to explain why some companies thrive, while others succumb. In practice, it did much more.

Dynamic systems theory helps to understand why a negative conjunction of factors sometimes leads to favorable outcomes. Yes, this happens, albeit rarely. An example was Elon Musk who in August 2018 tweeted “I’m considering converting Tesla back to a $ 420 private company. Payment secured”.

The SEC (kind of American CVM) thought he had forced the bar in saying that the payment was secured, since the shares were quoted at $ 281.70. It is worth noting that the company has been listed on Nasdaq since 2010 and, until then, it had never come close to being worth so much – who had given $ 420 / share. As a result of the apparent bluff, the SEC fined him in physics, as well as the company, by $ 20 million each.

To mitigate the fury of shareholders, Musk was willing to buy an amount equivalent to the fine, in company shares (71,000 shares for US $ 20 million). On July 27 this year, these shares were worth US $ 1,420 / each (after a 15% drop); that is, while seeking to reduce damage, Elon Musk profited about $ 60.8 million ($ 1,138 / share, totaling $ 80.8 million – $ 20 million fine). Ah, if every disaster were like that.

Brazil may be on a relatively similar route in terms of controlling the humanitarian and economic crisis caused by the Covid-19. It is public and notorious that the country emerged as one of the global epicenters of the pandemic, together with the United States.

Here, as there, merit is linked to the erratic conduct of public policies, which undermined the effectiveness of social isolation, under the combination of personal convictions, a desire to avoid identifying links with the economic core of the crisis and commitments to business forces. In parallel, the Bolso-Doria ideological alignment, of electoral origin, broke and both began to oppose in relation to almost all subjects that generate media, including vaccines.

Thus, on the federal side, Brazil announced, on June 27, a cooperation agreement with AstraZeneca / Oxford, which originally envisaged the acquisition of 30.4 million doses (secondly, Bolsonaro spoke of 100 million doses) the famous “Oxford vaccine”, coupled with the technology transfer required for subsequent local production, for $ 127 million.

It is as if each imported dose came to around R $ 23 – a value that should drop when national production begins. The agreement has not yet been signed, there is always the risk of not advancing, but, if it works, it can subsidize vaccination campaigns against COVID-19, as of the turn of the year, according to UOL reported.

The state of São Paulo opted for a specific agreement with the Chinese Sinovac, which has a similar format and will be operationalized by the Butantan Institute. THE initiative cost R $ 85 million and predicts that 60 to 120 million doses will be sent to the country (there are different public statements about this), if the vaccine is approved in phase III, which involves tests in 6 Brazilian states.

Regardless of these figures, the central argument behind the São Paulo agreement is that the Sinovac vaccine is based on inoculation of the inactive virus, a technique that has been dominated by Butantan for decades (click here to know more).

Critics of the initiatives are saying that they are nothing more than shots in the dark, as neither vaccine is guaranteed success. It is this caveat that I would like to discuss today, in light of the broader picture of the difficulties and opportunities that I believe are at stake.

To begin, it is important to know the chance of success of these two vaccines. Nobody knows, but many people take chances. A survey I made from statements by independent sources suggests that, in both cases, the chance of success is between 50 and 80% (average 65%), which means that the chance that at least one of the two vaccines will fulfill its purpose paper is about 88%.

In addition to the encouraging odds, it must be borne in mind that reducing the subject to the success / failure dichotomy is completely inappropriate – and here I am not appealing to your most noble and humanitarian feelings, but only to reason. For example, would you pay $ 100 on a raffle ticket that gave you only a 1% chance of winning? For me, the answer is “it depends”. If the raffle paid R $ 100 million, I would certainly pay. Not you?

The correct way to assess the pay-off for risky investments does not end in the presence / absence of it (nor in its magnitude) as suggested by some medical authorities who are talking about this in the media. It is important to know who is bigger: the product of the acquisition cost by the projected chance of success or the cost of postponing any action until the moment when we have more subsidies to decide. If the latter is greater than the product of the first two, the risk purchased from AstraZeneca and / or Sinovac will have paid off. It’s that simple.

This is not a trivial modeling, even disregarding the subjective daily costs, which will manifest as psychological suffering, interpersonal conflicts and psychological traumas associated with domestic violence, whose recent growth is partly explained by the fact that unbalanced husbands / partners are experiencing more time at home (the front door serves the house, dear ones). There is a lack of data on how much the launch of a vaccine against COVID-19 with, say, 80% effectiveness, would save us per day; neither have I found such data about any other country.

On the other hand, it is worth noting that, in the United States, projected economic cost of covid-19 is about $ 8 trillion, while the federal agreement made with Pfizer involves the payment of US $ 1.95 billion for 100 million doses (about R $ 100.00 / dose). Another 100 million doses were purchased from Sanofi and GlaxoSmithKline, for US $ 2.1 billion (about R $ 107.00 / dose). Moderna, whose vaccine was leveraged by US $ 483 million, in the context of the Operation Warp Speed, announced that it will charge $ 50-60 / dose, in the United States.

Even though the two countries have very different economic realities, the data reinforce the maxim that the daily impact of the complete absence of population immunity is enormous and that we are paying a bargain for vaccines. Thus, it seems that the pay-off for the combined acquisition of the AstraZeneca / Sinovac risks is both higher than that of waiting to decide later, as compared to betting on only one of them.

The disagreement has added – or rather, it can add, as long as it is not engulfed by distorted views about vaccines – which becomes clearer when we consider that there is a chance that it is important to have more than one type of vaccine “sufficiently effective for deserve large-scale distribution “, as Merck Vice President Julie Gerberding recent american congress hearing, above all, because “the first vaccine may not be the best for the elderly or children”.

The dual acquisition of doses and technologies is not the only “insurance” possessed. In fact, the most powerful of these is participation in the Covax consortium (Vaccines Global Access), an initiative of WHO and other international organizations, such as the Bill and Melinda Gates Foundation, to guarantee global access to a pool of vaccines (around twelve). The consortium should both help democratize vaccination and mitigate the global impact of the failure of some options.

However, the doses coming from the consortium, for which we must pay, should arrive after those derived from the expansion of large-scale clinical trials, which are being carried out in the country. And in this case, we are working with so-called intertemporal decisions, those for which time counts.

But, after all, why don’t other countries follow our example, opening the door for companies that produce more advanced vaccines to do their phase III tests, in exchange for better business conditions? For the simple reason that this offer is not on the table for everyone.

It is not that we are isolated in this situation (for example, the United Kingdom has a larger arm of the AstraZeneca vaccine clinical trial than ours, while in the United States, Moderna started phase III testing its vaccine, with 30 thousand subjects, under the premise that this serves as a mat to facilitate subsequent mass vaccination); but, in fact, Brazil is in a privileged position with regard to early access to vaccines at an advanced stage of development, especially if we consider that we do not yet have a local version at this stage.

Corroborating this point, Pfzier also included Brazil in its phase III clinical tests, which should take place in the cities of São Paulo and Salvador, during the month of August, while Paraná will host Phase III clinical trials of Sinopharm vaccine, as UOL reported.

The reason for this is simple and tragic: the high rate of spread of the disease puts us in the area of ​​interest to manufacturers. Against this background, a history of developing vaccines for tropical diseases of low interest to major international laboratories created the conditions to operationalize the most critical part of the two agreements: subsequent national production. I think it deserves a tweet, with one of those very cheesy – but sincere – hearts for the tireless Brazilian scientists who …

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