Well the key is that there is no one person making this call.

Some middle manager instructs a bunch of peons to look for places to cut costs. One of them finds that doing X costs Y when doing it another way could cost Z. This all gets packaged to a higher up who just sees it costs Y to do X, and writes a report noting that X is a result of W. This goes up the chain to someone who needs to evaluate whether to cut U,V or W and they recommend W because it ultimately costs Y. This goes up another level to someone who approves a budget that cuts W to save Y and packages this into some nice talking points. The CEO then presents these talking points to the board and is congratulated for saving Y and then move on to questioning why X isn't being done any more.

Every individual is making somewhat reasonable decisions from their myopic perspective but in aggregate they are incompetent. No one is deciding to let millions die, they simply don't take the time to understand what effects their actions have.

How do you imagine millions of people will die again?

I plan to disagree, but first I need to know what the hell you're trying to say.

In the case of Remdesivir, which is hard to make, imagine you're the CEO of Gilead and the government of a country tells you they need it, people are dying without it, they're going to mass produce it at scale, and you're going to tell them how to retool their factories to produce it, since it'll take extra months of trial and error if you don't, during which people are dying and the disease is spreading exponentially.

Now you have a decision to make: ignore your patent and your fiduciary duty to investors, or defend your patent in court and your right to profit from the drug you invented.

Yesterday you were a moral person, today you're faced with the chance to become one of history's greatest villains.

That's the crux of my earlier comment, with which you can now proceed to disagree.

(Note: in reality Remdesivir seems not to be an extreme life & death drug- it only shortens recovery time, so it wouldn't quite fit into the scenario I presented).

Thanks for playing along with my hostile invitation :)

The great argument I wanted to make is that if there is a finite supply of a drug, only enough for 20% of the sick, selecting which 20% gets it doesn't cause more people to die. It might select who dies in deplorable or admirable ways, but the death count is the same.

But you're making a different and better argument.

I agree that your scenario would be terrible. But I don't think it describes what Gilead is doing. According to posts here, they're allowing generic manufacturing in poor countries, and India doesn't even respect drug patents to begin with.

>The great argument I wanted to make is that if there is a finite supply of a drug, only enough for 20% of the sick, selecting which 20% gets it doesn't cause more people to die.

This is what is done in patient outcome rankings for exotic therapies and surgeries that are a skill-based premium or are exceptionally expensive.

My perspective is, most small molecule therapeutics are already prioritized for production and trials based on synthesizability. So if some corporation really did find a viable treatment for COVID, I doubt scarcity would be the issue unless it fundamentally fails some medicinal chemistry principles for ease-of-synthesis. This is given how primed the global supply chain is to pump out a real treatment. Think of these checks as "code smell" checks, except in the early stages of drug development. Lead optimization is essentially the entire field of optimizing for desired properties, which is what would most likely be done to an extent if a molecule was prohibitively difficult to synthesize.

Btw, there's actually a LaunchHN on the frontpage that's right in the middle of tackling this kind of problem.