This is a policy brief directed at decision makers in the UK government, with a view to accelerating production of tests, drugs and vaccines for COVID-19; but it could be adapted for a wide variety of countries, products and crises. Critical feedback is very welcome.

Thanks to Sam Hilton, Tim Colbourn and anonymous others for input on previous drafts.

Summary

Effectively tackling COVID-19 will require rapidly scaling up the production of diagnostic tests, pharmaceutical treatments and vaccines. In each case, preparations for large-scale manufacturing, such as building factories, are typically delayed until the product is proven safe and effective. This makes sense from a commercial perspective, but incurs great costs in terms of lives lost and damage to the economy.

There are several potential solutions, but the most promising appears to be “option-based guarantees”. In essence, the government commits to paying a proportion of the manufacturer’s preparation costs should the product turn out not to be viable. (If the product is viable, it can be sold as normal.) This reduces the risk to the company while maintaining an incentive to produce a high-quality product quickly and at scale.

The problem

The UK, like most of the world, faces an urgent need for increased COVID-19 testing capacity. As more people become infected and recover, large-scale screening for past exposure (antibody tests) will be necessary, but the shortage is especially acute for tests of active infection (“swab” tests). The government recognises this need and has set a target of 100,000 tests per day – a combined figure for antibody and swab tests – by the end of April. While this increase is welcome, safely bringing the country out of lockdown could require far more widespread swab testing, potentially as many as 10 million tests a day. Post-lockdown policy is still being developed so this may become the strategy within a few weeks. The UK should prepare now by deciding how market forces can be leveraged to rapidly scale up testing.

A long-term solution to the crisis will involve effective pharmaceutical treatments or vaccines (ideally both). Promising candidates have been identified, but most will take at least several months to complete Phase 3 studies – perhaps less if “human challenge trials” are permitted. Since many prod...

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