Thomas Pogge

GPCR-internal

Interview by Gilad Tanay

Interviewee

Thomas Pogge is the Director of the Global Justice Program and Leitner Professor of Philosophy and International Affairs at Yale University.  Having received his Ph.D. in philosophy from Harvard, he has published widely on Kant and in moral and political philosophy, most recently, Politics as Usual.  His current work is focused on a team effort toward developing a complement to the pharmaceutical patent regime that would improve access to advanced medicines for the poor worldwide (www.healthimpactfund.org).

How would you characterize the process that was used for the formulation, adoption, and implementation of the MDGs? How inclusive was it? What were the main strengths and weaknesses in that process?

 

Thomas Pogge: I think the truth is that we don’t know very much about the process that led to the adoption of the MDGs. As you know, the predecessor version was formulated in the Millennium Declaration, and that was passed by to the UN General Assembly, and of course we know how that happened. This was proposed, and it was adopted by the General Assembly in the year 2000.

But what then happened, what led to Article 19 of the Millennium Declaration to the MDGs is a process that is wholly unknown.  The goals were substantially changed and, in particular, diluted in that process. It’s clear that that happened somewhere in the United Nations but it is not clear which bureaucrats were involved in it. Truly, Kofi Annan was involved in it, but other people presumably as well. It’s also not clear what pressures these people responded to, and so I think the truth is that we don’t really know what led to that dilution of the MDGs.

 

What were the benefits brought about by the MDG framework?

 

Thomas Pogge: I think that relative to having no such framework at all, there were some benefits, and one benefit in particular was to focus world attention on the urgency of overcoming poverty. The modern poverty problem is different from the past where essentially much of the poverty of humanity was unavoidable. Since, maybe, the middle of the twentieth century, we have had the means available to overcome poverty for most of the human beings in the world. And that obviously is a very important, morally speaking,very important, urgent problem. If this poverty is avoidable, it must be avoided. And so the MDGs have the advantage of focusing humanity on this very urgent moral goal.

 

Were there ways in which the MDGs were detrimental to poverty alleviation?

 

Thomas Pogge: I don’t think they were detrimental relative to having nothing at all. But I do think that the MDGs were much inferior to what else could have been put in their place. And that is true in particular in two respects. First I think the MDGs were not nearly ambitious enough, in that they set very low goals, [in particular], the halving of the proportion of poor people in the world over a period of twenty-five years. That’s really not very ambitious. Given that the population in developing countries increases by somewhere around forty-six percent over that period, if you get poverty down to seventy-three percent of what it was in that same period, you have already halved the proportion. And so a twenty-seven percent reduction in the number of extremely poor people over twenty-five years is really ridiculously under-ambitious, given how rich in resources the world now is.

So, one problem is that the goals are under ambitious. The second very big problem is that the goals were just put out there without the slightest hint as to who bears what responsibility towards achieving these goals. And so, of course, everybody was very happy to celebrate the goals: to say, yeah, yeah-that’s good. Let’s just all reduce poverty. And nobody felt in particular called upon to do anything in particular to achieve the goals.

 

How would you assess the degree to which the MDGs have been achieved?

 

Thomas Pogge: Well, on their own terms– this is a very significant restriction here, right? The MDGs come with a very elaborate system of measurement. In the case of MDG 1, which I know the most about, the halving of poverty, there is a big methodology that the World Bank has developed for measuring or counting the number of extremely poor people. If you take that methodology for granted–and think it’s a good methodology for tracking the evolution of poverty–then you have to say that the world has been reasonably successful in achieving MDG 1. It looks like, by the World Bank’s standards, we will over achieve MDG 1 if we achieve more than that twenty-seven percent reduction over twenty-five years in the number of extremely poor people.

 

Should the MDG successors be an extension of the current goals, an expansion/revision of the current goals, or something different altogether?

 

Thomas Pogge: Well, it has to be something different altogether, I would say. The crucial thing here is that what we need here is not a statement of goals alone. What we need is a statement of responsibilities. So the goals have to be attached to agents. Unattached goals are no one’s goals in particular, and there is just no reason to believe that these goals will be achieved. The goals should be more ambitious and they should be tied to particular agents.

So for example: we need something like statements about how much aid should be given by various countries. We should have statements about how that aid should be spent—what should be prioritized. Again, example: we have about $120 billion in development aid today each year. But of that $120 billion, only about $15 billion goes for basic social services. That is to say, to poverty relief efforts. That number has to be increased. You know, we don’t need more development aid necessarily, but we certainly need more of that aid going into basic social services—basic education, basic healthcare, water and nutrition, and so forth.

Further, I think, and that’s maybe the most important point: we have to stop thinking about the poverty reduction project as being promoted by development aid only. Development aid is a very small niche in the international institutional architecture, and what happens there cannot possibly make up for the enormous headwind that is generated by the rest of the institutional order against the poor.

So, what we need to do is not just focus on development aid, but we must focus on the entire remainder of the international institutional architecture and analyse it to see how it is designed and to what extent its design is detrimental to the poor or helpful to the poor. So, by redesigning such elements, we can do a great deal more for poverty eradication than by increasing development aid.

Let me give one example that which I have worked on quite a bit, which is the TRIPS Agreement. The TRIPS Agreement basically establishes one uniform minimum standard for intellectual property rights the world over. That standard is very high. It requires, in the case of medicine, a twenty-year monopoly on product patents, protecting the particular molecule against copying. And so this enables innovators to sell new medicines at somewhere between 20 and 50 times the cost of production, thereby excluding poor people from the benefits of new medicines. Now, this is a tremendous detriment for the poor. And, of course, you can make up for that in some way if you subsidize medicine purchases here and there and so on, by way of development assistance of one sort or another.

But you could make up for this much more effectively if you found a different way of incentivizing pharmaceutical innovation. For example: in the way that we have proposed in the Health Impact Fund system. That will be a system where innovators would be rewarded not by being allowed to mark up their products in the patent-protected way that protects them from competition, but where innovators would be rewarded on the basis of the health impact that the medicine actually achieves. http://healthimpactfund.org/

 

What are the most important areas concerning global poverty and its alleviation that you think there is a broad consensus among informed people?

 

Thomas Pogge: I think one very important area that we have a great deal of consensus is global health. So, the last 10, 15 years we have seen a tremendous upswing in concern for global health and also a corresponding upswing in the willingness to promote real resources to that. Obviously, Bill Gates and the Bill and Malinda Gates foundation are part of that, but there are also the PEPFAR initiative, there is also the Global Fund, Gavi, Messon sont Frier there is a whole array of actors that more or less simultaneously have sprung up and have greatly increased resource mobilization to that area.

Academics have played some role here, in particular by pointing out how incredibly important early childhood health is for brain development, for physical development, and therefore indirectly for poverty alleviation because people who do not have a fully developed brain, a fully developed body will be less able to fend for themselves in future years.

 

What key areas in good faith, informed disagreement remain concerning global poverty? Here, the focus should be in those areas of disagreement are an impediment to presenting an effective academic consensus towards policy makers.

 

Thomas Pogge: Yeah, I think the most important thing to mention is disagreements about local versus global factors. I think everybody more or less understands that a lot of different factors come together in explaining the astonishing persistence of poverty despite the average income of the world. But, some people paint a picture that is heavily biased towards local and national factors, basically saying there are pockets of poverty left basically in remote areas that are disconnected from the world economy. Where the wonderful ideas of modern economics have not quite reached, where markets have not quite been established, and so essentially all we have to do is use the same ideas that have worked so well in China and Korea and so on. Bring these ideas out into the remote interland and we will see poverty melt away like snow in the springtime in the sun.

I really think that matters are more complicated than that, super national factors, foreign policy factors, and protectionism on the part of rich countries is also an important part in explaining the persistence of poverty. That is not in any way to deny the importance of local factors. Obviously, necessary in explaining why poverty eradication has succeeded so well in some areas of the world and succeeded so poorly elsewhere. For example, succeeded so well in China and succeeded much less well in India and Africa for example. But, we have to understand that local factors are persisting and having the positive effects in the context of a larger system in which these global factors codetermine what happens, codetermines what effect local factors have and codetermine what these local factors are.

 

What are the main things in your mind that academics can do in order to overcome this disagreement?

 

Thomas Pogge: I think just, more and better research. I think for example the impact of global factors, of super national factors is heavily understudied in the academy of social theorists among social scientists, and I think there are two main reasons for this, there are probably other reasons. But, the two main reasons are first that social scientists, just like everybody else, put preconceived notions about what the right explanations are, so they perform experiments to be tested empirically on the basis of what hunches they have. Their hunches in turn are influenced on the one hand by their education and their knowledge, but they are also influenced on the other hand by their ideas about, ‘What might be well funded, what hypotheses or conclusions might be well received and so on and so forth. And so for that reason, social scientists are more interested in local factors and figuring out what impediments might exist at the local level, and then for impediments that might exist globally. Another point here to be mentioned is that it is much easier to test hypotheses about local factors because there you can just, carefully try to find parallels across different geographic areas, you can for example compare how a certain program has worked in Brazil or how it has worked in Kenya. You can hold certain things fixed and do a regression analysis and so on. You have a lot of different geographical theatres to compare with one another, and then you can find statistical means of analyzing what the importance of causal factors is by looking at comparing those situations where these factors are present and situations where they are absent. It is much harder to try to figure out what the causal impact of global or super national factors is, because here we don’t have alternative wealth to observe, we only have limited cross historical comparisons that we can draw so we can look at what the world was like before the WTO agreement, what the world was after the WTO treaty and so on. Yeah, sure so we can do that but that again only gives us limited information because it compares two worlds with one another and of course there are lots and lots of differences between the pre-1995 world and the post-1995 world, all of which may be deemed cause irrelevant. So, there is certainly not enough richness of data to allow any kind of complex regression analysis. So again, social scientists shy away from that because if you have a paper that finds, you know, not enough evidence to support a particular hypothesis is it hard to try to get that paper published.

So again, for these two reasons, one reason that has to do with predilections of social scientist, what might be rewarded, what sort of their audiences in the rich countries might like to hear and like to fund. And the other one having to do with good scientific method, what is likely to get you an empirically supported conclusion. For these two reason scientists are too heavily focusing on local factors and shying away from any serious inquiry to the global and especially global institutional factors.

 

From informed disagreement to uninformed disagreement, what are some of the false or only partially true ideas concerning global poverty and it’s alleviation that are widely used in public and political debate to justify less than should be done to alleviate global poverty.

 

Thomas Pogge: Well, here I would like to mention first and foremost, I think the idea that poverty alleviation is highly correlated with overpopulation. It’s an idea that does not quite qualify, for what you said, it is not quite the case that this is always in public debates very prominently. It is not something people bring up explicitly and if they do bring it up they do so with a certain shyness, a certain embarrassment. But it is an idea that is in the forefront of public opinion that is many, many people have it in mind. Many more people have it in their mind and uppermost in their mind even when they are too shy to speak about it. Because, of course it is not very nice to say you know for the sake of future generations, for sake of avoiding dreadful resource depletions and ecological disaster, unfortunately we have to allow a few million people to die in this world. But, nevertheless, people more or less incorrectly believe.

Now what’s important here is the story that most people assume to be true just happens to be completely false. It is true of course we alleviate poverty to a point where some other people who would have otherwise have died, those people have survived and not died so they are around, in a year or two years or ten years where they otherwise would not have been, so that’s true. And it is also true that some of these people will have children otherwise they would have been dead and not been able to have children. But what is also true, is that total fertility rates have been in populations where poverty has been alleviated, dropped dramatically from a level like 6 or 7 children per woman to a level more like between 1 and 2, which is reproduction, two is reproduction. And we can see that diachronically that the statistics of total fertility rates in countries where poverty has been rapidly reduced, we find that in countries for example as diverse as Australia or Portugal and so on. China is a bit of a special case because of the one child per person capital policy, but really dramatic poverty eradication has led to a really dramatic drop in fertility rates because a cross the board, across cultures and so on. We are now at the point where 100 countries in the world fertility rates are below 2 already, and so in those countries population growth may not have peaked but certainly, the peak is in sight and there will soon be population drops.

In other countries where poverty has remained high, in particular African countries fertility rates have remained high, in the range of 7 at the top but many countries have rates are about 4. So, if you look synchronically you find that fertility rates in the less developed countries fertility rates are on the order of 4 and a half on average, in the middle income countries 2 and a half on average and in the fully developed countries around 1.6. So the best thing that we can do to deter overpopulation is to fight poverty aggressively and get it down and that would lead to an early leveling down of the population to around 9 billion or so by 2050 rather than a much later leveling off of the human population in the range of 14-16 billion near 2100 or even later. So I think a great deal is at stake in the overpopulation dimension by making an early and aggressive effort in poverty reduction.

 

Are there any features of the international institutional economic or political order that contribute to the persistence or perpetuation of global poverty and if so what are they?

 

Thomas Pogge: Well there are tons and tons of such of such features. I think that the order is essentially designed with tender loving care for a very small elite that is able to influence decision making about the features of this order. It’s an unintended but nevertheless foreseeable effect of all this tender loving care that the poor people get a short drift that their interest is disregarded. So, let me count the ways let me give you a few examples. The TRIPS agreement is one that I have worked on quite a bit in context with the Health Impact Fund. So, the TRIPS agreement essentially enshrines a high level of intellectual property but it is especially damaging in the area of medicines. Where poor people, and that consists of a vast majority of the population, simply don’t have access to advanced medicines because they are under patent and sold at very high prices. Disastrous for these people… disastrous to human kind at large, because we allow diseases to fester among the poor and of course, by the time these poor people get access these drugs, resistance will have developed, disease should essentially be eradicated but they cannot be eradicated because we don’t include the poor as recipients of these medicines.

Similarly, with seeds, we have wonderful seeds, much more high wield much less need to have pesticides and so on. But, we don’t make full use of these wonderful seeds because they are protected by intellectual property rights and many farmers in the poor countries aren’t able to afford protecting these crops.

Same in the realm of ecology, we are still working with old technologies that are much less clean, much less green than what we could provide. But again, intellectual property rights are in the way. I’m very strongly in favor of property rights, we need innovation and we need to reward most good people who bring us innovation. But, why in the world do we need to reward them through mark-ups than on what good the innovations bring to mankind. Anyway enough said, that’s a parcel of the health impact fund project.

Other very detrimental rules are the rules in the WTO that allow rich countries to grandfather in various protectionist measures: quotas, export credits, subsidies and so on. Which make it difficult or impossible for poor countries to export into world markets because in real world markets they have to compete with these heavily subsidized products in agriculture and textiles from the developed world.

And also, the barriers make it impossible to export into the richer countries. Yet, again is a great unfairness that we started the WTO project because the justification that open markets would be good for the poor. And so, we required them to open their markets  to our financial services products and much else but, we have simply not allowed them to import freely to our markets. This is to the detriment of the poor. Particularly pernicious because agriculture and textiles, these are industries that are highly labor intensive, at least in the developing world. Where for every job we save in the rich countries we save, where about 30-35 jobs get lost in the poor countries. So, it’s really an unjust feature that we have perpetuated these protectionist mechanisms.

Another very detrimental part of the existing global institutional architecture, is the way it also multi-national corporations to shuffle around their profits into low tax jurisdictions. Many of these multinationals produce in the developing world, they produce their goods there, they sell their goods there, but they don’t pay any taxes there. And they avoid paying taxes through all sorts of shenanigans where they make sure they are profitable not in the justifications of the developing world but in some low tax jurisdiction. For example, they register their trademarks or they provide various marketing services and so forth. So the idea is the subsidiaries in the developing world pay large fees to the subsidiaries in the low tax jurisdictions and thereby dissipate all the profits that would have otherwise been made in the developing world. These profits now accumulate in low tax jurisdictions, where the tax rates are about a half of a percent of something like that. And so, corporations can take advantage and exploit workers or consumers in the developing countries without paying their fair share of taxes in the developing countries.

This on top of course of the opportunities of lobbying and bribing and so on. Multinational corporations get sweetheart deals in developing countries all innocently disguised as incentive payments, where they pay you various incentives to come here and to create jobs here and so on. Companies would come without these incentives because they the customers they need the resources and so on. But, they bribe their way into getting all sorts of incentives, or they persuade legislators to give all sorts of incentives that further reduce the cost of doing business in these countries for them or we give them additional rewards for doing business in poor countries off tax revenues in those countries. Not only do they not pay any taxes but they also get all sorts of subsidies and revenues out of taxes of those countries. It would be entirely irrational in the sense of the taxpayers to award to them.

 

How might these features be change for the better?

 

Thomas Pogge:  Well, that’s in one sense a very easy question to answer. You for example could have country by country importing, in this case taxes but companies would have to show in detail what the business they are doing in various countries but it would make it much easier for poor countries limited innovative capacity. To see right off the bat that companies are doing a very large part of their business in their own country without paying anything like their corresponding share of their corresponding taxes or taxes having a corresponding share of their profits in that country. You could put kind of the same as a rigid rule but that’s somewhat more difficult to achieve for the government of the developing countries. So, the developing countries find it very difficult, certainly the people of these countries find it very difficult to get their fair share of value that is created by these companies in their own countries.

 

So taking into account these difficulties of political feasibility, which of these changes would you think would be the most realistic and effective objects for advocacy?

 

Thomas Pogge: Well, I’ve obviously thrown my eggs into the basket of the Health Impact Fund, I think the health Impact Fund is a very good reform project, a realistic reform project largely because it takes advantage of the fact that the current way of incentivizing pharmaceutical innovation is not only deeply immoral but also deeply irrational. It’s a completely insane way of rewarding pharmaceutical innovation, and you can see that, you can see the irrational enormous waste from it but just looking at a few figures, mainly how much the world is spending on medicines, that’s almost a trillion dollars, a year or 850 billion or something like that. And how much of that money actually goes to the manufacturing of medicine and for research and development of new medicines, which is a much, much smaller amount. Approximately 20 billion go to the research and development of medicines. So the question is where does all of this money go? All of the money we are spending on pharmaceuticals, where does it go? And the answer of course, is much of it goes for litigation, there is endless between brand name companies and generic companies about these intellectual property provisions. When do they expire? What does the patent actually cover? And so on a so forth, and another very large amount goes towards to promotion that is of medicines that actually benefits nobody. So, doctors are being influenced to prescribe medicines even if those patients don’t actually need those medicines. Patients are being influenced or demand medicines from their doctors that won’t do really any of them good and so forth.

There is the further fact that there is deadweight losses in the order of 200 billions dollars a year. Deadweight losses are losses that arise from mutually advantageous transactions coming about, so you have a drug that sells for a hundred dollars, say it could be produced for 5 dollars per package, then the innovator, the person who holds the patent on this drug would really love to sell packages at 40 dollars and there are customers who would really love to buy them at 40 dollars, but these transactions cannot come about because as soon as the innovator started selling packages at 40, other people that are now paying a monopoly price of 100, would find other ways to buy it at 40 and the innovator in the end would lose more money than they would by broadening the customer base. These so called deadweight losses are on top of the different between what we pay for medicines and what goes back into the manufacture and the research and development of the new medicines. It’s an additional 200 billion dollars that are not actually now spent on the medicines, but that are lost through the system as deadweight losses. So, because the system is very irrational we can find a way of reforming it that both makes it a lot more just and also makes really no party systematically worst off. It’s not the cases obviously that the reform can be designed so that no individual person or no individual nation becomes worse off, but at least the major classes, the pharmaceutical companies, the insurance companies, governments, taxpayers, patients, all the major stake holder classes gain from this reform. So, here irrationality here, as sad as it is to watch, is also something positive in a sense because it compels you to think of a reform idea that benefits everyone.

 

Moving away from international institutional factors, what other impediments to global poverty eradication would you say are extremely serious?

 

Thomas Pogge: Well, if we move away from multi-national institutions the only other factors to mention obviously are local factors, and obviously perhaps factors that are part of the mindset of people. You know, people have the mindset that poverty has always been there is nothing to do, that is totally the wrong mindset, because you have to look at it is not that, yes there has been poverty before but the morally salient question that we all should be asking is, has there been avoidable poverty before? And, there’s never been anything like the avoidable poverty on the scale that we find today. In terms of percentage, sure a majority of mankind has been poor people and each and every year all the way back to the stone ages and that is still true today, a majority of humans are poor. But never has poverty been so easily avoidable at so little a cost to the people who are not poor as has been the case today. So, we have to learn to resee poverty a just a giant crime against humanity that it hasn’t 100 years ago or 200 years ago.

So, that’s I think one important factor to mention, I think there are really many local factors that vary from country to country. The incredibly deep corruption in some countries, India for example where it is quite nice to see how many rights poor people have on paper and absolutely disheartening to see how difficult it is for poor people actually to get the objects of their rights, how they get chewed away by bureaucrats and how often they, whole classes of bureaucrats are routinely corrupt in appropriating what poor people are entitled to for themselves and denying it to poor people and that system is so likely to be taken for granted and that nobody even raises a big fuss about it anymore.

 

Finally let’s talk about policy recommendations, so taking into account political and economic feasibility constraints, what are the top three policies you would like to see implemented towards eradicating the end of global poverty?

 

Thomas Pogge: Well, again I would like to mention the Health Impact Fund, I think the Health Impact Fund would be a very crucial reform that would open up further reform opportunities. So, it is exactly a fund of the right size, that is to say it is not so large that it is entirely politically unrealistic, and yet it is such a symbolic importance it might actually change the course of human history. So, I would put that at the top of my list. I think that the second thing that for and concentrate are the political reform energies on probably has to do with the illicit financial flows, which try to shut down the opportunities for corruption of many types: tax evasion, and bribery, and so on that are now heavily operated by share corporations, banks that are helping clients avoid taxes in other countries and so on and so forth.

And that again can be relatively easy to shut down and the reform is politically realistic as far as also the richer countries are losing a lot of money through the resource shenanigans. And so the political will to shut down the avenues of corruption, the international avenues of corruption and illicit financial flows are there, it’s possible to achieve that.

So, that would be a second project, and I would think these would be the two main things that I would mention. A third thing that is gathering momentum and one could talk about in this context, is the establishment of a kind of an international revenue raising instrument. People often talk about international taxes but I’m not sure the word taxes is the right word to use partly because it gets people resistance up, and secondly also because some of the financing mechanisms wouldn’t actually be taxes. So, they would be a little more creative and a little more broadly, so one thing that I have proposed in that space is a mobile resources dividend, which is based on the very intuitive plausible view that the worlds resources, the resources of the natural planet in a deep sense belong to all of humanity in common. And of course, they should be locally controlled, it should be the people who live in a certain country or area should have the right to decide what happens with the resources. We should not of course force a country with resources to extract minerals or oils from the ground in their country if this is not what they want to do. But, nevertheless, we could have a global resources dividend that would require such countries to pay a small portion of the value of any of the resources that they do decide extract into a central fund that would then be used to the benefit of those people who are benefitting the least from the extraction of the resources worldwide and those people of course the global poor. Now, that sort of a system I think would be a system that could on the one hand raise revenues for the eradication and on the other hand could also slow resource depletion and consumption of precious resources and pollution of course which would be good for future generations. Again a kind of win, win solution by raising the price of resources in consumption, it would shift consumption in less resource intensive consumption. Thereby slow down the rate of pollution, slow down the rate of resource pollution of future generations.

 

Now, extracting the constraints of at least political feasibility, you where nominated 5 year dictator what would be the top three policy changes you would make globally?

 

Thomas Pogge: Well, that’s a pleasant thought experiment! What would I do there? There is without doubt, the key thing I would focus on is to establish a political system globally that would perpetuate whatever good things, I would do in the 5 years. So, the key thing is to think is, how can we organize our political life? How can we prioritize political decision-making? We need here, this is very utopian but I need to think of myself as dictator for five years so here we go. What I think we need to do is establish a multilayered system of governance, where you have genuine democracy at a global level. At the top, the global level should not be all-powerful in the sense that it should be able to anything, anywhere. But, rather it should get very carefully a set of decision-making authorities in those areas where international collaboration is especially crucial and those areas where externalities are great. So, here I am thinking of in particular three things. First is security, so, we are really living in a dangerous world for which the incentive for any state are very powerfully in the direction of having weapons of mass destruction. You see this now with Iran and North Korea and so on, countries that don’t have a credible deterrent can be very easily invaded, pushed around, and so on. Countries notice that and for that reason, we have evermore countries posing a significant threat with weapons of mass destruction. This is something that cannot really work in the long run. In the long run, it’s just a matter of time, sooner or later we will get a major catastrophe and I’m sorry to say the later that the later this happens, the more devastating it is going to be, because the more developed and dangerous these weapons are going to be. So, the first thing we need is a global decision making mechanism or global governance institution genuinely governing to sort the control of these weapons of mass destruction, and to give the smaller states who can develop these weapons a real incentive not to do so. So, tell them credibly, look you can participate in global governance on fair and reasonable terms even without developing these kinds of weapons.

The second point is ecology and we are living in a giant collective action problem, where we still haven’t managed to internalize externalities that countries are producing pollution and resource depletion and we urgently need to do that for the sake of the future of humankind. And that again requires global mechanisms that put a price on pollution and resource depletion that reflects appropriately all of the damage that this does to the future generations and thereby reduces the rate at which we are using up these precious resources.

Another point is global health, diseases don’t know national borders as is per verbally said. And so, we need to try not only muddle through and let the various countries with the help of the World Health Organization and various international organizations try to fight diseases the best they can. We need to start thinking more ambitiously about the eradication of diseases. Can we simply get rid completely of a disease like: polio, malaria, tuberculosis, and so on, rather than simply keeping it at bay. Keeping it at bay is all fine and good, but the point is that diseases especially infectious diseases always find ways of responding to treatments. They become resistant over time, and soon or later, it’s just a matter of time when we run out of effective molecules to tackle these diseases. And then we will go back to the dark ages that we were in before medicine was invented in a world in which we really have no resistance. No way of tackling these diseases, tuberculosis we already have xxx, multi, multi drug resistant strands of tuberculosis developing in parts of the world. And, it could potentially spread like wild fire, because nothing that we can do to treat patients with these diseases, at this point we isolate them. So again, we need to work together, we need to solve these collective action problems and for that we need global governance institutions.

So maybe these are the three most important ones, probably eradication is something that should be mentioned should be handled at the global level. Other levels such as the national level should remain very prominent and countries would run their own affairs in many, many ways, but they would work together on fair and democratically determined terms on these important issues that address humankind collectively.