Alex Tabarrok has posted a talk he gave at Bowling Green State University in February. The title is “U.S. Pandemic Policy: Failures, Successes, and Lessons.”
Alex does a good job of presenting his case. I’ll hit the main highlights on which he does well. At the same time, there are yawning gaps that leave me wondering whether he has no view on the issue (for example, he mentions zero about lockdowns) or whether he just is not familiar with what I thought were pretty well-known failures (e.g., nursing homes in New York, New Jersey, and Pennsylvania.)
I’ll go through the talk seriatim. Because my comments are extensive, Part I is today and goes to about the 41:00 point of the 60-minute talk. Part II will be tomorrow.
Alex starts off by pointing out the huge number of U.S. deaths due to Covid-19, now in excess of 900,000. He notes that this is greater than the total number of U.S. deaths in all foreign wars the U.S. has fought in. That’s correct.
For completeness, though, it would have been good to point out that the median age of military members’ deaths in all U.S. foreign wars was almost certainly below 40 and probably below 35, whereas the median age of Americans who died of Covid was about 80. That means that the number of life years lost to Covid was substantially below the number of life years lost to all those wars combined. (I’m focusing on Americans here. Comparing worldwide deaths from Covid to worldwide deaths from World War II alone shows Covid to be a fraction of WWII, even putting aside life years.)
Am I callous about people close to age 80 who die? No. For one thing, I’m only 9 years away from that age. I’m simply pointing out what Alex’s George Mason economist colleague Don Boudreaux has pointed out well here, namely, that we sensibly react differently to the death of an elderly person than to the death of a teenager.
Next, Alex discusses the economic costs and shows that they are huge. Here’s where I first started wondering: are these the costs of the pandemic alone or are they the costs of the pandemic and of the lockdowns that governors of states with over 98 percent of U.S. residents imposed on those residents? Alex doesn’t address that. The losses in the first few months from early March 2020 to about June 2020 are likely due mainly to people’s voluntary reactions to the pandemic. But after that, the losses were probably mainly due to lockdowns.
His next major point is that Covid-19 was not a “Black Swan” event but, rather, was a predictable and predicted event. Alex says that we were not ready for this pandemic. I’m not sure that’s true. I think we were somewhat ready. As Phillip W. Magness and Peter C. Earle pointed out in “The Fickle ‘Science’ of Lockdowns,” Wall Street Journal, December 19, 2021, in 2019, both the World Health Organization (WHO) and Johns Hopkins University’s Center for Health Security had concluded that large-scale quarantines were not a good way to deal with the pandemic. So it wasn’t so much that “we weren’t ready” as that we were somewhat ready but Donald Trump’s task force and a whole lot of similar organizations in other countries threw out the playbook, ignored tough tradeoffs, and went with widespread lockdowns even of people for whom there was no evidence of disease and people (children) for whom the risk of death was tiny. Alex mentions none of that. Regarding tradeoffs, Scott Atlas, one of my Hoover colleagues and an adviser to President Trump on Covid (too late in the game, given the disastrous decisions Trump made in the first few months) points out in his 2021 book, A Plague Upon Our House, that he (Atlas) tried unsuccessfully to get his colleagues who were advising Trump to look at tradeoffs. I talk about that in my forthcoming review of Atlas’s book in Regulation.
Instead, Trump’s government and governments around the world were influenced by a model created by Neil Ferguson and his colleagues at Imperial College London. The model turned out to be way off-base. One fact that Magness and Earle cite:
Imperial predicted up to 42,473 Covid deaths in Sweden under mitigation and 84,777 under uncontrolled spread. The country, which famously refused to lock down, had some 13,400 deaths in the first year.
More on the Ferguson model later, in Part II.
Here’s one recommendation from the Johns Hopkins study that caught my eye (p. 13):
WHO and national authorities will need to provide strong evidenced-backed reasoning for the necessity of NPIs in order to effectively implement them and to communicate their role and necessity to the public, especially for NPIs such as social distancing that inherently limit civil liberties. Therefore, they should under- take directly or support research on NPIs and disseminate their findings on these analyses.
NPIs are “non-pharmaceutical interventions.”
Next Alex goes over a timeline showing some huge mess-ups by the CDC and the FDA. Alex does such a good job of this, and with a beautiful righteous anger. It goes from about 6:30 to about 14:30. I highly recommend this segment. It covers Helen Chu, whom I wrote about here on April 8, 2020, among others.
A minute or two later Alex, justifiably goes after the FDA for slowing down tests and compares our experience to that of other countries like South Korea. That goes to about 24:00. His story about South Korea (from about 22:00 to about 24:00) is really powerful.
Like Alex, I think these were huge mistakes. Because of these mistakes that slowed testing, we in the United States were flying blind.
Well, almost. Stanford medical professor Jay Bhattacharya, who has a Ph.D. in economics and earned an M.D., was skeptical from the beginning about two things: (1) that the reported fatality rates of about 3 percent were real; and (2) that the virus had not already spread widely as, in his reading of the literature, had happened with previous viruses.
On (1), his reasoning was that what was being measured was the case fatality rate and this was likely to be much higher than the infection fatality rate. Why? The people who went to get tested were disproportionately people who had symptoms, and not just symptoms, but bad symptoms.
To test (2), he and some colleagues, in early April 2020, tested 3,328 residents of Santa Clara county (California) to see how widely the virus had spread. What they did is called a seroprevalence study. They concluded that 1.1 to 2.0 percent of Santa Clara county residents had antibodies. This implied about 53,000 people, which was a large multiple of the 1,200 confirmed cases at the time.
In private conversation, Jay told me that that percent was just too high for a society-wide lockdown to be effective.
Alex doesn’t mention Bhattacharya’s seroprevalence studies or those of many others who were conducting such studies at the same time who found numbers broadly consistent with Jay’s.
In Alex’s view, the big success was something he had a large role in: persuading the Trump administration to give drug companies many billions of dollars so that they could build capacity and be ready to quickly scale up production once a vaccine was found. This was Operation Warp Speed. OWS also guaranteed that the government would buy the vaccine once it had been produced, even if the virus went away. His story about how they went about that is very interesting and I recommend listening to it. It goes from about 24:30 to about 41:00. The best part, in my view, is getting the FDA to back off from business as usual (at about 25:50.)
Also, Alex says (26:10) that OWS paid firms to start building factories now. I think he leaves out a major, and successful, exception. While Moderna, the company that vaccinated me 3 times, did take that money, I think I recall that Pfizer refused. (I can’t find the link: I remember reading it in the Wall Street Journal in the spring or summer of 2020. Please correct me if I’m wrong.)
I’m a fan of the vaccines. I think they accomplished a lot. The big unknown is whether we would have had the vaccine without the subsidy elements of OWS. Alex clearly thinks we wouldn’t have. He emphasizes the importance of building capacity even before the drug is proven effective. Co-author Charley Hooper, who makes his living consulting to pharmaceutical companies, and I wrote an article in December 2020 titled “The FDA’s Deadly Caution.” We lay out a timeline where, without FDA regulation, we might have had the vaccine months earlier than we had it. As Alex agrees, a few months difference is huge.
That’s it for Part I.
READER COMMENTS
Scott Sumner
Mar 16 2022 at 8:01pm
In some case subsidies can make up for other regulatory failures. There are all sorts of regulations (from price controls to FDA approval to tort laws) that makes vaccine development far less profitable that it would be in a truly free market where consumers could freely sign wavers promising not to sue vaccine providers and companies could price gouge and no FDA approval was needed and vaccine developers could do challenge studies. Given all these implicit and explicit government regulatory barriers, subsidies can help to boost the profitability of vaccine creation back up closer to what it would be in a free society.
David Henderson
Mar 16 2022 at 10:11pm
All true. But given that the powers that be were open to clipping the FDA’s wings and did so, something Alex mentions, what would have happened if Alex, Michael Kremer, Susan Athey, et al had pushed really hard for relaxing FDA regulation even further?
Scott Sumner
Mar 17 2022 at 1:50pm
That’s certainly my preference, although it’s quite difficult to roll back all of the implicit and explicit regulations mentioned above. But I think you and I have a pretty similar view of the ideal situation—no FDA at all.
zeke5123
Mar 17 2022 at 9:20am
No doubt. But the problem with subsidizing government regulatory failures is (i) even if you get to the “right” answer there is significant waste (i.e., bureaucracy always springs up) and (ii) odds are the “right” answer is not arrived at (i.e., the subsidy will either be too little or too much).
Mark Brophy
Mar 16 2022 at 8:19pm
The “vaccines” are worthless. Obama took them 3 times and still contracted Covid, as did millions of others. The “vaccines” also caused blood clots, neuropathies, and other illnesses on a mass scale. Nobody benefitted from vaccines and Obama wasn’t vulnerable because he’s young and lean. It’s absurd to “vaccinate” children and others younger than 40.
TGGP
Mar 17 2022 at 11:24am
The vaccines are not worthless, they make a huge difference in terms of deaths.
Todd Kreider
Mar 17 2022 at 6:17pm
The vaccines make a notable difference among the elderly with comorbidities and much less so with the middle age who have comorbidities. They may have a little value for the healthy under 60 but are known to have a non-trivial risk of serious side effects. The healthy under 30 have had no reason to get a vaccination that has been tested far less than previous vaccinations.
Scott has often lumped everyone together in terms of risk over the past two years. It’s the same craziness of the late 80s and the entire 90s that “everyone is at risk” of getting HIV and dying from it that Fauci and universities promoted.
Scott Sumner
Mar 17 2022 at 1:52pm
“The “vaccines” are worthless. ”
This shows an amazing ignorance. You should refrain from commenting on things you know nothing about. People are dying because of this sort of fake propaganda.
Charles Hooper
Mar 21 2022 at 4:14pm
Statements such as “the vaccines are worthless” or “the vaccines are great” are too broad. The vaccines proved their high value and low cost for the more vulnerable members of our population, while for the young and healthy, the value was so low that it’s a toss up whether the benefit was greater than the cost or vice versa.
Pierre Lemieux
Mar 17 2022 at 12:30am
David: On the refusal of Pfizer to receive federal research and development money for its eventual vaccine, you will find two references in my post at https://www.econlib.org/the-pandemic-in-europe-and-america/.
Alan Goldhammer
Mar 17 2022 at 9:55am
I could spend all day pointing out all the problems with what Bhattacharya has said about Covid over the past two years but since there is so much confirmation bias around here I’ll not take up peoples time other than this one rebuttal. The researchers on the Santa Clara study were deservedly skewered by Andrew Gelman who is one of the best statisticians around. There were others but the Gelman post is perhaps the best.
TGGP
Mar 17 2022 at 11:28am
Greg Cochran was saying at the time that estimates of high existing infections were nonsense (during a rapidly growing epidemic the vast majority of infections will be new). Due to his more accurate understanding, he repeatedly made correct bets about the number of deaths that would result. Whereas Hoover’s Richard Epstein kept having to add extra 0s to his old estimates to explain away how many more deaths there were.
Jon Murphy
Mar 17 2022 at 6:38pm
While I agree with the criticisms of the Santa Clara study, it is worth noting that the ultimate conclusion (that spread was way way higher than testing indicated and illness was way way lower) has been confirmed thoughout the pandemic by multiple studies using multiple methods and reported by the CDC, WHO, and other organizations.
Monte
Mar 19 2022 at 11:29am
And this is the more salient point. The authors were certainly errant in accepting, prima facie, the original study’s implications and were careless with the statistics supporting those conclusions. But in revised (and more robust) analysis, the number of infections estimated in Santa Clara county by early April were still staggering.
The truth is that we’re all guilty of confirmation bias to one degree or another, even the great and powerful Andrew Gelman.
Philo
Mar 17 2022 at 11:24am
Thanks for this post; I look forward to Part II.
You might be right that the economic losses after June, 2020, were mainly due to lockdowns, but I wonder what about your evidence. By that time, people were quite frightened; they might well have behaved pretty much as if they were locked down, even if governments had imposed no lockdowns.
Alan Goldhammer
Mar 17 2022 at 2:05pm
This is exactly right. There was a tremendous amount of uncertainty which many Covid revisionists choose to ignore. I spent my working career in the biopharma industry and many of my ex-collegaues were constantly emailing one another on this exact topic. We were all being super cautious, no longer going to restaurants (some of them still won’t), movies or traveling. 1/3 of the American public pretty much stopped being consumers other than ordinary staples and even then many of them had everything delivered. This sucked a huge amount of money from the economy and would have done so regardless of lockdowns as this group is incredibly risk averse. You had another third who were cautiously waiting to see what would happen but paying more attention to the risk averse group.
The remaining third were willing to go out and buy and do things but this is the group with a much lower level of disposable income. The economics are pretty clear in terms of what will happen.
Obviously, there is a lot known now and it is easy to see what was done wrong and what was done right. Making decisions in real time is difficult; being a Monday morning quarterback is difficult. There have been a number of books written about the early days of the pandemic that get things correct in terms of the uncertainty. I spent every day for 10 1/2 months documenting what was going on regarding the research and policy issues surrounding Covid; not many others put in this amount of time..
Thomas Lee Hutcheson
Mar 17 2022 at 4:57pm
Actually, I’d like to see some actual Monday Morning quarterbacking, not just grousing that the coaching was bad.
It was clear to many people that some NPI’s were excessively costly for little benefit. But EXACTLY what does Henderson think should have been done and when and using which data how? what data? He has Gov Newsom’s ear. What does he advice?
Charles Hooper
Mar 21 2022 at 4:33pm
The point is that the “coaches” had a game plan that was fully researched and analyzed and then they panicked and ignored their own game plan. Further, they denigrated anyone who questioned their actions during the game or questioned why they had abandoned the game plane.
There are many examples to point to, but here’s one. A paper published by the CDC in 2020 looked at all the literature covering the effectiveness of non-pharmaceutical interventions for the transmission of influenza (similar behavior to SARS-CoV-2) and found that none of them (hand washing, masks, wiping down surfaces) worked.
“Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures”
Emerging Infectious Diseases • http://www.cdc.gov/eid • Vol. 26, No. 5, May 2020
Other studies explained why lockdowns and quarantines don’t work—for logical reasons—once the infectious agent is well established in the geographic area.
Monte Woods
Mar 19 2022 at 8:12pm
The expert’s modeling predictions, promulgated by a hyperventilating media that induced fear and groupthink in the American people, opened a window of opportunity for our politicians and public health officials to seize on and impose these ill-considered lockdowns. The costs far outweighed the benefits. Severe adverse effects were felt by millions, falling disproportionately on the disadvantaged. The collateral damage was devastating, resulting in losses to current and future wellbeing from unemployment, poverty, and crime.
The lockdowns interrupted preventive, diagnostic, and therapeutic healthcare and education. Loneliness, deterioration of mental health, suicides, and domestic violence rose to unprecedented levels. The vitriol aimed at those of us who questioned or were opposed to the lockdowns was acute. We forgive, but we don’t forget.
Jon Chenoweth
Mar 17 2022 at 2:55pm
Thank you, David, for an interesting post. I think it would be helpful for future posts if you would define “lockdown”. Covid regulations varied from state to state, county to county, town to town. If each regulation is considered a “lockdown”, then I agree with your conclusions regarding cost, etc. But I’m not sure if that’s your definition. Thanks again.
Todd Kreider
Mar 17 2022 at 6:35pm
Tabarrok and the MSM made a big deal out of South Korea’s “rapid test and tracing response” throughout 2021 while they completely ignored Japan, apart from the early Princess Diamond cruise days and a few articles a week in June 2020 when MSM interviewed the same Japanese virologist. Japan mostly used pooled testing but not nearly as much test and tracing and was also (anecdotally) less strict when tried. Pooled testing is cheaper but no longer cost effective after just 8% of the population has a virus. Both countries were the lowest per capita testers in the OECD, along with Mexico.
In 2020, Covid deaths per capita were 50% lower in South Korea than in Japan despite having about the same demographics with life expectancies at 83 and 84 years, a very low 4% obesity rate and likely very similar ways of considering a death from/with Covid. Unlike the U.S. these countries didn’t change how to record a death from March 2020 as the CDC changed its guidelines for doctors.
By autumn of 2021, South Korea had 85% the per capita Covid deaths of Japan, which shows the acclaimed test and tracing did little to nothing to slow the spread of coronavirus. South Korea’s Omicron wave is still going and despite high vaccination now has 5% more Covid deaths per capita than Japan.
Roman Lombardi
Mar 17 2022 at 8:51pm
I would love a world where economist’s stayed out of epidemiology altogether. Also it would be great if they refrained from ad-hominem’s and absolutist thinking that has been adopted since oh, around the beginning of 2020.
I used to come here to escape all that and frankly its disappointing to see someone as esteemed as Mr Sumner hiss about the value of vaccines in that way. If he wants to take up the argument then great, state your case but the condescending hand-waving won’t do. If there was a greater willingness to debate these things openly, perhaps the public wouldn’t be so skeptical. I can’t say that I blame them. Formerly trustworthy sources have let them down. I hope that doesn’t happen here at EconLog.
artifex
Mar 17 2022 at 9:09pm
The Pfizer CEO’s stated reason for refusing the government funding was that he thought they could finish faster without being part of OWS by thereby avoiding the government’s bureaucracy and politics. They published their phase III results earlier than Moderna, so their advance prediction seems prima facie to have been correct. We can’t know for sure because they could have been lucky and Moderna unlucky (maybe Pfizer was just lucky and Moderna’s vaccine would have taken even more time if they hadn’t been part of OWS). But the reverse (Moderna having been lucky and Pfizer having been unlucky and still finishing their trials faster because of Moderna’s OWS-caused delays) is equally possible, so in expectation we ought to think that the prediction was right.
This makes me moderately confident (70%) that the delays OWS introduced with additional bureaucracy and political requirements (which did cause some pauses in trials) were greater than any time savings due to government funding and therefore that OWS delayed the vaccines overall.
Alex Tabarrok has repeatedly claimed otherwise, justifying OWS by comparing with vaccines for previous epidemics, but, if one wants to estimate the causal effect of OWS, the best comparison for the OWS COVID-19 mRNA vaccines is the non-OWS COVID-19 mRNA vaccines, not non-OWS non-COVID-19 non-mRNA vaccines from previous epidemics. There are fewer differences between Moderna and Pfizer vaccines that are irrelevant to assessing OWS than between Moderna and pre-COVID-19 vaccines, so our assessment of OWS (if we’re using the methodology of comparing some realized vaccine timelines with other realized vaccine timelines, which is what Tabarrok is doing) should be based on comparing Moderna to Pfizer, not on comparing Moderna (or COVID-19 vaccines in general) to pre-COVID-19 vaccines.
TMC
Mar 18 2022 at 1:00pm
“The Pfizer CEO’s stated reason for refusing the government funding was that he thought they could finish faster without being part of OWS by thereby avoiding the government’s bureaucracy and politics.”
Pfizer did participate in OWS, and issued a press release stating just that. They did not take up front money, but a guaranteed order for about $2 billion. This basically guaranteed them they’d lose no money for their efforts – huge in pharma.
Ironically, Pfizer CEO did engage in politics by delaying results to after the election, costing thousands of lives.
artifex
Mar 19 2022 at 2:55pm
Well, thank you for pointing that out. I knew they had received an advance order from the US government but didn’t know that advance order was part of OWS. I think that invalidates my argument.
Charles Hooper
Mar 21 2022 at 4:46pm
There’s one huge difference between Pfizer and Moderna which makes the OWS versus non-OWS comparison difficult and that’s Pfizer’s resources and experience. Moderna was a tiny biotech company without a single success to its credit before COVID-19 while Pfizer was a drug development behemoth. Is it any wonder that BioNTech, also a small company, did a deal with Pfizer to develop its mRNA vaccine? BioNTech must have figured that 50% (or something like that) of a successful vaccine was worth more than 100% of an unsuccessful (not tested properly, too late to market, not manufactured properly, not in synch with regulatory requirements, etc.) vaccine.
Vivian Darkbloom
Mar 19 2022 at 12:49pm
A little late to this discussion, but for what it’s worth, there seems to be a lot of confusion and perhaps (political) obfuscation surrounding Operation Warp Speed. Part of OWS offered research and development assistance to companies searching for a Covid vaccine. As noted, Pfizer turned down the research and development financial assistance that other firms, such as Moderna, accepted. Perhaps they didn’t need the funds and one reason for this was that Pfizer’s partner got substantial assistance from the German government.
However, another and equally important part of OWS was an upfront agreement of the federal government to purchase vaccines that proved safe and effective (essentially passing FDA muster). In Pfizer’s case, the federal government agreed quite early in the process to purchase $2 billion of (eventually approved) vaccines and to provide those vaccines free of normal charges to US residents. Didn’t this provide substantial financial incentive and indeed if not direct, indirect financial assistance to Pfizer.
And, we don’t know whether the terms of the R&D loans with other pharmaceutical companies provided any substantial bureaucratic obstacles to development of a vaccine. Ariflex who commented above, for example, seems to assume these loans introduced obstacles, but fails to point out what they were. Those contracts, as far as I know, have not been made public. Nevertheless, there has been speculation that those loans didn’t contain the normal “march-in” provisions that would have otherwise been normal.
https://qz.com/1930404/what-we-dont-know-about-pfizers-operation-warp-speed-deal/
If I were a fact checker, I think I would say it is false to say that Pfizer didn’t benefit from OWS and I would say it is a half-truth (by omission) that they didn’t get any financial assistance even though they didn’t get any *direct loans for R&D*.
artifex
Mar 19 2022 at 3:06pm
Agree, I was wrong about this. Probably OWS did help.
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