I don’t see much discussion in the media of an issue that will soon take front and center stage. In America, over 700 people die of Covid each day. Almost all of the deaths are among people who have not been vaccinated.
Within a few weeks, almost all of the deaths will be among people who chose not to be vaccinated. Of course each of those deaths is just as tragic as anyone else. But what will be the implication of that fact for public policy? For private policy? This will be an issue worth watching, and I expect a lot of disagreement between various factions (as usual). Again, this issue will blow up within weeks.
BTW, most old people have already been vaccinated:
I’ve been a frequent critic of almost all aspects of our approach to vaccinations. One of my complaints has been that the system is overly complex, and that as a result the vaccines would end up going disproportionately to people who were most able to hack the system. Now there is evidence that this group is disproportionately highly educated:
That fits in with what I’ve observed in my daily life. “Here’s what you need to tell them.” “No one checks.” We should have rationed by money, or perhaps by age.
I’ve also been a fan of the British approach to vaccine delivery, which focused on getting as many first doses out as quickly as possible, before worrying about the second dose. The FT reports that this approach has been a success:
Some 93 per cent of recipients of the Pfizer inoculation and 87 per cent of those who had the AstraZeneca shot showed spike protein-specific antibodies, likely to have been induced by the vaccine. Responses were stronger for people who had recovered from Covid-19.
“There’s increasing evidence that as a health care measure this decision to delay the vaccine has worked in the UK. We’ve got very good clinical protection from the one dose scheduling,” Moss said.
I would add that if the US had adopted this approach a few months back, thousands of lives would have been saved. When I recommend this approach for the US, people said we don’t have enough data yet. Well, what’s the excuse today?
I’ve been a long time critic of the FDA (and our broader regulatory apparatus), and it seems like hardly a day goes by without further examples of why we need to abolish this bureaucracy. As an aside, I should apologize to Europe. When they delayed their vaccine rollout due to a trivial blood clot issue, I remember thinking to myself, “What’s wrong with those people”. Well, now “those people” include my fellow Americans.
Here’s what I don’t get about progressives. If a private corporation were killing even 1% as many people as the FDA is killing, there’d be cries of outrage. So why isn’t there more outrage about the FDA? Where are the “Defund the FDA” signs?
PS. A year ago I suggested that began by underreacting to Covid and would end up overreacting. Check this out.
READER COMMENTS
Nathan Taylor
Apr 14 2021 at 3:51pm
Re “Here’s what I don’t get about progressives. If a private corporation were killing even 1% as many people as the FDA is killing, there’d be cries of outrage.”
This problem is not limited to progressive. Rather we know exactly what’s going on here. It’s not progressivism, it’s human nature. You can call it Consequentialism v Deontology, or Acts of commission versus omission, or the trolley problem. But at it’s heart, people intuit the world should be about moral rules to follow, not about utilitarianism/consequentialism. And if by giving a shot to someone, a few of them might die, even if it saves millions, it’s immoral to do it.
Here’s a better way to get the intuition if you are too utilitarian minset to intuit what’s going on. Suppose the secret to vaccines were inside a baby, and you had to cut the baby open with a knife to get the secret and save millions. Most would revolt in horror at the idea. But of course the utilitarian would say awesome, pull out his knife, and slice slice slice and get the vaccine.
Now, I’m not saying that the utilitarian/consequentialist framework is wrong. I’m just pointing out that human nature believes you must follow moral rules, not consequences. And one of those rules is you can’t actively hurt someone, even if it woudl save lives.
And lest you think this is completely a bad thing, remember that all dictators are utilitarians. Mao. Hitler. Stalin. All slaughtered to make the utilitarian calculus for a better world.
Scott Sumner
Apr 15 2021 at 1:07pm
You said:
“And lest you think this is completely a bad thing, remember that all dictators are utilitarians. Mao. Hitler. Stalin.”
Hitler cared about the welfare of Jews? Could have fooled me.
BW
Apr 16 2021 at 1:30pm
On deontological grounds, so long as consent is given, it is perfectly moral to give someone a vaccine which has a small chance of killing them. It’s actually immoral to forcibly prevent someone from taking a vaccine which is overwhelmingly likely to have a net benefit. What’s the deontological argument for forcing some people to undergo a substantial risk of death from Covid-19, in order prevent other people from accepting a miniscule risk of death from a vaccine.
robc
Apr 14 2021 at 4:04pm
First shot today, second 4 weeks from today (Moderna). I don’t know what that means, I was mostly indifferent to getting it (literally, in I had no preference), but am going to spend some time with my Mother this summer, so that pushed me over the line.
Wherever I am. South Carolina, for now.
Alan Goldhammer
Apr 14 2021 at 6:03pm
A bunch of us who actually did drug safety for a living have been discussing the clotting issue. It’s pretty confounding and appears to be linked only to the adenovirus vectored vaccines. It is also similar to what was observed in the early days of oral contraceptives which also caused clots in some women. Interestingly, the clotting adverse events seem also to be linked to gender, affecting women between 20-50. We don’t know whether younger females will be impacted as they have not been vaccinated yet.
Some of us watched the FDA press conference the other day and I thought it pretty reasoned. These kinds of decisions are always difficult to make. I would have discontinued administration to pre-menopausal women but continue to use it for the rest of the population.
With respect to defunding the FDA, who will replace them? It’s not only drug/vaccine approval, but inspection of manufacturing facilities and collection and analysis of adverse drug/vaccine reactions. Do you think that these activities are no longer needed?
Mark Brophy
Apr 14 2021 at 6:48pm
Leave the inspections and data collection as they are and abolish the approvals for drugs and vaccines and labels of drugs and vaccines. That’s not acceptable in a “free” country. The speech restrictions are also unacceptable due to the First Amendment.
Mark Z
Apr 14 2021 at 7:23pm
I’d really love to see the math showing how this was a reasonable decision. “Show your work” as Tyler Cowen likes to say. By back of the envelope calculations I doubt there’s an identifiable demographic group for which the risk of death from thrombosis could be within 2 orders of magnitude of the risk of death from covid, Note that cerebral venous thrombosis is already much more common in women than men, and is also caused by birth control (rarely, though not as rarely as the J&J vaccine). I mention this both because it is also a potential confounder given the demographics of the people who got the blood clots and because I’d like a rational explanation why it’s safe for pre-menopausal women to take birth control but not the J&J vaccine.
Mark Z
Apr 14 2021 at 7:25pm
To specify: the risk of death from thrombosis *caused by the vaccine* assuming the current point estimate is accurate.
Michael
Apr 15 2021 at 8:51am
This is a comparing apples to oranges. Women deciding on birth control are given information on the risks and benefits that yet doesn’t exist for the J&J vaccine given how recently this issue has been observed. Pausing to collect information is not the same as withdrawing a product from the market entirely.
Anonymous
Apr 15 2021 at 9:38pm
Yes, well this “only a pause” will kill many people. Why not just tell people what we know and let them decide whether to get it, and not cost hundreds or thousands of lives needlessly? Is it really so important that we have the exact figures well established before someone can decide whether they want to take it or not? As if most people are equipped to make such a calculation. How many women are debating whether to take oral contraceptives because of the blood clot risk? Note that heparin also causes the exact same issue with a much higher risk, no one is suggesting we stop using heparin.
Scott Sumner
Apr 14 2021 at 8:09pm
I would let the market decide the best way to evaluate new drugs. Perhaps a private firm (or NGO) would take over that role.
My primary complain is the way the FDA is able to use police powers to control what we put in our bodies. I have much less objection to their role in evaluating new drugs.
robc
Apr 15 2021 at 7:01am
I will answer your question with a question. If the government doesn’t do it, who will determine if food is kosher or not?
This is my same answer for “organic” designation, and restaurant safety inspections, and the FDA. And a number of other similar issues. The market has already figured out how to handle this for people who care about the issue. I don’t care about kosher myself, but if I was an oberservant jew, I would. And I would trust [pick org of choice here] more than a government org. There are lots of complaints about what the USDA allows to be called “organic”. This problem wouldn’t exist if there were a couple of dozen private organic labeling orgs. You could pick the level of organic you trust.
And the same goes for drugs. A company could, if they so chose and were willing to risk the lawsuits, release a drug without an approval, or they could wait until they got the approval from org X, Y, or Z. Insurance companies might only cover drugs approved by their org(s) of choice, and etc.
Thomas Lee Hutcheson
Apr 15 2021 at 7:24am
“These kinds of decisions are always difficult to make.”
No doubt. So why not lay out the reasoning? How does one and should one go about figuring out when news circulating about side effect X is likely to cause so much additional vaccine hesitance as to delay actual vaccinations?
It’s like the decision not to delay second doses. What was the cost-benefit analysis that led to that decision?
FDA undermines credibility that is actually know what it is doing by failing to be transparent about its reasoning.
John Thacker
Apr 15 2021 at 10:05am
Difficult to make, but the FDA has fundamentally misaligned incentives. It always is willing to kill thousands by banning a life-saving treatment than allow tens to get side effects. People who die of disease when their lives could have been saved are invisible. It’s nothing particular against the people at the FDA, but their structure and incentives apparently makes it impossible for them to make the correct decision.
Even in normal times, the FDA kills more Americans than it saves, but during this pandemic the net lives lost to the existence of FDA banning life saving tests and treatments is in the hundreds of thousands.
There is no good reason for the pause; admittedly I’m biased, because my wife’s appointment was canceled and it will now be weeks until she can get a new one here in Fairfax County.
Dale Doback
Apr 14 2021 at 10:54pm
You still need independent third party reviewers if you defund the FDA. If the Food and Drug Administration becomes the Food and Drug Corporation, they still have the same bad incentives favoring cautious reluctance.
Matthias
Apr 14 2021 at 11:55pm
A corporation would likely not have the power to ban drugs.
I don’t think the incentives are that straightforward: a common complaint about private credit rating agencies is that they are too favourably inclined to the financial securities they are eating. Similar for auditing companies.
In any case, defining the FDA could also mean that eg the states could do the regulating.
(And in that case, many states would presumably want a harmonised regime, so they could work together. The practical difference to the current FDA regime would be that individual states could opt out of that voluntary cooperation.)
robc
Apr 15 2021 at 9:28am
See my post above. We wouldn’t have one FDC, we would have a dozen or more, with differing approval criteria. Some insurance would accept one, some would accept another, some would accept a group of them. Ditto for individuals based on what level of safety/efficacy they care about.
We have a perfect model of how it would work, and people are too blind to see it.
MikeP
Apr 14 2021 at 11:29pm
A letter I wrote to the local California paper that of course was not printed:
Jerry Brown
Apr 14 2021 at 11:37pm
Yeah- that is an interesting question about how people will react to deaths of those who chose not to get vaccinated. I imagine it would be similar to a death of a cigarette smoker (like me) from lung cancer. But I know I am putting myself at an increased risk from something I chose to do, and so does everyone else. I wouldn’t expect all that much sympathy if I went from that. Compared to getting killed in some freak accident.
Well I wonder how it will play out. We should know a little in a few months when everyone in the US has had the opportunity to get vaccinated. Just got the second Pfizer shot today so presumably I won’t have to worry about this issue personally.
John Thacker
Apr 15 2021 at 10:08am
In fact <A HREF=”https://twitter.com/zeynep/status/1382671864410087425″>the same rare blood clots also occur with the mRNA vaccines</A> – and occur an order of magnitude higher with getting the disease itself. Some of the British data show that the blood clots may in fact be higher with Pfizer than with AZ, though rare in any case and rarer than the disease.
It’s possible that the nature of the antigen is such that the body’s own antibodies end up attacking platelets in some rare cases, vaccine or natural infection.
Michael Rulle
Apr 15 2021 at 2:00pm
Re: Covid
Interesting observation on your part re: older people being vaccinated. Deaths should continue to drop considerably. I believe there are 55-60 million people over age 65—and that group represented about 75% of Covid deaths (about 400K).
If 80% of those over 65 have been vaccinated we should expect deaths from that group to drop to 100k from 400k over the same time frame ((400k) minus .8x.94(Pfizer prevention rate)x400).
Not sure we can tell yet—although the results are consistent with your point.
Of course, deaths will still be very high (about .97%-.99% of total population—–versus 1.1%). Bummer.
Todd Kreider
Apr 16 2021 at 12:16pm
Scott wrote: “In America, over 700 people die of Covid each day. Almost all of the deaths are among people who have not been vaccinated.”
This is most likely not true. A German study showed that 1/3 of 80+ year olds did not get a benefit from the Pfizer vaccine. So many vaccinated who are over 75 are still going to be a fairly large share of recent Covid deaths.
Scott Sumner
Apr 16 2021 at 12:35pm
As is almost always the case, your claims are false. There are extremely few deaths among vaccinated people.
Todd Kreider
Apr 17 2021 at 7:50am
Can you back up your claim of “extremely few” with statistics?
There are a lot of 80+ who have been vaccinated and are in the most likely to die age group if they get Covid-19. A full 1/3 of those have no protection after being vaccinated, so I don’t see how it follows that “almost all” Covid-19 deaths are the unvaccinated.
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