Great Moment in Public Service Number 12,933

I live in Monterey County, where the Monterey County Health Officer, Dr. Edward Moreno, has had a lot of control over our daily lives since last March. Many of us were hoping that at least he would do his job and get Monterey County its pro rata share of the Covid-19 vaccines allocated to California.

No such luck.

Here’s what a local weekly publication, the Carmel Pine Cone, reported in an email on February 13:

On Thursday the Wall Street Journal, citing data from Feb. 9, reported that Alabama had the worst vaccination rate in the nation, with just 10,013 doses administered per 100,000 residents. But on the same date, Monterey County said only about 8,000 doses had been administered here per 100,000 county residents. Nationwide county-by-county vaccination data doesn’t seem to be publicly available, but if Monterey County is that far behind Alabama, the county’s vaccination rate has to be one of the worst in the country.

Many of us suspect that Dr. Moreno has not been aggressive in pushing our county’s case and getting more vaccines.

And in a front-page news story in the February 12 Pine Cone, we might have found out why. Here’s a paragraph from a story about the grilling that Monterey County supervisor Mary Adams got in a recent town hall:

As for Moreno, who is often under fire for his poor communication skills, failure to crack down on the county’s hot spots and dysfunctional vaccine rollout, she [Supervisor Mary Adams] said, “I hear so many people say Dr. Moreno is not the greatest communicator. Dr. Moreno is the most shy person I have ever met, and this is agony for him to have to speak publicly. He also is very conscious of giving precise and correct answers.”

The reporter, Mary Schley, adds:

Unmentioned during the call was the fact that Moreno’s job description requires him to be able to “prepare clear and concise written and oral reports,” and “speak effectively before large groups.”

 

 

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The Magness Horpedahl Convergence on Masks

Last week I posted on the lockdown debate between Phil Magness and Jeremy Horpedahl. I noted that Horpedahl and Magness were not very far apart on lockdowns. Magness opposes lockdowns and Horpedahl favors only very limited local lockdowns in response to local information about spikes in cases.

Today I watched the whole discussion over in order to focus on the extent to which they agreed or disagreed on mask mandates. There was more disagreement on mask mandates, with JH (I’ll use initials from now on instead of full names) favoring mandates more than PM. What was also interesting, though, is the extent to which they agreed. I’ll note some highlights and then briefly note other interesting parts of the discussion that didn’t relate to masks.

Masks

JH  argued (at about 15:10) that mask mandates are a small restriction on liberty. He also stated, though (at about 17:00), his strong objection to governors like South Dakota’s Kristi Noem telling that state’s residents that if they want to wear a mask, that’s fine, and if they don’t, that’s fine also. Politicians, he argued should be pushing personal responsibility.

Notice, though, that the mask messaging of politicians is different from the issue of mandating masks. Like JH, I would have preferred that Governor Noem strongly recommend masks. She could still say that it’s a personal choice but that in indoor situations with other people present, the wise choice is to wear them.

PM noted (45:40) that masks work indoors and that (46:40) 80% of the public wears masks when venturing out. Given that high percentage use, PM asked (54:10), what does a mask mandate achieve?

JH noted (56:10) that PM’s 80% figure is right but that in private indoor spaces (family gatherings, etc.) the percent is much lower. JH dd note that the mandate won’t get at that indoor behavior in people’s homes. He’s not quite right, by the way. Wc could have police patrolling houses to enforce a mandate. Fortunately, JH didn’t even countenance that; good for him. In short, both clearly opposed pushing enforcement into people’s homes.

JH later (1:08:30) pointed out that a lot of people comply with the mask mandate because it is the law. I agree. Which means that a mask mandate, even if not enforced strongly, will cause many people to wear masks.

I asked JH a question on line that they didn’t get to in Q&A. It was this: What is the extent of the mask mandate you favor. Do you favor it for indoors vs. outdoors, for example? (That wasn’t the exact wording but I don’t have the exact wording.) I was surprised that in 1.5 hours of discussion, at least 15 minutes of which were about masks, the question of indoor vs. outdoor didn’t come up. I still would like to know.

I want to know for two reasons: one intellectual and the other personal. When I walk around Monterey in pretty undense situations where I can walk by people quickly and stay at least 5 feet from them and usually 6 feet or more, I often get dirty looks (I think: it’s hard to tell whether the looks are dirty when people are wearing masks) and even critical and sometimes nasty comments from mask wearers. Does JH think that, if I were a carrier, I would be putting these people at much risk?

Vaccine Mandates

This was probably the area in which there was the biggest difference. JH said (1:09;20) that schools already have mandates for various vaccines so having a mandate for children to be vaccinated is not a large step. He also said that it’s reasonable to have a mandate for people who want to travel internationally or even on buses. He said that you could have a rule that if you aren’t vaccinated, then you would have to follow the other rules about masking and distancing. My question: How would an official know who was vaccinated? Wouldn’t it have to be something like “Show me your vaccine card.”

PM answered (1:11:00) that it’s premature even to consider a vaccine mandate when current demand vastly exceeds supply.

PM also made 2 other points. First, remember the infamous Supreme Court case of Buck v. Bell in which the Court found forced sterilization constitutional and cited as precedent the existing compulsory vaccination laws. (That was the case in which Oliver Wendell Holmes, Jr., justifyng forced sterilization, stated “Three generations of imbeciles are enough” and leading me to wonder whether Mr. Holmes had grandchildren.)

Second, said PM, it doesn’t make sense to require the tens of millions of Americans who have had COVID-19 to get vaccinated.

Trading Off Lives and Mental Health

One questioner asked how lives saved from government interventions should be traded off against mental health. Both JH and PM gave thoughtful answers.

JH pointed out (1:23:00) that many people have a tendency to dismiss the value of the lives of the elderly because they have little of it left. But he noted that many of the elderly badly want to live and that one reason is to be around grandchildren. People in their 20s, on the other hand, often take big risks that suggest that they don’t necessarily value their lives very highly. He could have cited a study that I think was done by Robert Hall, Gary Becker, and another economist that found older people willing to pay a lot to live another few months. (My memory on this is vague.)

PM noted (1:25:00) that the question of the tradeoff between lives and mental health assumes the efficacy of interventions, which is something that has not been established. He noted also that the very lockdowns at issue often require the elderly to wither away in nursing homes, being able to visit their loved ones only through a window.

I have two personal stories that relate directly to PM’s point above. The father-in-law of a good friend of mine is about 95 years old. He was in a nursing home and was isolated by law even though he didn’t have the disease. My friend’s wife (the elderly man’s daughter) flew all the way from California to Pennsylvania so that she could take him to a doctor’s appointment. That was the only way she could actually visit him in person. This is insane. A few months ago, they decided to move him out of the nursing home and into the home of one of the elderly man’s daughters so she could take care of him.

Another friend in the Monterey area who’s quite wealthy had a mother-in-law stuck in a nursing home in Pennsylvania. She was stuck there because of the regulations and not doing well. My friend hired a jet to bring her out to Monterey, where she had a good last few months before dying late last year.

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Vaccine Adventures

Following up on information that Covid-19 vaccines were available there, I walked into the small Maine pharmacy. I saw nobody inside, not even at the cash register. I continued to the back of the store: nobody manned the two counters of the pharmacist’s hideout. I stood in front of one. After just a few minutes, an employee appeared on the other side.

“Could I see the pharmacist?” I asked.

The pharmacist came.

“I have been told that you have Covid vaccines,” I said.

“We have a waiting list,” she replied.

I asked to be put on it but she would not, or could not, tell me when they were likely to phone me for an appointment. I recognized something like the Canadian health system, under which I lived for decades.

“Is it a matter of days, weeks, months, or years,” I asked.

“Days. At least.”

That looked good, except for the “at least.” In some of the on-line and mortar-and-brick places, there is not even a queue you can get at the back of.

At this stage, the actual vaccines don’t seem to be the problem. In the United States, the manufacturers have delivered twice as many vaccines as have been administered. According to the Wall Street Journal (Jared S. Hopkins and Arian Camp-Flores, “Demand for Covid-19 Vaccines Overwhelms State Health Providers,” February 8, 2021),

[a]lthough state officials often cite limited vaccine supply, manufacturers are producing largely on schedule. Pfizer Inc. and Moderna Inc. since December have supplied about 60 million doses, nearly one-third of the 200 million the companies together must deliver by the end of March.

State governments are supposed to distribute the vaccines that the federal government, after literally monopolizing the market, makes available to them. The length of the queues varies from place to place, perhaps depending partly on the success of whatever entrepreneurship can creep into what is basically a socialized distribution system. One Missouri hospital has a waiting list of 100,000 names and no vaccine left. Queues are not an efficient way to ration demand.

In the former Soviet Union, the government always had an excuse for shortages. The real problem was different: no private property, no market prices to signal scarcities, and no free entrepreneurship to respond to the signals.

In America, once the federal government has purchased them, the Covid vaccines are priced at zero, which implies that government allocation is required. At a zero price, demand is much larger than the quantity that bureaucrats can supply. The fee governments pay providers (hospitals, pharmacies, and such) for administering the vaccines may not be higher than the latter’s cost. For example, Medicare pays about $40 for administering the two doses of the currently available vaccines. In a flash of economic realism, Joe Biden has expressed some concern that this fee may not be sufficient.

It is no consolation that all governments in the “free” world have adopted similar policies. No “American exceptionalism” here.

For Soviet agricultural production, the weather was often the excuse. For Covid vaccines, we are told that “the supply chain” and logistics are the problem. The Wall Street Journal‘s Jennifer Smith reported (“Mass Vaccination Sites Will Mean Scaling Up Logistics Coordination,” January 30, 2021):

Other local health departments might need information technology help to cope with overwhelmed appointment systems, or assistance with planning and sourcing the labor, supplies and procedures needed to administer hundreds of shots a day. “People underestimate that this is a massive logistics operation,” Dr. Wen said. “That type of expertise is often missing in state and local public health.”

But except for governments—that is, political and bureaucratic processes—that should not be an unsurmountable logistics problem. Private businesses without central coordination produce and deliver the food, in innumerable configurations, for the daily meals of 320 million Americans. Recall 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?”

In 2020, Amazon shipped 4.5 billion packages to American consumers—more than 12 million per day. The UPS hub in Louisville, Kentucky has a five-million-square-foot facility for sorting and treating more than 400,000 packages or documents per day. The hub sees 387 inbound or outbound flights daily from the company’s fleet of nearly 600 aircraft. What is more impressive is to think of the millions of individuals around the country and around the world who work in long and diverse supply chains to provide the equipment and inputs necessary for UPS’s operations. We are reminded of Leonard Read 1958 essay I, Pencil, which explains how the manufacture of a simple pencil requires the voluntary cooperation of a multitude of individuals producing, without a mastermind, the zinc, the copper, the graphite, and the equipment to make pencils out of that, and all the equipment for producing that equipment, and so on.

Although working under no central direction, these innumerable people who contribute to the production of pencils or UPS’s equipment and supplies are coordinated by markets (supply and demand) and the prices that signal what is needed where.

Compare this to the federal government’s “centralized system to order, distribute, and track COVID-19 vaccines” in which “all vaccines will be ordered through the CDC” (see the description by Anthony Fauci’s shop: COVID-19 Vaccine Questions and Answers, accessed February 10, 2021), the price for the final consumer is zero, and providers are paid fees determined by bureaucrats. No wonder the distribution runs into problems. The contrary would be surprising.

Note that the vaccine could still be free for the final customer if the federal government had simply subsidized consumers for their vaccine purchases (with vouchers, for example) and had let markets, entrepreneurship, competition, and prices distribute the stuff. And it wouldn’t take ages, luck, and some humility to put one’s hands on the thing—or one’s arm under the syringe.

The consumer who wants a vaccine gets a small taste of what French philosopher Raymond Ruyer, in his 1969 book Éloge de la société de consommation (In Praise of the Consumer Society), described as the difference between a market economy, where the consumer is sovereign, and a planned economy, where the producer runs the show (under government’s control):

In a market economy, demand gives orders and supply is supplicant . . . In a planned economy, supply give orders and demand is supplicant.

« Dans l’économie de marché, la demande est impérieuse, et l’offre suppliante (the supply is supplying). Dans l’économie planifiée, l’offre est impérieuse, et la demande suppliante. »

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Reciprocal Externalities: A Refresher

A key insight of the Coase Theorem is that externalities are reciprocal.  Yes, a polluter imposes a negative externality on his neighbor.  But if the neighbor insists on clean air, he imposes a negative externality on the polluter.  While common-sense morality may urge you to take the side of the neighbor, economic efficiency urges you to keep an open mind.  If the polluter’s cost of reducing pollution greatly exceeds the neighbor’s cost of enduring pollution, the Coase Theorem tells you to tell the neighbor, “Tough luck.  Suck it up.”

This Coasean insight is deeply relevant to COVID policy.  It’s also been almost entirely ignored.  Yes, people who don’t wear masks impose negative externalities on others.  But people who insist on masks impose negative externalities, too.  Efficiency requires both sides to consider the burden they’re imposing on the other.

Is the cost of wearing masks ever actually lower than the cost of enduring COVID exposure?  Definitely.  Suppose ten healthy young people all work in an office from 9-5 on weekdays.  Once a week, an immuno-compromised senior citizen stops by for five minutes.  The unmasked workers definitely impose a tiny negative externality one senior.  But if you require everyone to wear masks all the time, you impose a large negative externality on all ten young workers.  The efficient outcome would probably be to tell the senior to stay home if he’s nervous – not tell everyone else at the office to remain masked forty hours a week to accommodate him.

You might reply, “Forcing everyone to wear masks is inefficient, but we should still follow common-sense morality.”  I’m sympathetic, but is common-sense morality really on the senior’s side?  Not really, for two reasons:

1. Voluntary assumption of risk.  Every job has problems, including a bundle of risks.  The risks are unacceptable?  Common-sense morality’s standard reply is: “If you don’t like your working conditions, quit.”

2. De minimis. Even if you don’t voluntarily assume a risk, common-sense morality says that the expected severity of harm matters.  If the expected harm is trivial, you’re free to inflict it.  Example: I risk your life whenever I drive in your vicinity.  You don’t consent, but common-sense says I’m still entitled to drive.  Why?  Because the expected severity is low.  You could protest, “Only because you’re liable for any harm if it occurs.”  But in the real-world, imposing such liability is easier said than done.  After all, a lot of people are judgment-proof.  While you could heavily restrict the freedom of everyone who fails to post a $1M bond, common-sense morality strongly condemns such measures as tyrannical.

To state the obvious, I respect not only the individual right to wear a mask, but property-owners’ right to require a mask as a condition of entry.  But not only do I have a strong presumption against any stronger legal support for mask-wearing.  I also think that informal norms should take Coase’s notion of reciprocal externalities seriously.

 

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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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Selective outrage

Back in 2019, there was outrage among the public that Boeing had built an dangerous airplane that in 500,000 flights had killed precisely . . . (checks notes) . . . precisely zero Americans.  (Two international crashes.)

Matt Yglesias has some interesting comments on the lack of outrage over the botched vaccine rollout:

What’s striking to me, however, is that not only hasn’t the AstraZeneca vaccine been approved for use even on a special “right to try” basis, but that there is absolutely no movement in favor of such approval. And that’s not because Americans lack the know-how or will to protest things. Just during the past twelve months, we’ve seen big stop-the-steal rallies, huge anti-racism protests, and several rounds of protests against non-pharmaceutical interventions. The takeaway from the anti-lockdown protests was that Americans are too individualistic to abide by prolonged business closures. The takeaway from all three rounds of protests is that Americans of diverse ideological backgrounds have profound mistrust of America’s governing institutions. This is a country so taken with the spirit of liberty that we can’t get people to endure the relatively minor inconvenience of wearing a mask while out and about.

The minority of libertarians who aren’t deeply invested in being Covid denialists would like you to believe that the fussbudget FDA is standing between you and the AstraZeneca vaccine. But it’s clear that the American people are absolutely not prepared to let public health experts tell them what they can and can’t do. If people were clamoring for faster approvals, we’d get them. But there’s no Covid Era version of ActUp demanding access. If public health bureaucracies ask people to change, a large share of the population declines to do it. If they try to force people to change, you get significant resistance. But if they block change, then the public is fine with that.

Even if you are not convinced on the AstraZeneca issue, there are many other areas where outrage is the appropriate response.  Why didn’t the federal government go all out subsidizing the manufacturing of vaccines in case they work?  Alternatively, why not encourage production using free market price signals.  We did neither.

Why wasn’t there a plan for distributing the vaccines?  Israel had a plan; why didn’t we develop one over the past 10 months?  Alternatively, why not use market incentives to speed up delivery of the vaccines?  We did neither.

Again and again, we see failures that cannot be justified from either a libertarian or a statist perspective.  And yet there are no street protests.  Why not?

You might say the issue is complex, hard to understand.  But Boeing jets are complex machines, hard to understand.  Statistics are hard to understand—do two crashes out of 500,000 flights represent a good or bad safety record?

I suspect the actual explanation lies elsewhere.  The experts told the public to be outraged over the Boeing 737 Max.  The experts did not tell the public to be outraged over the vaccine fiasco.  Instead we were told that “Operation Warp Speed” was a huge success.  In one respect it was—the vaccine was developed rapidly.  But experts also needed to point out that once the vaccine was invented back in January, we’ve stumbled from one fiasco after another.  The experts did not do so (with a few exceptions in the blogosphere) and hence most Americas don’t even know that it’s been a huge mess.  At least this is what I find when I speak with average people.

I’m outraged that experts are not whipping up outrage among the general public.

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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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Noubar Afeyan on Academia, Business, Immigration, and the American Dream

Tyler Cowen has posted an outstanding interview of Noubar Afeyan, co-founder of Moderna, which produces one of the two COVID-19 vaccines approved so far by the Food and Drug Administration. Tyler is at the top of his game, asking really good questions, and you can just see the respect that that creates in Afeyan.

Some highlights follow.

On individualized medicine

We have a program in cancer vaccines. You might say, “What does a cancer vaccine have to do with coronavirus?” The answer is the way we work with cancer vaccines is that we take a patient’s tumor, sequence it, obtain the information around all the different mutations in that tumor, then design de novo — completely nonexistent before — a set of peptides that contain those mutations, make the mRNA for them, and stick them into a lipid nanoparticle, and give it back to that patient in a matter of weeks.

That has been an ongoing — for a couple of years — clinical trial that we’re doing. Well, guess what? For every one of those patients, we’re doing what we did for the virus, over and over and over again. We get DNA sequence. We convert it into the antigenic part. We make it into an RNA. We put it in a particle. In an interesting way, we had interesting precedents that allowed us to move pretty quickly.

Big question I wish Tyler had asked as a follow-on: Do you think the FDA will loosen its reins enough that Moderna and others can deal that way with individual patients without getting permission and doing large-scale tests?

The Academic Scientific Community vs. the Business Scientific Community

Look, the scientific method, the scientific community — it works on advances that are predicated on current and prior advances. Incremental advances are the coin of the realm. It’s not that they’re conservative. It’s just that the process, the communal process of accepting truth as that which can’t be negated, causes you to therefore be, in every which way, questioning everything.

I learned long ago the expression organized skepticism. That’s what science is predicated on. As a result, if you come forward with something that is not fully supported by and connected to the current reality, people don’t know what to do with it. What many academic scientists do is to spend the next 5, 10 years putting the connections in place to make what’s being proposed a natural extension of what existed before.

In industry, we don’t have that need, and the reason Moderna was able to really be the pioneer in the space of establishing a therapeutic platform, even before a vaccine platform, is because for us, the lack of connection between what we were able to do and what had been done before was marginally interesting, but we weren’t trying to publish it.

When you patent something, you don’t have to show that it’s a natural extension of what people did. You just have to describe something that is novel, that is unobvious. In fact, the less connected, the more unobvious, and/or the less connectible.

Note this sentence: “What many academic scientists do is to spend the next 5, 10 years putting the connections in place to make what’s being proposed a natural extension of what existed before.” It reminds me of the old joke about the academic who, observing that a TV works in practice, wants to understand whether it works in theory.

On Immigration and the American Dream

This next is my absolute favorite of the interview.

I also would say that as a country, there’s so many people who have the experience of coming here, that that experience can also be transmitted to people who are born here, for whom the same mindset of being willing to imagine a better . . . If you look, every single person who comes to this country imagines a better future for themselves. That’s my belief. Maybe not every single person — 99 percent.

Imagine if all of us were also born imagining a better future for ourselves. Well, we should be, but we’ve got to work to get that. An immigrant who comes here understands that they’ve got to work to get that. They have to adapt. The problem is, if you’re born here, you may not actually think that you’ve got to work to get that. You might think you’re born into it.

This will be a funny thing to say, and I apologize to anybody that I offend. If we were all Americans by choice, we’d have a better America because Americans by choice, of which I’m one, actually have a stronger commitment to whatever it takes to make America be the place I chose to be, versus not thinking about that as a core responsibility.

That brings up two memories, one old, one relatively recent.

The old memory is that when I came to this country in 1972, at age 21, I had the American dream in mind and I noticed right away that a large swath of the people I ran into in Los Angeles, whether at UCLA or in the city generally, who had grown up in the United States, didn’t.

The more-recent memory is of an interaction I had with a man who was considering running for the Republican nomination for president in 2016. I think the conversation happened in 2015, and it was at a Hoover Institution roundtable I had been invited to. I can’t name the person without violating the confidentiality rules.

He made a statement about immigrants that surprised me. He said (and I think I’m getting his words almost word for word), “So many immigrants come here and act right away as if they just arrived at home base after hitting a home run.”

When it was my turn to talk, I said, “Person X, I’m an immigrant and I thought when I got my green card I’d arrived at home base or at least at third base. I was given a list of crimes that, if I committed them, would get me booted out of the country and none of these crimes were ones I planned to commit.”

Then I made the mistake of asking about his record in a previous office he had held. He answered about his record but didn’t address my point about immigration. This man had the attitude that Afeyan attributes to many Americans: Simply by being born here, he seems to think that he’s made the rounds to home base.

I really don’t know what some politicians and some Americans expect out of us immigrants.

 

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Thoughtful Pieces on the Lessons of COVID-19

Janan Ganesh, in the Financial Times, forcefully argues that the Covid19 has “no grand lessons for the world”. The significance of the pandemic is being stretched as implying the triumph of a “system” over another, but on the basis of poor evidence. Covid19 has taken the world by surprise and it is difficult to claim that systems characterized by more civic trust, or with stronger government, or with more liberal governments, performed better than their opposites.

Writes Ganesh:

The closest thing to a pattern in this tempest of data is the scarcely believable success of east and south-east Asia. But that region encompasses communist China, the multi-party democracy of South Korea and various polities in between. What systemic lesson is the rest of the world to take from this zone of competence?

There is no disgrace in the quest for such certainty. The “narrative fallacy” is a technical term for a very human foible. It refers to our need to see shape and order in scattered events: to explain and not just record them. The alternative, which is to accept the role of randomness in life, is often too much to ask. And so an on-form sports team is assumed to have a sublime new tactic at work. Energy stocks are said to rise “on the back of” an oil-price rise, as though coincidence is unthinkable.

This urge to attribute cause and effect is all the stronger in a mortal crisis. Confronted with mass suffering, it is soothing to believe that we will emerge wiser about how best to arrange our societies. A tragedy without a corresponding agenda for reform is all the harder to bear.

Unless the data coheres into some shape, however, that is what we have. The evidence does not even throw up many hard-and-fast rules about the right policies for a virus (Taiwan, whose total death toll is seven, has had no national lockdown). Far less does it elevate one model of social organisation over others. In the geopolitical propaganda war, China will claim that its system is the one that worked this year. The liberal west will argue the same, and both will have half a point, without a clinching case.

Beyond the tautological — good government is preferable to bad government — the world has amazingly little insight to show for its year of anguish. Its challenge is to resist forcing a narrative on to facts that do not support one.

I found the piece refreshing.

Miles Kimball, instead, points out that “perfectionism made the pandemic worse”. Kimball writes that “some of the caution about evidence, accuracy, efficacy and side-effects would make sense if we were facing a lesser disease. But when people are dying all around, getting the job done is what counts, even if you get the job done by imperfect means. The way the reproduction ratio works, combining a set of several very imperfects means that pushed the reproduction ratio below the critical value of 1 could crush the spread of the coronavirus.”

In other words, “every little bit would have helped reduce the reproduction ratio of the coronavirus, but only things that were big bits were allowed”.

Consider particularly his last two points:

– Because the vaccine protocol used two doses, the vaccine-rollout plan while vaccine doses are scarce is to vaccinate half as many people with two doses rather than twice as many people with one dose, which the vaccine trials suggest has a high enough level of efficacy that vaccinating twice as many people with one dose would lower the vaccines reproduction ratio much more.

– Finally, in something that shocks me, the article at the top, “Highly Touted Monoclonal Antibody Therapies Sit Unused in Hospitals” by Sarah Toy, Joseph Walker and Melanie Evans suggests that there is a reluctance to use monoclonal antibodies because there is not yet evidence that goes far beyond what was needed to get government approval. Monoclonal antibodies work by the same principles as vaccines; the big differences are (a) vaccines get your body to make antibodies, monoclonal antibody treatment directly injects antibodies, (b) the monoclonal antibodies are chosen to be especially high-quality antibodies, while your body might or might not make a lot of high-quality antibodies after you are vaccinated, and (c) you have to vaccinate everyone, but the monoclonal antibody treatment can be given to people after they start to show some symptoms and so can be prioritized better. You can bet that I would ask for monoclonal antibody treatment if I got Covid-19.

I shall add that this attitude goes very well with the unrealistic expectation that we can and should aim for “zero risk”. This would imply that either we can reach for big enough guns enough to achieve that goal, or it is better to wait. This strikes me as unrealistic.

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