Serbians’ Freedom to Choose

Serbia has adopted an approval mechanism for vaccinations, giving citizens the option to choose which vaccine they want to get and in which location they want to get vaccinated.

This makes Serbia the only country in the world where citizens can choose the vaccine type, between shots from Pfizer-BioNTech, China’s Sinopharm or Russia’s Sputnik.

This is from Sara Mageit, “Serbia reaches one million vaccines with help of AI framework,” Healthcare IT News, February 23, 2021.

There are 6.9 million people in Serbia, of whom over one million have received their first dose of vaccine. That’s 14.5 percent of Serbia’s population.

Let’s compare that with the United States.

64 million doses have been distributed in the United States. 64 million is 19.4 percent of the U.S. population, which makes the U.S. look better than Serbia. But that would be if everyone who got a shot here got just one shot. Such a policy would be quite sensible. But it’s not the one that U.S. governments have chosen. 13.3 percent of the U.S. population have received at least one dose. 13.3 percent of 330 million is 43.9 million people.

So 20.1 million people in the United States have received 2 doses and 23.8 million have received 1 dose.

Since 2 doses isn’t much better than 1, a reasonable comparison would be between our 13.3 percent and Serbia’s 14.5 percent. In other words, almost a dead heat (because getting 2 doses is slightly better than 1 dose.)

Interestingly, 14 U.S. states plus the District of Columbia have populations in which the percent having received at least one vaccination exceeds 15 percent. 3 states (Colorado, Iowa, and Wisconsin) have exceeded 14% but not 15%.

 

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In Praise of CVS

As I mentioned in a recent post, Monterey County, where I live, is behind almost every other part of the country in achieving vaccinations.

Enter CVS.

Last Friday, my wife, Rena, got on a user-friendly CVS site to see where she could get vaccinated. She was still working with it when I left for work. I have a 10-minute commute. A minute after I arrived at work, she called and told me that she had an appointment for the following Monday, Feb. 15, in Capitola, about 45 minutes north of us. She told me how to get on and find an appointment. I got on the site and it seemed that everything had been taken. I called her and told her that.

Rena said, “You always give up too early. Let me try it. How far are you willing to drive?”

“Quite far,” I said. I was picturing driving 2 or 3 hours to Modesto or Fresno. Ten minutes later she called back and had an appointment for me on the next day, Saturday, Feb. 13, in Santa Clara, a 75-minute drive each way. I drove up there the next day. I called a friend on the way, a fellow Canadian who had come with me to UCLA in 1972, and told him that I hadn’t been that excited since getting my green card. A couple of hours later, I got the Moderna shot.

Thank you, CVS. I like you so much more than the Monterey County government.

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Bioethics: Tuskegee vs. COVID

When bioethicists want to justify their own existence, they routinely point to the infamous Tuskegee Syphilis Study.  It’s a gripping story.  Back in 1932, the U.S. Public Health Service started a study of 399 black men with latent syphilis, plus a control group of 201 black men without syphilis.  Contrary to what I’ve sometimes heard, the researchers never injected anyone with syphilis.  However, they grossly violated the principle of informed consent, with disastrous consequences:

As an incentive for participation in the study, the men were promised free medical care, but were deceived by the PHS, who never informed subjects of their diagnosis and disguised placebos, ineffective methods, and diagnostic procedures as treatment.

The men were initially told that the “study” was only going to last six months, but it was extended to 40 years. After funding for treatment was lost, the study was continued without informing the men that they would never be treated. None of the infected men were treated with penicillin despite the fact that by 1947, the antibiotic was widely available and had become the standard treatment for syphilis.

Why do bioethicists habitually invoke the Tuskegee experiment?  To justify current Human Subjects Review.  Which is bizarre, because Human Subjects Review applies to a vast range of obviously innocuous activities.  Under current rules, you need approval from Human Subjects merely to conduct a survey – i.e., to talk to a bunch of people and record their answers.

The rationale, presumably, is: “You should only conduct research on human beings if they give you informed consent.  And we shouldn’t let researchers decide for themselves if informed consent has been given.  Only bioethicists (and their well-trained minions) can make that call.”

On reflection, this just pushes the issue back a step.  Researchers aren’t allowed decide if their human experiment requires informed consent.  However, they are allowed to decide if what they’re doing counts as an experiment.   No one submits a formal request to their Human Subjects Review Board before emailing other researchers questions about their work.  No professor submits a formal request to their Human Subjects Review Board before polling his students.  Why not?  Because they don’t classify such activities as “experiments.”  How is a formal survey any more “experimental” than emailing researchers or polling students?  To quote The Prisoner, “Questions are a burden to others; answers, a prison for oneself.”

The safest answer for bioethicists, of course, is simply: “They should give our approval for those activities, too.”  The more territory bioethicists claim for themselves, however, the more you have to wonder, “How good is bioethicists’ moral judgment in the first place?”

To answer this question, let me bring up a bioethical incident thousands of times deadlier than the Tuskegee experiment.  You see, there was a deadly plague called COVID-19.  Researchers quickly came up with promising vaccines.  They could have tested the safety and efficacy of these vaccines in about one month using voluntary paid human experimentation.  How?

Step 1: Vaccinate half the volunteers and give the other half a placebo.

Step 2: Wait a week, then inject all the volunteers with COVID-19.  (Alternately, give half of each subgroup a placebo injection).

Step 3: Compare the COVID infection rates of the vaccinated and unvaccinated 2-4 weeks later.

In the real world, researchers only did Step 1, then waited about six months to compare naturally-occurring infection rates.  During this period, ignorance of the various vaccines’ efficacy continued, almost no one received any COVID vaccine, and over a million people died.  In the end, researchers discovered that the vaccines were highly effective, so this delay really did cause mass death.

How come no country on Earth tried voluntary paid human experimentation?*  As far as I can tell, the most important factor was the formal and informal opposition of bioethicists.  In particular, bioethicists converged on absurdly (or impossibly) high standards for “truly informed consent” to deliberate infection.  Here’s a prime example:

An important principle in human challenge studies is that subjects must give their informed consent in order to take part. That means they should be provided with all the relevant information about the risk they are considering. But that is impossible for such a new disease.

Why can’t you bluntly tell would-be subjects, “This is a very new disease, so there could be all sorts of unforeseen complications.  Do you still consent?”  Because the real point of bioethics isn’t to ensure informed consent, but to veto informed consent to whatever gives bioethicists the willies.

I’m no paternalist, but I understand paternalism.  Paternalists want to stop people from harming themselves.  The goal of bioethicists, however, is far stranger.  Bioethicists want to stop people from helping others! Even if experimental subjects heroically volunteer to be injected for no money at all, bioethicists stand on guard to overrule them.

I’ve said it before and I’ll say it again: Bioethics is to ethics as astrology is to astronomy.  If bioethicists had previously prevented a hundred Tuskegees from happening, COVID would still have turned the existence of their entire profession into a net negative for humanity.  Verily, we would be better off if their field had never existed.

If you find this hard to believe, remember: What the Tuskegee researchers did was already illegal in 1932.  Instead of creating a pile of new rules enforced by a cult of sanctimonious busybodies, the obvious response was to apply the familiar laws of contract and fiduciary duty.  These rules alone would have sent people like the Tuskegee researchers to jail where they belong.  And they would have left forthright practitioners of voluntary paid human experimentation free to do their vital life-saving work.

In a just world, future generations would hear stories of the monstrous effort to impede COVID-19 vaccine research.  Textbooks and documentaries would icily describe bioethicists’ lame rationalizations for allowing over a million people die.  If the Tuskegee experiments laid the groundwork for modern Human Subjects Review, the COVID non-experiments would lay the groundwork for the abolition of these deadly shackles on medical progress.

Which is further proof, in case you needed any, that we don’t live in a just world.

* At least as I’m writing.  Maybe this will have started by the time you read this.

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Pandering to the public’s ignorance

Andrew Gelman has a post discussing a website called “Panda”, which provides a wealth of misinformation about Covid-19. What makes the site of interest is that its board contains some pretty big names, including former Trump advisor Scott Altas, as well as some Stanford University professors:

The board also includes, among others, Stanford medical school professor Jay Bhattacharya, Stanford biology professor Michael Levitt, and Michael Yeadon, a retired pharmacologist and drug company executive who, according to the website, “believes the pandemic was over in the summer”?

Gelman points out that until a few days ago the site was discouraging people from using Covid vaccines:

There was also this, from the organization’s webpage entitled, “You asked, we answered,” under the heading, “Would you have the vaccine yourself?”:

As for any other medication, a vaccine must be shown to be safe and effective before it is introduced to the general public. Vaccines take 10 to 15 years on average to be developed. . . .

Currently, there is no one for whom the benefit would outweigh the risk of these vaccines—even the most vulnerable, elderly nursing home patients.

. . .  I guess this statement was a bit of an embarrassment after one of the members of the Panda scientific advisory board publicly stated that he and his mother had received the vaccine. The above link is from 22 Jan 2021, courtesy of the Internet Archive. Go to that page now and that whole section has been removed.

OK, fine. But . . . also no acknowledgment of their earlier ridiculous statement.

And this is just the tip of the iceberg.  Even the revised statement is loaded with mistakes:

the mortality overall is relatively mild compared to past severe pandemics such as the 1918-19 Spanish flu and several more recent influenza pandemics such as the Hong Kong flu of 1968 and the Beijing Flu of 1993. The UK government even declared that “[a]s of 19 March 2020, COVID-19 is no longer considered to be a high consequence infectious disease (HCID) in the UK”.

Given that the overall statement was revised within the past week, I’m not sure why they still rely on estimates from March 2020.  In any case, Covid-19 is an order of magnitude worse than the Hong Kong Flu of 1968.  There was very little social distancing in 1968, and without social distancing the death toll from Covid in the US would already exceed a million.  (About 34,000 Americans died of the Hong Kong flu, although the number would be several times larger today, as there are now far more older Americans.)

The low mortality across the South East Asia and Oceania super region is likely driven by other factors, possibly prior immunity.

I don’t think there’s any evidence that prior immunity explains the success of Australia or New Zealand.  A recent outbreak in Melbourne spread rapidly before being brought under control, and of course Wuhan was devastated back in January.  Does anyone seriously believe that all of China except Wuhan had natural immunity?  (Almost all Chinese Covid deaths were in the Wuhan area.)  Yes, some countries may have some natural immunity, but it’s disingenuous to minimize the role of behavioral changes, which obviously played a huge role in China, Australia, and elsewhere.

We are unaware of any studies using sound methodology that show a benefit for masks in the general population. The only COVID-19-specific mask study using sound methodology found no significant impact of mask wearing on the spread of the disease.

If you follow the link you find a Danish study that did not even test whether masks help to slow the spread of the disease.  To do so, you’d have to test whether mask wearers are less likely to spread the disease.  Did they even read the abstract?

The fatality rate in most people infected with SARS-CoV-2 is very similar to that of the flu. COVID-19 is less severe than the flu for children and young people and more severe than the flu for the elderly with severe underlying illness.

I’d call this misleading, albeit not false.  It’s true if by “elderly” you mean a 55-year old man.  However for older middle-aged people, especially men, Covid is far more dangerous than the flu.  Indeed it’s not even close.

And this is just ridiculous:

On the other hand, it has been observed that winter respiratory mortality patterns are usually associated with a single dominant pathogen at any time, so it could be that (this year at least) COVID-19 has simply supplanted influenza and is, in the main, taking the lives that would have previously been lost to influenza.

New York and New Jersey already have more than 65,000 Covid deaths, despite widespread social distancing, and yet they contain less than 10% of the US population.  The entire US usually has far less than 65,000 flu deaths each year.

This is also extremely misleading, if not outright false:

There is no clear evidence in the literature showing that asymptomatic transmission is a major driver of the pandemic. The poorly supported theory that suggested this, was the main logic behind lockdown policies, which in any event have been shown to have no beneficial effect on death curves.

The primary worry was that presymptomatic people would spread the disease, but according the Panda those people are not “asymptomatic”:

An asymptomatic person is one who never develops clinical symptoms at all (no sneezing, coughing, fever, loss of taste or smell). This is distinct from a presymptomatic person, who begins to show symptoms after the incubation period of a few days.

A meaningless distinction.  Almost every average person would assume the term ‘asymptomatic’ applies to the presymptomatic.  People without symptoms often spread Covid.

However, many countries are recording COVID-19 official deaths if there is past evidence of a positive PCR test, or the patient is considered “probable” or “presumed’ to have COVID-19, even where the cause of death is clearly unrelated and symptoms are not present. This generous diagnosing can inflate the number of deaths in the data. Countries categorize deaths as “COVID deaths” using different criteria, so comparisons of such statistics are of questionable validity.

In fact, excess death data suggests that most countries have severely undercounted Covid deaths, and also that the excess deaths cannot be explained by other factors like suicide or people not getting cancer screenings.

Gelman suggests that this website has links to the conservative movement.  One thing I’ve noticed over the past year is that conservatives seem obsessed with minimizing the severity of Covid-19, and also seem interested in showing that measures to prevent Covid-19 (such as masks) are not likely to be effective.  This “head in the sand” approach has done a great deal to discredit the entire conservative movement with the well-informed part of the population.  That’s a shame, as there are areas (such as economic policy) where conservatives have lots of good ideas.  But they are rapidly losing votes among the college educated part of the population, and this sort of misinformation doesn’t help.

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Nationalism, prejudice, and FDA regulation

President Trump was a forceful advocate of nationalism. Many intellectuals (myself included) are strong opponents of nationalism. Indeed I view nationalism and communism as the two great evils of the 20th century. Thus it’s ironic to find many proponents of government regulation making essentially nationalistic arguments.

Alex Tabarrok recently pointed to the FDA’s scandalous refusal to allow the manufacture and sale of AstraZenaca vaccine in America:

By the way, the US failure to authorize the AstraZeneca vaccine in the midst of a pandemic when thousands are dying daily and a factory in Baltimore is warmed up and ready to run is a tragedy and dereliction of duty of epic proportions. The AZ vaccine should be given an EUA immediately and made available in pharmacies for anyone who wants it while continuing to prioritize Moderna and Pfizer for the elderly and essential workers.

When I advocate allowing people to be free to take a non-FDA approved drug or vaccine, the response is generally an argument relying on some form of paternalism. People are too poorly informed to be allowed to make these choices. They should not be allowed to take the drugs unless experts have verified that the drugs are safe and effective.

But that’s obviously not their actual motive. Experts in the UK have looked at the AstraZenaca vaccine and found it to be safe and effective. And yet Americans are still not allowed to use the product. So if paternalism is not the actual motive, why do progressives insist that Americans must not be allowed to buy products not approved by the FDA?  What is the actual motive?

The answer is nationalism. The experts who studied the AstraZenaca vaccine were not American experts, they were British experts. Can this form of prejudice be justified on scientific grounds? Obviously not. There has been no double blind, controlled study of comparative expert skill at evaluating vaccines. We have no way of knowing whether the UK decision is wiser than the FDA decision. Instead, the legal prohibition is being done on nationalistic grounds. We are told to blindly accept the incompetence of British experts, without any proof.  (And even if you believed there was solid evidence that one country’s experts were better than another, it would not explain why each developed countries relies on their own experts.  They can’t all be best!)

These debates always end up being like a game of whack-a-mole. Shoot down one argument and regulation proponents will simply put forth another. Their minds are made up.  You say people shouldn’t be allowed to take a vaccine unless experts find it to be safe and effective? OK, the UK experts did just that. You say that only the opinion of US experts counts because our experts are clearly the best? Really, where is the scientific study that shows that our experts are the best? I thought you said we needed to “trust the scientists”?  Now you are saying we must trust the nationalists?  Was Trump right about nationalism?

My dream of a completely free market in drugs will likely never happen. But what’s wrong with the following three-part system of regulation as a compromise solution:

1. FDA approved drugs can be consumed by anyone in America.

2. Drugs approved by any of the top 20 advanced countries (but not the FDA) can be consumed by anyone willing to sign a consent form indicating that they understand the FDA has not approved this product. I’ll sign for AstraZeneca.  (The US government puts together a list of 20 reputable countries.)

3. Drugs approved by none of the top 20 developed economies will still be banned.

This is what regulation would look like if paternalism actually were the motivating factor. But it’s not.  It’s Trump-style nationalism that motivates progressives to insist that only FDA approved drugs can be sold in America. They may look down their noses at Trump, but they implicitly share his nationalism.

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Will the Vaccines Mess With Our DNA?

 

A friend on an email group I’m on asked my friend and co-author Charley Hooper the following question about the COVID-19 vaccines:

Are you sure that the vaccine won’t mess with our genes?

Charley allowed me to share his answer:

No, I’m not 100% sure. But I’m one minus epsilon (a very small number) sure.

Biological reason:

I’m not an expert in this area. This is from my reading…RNA is a notoriously fragile molecule. Delivering mRNA successfully to the cells inside our bodies and ensuring that enzymes within our cells do not degrade it are key challenges in vaccine development. Chemical modifications during the manufacturing process can significantly improve the stability of mRNA vaccines. Encapsulating mRNA in lipid nanoparticles is one way to ensure that a vaccine can successfully enter cells and deliver the mRNA into the cytoplasm. 

mRNA does not linger in our cells for long. Once it has passed its instructions to the protein-making machinery in our cells, enzymes called ribonucleases (RNases) degrade the mRNA. mRNA dies a quick death once in human cells.

It is not possible for mRNA to move into the nucleus of a cell as it lacks the signals that would allow it to enter this compartment. This means that RNA cannot integrate into the DNA of the vaccinated cell. There is no risk of long-term genetic changes with mRNA vaccines.

Clinical reason:

Moderna’s Phase 3 clinical trial of its COVID-19 vaccine enrolled 30,420. We haven’t seen any genetic damage to these participants. Ditto for Pfizer and BioNTech’s trial that enrolled 43,448 participants. How have we not seen any genetic damage in over 70,000 closely monitored individuals?

Economic reason:

Why would a company market a vaccine that could mess up the genetics of its customers? I shudder to think of the lawsuits. This goes against everything I’ve learned from spending the last three decades in the pharmaceutical industry.

Genetic reason:

If the vaccines do alter human DNA, what is the result? To make us healthier, stronger, smarter, more beautiful? That would be extremely difficult to accomplish. To make us mutants? If the vaccines do alter our DNA, I think it’s virtually certain that the alterations would be harmful and perhaps fatal. Who other than an extreme environmentalist or a mass murderer would want this? However, these vaccines were developed by drug companies, not mass murderers. There’s no group of people that I know of that had both a motive for such a crime and the ability to perpetrate it.

Insider information reason:

Have we heard of large numbers of employees at Moderna, Pfizer, and BioNTech avoiding the new vaccines? No.

 

 

 

 

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Why Is the Vaccine Distribution So Difficult?

Imagine if food were allocated and distributed by the government. Wouldn’t this prevent hunger and famines, which have certainly killed more people than epidemics in the history of mankind? Most students of economics should have a ready answer. The opposite approach—that government allocation is more efficient than the anarchy of the market—is illustrated by the story of the Russian official who, shortly after the collapse of the Soviet Union, asked British economist Paul Seabright, “Who is in charge of the supply of bread to the population of London?” (recalled by Philip Coggan in his recent book More).

There is somebody in charge of the supply of Covid-19 vaccines in the United States, and that is precisely the problem. (That both the federal government and states government are involved is not the basic problem; on the contrary, decentralization prevents the centralization of error and improves the Soviet-inspired distribution system, if only by permitting experimentation.) A Wall Street Journal story sounded the alarm (again) on the dramatic inefficiency of the current distribution system (Elizabeth Findell, Jared S. Hopkins, and Dan Frosh, “Covid-19 Vaccines Are Getting Stuck at the Last Step,” January 17, 2021):

In South Texas, a man slept in his car for two nights straight so he wouldn’t lose his place in a line of hundreds of people at a mass-vaccination event. In Western Kentucky, residents registered for vaccination slots online, only to find when they arrived that their doses had been taken by walk-ins. In New Mexico, state officials scrambled to hire more people to staff a vaccination hotline after it was overwhelmed with callers. …

“It’s crazy that people have to call around to see what different providers have the vaccine, rather than having a central place,” [Texas state REp. Vikky Goodwin Goodwin] said. “People are thinking that we had months and months to prepare for this.”

Isn’t it tragic that such things happen and the same failed government interventions are proposed (like by Ms. Goodwin above) after nearly three centuries of modern economic analysis? When prices don’t clear the market, people wait in line and those at the end of the queue don’t even know if they will get anything when their turn comes. In this respect, the United States is not worse than other regulated countries but it is often not better either.

We should not exaggerate the Sovietization of the American economy. Looking at the throve entrepreneurship deployed by American private businesses during the pandemic suggests that the economy is more resilient than many would have thought. Yet, the trend of the past few decades is unmistakable. Sometimes, it even looks like military Sovietization, from the retired army officer running Operation Warp Speed to president Biden considering deploying the National Guard to set up Covid-19 vaccination clinics.

Even if government intervention is judged necessary in a pandemic, less Sovietized and more efficient ways would be more productive. The federal government could buy enough Covid-19 vaccines from the manufacturers by bidding up prices to obtain enough for the whole population—that is, by bidding high enough to divert enough economic resources to manufacturing and shipping these vaccines. It could then offer the vaccines for free to interested health providers and pay the shipping by Fedex and UPS. Even better,  the government (at the federal or state levels) could offer vouchers to anybody who wants the vaccine and let Amazon (or any retailer) buy the vaccines and sell them in exchange for the vouchers or for ordinary cash from those who are willing to pay. With tens of thousands of intermediaries with incentives to deliver the vaccines because it pays to do so, the distribution would proceed like for food or computer equipment.

The trick is to allow the market to clear as fast as possible. Even the government’s preferred clientèles would be better served by a liberalization of entrepreneurship and a large measure of economic freedom.

It would go less smoothly in states, such as New York State, that have set up their own Soviet-style allocation of vaccines, but individuals could at least cross state lines to buy a vaccine if they want. And competition would, to a certain extent, push state governments not to hamper private distribution.

If ordinary economic markets are not allowed to clear, expect the political market to clear with the help of patronage, random access, and waste. We have seen much of that since the beginning of the pandemic. It would not be surprising if, as recently reported, a large number of vaccines are trashed because not enough government-prioritized recipients are available at any given time or place. (See also Scott Sumner, “Regulation and Vaccines: It’s Much Worse Than You Think,” Econlog, January 17, 2021, who correctly defends a free market in vaccines.)

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Regulation: It’s much worse than you think

The distribution of vaccines is being held up by regulation. But I suspect that even opponents of regulation underestimate its pervasive effects. Regulation goes far beyond things like price controls and mandates regarding distribution, it extends into all aspects of our society (including the “private” sector), in ways that many people don’t even think about. Let’s start with health care:

1. We have a tax system that pushes people into gold-plated health insurance plans, and then the government regulates the way that those plans can operate. That problem was made dramatically worse by the recent decision of Congress and the President to kill the so-called “Cadillac tax”, which would have gradually eliminate the tax subsidy for health insurance.

2. We have many controls on entry into the provision of health care, which drive up costs in numerous ways.

3. Ever get a severe toothache on a Friday night, and be unable to visit a dentist for relief until Monday? I have. In 1910, I could have walked to the local drug store and bought some serious pain relief. Not today.

4.  Fear of lawsuits.  Many of the practices that make life in America both frustrating and inefficient are driven by a fear of lawsuits.  Yes, lawsuits play a valuable role in enforcing contracts, even implicit contracts.  But firms should also be able to have consumers and workers sign agreements not to sue under certain conditions.

5.  Price controls that create shortages.

I wonder if even sensible regulation skeptics like Tyler Cowen realize just how bad things are. In a recent post, he suggests we should praise the UK’s efforts in distribution the vaccine.  But the UK has done a horrendous job of distributing the vaccine; indeed Israel is doing the job 5 times faster.

So why does Tyler praise the UK? Because almost every country in the world is screwing up even worse than the UK. Regulation has made things so bad that even “pretty inept” starts to look good on a comparative scale.

[And don’t say, “Israel is small”.  Israel is roughly the size of many American states (such as New Jersey), each of which is doing a horrible job.]

Here’s another example:

A hospital Covid-19 vaccination team shows up at the emergency room to inoculate employees who haven’t received their shots.

Finding just a few, the team is about to leave when an ER doctor suggests they give the remaining doses to vulnerable patients or nonhospital employees. The team refuses, saying that would violate hospital policy and state guidelines.

Incensed, the doctor works his way up the hospital chain of command until he finds an administrator who gives the OK for the team to use up the rest of the doses.

But by the time the doctor tracks down the medical team, its shift is over and, following protocol, whatever doses remained are now in the garbage.

Isolated incident? Not a chance, Dr. Ashish Jha, dean of the Brown University School of Public Health, told NBC News.

“This kind of thing is pretty rampant,” Jha said. “I have personally heard stories like this from dozens of physician friends in a variety of different states. Hundreds, if not thousands, of doses are getting tossed across the country every day. It’s unbelievable.”

People consistently underestimate the responsiveness of industries to market signals.  I’d be happy to pay $2000 to get a vaccine today, rather than have to wait a few months.  Yes, health care workers are overworked.  But if I offered a nurse $2000 to give me a jab on the way home from a grueling 12-hour shift, would he refuse?

People gave Charles Barkley a hard time for suggesting that NBA players should get priority.  But why not? They are highly productive.  I don’t recall many people criticizing President Trump for getting special treatment when he contracted Covid, and I’d say the average NBA player is more productive than Donald Trump. So why the double standard?  BTW, if the NBA shuts down then lots of average workers also lose their jobs.

I could understand the “social solidarity” argument against a free market if this were a zero sum game.  But as Israel has demonstrated, the inefficient distribution of vaccines is a negative 80% game, that is, we are vaccinating 80% smaller share of our population than Israel. Yes, eventually we’ll catch-up.  But time is of the essence.

Under a free market, most people would receive vaccines sooner than under our current system.  Thousands of lives would be saved.  Perhaps it might seem a bit less “fair”, but what is fair about needlessly killing thousands of people just to be politically correct?  The price would likely fall sharply once the first few tens of millions were vaccinated.  And if there are some people too poor to pay for vaccines, then we have public charities like Medicaid and private charities like the Bill Gates Foundation.  As the Maoist experiment in China demonstrated, egalitarian intentions are not enough—you need incentives to produce goods and services.

People seem almost hardwired to resist the idea of deregulating health care.  Whenever there is a problem, they instinctively reach for even more regulation.  The FT has a long article discussing all the ways that bureaucrats have screwed up the distribution of vaccines, which ends as follows:

But some worry it is too late for money to have much of an impact and argue that the federal government should take control of the process rather than leaving it to states.

“The federal government could send a few thousand vaccinators,” Ashish Jha, dean of the Brown University school of public health. “They have a public health workforce. They’re just not for reasons that neither I nor the states can figure out.”

So the federal government has completely screwed up “for reasons that neither I nor the states can figure out” and thus we can conclude that “the federal government should take control of the process”?  Hmmm.

Here’s another thought.  Doesn’t this quote suggest that capacity limits are not the core problem?  We have “thousands” of vaccinators who are available but for some strange reason are not being used.

This is the whole point of markets.  To connect up desperate consumers with unmotivated providers.  The price system will provide the motivation that providers need to speed up the process.  You may find free markets in health care to be distasteful, but you should find thousands of needless deaths to be even more distasteful.

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The “mad scientist” problem

Matt Yglesias has an interesting tweet:

This image has an empty alt attribute; its file name is Screen-Shot-2021-01-15-at-6.01.30-PM.png

Last May, I said the following:

Occam’s Razor also applies to the lab release theory. We know that dozens of epidemics have come from viruses jumping from animals to humans without any “lab” being involved. Why construct an entirely new theory for this epidemic?

. . . Actually, the CCP would look far better (in a ethical sense) if the virus accidentally escaped from a lab doing valid and useful scientific research, rather than from disgusting “wet markets” that the CCP refused to shutdown. . . .

Of course it’s certainly possible the virus did escape from a lab during research on bat coronaviruses. I really don’t care.

In retrospect, that wasn’t my finest moment. I meant that I don’t care in an ethical sense, and I still hold that view. But Yglesias’s tweet raises an interesting issue. If it was a lab escape, then what are the public policy implications, if any? And I don’t know how to answer that question.

Over the years, I’ve argued that things like accidental nuclear war and bioterrorism were much bigger threats than global warming. (And I view global warming as a fairly big threat.) But I don’t know enough about science to know how policymakers should respond to the risk of bioterrorism.

However, I do know more about science than I did two years ago. As an analogy, before 2009 I thought Western policymakers knew how to handle the zero lower bound problem for interest rates. In 2009, I discovered that they did not, or at least there wasn’t a critical mass that knew what to do. Similarly, last year I found out that we were far less prepared for a pandemic than I had thought. Indeed, my perception of our preparedness seems to fall almost by the day, as I recently discovered our inability to deliver a vaccine to the public that has already been invented, tested, manufactured and distributed to states.

In the past, people who know more than I do told me not to worry about bioterrorism. But their arguments were not persuasive. Now I have zero trust in the public health establishment. I see no reason at all not to fear a “mad scientist” creating a virus 50 times more deadly than Covid-19, and letting it loose.

So to answer Yglesias’s question, it seems to me that if the virus escaped from a lab, then we should conclude that a future scientist with the same sort of psychological problem as that rogue Malaysian Airline pilot might someday unleash another Black Death. Say something as deadly as HIV, where symptoms show up with a long delay (as with HIV), and as easily transmitted as the flu. If you think I am wrong and are able to explain why this cannot happen, I’d love to be reassured on this point.

One thing I know for sure; if something bad can happen, at some point it almost certainly will happen.

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