There were a lot of Chinese students at the University of Virginia when I was a grad student there in the 1990s. Having thrown off the yoke of communist economics, China was undergoing an industrial revolution and did not have enough colleges and universities to prepare the number of scientists and engineers it needed to build its industrial base. Because they were majoring in science, technology, engineering, and math these students had all of their tuition and living expenses paid for by the Chinese government. UVA benefitted financially because as foreign students they paid full tuition.
Today, China leads or matches the United States in most areas of science and technology. However, one downside of this rapid industrial expansion has been air pollution. At one point, China was building a new coal-powered power plant every week and the country is committed to continuing to build coal-powered plants into the next decade, despite the impact on the environment.
One consequence of relying on dirty fossil fuels is the significant degradation of public health. Although air quality in China is improving in response to new regulations, it is estimated that air pollution contributes to over one million premature deaths each year in that nation. For example, in China’s capital of Beijing, air pollution is classified as unhealthy ten out of the twelve months of the year. Subsequently, since the beginning of China’s industrial revolution in the 1990s, it is not uncommon to see photos of Chinese citizens wearing masks.
In some ways this has been a good thing, because mask wearing is culturally acceptable and the norm in large parts of China. Chinese citizens did not push back against the government’s directive to wear masks to prevent spreading the Covid19 virus (it is also unlikely they would push back against their authoritarian government for fear of reprisal). As a result, China has been more effective at limiting the spread of Covid19 compared to the U.S. Although the United States has one fifth the population of China, it has had more than a thousand times the number of deaths!
China is the most populous country in the world – nearly 1.5 billion people – and as a result, public health is an important goal for the Chinese government. Had they not been able to contain the Covid19 virus, which certainly originated in that country, tens of millions of Chinese would have surely died from it. A recent article in the British medical journal The Lancet observed that, “China has robust systems to respond to infectious diseases and is well placed to develop and strengthen community public health systems to tackle non-communicable diseases and health inequities.”
As I have pointed out a number of times in this blog, public health initiatives have been instrumental in extending life span and reducing mortality in the United States. Thus the response to recommended actions for controlling the pandemic from the political right, which has rejected mask wearing, social distancing, and has not even encouraged getting vaccinated, has been alarming, frustrating, and nonsensical.
Instead, Republicans have taken an approach based on individual rights: do your own thing, regardless of the impact it has on others. That’s one of the reasons the United States has the highest Covid19 mortality rate in the world; we’re number one at something we shouldn’t want to be number one at. Rather than being a ‘we’re all in this together’, nationwide response, the Trump administration left it to the states to decide when, how, and where the vaccine would be distributed. And notably, many Republican governors have been resistant to social distancing and mask mandates and have not support vaccination efforts.
How would have Republicans responded in regard to the vaccine if based solely on right wing, conservative political and economic principles? First, there would have been no government support of vaccine development. They would have left it solely to the marketplace, in this case biotech companies, to determine if it were in their economic interest to develop and manufacture a vaccine, i.e., rather than a humanitarian crisis, for Republicans it is strictly a business decision. And if these companies had determined that the return on investment was not profitable, there is no guarantee they would have had the economic incentive to develop a vaccine.
Leaving it to the marketplace also determines the monetary value of a medication. The manufacturer might decide that it is profitable to mass produce the vaccine and sell it at a cost where most people can afford it. That would fulfill society’s needs while guaranteeing large profits from mass sale of the product. Conversely, the manufacturer could keep supply much lower than demand, making the vaccine expensive for consumers. The pharmaceutical company would profit at the expense of more people being unprotected and possibly dying from the virus.
Before you think the above scenario is unlikely, let me assure that it does happen. Epinephrine is administered when someone has an allergic reaction and goes into anaphylactic shock, such as being stung by a bee or having a peanut allergy and not being aware you are eating something that contains peanuts. The EpiPen is an auto-injectable device that delivers epinephrine in an emergency. Here’s what happened after the pharmaceutical company Mylan purchased the rights to manufacture the EpiPen:
“Mylan outraged patients and lawmakers by ruthlessly hiking the price of its product by more than 400 percent. Mylan purchased the rights to EpiPen in 2007 and gradually raised the list price from about $50 per auto-injector to slightly over $600 for a two-pack. The move boosted EpiPen profits to $1.1 billion a year. In step, Mylan CEO Heather Bresch saw her salary soar by millions, reaching nearly $19 million in 2015.”
Fortunately, the patent on the EpiPen expired in 2018 and less costly generic brands are now available. Although still pricey at about $150 a device (less with a pharmacy discount), it is half the price Mylan was charging prior to going generic and especially so since the drug that the EpiPen delivers, epinephrine, costs about one dollar to manufacture.
Fortunately, governments worldwide decided to fund research and development of Covid19 vaccines and also committed to reimburse pharmaceutical companies for the vaccine. Without that commitment it is unclear if or to what extent these companies would have engaged in vaccine development and production. I’d like to think that the humanitarian need for the vaccine would have outweighed the profit motive and Republican economic values. However, given Donald Trump’s reluctance to acknowledge the breadth and depth of the pandemic it is unclear whether his administration would have supported vaccine development without external pressure to do so.
Republicans also believe acquisition of health care is a personal responsibility. They believe all government programs such as Medicare, Medicaid, SCHIP, Tricare, and the Veterans Administration should be abolished and everyone should purchase health insurance. If the individual doesn’t have or can’t afford health insurance then they would need to find another way to pay for the vaccine, such as with cash or credit card. Consequently, the Republican market-based approach to health care is based on a system where there are winners and losers. In that kind of system, when there is a pandemic, there can be a lot of losers.
China has set the goal of overtaking the United States as world leader. They want to land a man and woman on the Moon before the U.S.; they want the yen to replace the dollar as the world’s currency; and they want to lead the world in science, engineering, and technology. China invests more than the U.S. in infrastructure, and it shows. Over the past decade, China has built more miles of roads, more bridges, have expanded broadband, have more miles of high speed rail service, more dams, windmills, and more non fossil fuel power plants than the U.S. has built over the past three decades. China is also committed to providing universal health care as well as enhancing the quality of medical care its citizens receive. They’ve achieved these accomplishments in part because the Chinese government has been willing to invest in the country whereas Republicans want to leave that investment solely to the private sector. And in part, they have been able to accomplish these activities because the Chinese students who attended UVA and other American universities in the 1990s are now the professors and professionals leading this change.
 Most health experts agree that China has suppressed the actual number of covid related deaths, however, even if twice as large, that would be about 10,000 deaths compared to the U.S. with nearly 600,000.