How to end the pandemic this year
LONDON — Research to develop a safe, effective, and widely available COVID-19 vaccine is advancing rapidly. But when it will happen is not clear. Much depends on how we govern the production and distribution of new drugs. While the World Health Organization’s COVID-19 Technology Access Pool promises to foster accessibility, the actual availability of vaccines and treatments also will hinge on local manufacturing capacity, which in many countries has been eroded by deindustrialization.
Moreover, while universal testing remains a feasible, cost-effective, and immediately available method of managing the pandemic until a vaccine arrives, this approach also requires manufacturing capacity and sound governance in the public interest. Yet even in advanced economies, over-reliance on the private sector may prevent governments from maximizing test production and deployment.
As has been demonstrated by the Nobel laureate economist Paul Romer, the epidemiologist Michael Mina, a recent IMF working paper, and many others, a properly designed universal testing program could bring the pandemic to an end within just a few months. The missing ingredients are industrial policies and other government measures to coordinate and steer production, in order to eliminate the bottlenecks that the private sector faces.
The necessary testing technology of rapid immunodiagnostic tests—such as saliva-based antigen tests that are similar to home pregnancy tests and cost less than $5—already exists. Although these tests are sub-optimal in sensitivity compared with the standard polymerase chain reaction (PCR) tests, they are specific enough to detect infections at scale in settings disease prevalence is high; and, crucially, they do not require centralized laboratory facilities.
Therefore, with a purposeful program design that carefully considers the functionality and limitations of the technology deployed, rapid tests can enable decentralized universal testing programs at the community level. For example, tests could be made available free of charge at local pharmacies, with the expectation that everyone test themselves on a regular basis and self-isolate if positive. The same kits could be used as “infection-free” passports for admission to public spaces such as schools and workplaces. In this case, a new market would likely emerge as airlines, malls, restaurants, and cafés start purchasing cheap, rapid tests so that they can get back to business.
Similar strategies need to be launched at the national level, especially in low- and middle-income countries where the affordability and scalability of molecular testing is low. Many countries have the capacity to produce a sufficient supply of tests at a cost that would pale in comparison to those inflicted by the pandemic. The number of tests needed globally over a year to supply a weekly testing regimen would be equivalent to less than half the number of cans of soda consumed annually. Moreover, scaling up production of antigen tests could be done relatively quickly, and would be a minor effort compared to the US mobilization for World War II.
While billions of dollars are being funneled toward vaccine development and production, additional funding also must be directed toward strengthening our testing infrastructure. At $5 per unit, the cost of testing the world’s population every week would come to around $2 trillion. That is far less than the pandemic-related loss of global income during this period (as measured by the difference between pre- and post-pandemic growth forecasts) and fiscal stimulus so far this year, an estimated total of $20 trillion. And these comparisons don’t account for the costs of lost lives or the potential benefits of achieving new economies of scale in test production — a spillover that could enable the eradication of the seasonal flu.
There are potentially steep challenges beyond production, of course. As practical as universal testing is, any such effort could still come under pressure if governments believe they must choose between different production needs for vaccines, anti-viral drugs, personal protective equipment, and expanded medical facilities.
But universal testing must not be viewed as a separate item on a larger list of priorities. The point of a mission-oriented approach is to create dynamic public-sector capabilities and strengthen the entire health system at once. New testing capacity should be integrated with national and local health systems as part of a broader program design, so that each leg of the strategy supports the others.
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Reda Cherif is senior economist at the International Monetary Fund. Fuad Hasanov is senior economist at the International Monetary Fund and adjunct professor of economics at Georgetown University. Mariana Mazzucato is professor in the Economics of Innovation and Public Value and founding director of the UCL Institute for Innovation and Public Purpose (IIPP).
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