Watching the COVID vaccine/IP debate, I'm struck that every perspective in this debate has significant validity--and that every one is also vulnerable to public backlash and over-reach. (thread 1/n)

With the whole world watching, Big Pharma lacks public legitimacy to deny vaccines to the world in the name of IP protection. It would be morally monstrous, politically+epidemiologically insane not to vaccinate the world. (2/n)

One aspect--Twenty million humans move back and forth across our southern border. There is simply no way we can control this epidemic in America if we allow the pandemic to rage uncontrolled and to generate variants outside outside our border (3/n).

At the same time, Big Pharma has delivered. They offer a remarkable, pretty reasonably priced vaccine.This is no $700 epipen. I'm really happy that the big three firms are profiting from this. I want them to see vaccines+public health preparedness as profit opportunities. (4/n)

It's not clear that simply dropping strong patent protections allows massive +safe vaccine production around the world. There is a lot of process engineering, technology+distributional logistics under the hood here. (5/n)

From an entirely political perspective, I don't think COVID is the ideal domain to go full anti-pharma here. (6/n)

The U.S. and other wealthy democracies have our own legitimacy at stake. This isn't only or particularly a Big-Pharma moral failure. We wealthy nations could easily buy vaccines, at full list price, for every human in the world. Our poor domestic response was humbling, too (7/n).

We must make huge investments in global health that we're just making. Heading into COVID, WHO's $2.4 billion annual budget was about 1/5 the annual revenue of the Harvard teaching hospital network. It's the opposite of surprising that WHO was over-matched by COVID (8/n).

The scale of the COVID failure should humble us all . We definitely must demand more of others--call out blind spots, selfishness+occasional misconduct. We must demand more of ourselves, too. Fill in our own blind spots, and respond to catastrophe+failure w/true humility.(9/n=9)