good afternoon and welcome to the 16th edition of the festival of economics of trento we are very happy to have for this opening lecture michael cramer michael kremer has already been to previous edition of a festival he was here some five years ago before being awarded the nobel prize and has been devoting all of this research agenda to issues that are in between development and health economics starting from the field experiment carried out just after uh receiving the phd in in economics carrying out a field experiment in kenya on issues very important like the dewarming of entire population and it is because of the method developed in that context that he was awarded together with esther dufle and the badgery via nobel prize in 2019 he has been a pioneer on studies of vaccines indeed there is a book that i invite all of you to read very carefully because this is a book that came out in 2004 and i think it has in it a lot of the hobby issues that and the answers ought to be core issues that we are debating these days how to fund uh the research on vaccines uh how to make sure that this will be they will be structured in such a way also to reach uh you know those who need uh the vaccine how to make commitment from the standpoint of government vis-a-vis the firm the private investors won't invest on vaccines these are issues that are discussed there and i have to say that if one were to read this book without knowing that it had been written 15 or 16 years ago one would think that being written today so today michael will talk to us about what is what can happen next in this vaccination campaign what can be done to increase its coverage to reach those population that really need and there are many parts of the planet that are still running late in this in this respect uh it will talk us about various proposals that have been put forward including both of the ob biden administration according to licenses and other possibilities like those stretching and so on and so forth and today we will also have the opportunity to have a discussion of the uh proposal put forward by michael cramer by reno rapalli river paulie is a a famous biologist and immunologist who has been not only contributing very much to research in this field is founder of some fields of research on microbial biology as recognized worldwide but he's also a chief of research at glasgow's myth klein who is a multinational producing vaccine so the discussion is going to be not only on broad principle but it will be a very concrete discussion on the issues that we are facing nowadays so without further adieu let me give immediately the floor to michael cramer hoping that perhaps next year when we will resume the festival having presence and there will be no longer travel restriction it will be also in presence with us in trend michael the floor is yours thank you very much uh it's a would have nice to be there in person but uh but happy to do so virtually so i've been working with a team of other economists and other experts um since early in the pandemic to try to think about strategies to accelerate vaccination to help end the combat 19 pandemic earlier and you know i think the work while useful for covet 19 i hope has also produced some insights about how we can prepare for future pandemics and i've on the slide are a couple of the articles that we've uh we've produced from that work um i'll draw on each of those but i would also like to discuss some some new work on pandemic preparedness so we have in this crisis developed and manufactured covert 19 vaccines at a truly unprecedented pace at the same time it still hasn't been fast enough many countries still face a very long delay before they can expect widespread vaccination we've had damaging export restrictions and hoarding of vaccines and i think we need to prepare now for future pandemics so that we can invest in advance to make sure that we have the production capacity for vaccines that we have the right supply chains in place and that we have better incentives for research and development and that we structure those in ways that we can simultaneously promote the goals of inventing new products and assuring access to them so let me start out and of course i'm an amateur on these issues but i'll start out with uh my amateur economist view of some background on vaccine development and production and look forward to uh to to hearing uh hearing a more accurate and comprehensive view but one thing to bear in mind is that historically most vaccine candidates uh don't actually succeed you know it's it's a there's a very uh difficult process of taking of vaccines through the different stages of the process and we have historical data on the rates of success at each stage and it this is this is a very a very risky endeavor indeed you know this i feel like this time we were actually in some ways uh we were both we both were we have some we can congratulate ourselves to some extent in in in both in trying to in the companies and governments uh and international organizations trying to put some policies in place and then the scientists and companies doing hard work on this but i also think we were we were partly very lucky that we had so many successes um you know it's also very time consuming so until 2020 vaccines usually took years if not longer to develop and even longer to produce at large scale even with the urgency of a global pandemic there was a survey in october 2020 of experts and many of them thought that we would wait for 2021 until late 2021 for a vaccine to be approved and the estimates were that we would produce just 115 million doses by the end of the year so we've done much better than than expected vaccines aren't just difficult to develop and to test but they're also very difficult to manufacture there's a saying in the industry that the process is the product this is very unlike the situation for most drugs where they're small molecules and for the if if the formula is available then a new manufacturer can potentially copy that and produce a generic version it's much harder with vaccines you know um the um and we've seen just the problems in production capacity in this case often even uh you know just moving from one factory to another within the same firm um so the this it typically takes years even just repurposed to construct brand new vaccine capacity can take more than six months to repurpose existing capacity okay let me note also that just an additional complexities there are many different platforms for producing vaccines so you know some of them could succeed others could fail and then within each platform there are multiple candidates so the so background information is this is very difficult and very time consuming now the flip side of this is that having the manufacturing capacity available is extremely valuable to society during a pandemic and just to get a rough sense of this note that if you take the estimates of the international monetary fund they estimate that the that over two year period there was a 12 trillion dollar loss in gdp on a monthly basis that's 500 billion dollars every month so the and that's not even including the the knock-on values beyond just gdp there's obviously the health benefits they're the benefit the cost of the epidemic to education as kids are missing school there have been estimates that are many times larger than this 500 billion so with together with the team of of researchers we tried to estimate the value of each course of capacity where of course is the ability to produce two doses for two dose vaccine over a year and we estimated that the social value of that capacity was around for for every unit of capacity was around 5 800 now of course in the middle of a pandemic they're going to be social political um limits on pricing or ethical limits if you look at actual prices those are they vary uh you know the lowest cost vaccines may be six dollars for two doses the more expensive ones may be forty dollars now i'm not i i'm not here to argue that the prices should be higher um obviously they're going to be limits in in a pandemic but i think we need to recognize that the huge gap between the social value of vaccines and the purely commercial incentives to invest you know firms may have been gone beyond their commercial incentives and they are getting some rewards but if you think about do you build out very early and do you build out very large scale that's expensive and it's risky and the the the private incentives to do that the purely commercial incentives won't match the social incentives in this type of situation where there are de facto limits on pricing so that means there's a very strong case for government programs to incentivize early installation of capacity and large-scale scale capacity in installation so early in the pandemic we had proposed that one way to do this would be through advanced contracting in particular we suggested that governments pay to install capacity to produce enough vaccines for their entire population i'll come back to that later or recognizing of course that you know some people won't take it but basically enough for their entire population for each of 15 to 20 promising vaccine candidates no no that was a very large number larger than uh it was actually done why did we recommend such a large number basically because we felt it was important to get many shots on goal the success rate historically is pretty low and so we thought it's it's given the enormous cost even a small increase in the chance of success from having another shot in goal we calculated was was worth it and what we proposed was that you know what would governments ask for an exchange we'd ask for the governments the governments would ask the companies to agree to sell vaccines that proved to be successful you know because uh the the suggestion was to do this before the uh before we knew which vaccines would be successful that if they turned out to be successful to sell them at a pre-specified price and the the benefits of this advanced contracting first it allows the capacity construction to occur in parallel with testing and you know we obviously weren't the only ones suggesting this others including uh bill gates and others were suggesting this and that this could also expand total vaccine production capacity and speed is obviously of great importance in this in in this situation now you know what happened governments did invest in expanding capacity and they did so in through contracts that were quite similar to the to to the the type we would have advocated obviously some some differences in particular the us and uk governments made very large investments and you know we'll never know um you can always debate this but it seems very likely that this significantly increased global manufacturing capacity you thought about the projections of what would be possible you know we've greatly exceeded this you know was it worth it well if we take operation warp speed the u.s program that costs 13 billion dollars if you take the estimates of the just the economic losses leaving aside the health losses that would have paid for itself if it ended the pandemic just 12 hours sooner so i think it was worth it but we probably should have done more um you know the eu has obviously seen insufficient capacity and many low and middle income countries have earned an even worse situation we estimate that the additional value so even taking into account the production capacity that was already there additional production capacity in early 2021 would have been worth 1400 per course um we would still advocate you know it's getting we're we're getting further and further into the pandemic but i still think it would be worth getting bids to try to to see if we could further expend capacity now because speed is just so valuable let me at least turn slightly to the issue of the next pandemic so let me in doing so let me acknowledge some of the controversies um around uh some of the us and uk efforts to do advanced contracting so let me show this uh you know this is a economics presentation wouldn't be complete without a supply and demand diagram so if you look at the um yellow curve you can think of this as the social value of a vaccine that's highest uh having more capacity makes this um uh um you know the the initial units of capacity are very valuable uh basically the time until people are vaccinated is the number of people vaccinated divided by the capacity so once you've got a lot of capacity additional increases don't provide as much benefit as the initial uh capacity so that's the doubt but the the value of this is very very high as you can see um the um the think of the blue line as the short run supply a uh schedule so and obviously we were you know we had very little information these were these were you know very rough estimates really conjectures but i think the well i wouldn't attach much meaning to the precise numbers there what i would attach something to is the shape and that's that in the short run there are limits on how much supply can be created because it takes so long to build build capacity and there's so much only so much capacity that can be repurposed so that's why we had some area where this was relatively flat but then it starts increasing steeply eventually you have to start repurposing capacity used for other things or that isn't so suitable so you can see that if you just if you just let the market price you'd be at a very high price on that where the supply and demand curves intersect but of course we don't let that happen as a society and so prices were much lower you know we had shortages in that type of a situation you can argue and i don't think we'll ever know the answer what was the what was the result of the us and uk expanding uh capacity and putting in these contracts maybe it shifted that blue curve out to the right and increased capacity for the world and will have benefits for the world in the long run because the supply will eventually benefit everyone on the other hand you could argue that in a world where capacity is limited in the short run if one country buys up the supply maybe that hurts other countries their effects in both directions what i'd like to emphasize is the situation is very different if we think about if we think about things going forward if we think about the future in the long run we can always build more capacity and the costs of doing so are very modest relative to the cost of pandemics so here i've drawn the red curve that's flat maybe that's extreme as a perfectly elastic long run supply but we can build out more capacity and what that means i think is that as we think about um just as we think about expanding um expanding capacity uh to try to address um address the future um to address future potential pandemics it's actually in everybody's interest if individual countries or global entities build out more supply then that's actually very good for the world because they're not driving up the price for for other countries they're not creating shortages um but they are creating more capacity and that capacity may indeed turn out to be very helpful the in the long run uh because we don't know where where the epidemics will hit let me note that we should think about this not just as the actual vaccine production capacity but as the supply chain capacity uh we need many things to produce it not just a factory but quality control inputs trained staff etc so for future pandemics we should invest now in standby capacity for both vaccines and for the inputs uh we need standby capacity so we can rapidly expand production once we have the vaccines you know we had the formulas very very quickly it just took time to test them and to wrap up production we also need stockpiles of inputs and standby capacity to produce more inputs we need to be able to install enough to rapidly vaccinate the world using each of multiple vaccine candidates because we don't know which which which candidates will succeed so we want to be able to not just have enough to supply the world but to have this enough to supply the world with each of several different candidates so we can build out quickly while we're still waiting for the results it turns that sounds costly and inefficient duplicative but this is like insurance you know even a small chance of the event or maybe better than saying it's like insurance it's like do you want a fire department for your town you know the chance the chance that any any one house catches on fire is very small but collectively you know this is something that's worth it because of the times when you need it okay i also want to emphasize that having this capacity in place not only if you look at this from a health point of view is a desirable not only if you look at it from a benefit cost calculation is a desirable but i also want to emphasize this is really what promotes equity and one way to think about this is if you have a limited amount of capacity and you ha and that means the cue to get vaccines is is effectively two years long so that the you know the rich countries might get it quickly after a month the poorer countries might have to wait two years well we can try to change that that and we should but it's also worth noting that if we expand capacity and now we have twice as much capacity and we can vaccinate the world in half the time you know that might speed up things for a couple of weeks for somebody at the front of the queue for somebody at the back of the queue that speeds things up by a year so it inherently promotes equity to have more capacity here's a point that's a bit more subtle which is that putting capacity in place may help actually address the problems of vaccine nationalism you know what we've seen um in the current cases there have been shortages and that means governments have very strong incentives to vaccinate their own population first you know we obviously are in a time of nationalism and populism and that may make this these forces even stronger but i don't think it's just a matter of nationalism and populism any democratically elected government is going to have very strong incentives to serve their population and so that leads to export bans it leads to hoarding of vaccines moral persuasion alone i think it's important but by itself it's not likely to solve the problem if governments anticipate that they might focus on trying to produce domestically but that's extremely risky that's extremely risky even for you know large countries like the us or for china you know we happened to get lucky in the u.s the mrna vaccines were very successful but what if the mrna vaccines hadn't succeeded what if other vaccines that were produced in china had been successful and ours hadn't been successful it's you know for for the largest countries this is risky for small countries you know this is going to be impossible australia australia tried to build its own vaccine they they failed you know they got unlucky we don't want to be in a situation where we we rely on every every country has to rely on itself so but what i'd like to point out is if we do have a lot of capacity and we do have the stockpiles then that can really change politicians incentives if there's a shortage then you want to grab for yourself first if there's no longer a shortage you don't have to put in these export controls you don't have to hoard vaccines you know the shortages can be self-affiliate if you see a shortage then you think oh i better buy now we've seen this with in the u.s with toilet paper i don't know what what's happened elsewhere um this is something that we can help avoid by putting in the capacity i think we need both national efforts to do this you know certain countries regions will put in capacity that's fine i don't think that hurts other countries in the long run you can argue it either way for covet 19 but in the long run uh this will be beneficial so we should welcome national efforts but we'll need to supplement them with global efforts because we can't expect uh the lowest income countries uh to be able to to keep the standby capacity going and there will be a cost to it things will go out of date they'll need to be replaced let me turn to a broader issue um which um and thanks for mentioning the book this is the broader issue of patents and incentivizing innovation so in our society we have two very important needs one is to get more research and development so we can get the vaccines we need and the other life-saving technologies and the other is to to to provide access to them and thinking generally i'm not thinking about covet 19 in particular patents incentivize r d but the way they incentivize r d is by providing a monopoly uh to whoever develops the the new product and monopolies in general tend to restrict access and and so that becomes not just a matter of abstract economics but a matter of life and death and a pandemic so that means that governments have very strong uh incentives uh during a pandemic to wave patents but of course that could hurt future incentives for research and development so how can we get out of this area where we have an inherent tension we pursue one objective increasing research incentives that that might hurt access we pursue access that might hurt research incentives i think we need to break out of this paradigm and think about other ways of incentivizing r d and in particular we can do uh what we advocated in the book um and was as was done for uh in a previous case before and has now been done for copen 19 is advanced contracting so what we have in the book we focused on malaria but after the publication of the book um was asked to help co-chair commission that looked into how could we go from an abstract academic proposal to something in the in the real world and and the case that um that the political leaders decided to focus on was pneumococcus while the commission we were still just a commission but then later this was taken up by political leaders um in fact italy was a was a key leader of this movement it was the single largest uh contributor to this 1.5 billion dollar commitment um that i think italy had been the chair of the um i believe it was the g8 at the time uh um russia was still in so there was a commitment that if firms developed a vaccine covering the strains of pneumococcus disease that affected low-income countries then the donors would help cover the cost of purchasing this in exchange for a commitment by the companies to uh have to what's called a tail price to not uh increase the price beyond that level after the end of the program well following that commitment three vaccines were developed um the um they've now been rolled out to hundreds of millions of people and thanks to these vaccines and estimated 700 000 lives have been saved i don't think that that you know that i don't want to claim that all of that worked perfectly we can always improve on how things are done but i think that was an important lesson going into the covet 19 case and you know while the specifics were quite different for kobit 19 and we suggested somewhat some differences in the form of the contract the basic approach of advanced contracting to make sure that you get sufficient quantity to serve an entire population and i wish it had been the population of the world rather than just other populations of the us and uk um that that basic principle um seems to have been successful in both creating incentives for r d and in in uh in creating access okay beyond this i think it's worth thinking about how can we form research institutions and methods you know one issue with the vaccine trials is you normally these are kept uh confidential until the data is released and there are good reasons for that but because manufacturing takes so long i think it might be worth trying to look for mechanisms to release partial data from the trials before the complete data is ready not so we can start putting the vaccines in people's arms but so we can better plan the manufacturing if we knew again we had the vaccines very very early it just took time to test them we might wait for 95 confidence before humans get them but we could start making the financial investments and scaling up production of the successful vaccines and redirect inputs from the unsuccessful vaccines earlier on maybe when you're you know 80 90 percent confident you know human challenge trials are very controversial area um i think however uh so this is the old-fashioned method of testing vaccines when scientists used to you know deliberately inject themselves with uh with the disease to test whether it worked the advantage is they're very rapid they're clearly some cases where this would not be at all ethical um think about you know hiv when that came out a fatal disease uh there are other cases where this might be ethical if there's a disease that where we can identify for certain people it doesn't pose any danger for other people it's it could be fatal then perhaps we could do this ethically i think we want to set up the committees now to think through the ethics so we can make appropriate decisions next time and that also requires setting up some scientific infrastructure i um the i also think that we should examine in a pandemic normally in designing a vaccine and again i i defer to the to the next panelist but um you're trading off efficacy and side effects in a situation in a pandemic like we are now there might be advantages to going with smaller doses because more people could be could get the vaccine if you have a shortage there aren't sufficient commercial incentives to do that and so testing fractional doses testing things like the first doses first approach in in the uk testing mixing and matching um making sure we have institutions to do that early because the commercial incentives may not be might be enough it's important i wrote down non-pharmaceutical interventions obviously even before that i should have said yeah we got lucky with vaccines this time we need to think about you know drugs diagnostics but also at least there in those situation there's a company which can perhaps make some money if it's successful for non-pharmaceutical interventions i think it's tragic that we didn't have enough information uh quickly on what's the impact of masks what's the impact of either now looks like you know perhaps school closures weren't necessary a lot of children have missed a lot of school because of that i'm not a scientist i'm not going to pronounce on that but i will pronounce on is we ought to have ways of getting the data much more rapidly you know ventilation and the role of aerosols maybe there's more we could have done had we known earlier we should set up trials on the server so let me uh let me let me leave it at that and uh very much look forward to the rest of the panel very effective and i think you highlighted the two episode one uh given that the overall title of this festival is the return of the state or the state strikes back an example of the tremendous success so the fact that we were able to develop the vaccine within such a short amount of time while normally it takes some 12 years and there are many viruses that are still looking for a vaccine so that was certainly an incredible remarkable and unexpected success but also we had some failure and the failures are involves the mechanism of self-fulfilling shortages that you were mentioning and of nationalism you are also making a number of proposals that are very interesting and i think that uh well rino rapport is is a person who can really discuss this proposal knowing very well the situation knowing very well all of his shortages the supply chain and what are the limits and the pros and cons of the waiver on the licensing rule that has been advocated so reno thank you so much for being with us today we are looking forward to your comments well thank you uh thank you it's a it's really great pleasure to be here at this panel i've been extremely interested in the in the lecture by uh michael kramer i think it's uh uh very very inspirational um well let me uh i'm not gonna use slides i'm gonna talk to you in the next 10 minutes about my experience i've been in the vaccine field for 40 years and i've seen all these kind of things and um one year ago when the pandemic started uh all the vaccine experts including myself were asked how long is going to take to make a vaccine and my answer but the answer of tony fauci and all the key people in the field were well you you know usually to make vaccines takes between 15 and 20 years that's the what it takes uh we understand that is going to this is a pandemic because we are in an emergency so we'll i'm sure will do much faster but realistically will not be able to make a vaccine before 18 months and uh probably would be three years and that was the standard response that we gave a year ago and most of the experts agreed on this on this type of response in this i'm very happy with wrong and we were wrong and by far because vaccines i mean the first vaccine was licensed basically with emergency use application in the united states in 10 months so why did that happen well i think uh i can put together three main reasons one i mean coffee vaccine was very easy to make uh if we had if had hiv have been so easy or as easy as coping we were going to have an hiv vaccine in 1983 because basically every single technology that's been used to make a coffee vaccine work so that that's a good reason in fact today we still don't know how to make a vaccine for hiv why we have 15 vaccines already licensed to about to be licensed for color so first thing the biology the science was easy the second thing is that we were ready with new technologies rna will today we all talk about rna but uh it's not new rna we have been working uh from early 2000s on rna vaccines i've been working on it since 2008 and uh that but the when we were ready it went a year ago when clearly rna became a front runner the technology was not mature for normal commercial products under normal conditions without the pandemic rna vaccines were going to become commercially viable in five seven ten years why well because only a few phase one trials have been done we knew a little bit how they were working but we didn't have any study in the formulations i mean they were in order to make them work we had to keep them minus 80. normally we'll never put on the uh will never develop a commercial product that needs to be stored -80 i mean you have to work the formulation it's going to take three four five years and then you put that you make available commercially but then when the pandemic basically say who cares about -80 i mean so important and so basically we accepted no mature products uh not for safety but for uh for convenience for formulation for delivery for supply chain we accepted imperfe supply chain and we said let's go with the rna and now basically the pandemic has accelerated rna as a new class of vaccines but also a new class of drugs by five ten years so the first two things one was the easy vaccine the second uh technology is ready to go and similar thing was for viral vectors vital vectors have been around for uh for a while they've been validated by the ebola vaccine and they were ready to go so but they've never been used before in large scale and these two technologies basically really change the field because they move very quickly however the we were not going to have a vaccine license in 10 months without the two of the most important factor and that was the basically the unprecedented investment of the public sector in developing these vaccines and what happened was uh worse speed 13 billion on the table every the major companies the major runners someone got 1 billion someone got 1.2 billion and others got 2 billions to develop vaccines which means that basically normally when we develop vaccines we do things eventually first we do discovery if the discovery works we do early development if the early development works we go into clinical trials which means phase one if phase one works we go in phase two phase two works we do phase three and then at that time we make the investment to make a manufacturing plan and and the reason we do things sequentially is because at the beginning the cost is is pretty low but you never make the next investment unless the first one is successful and so because we want to manage the financial risk since the developer vaccine more or less takes more or less a billion uh i mean you cannot spend all the billion in parallel you invest the first 10 million that works you spend the next 30 and so on well this time what happened was the public sector said i don't care i take the financial risk and you basically develop everything in parallel and that has been a new paradigm that never been done before and basically the phase one as soon as the phase one was basically we got the first piece of data moved into phase two and uh as soon as phase two data got the uh better fit uh first results phase three and so on and basically everything has been done in parallel amazingly and that's important for the people to understand we took a big financial risk because the public sector took the risk but we did not take any risk in uh set about the safety and efficacy of the vaccines because we did not skip any of these sets we did phase one the phase two the phase three everything was done uh but was done in parallel instead of of being done sequentially so basically what has really transformed the vaccine developed and made things so quickly has been the uh investment from the public sector um and that's the reason why we have uh the vaccines and we have at this point more than a billion dollars of vaccines produced in such a short period of time uh so i think that's the what happened and the obviously uh what we are talking today is that when the rich countries they got their own vaccines but there's a lot of inequalities because most of those that have been developed and deployed in which countries what are we going to do for poor countries and and it's going to take a while there's no question without ways to accelerate and there is a lot of discussion uh how we do deploy vaccines over there what and all the discussions i mean building more capacity is extremely important building capacity in those countries that don't have manufacturing is important a lot of discussions africa doesn't have one vaccine manufacturer we should do vaccines in africa we should build capacity all these things are extremely important i just want to say a couple of caveats which is my experience with this is that building capacity is not enough because right now we need to make vaccines but in two years uh when the pandemic is over we will not need 16 billion of dozens of vaccines we'll need much smaller amounts and then you have over capacity and when you have world cup over capacity basically those plants which are not that capacity is not being utilized uh and will be shut down because keeping keeping the capacity up and running ready to go is because you cannot use leave a manufacturing don't do anything for years i mean because you need to i mean the manufacturing plant needs constantly to be up to speed to have the people trained to have to be ready i mean to have all the license so basically keeping a plant is gonna cost a lot of money and nobody so far has been able to prepare and pay for those things so i think it's very important that we keep these things in mind that if we want to deploy more capacity we also need to have a solution how to keep that capacity available when the emergency is going down because i i've been there before and as soon as the emergency is over nobody cares anymore and those plans are going to be shut down they're not going to be available for less pandemics so i think one important recommendation i think all these things about the cost the analysis of the cost of this pandemic and the benefits of vaccines has been incredibly good uh the what has been presented before and frankly i've been trying to fight the cost-benefit ratio that is usually used to evaluate vaccines and i'm very disappointed that the last 20 years we've not been able to increase the real value of vaccines if you look at the all the the ways vaccines are evaluated when you look at the cost benefit i mean we have been extremely good in evaluating the cost extremely bad in evaluating the benefits because the benefits we don't include any anything there is nothing about what is the the advantage every vaccine because it's going to prevent the pandemic no there's no economic uh calculation that uh where those things are are included so i think if we really want to change the world we need to change the paradigm by which we calculate the cost and the benefits of vaccines and my known as a non-economist i cannot calculate exactly what it is but my back on the envelope calculation is that i think the way the value of vaccines today economically is underevaluated by a factor between 10 and 100. and if we just change that we'll be able to convince governments public sector to invest in a sustainable way in research manufacturing or vaccines i think i should stop there and and will be basically see what the next things in the discussions thank you so much i think this conversation is suggesting that this is really scope for cross-fertilization between economics and and microbiology and thank you so much also for the effort in explaining in a very simple way difficult competence scientifically and also reason in economic terms i'm sure that michael kramer will say something about also this estimation of the benefit of vaccine and the cost benefit analysis we were talking about but before going giving back the floor to uh to to michael let me just ask you something related to the proposal that he was putting forward one is on uh research spillover so however there can be at an earlier stage as a sharing of the result of the experiment so that you know different companies correct the strategies in such a way to take into account what is happening elsewhere the second thing was this link between investment public investment and and pricing so there has been substantial surprise discrimination in this case it seems to me so i wonder whether the contract should have been done preventing this to happen and finally this idea of those stretching in order to increase the coverage so if you can tell us something about these three uh ideas but let me let me start from the last thing and then so um i think those stretching and vaccine mix and matching are very important especially in the pandemic however the private sector is does not have any incentive to do it because i mean any company would say i'm developing my vaccine and i will try to deploy and sell as many doses i can so that's the public sector unless the public sector is going to do it nobody's going to do it they are very important we want to stretch with those test that you want to mix and match do it they're very important but that's something that only the public sector can do or can incentivize company or force companies to do that there's no there's no other way uh oh now i forgot the first two questions we researched spillovers we're sharing of the results of the of the early research on vaccine find better ways yeah yeah well i i is extremely important clearly but if we look back in uh in this pandemi uh that really happened uh and we have seen that from the uh every single result has been published in preprints in real time i think preprints which are uh publication in pre-printers instead of uh peer-reviewed journals was something that people in physics have been doing since 1960s but in biology uh we are very reluctant to do it well the pandemic changed completely that picture i mean every single result was put on real time by companies by by universities by everybody it was a race to put the results make the results publicly available so i think that happened was a lot of collaboration that happened because of the merchants so i think i agree is extremely important but it did happen uh and i'm pretty and i think that was a very important uh factor that contributed to the early success and then the last one was the yeah the idea of uh supporting investment in exchange of having an agreement on pricing later on and avoiding price discrimination across yeah i think that's that's okay i mean i i think that should be part of the discussion i mean if you obviously do risk something you have the the right to say i mean i'm gonna buy uh so many doses uh at the discounted price that that's fine i think where companies will be reluctant is to have pricing control forever i mean that should but the price in control for epandemic for or for the contract you have i think that's perfectly fine um there are some companies that will say i'm not going to accept your money because i make my own investment because i don't want my price to be controlled but most of the companies actually accepted the i mean the negotiations on pricing uh in exchange of a certainty of having a conference so i think that's a good mechanism very good thank you so much michael back to you michael sorry it was still muted um thanks very much no it was uh wonderful to to to to get this perspective and i think i i was struck really by how much you know how much agreement we have that there's a very important role for the public sector in in in this type of situation and financing providing the financing to enable all that work to be done in parallel and i think that this um this experience you know we've all suffered terribly from cobot 19 but um i think one of the things that comes out of emergencies is the adoption of new technologies to address them and you know we're seeing that now as we do the conference by video but perhaps another technology is this this meta technology if you want to call it this new approach of governments making advanced contracts to commit in advance that if that they will help finance the the either commit to byproducts if they're if they're developed and meet certain uh criteria as was done for pneumococcus or as was done for coba 19 commit in events to fund the installation of all of the capacity and the the to find the parallel development um in exchange for for vaccines sufficient vaccines for their populations afterwards and i think the um i think that approach of advanced contracting is something that we may be able to apply in other areas obviously right now the critical thing will be to the most immediate need is to try through a variety of approaches to get capacity for the rest of the world very good uh reno you want to say something else you have still a couple of minutes well the the only thing i probably want to repeat something i said because that's not visible to most of the people because all these solutions are okay and we are nobody discusses and they said they're inappropriate during the pandemic but i promise you that in in the previous pandemics was the same thing during the pandemic everybody agrees but two years later when you go back to normal things basically everybody forgets about these things and so now you have invested in plans you have to shut them down because we are not proactive and we don't make the investment to keep them running so i think whatever interventions we make has to be sustainable uh because uh companies will not make investments uh for waiting for the next pandemic in 30 years or in 20 years i mean that will go bankrupt so is the public sector that's the only one that can keep as an insurance uh the investment that we make open and working and sustainable during the when the pandemic is over very good so i think a lesson that we learned today is that indeed the public sector should invest more index in production in supporting in private investment in this field and if anything fau has not done enough of that compared also to the us and and the uk and there is also really room for cross-fertilization between economics and biology in various fields including what michael just mentioned so improving advance contracting another technology that today was worked very well was video conferencing as you know we have been able to interact very quickly without any any problem but let me hope that next time we meet we will be all in presence here in trento so thank you so much both of you for this very enlightening lectures well thank you thank you michael thank you thank you for today nice meeting you you