Artists perform at the Youth Theater in Hanoi after it reopened following a closure to combat the spread of the Covid-19 virus. Photo: Nhac Nguyen / AFP

Vietnam has been an anomaly for many outsiders throughout the Covid-19 pandemic. How has a developing country with limited health infrastructure appeared to have pulled off the impossible?

Others have outlined the methods used to contain the virus, and whatever your thoughts about them, Vietnam has, once again, proved effective in fending off its latest intruder.

As the death toll from Covid-19 in some of the world’s greatest powers, including the United States and United Kingdom, reached new heights, in Vietnam, people have been praising the authorities for achieving the first duty of any government: to protect and safeguard its citizens.

It has been interesting to see how this country of 96 million people has become the envy of the world’s richest nations. It was only a matter of time before someone suggested that Vietnam opens its borders to rich Westerners wanting a share of the health benefits their own countries have failed to provide. 

The proposal was put forward in response to a Twitter challenge by renowned Massachusetts Institute of Technology economist Erik Brynjolfsson: “At least so far, I haven’t seen any one suggesting to use the market system to allocate vaccines. Not even those who strongly advocate it in other areas. Why is that?”

There are a number of problems with George Mason University economist Tyler Cowen’s response to this question, set out in his May 27 Bloomberg article “Vaccines Should Not Be Immune to Market Forces.”

First, a failure of leadership, in the context of a market-based health-care system, is precisely what has led to America’s unenviable death toll. The tired argument that the market knows best and that vaccines should, in essence, be sold to the highest bidder fails to acknowledge the role that these same market forces have played in undermining America’s ability to deal with the pandemic.

While Cowen begins his premise by making clear that medical staff on the frontline, as well as those in critical jobs, should be first in line for a vaccine, he does not make clear who exactly qualifies as a critical worker.

Among many of the shortcomings this global health crisis has exposed is the myth that essential workers are the ones whose remunerations best reflect their worth to society. Perhaps for the first time, we have collectively realized the importance of hospital janitors and cleaners, supermarket cashiers and care-home workers.

It has become apparent that employees in factories and the food supply chain along with delivery drivers are also key workers. And these are just to name a few – a fact that has not been lost on the US government, despite its pitiable response to the disease.

It is not surprising that these people, who have continued working while many others have been able to stay home, have been disproportionately affected by the coronavirus, with women of color bearing the brunt in the US.

Cowen’s deliberate obfuscation allows him to make his argument without having to worry too much about the detail, practicality and effects of such an approach. Were governments to follow his advice when choosing whom to immunize first, would the wider definition of Essential Critical Infrastructure Worker as outlined by the US apply, for example?

Cowen is aware that what he proposes is not uncontroversial – as a tweet, in which he shares the link to his editorial – demonstrates. If other “market-oriented economists are a bunch of wimps and pikers” for failing to argue in favor of allowing the market to determine allocation of Covid-19 vaccines, he is clearly made of sterner stuff – or so it is implied. 

His suggestion that vaccines should be available as “luxury goods,” in the same way you might purchase a luxury handbag, is an affront to the 100,000 or so Americans who have lost their lives and to others who have lost their livelihoods on the back of this pandemic. 

The notion that travel should be made “easier” for the rich to boost the economy likewise fails to understand the need for America’s richest to invest first and foremost in – and help rebuild – America. His recommendation that the rich should gift vaccines to their (probably already wealthy) social circle is a provocation.

Is he genuinely advocating for the likes of Amazon chief executive officer Jeff Bezos or Kylie – is she or isn’t she a billionaire? – Jenner, say, to fly over a few hundred of their closest friends to Vietnam – one of two destinations put forward by Cowen – so they can all treat themselves to the latest in Covid immunization?

Having argued that the market cost of of a vaccine would help people determine quality when making their consumer choice, we are told not to worry for those unable to afford a dosage themselves: “And if you are worried that poorer people won’t be able to afford the vaccine, give them vouchers or other forms of aid.”

In other words, following this logic through, (US) state aid could contribute toward helping the poor access vaccinations, with benefits not as clearly determined as those at the more expensive end of the market.

We are also told that the health benefits will trickle through the population because “each person getting a vaccine confers significant benefits on others, through a reduced risk of infection” – however, this principle of herd immunity only works when the majority are vaccinated, not just the few.

Cowen’s premise – to say nothing of the risks inherent in allowing entry to anyone traveling from the US – is one borne of entitlement that has been characteristic of America’s attitude throughout this pandemic. However, as Vietnam has proved, financial brawn is no substitute for brains.

Vietnam was among the first countries to act – ignoring official World Health Organization advice at the time – shutting down borders and stopping all flights to and from Wuhan, China, as early as January 23.

lower middle-income country like Vietnam, which could not afford to deal with an influx of Covid-19 infections and did everything within its power to curtail the spread, would not now sacrifice the nation’s health at the altar of free-market fundamentalism.

Vietnam’s efforts have been rewarded. At the time of writing, there are only 328 confirmed cases, with no reported deaths. A government that has struggled to win over its people in the past has finally gained their trust and thus seen its legitimacy strengthened – not a bad position to be in, ahead of an election year.

The suggestion that it would jeopardize everything that it has worked so hard to achieve is shortsighted. Cowen’s insular view likewise reeks of paternalism. Vietnam will not open its borders to one of the world’s worst-affected countries purely because a handful of its millionaires – unable to get what they want at home – are prepared to throw some money its way.

Vietnam must do what it can to sell its wares to rebound from the economic impact of Covid-19, but do not expect it to sell itself to the highest bidder.

Where Cowen is right is that once a Covid-19 vaccine has passed the necessary scientific and bureaucratic hurdles to obtain its license, there will not be enough of it to go around. This is why every country with the capacity to work on a vaccine is doing precisely that.

In Vietnam’s case, it is about to enter the second phase of testing of its vaccine, which state-owned Vabiotech, based in Hanoi, has developed together with a team from Bristol University in the UK, thanks to a partnership established before the outbreak. Should the second phase prove successful, the research team will seek funding from international agencies to push forward with their contribution.

A vaccine will take anywhere from 12 to 18 months before it is readily available. There are 150 vaccine development projects worldwide, of which only eight have begun testing on humans. 

Cowen acknowledges that the United States may not be the first to get ahead in the coronavirus vaccine race. Indeed, he suspects China may get there first, which is why he suggests a “$30,000 vaccine vacation.” He doesn’t appear to know about Vietnam’s attempts to produce a vaccine, not that it seems to matter to him. What he’s interested in is its proximity to China.

Unless the world finds a fail-proof method of allowing people to travel, without exporting Covid-19 to their destination, allowing rich Americans (that is the implication, although I suspect anyone with enough money would qualify) the privilege of flying overseas may yet be some way off, particularly when the potential for the virus to hitchhike on to a flight remains high.

To argue in favor of markets determining who gets access to vaccines and how much for shows a lack of awareness. The risk of a Martin Shkreli-style price-gouging occurring during the midst of a global pandemic, one would think, might be argument enough to deter even the most avid pro-market supporters from pursuing this line of reasoning. 

It must be hard, as a middle-class American, to grapple with the notion of free health care to all, as a matter of principle. To this European living in Southeast Asia, the importance of universal health care has been evidenced by this virus (health care is usually paid for in Vietnam, but all patients with Covid-19 have received free treatment). 

Vietnam has understood that there is no better definition of public good than ensuring community-wide protection. Once this public health crisis has passed and it is no longer considered a pandemic, but a chronic mainstay such as a regular flu, Cowen’s idea might be worth returning to. 

Until then, as French President Emmanuel Macron’s office said a few weeks ago, any vaccine should be treated as “a global pubic good, which is not submitted to market forces.”

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Soraya Kishtwari

Soraya Kishtwari is a former UK political journalist currently living in Vietnam.