There is some level of danger that pushes even the most stubborn government bureaucracies to start acting semi-rationally. Tyler Cowen has a brilliant new post that clearly demonstrates that the US has not reached that point.
But things are much worse in the UK, due to a new variant of Covid-19 that spreads much more rapidly. As a result, the UK has switched to the “first dose first” approach, which is very likely to save lives. And even if it doesn’t, the approach can be reversed at a far smaller cost than if the alternative view is correct.
The UK is already beginning to make substantial progress in vaccinating old people, who are of course much more likely to die of Covid-19:
Prime Minister Boris Johnson said 23% of all over-80s in England have now been given a dose of a Covid-19 vaccine, meaning some of the most vulnerable patients are getting the protection they need.
Given the new variant of Covid, the British are engaged in a race against the clock.
If the new variant becomes widespread in America before the vaccine is distributed, the entire country could end up being hit as hard as places like New Jersey, meaning several hundred thousand extra (unnecessary) deaths. Let’s hope our public health authorities come to their senses before its too late.
PS. For those who like numbers, here’s the sort of decision we face:
Likelihood of one dose first being the wrong approach: Very low, say 10%. Cost of adopting it if it is the wrong approach: Relatively low, say a few thousand deaths.
Likelihood of two doses first being the wrong approach: Very high, say 90%. Cost of adopting it if it is the wrong approach: Relatively high, say tens or hundreds of thousands of deaths.
You do the math.
READER COMMENTS
Garrett
Jan 5 2021 at 1:46pm
What would constitute being wrong about administering the first doses to everyone before moving on to second doses, and how would it lead to higher deaths than the alternative?
Dylan
Jan 5 2021 at 3:01pm
One concern is that not only might it not work, but it could generate more resistant forms of the virus and that we will lose the weapon we have. That’s not a sure thing of course, but something that needs to be considered.
Dylan
Jan 5 2021 at 3:10pm
Scott,
Given my limited knowledge of the science, I tend to be in agreement with you on the risk/reward profile, although at the moment the problem seems to be actually using the doses we do have, so I’d want to focus on that part first before committing to a one dose and delayed second dose strategy.
But, I think it is important to realize this isn’t a no-brainer. There is a very real possibility that by adapting this strategy, you accelerate vaccine resistance, in fact, if you wanted to try to develop vaccine resistant virus in the lab, this is how you would go about it.
As Derek Lowe says:
Thomas Hutcheson
Jan 5 2021 at 5:55pm
Lowe is correct about the need for brainpower to make the decision. What is disconcerting is the impression that none has being employed in the decisions made so far NOT to go with 1D1. At least on has been deployed in the explications given for the decisions.
Scott Sumner
Jan 6 2021 at 12:53am
Here’s how I look at it. Each month during 2021, our ability to address this problem will improve, as more and more vaccines come on stream and we learn more from what we are doing today with our current vaccines. The real problem is the next three or four months, when lots of people will die. We need to address this as quickly as possible.
I’m willing to suggest this even if there is a risk it leads to a mutation. Recall that when vaccines were first proposed we were told that 70% effectiveness would be great. Now we have vaccines where the first dose alone is probably 80% effective.
I agree that there is a small chance it could be worse, but the downside seems low due to a combination of that fact that if bad results showed up quickly we’d stop, and if they showed up slowly we’ll have the ability to address it with alternative vaccines.
And remember, the proposal is not “one does”, it’s one dose now and one more dose later. And also that science can’t even tell us the optimal waiting time, and with previous vaccines it often didn’t seem to matter that much.
You need to go with the probabilities, and not worry about what Lowe calls the “politics”. The public looks to the experts to propose the best policy.
Alan Goldhammer
Jan 5 2021 at 4:11pm
It’s already here and likely much wider spread because of poor sequencing work that has been the hallmark of the US response. We also do not have any idea why this variant is more infectious and all one can do is come up with a lot of conjectures.
From all that I’ve seen, there is no reason to believe that the current vaccine approaches are at risk. I was always in favor of a multi-valent vaccine approach but that is more time consuming to carry out than the mRNA approach. As was noted in another post, Derek Lowe’s column on this is good reading.
Jerry Brown
Jan 5 2021 at 4:16pm
I would support giving out the first shot to as many as possible as soon as possible. Trusting both that supplies of the vaccines and our abilities to vaccinate are both ramping up quickly and will be able to handle giving the second shots close to when they are needed as well as continuing to vaccinate for first shots at an increasing rate. As in don’t sequester half the current supply until receiving additional supply.
So to a certain extent, I think Tyler and Alex are correct but also maybe overthinking a problem that we are in the process of solving.
David Henderson
Jan 5 2021 at 5:58pm
I agree that the piece by Tyler is excellent.
Ken P
Jan 6 2021 at 12:07am
Probably much lower than 10% and much lower than a few thousand deaths. So you have a conservative estimate in my eyes.
There are other vaccines in the pipeline that include additional antigens (Ex. I know there is at least one whole virus inactivated vaccine under development) which would be expected to provide additional protection against escape mutants if we ended up needing a backup in that unlikely scenario.
At this point, my expectation would be that this higher R mutant would have a lower IFR, because selective pressure for higher spreading tends to favor lower pathogenicity if spreading in the general public. I will update my Bayesian priors if data contradicts this perspective.
Right now, the bottleneck seems to be at the vaccination end of the supply chain.
Scott Sumner
Jan 6 2021 at 12:54am
Thanks. Very informative comment.
Phil H
Jan 6 2021 at 1:30am
I like Tyler Cowen a lot. His directness is great, and I’m sure he wouldn’t mind being responded to equally directly. I’m not a “public health expert,” but if I were, I’d respond to him:
A. Oh, great, unsolicited advice from the guys who brought us 2008. You keep on writing, and don’t call us, we’ll call you. (Tyler’s obvious disdain for a particular professional group is definitely non-collegial, and is bordering on the unprofessional. Those bits of his post can be dismissed with an equally stiff retort.)
B. At present the number of people who have not been vaccinated because second doses are being given out in priority over first doses is: zero. It’s always possible that this may become a problem in the future, but at present, this issue is *not a problem*. We don’t know whether it will be a problem in the future. That’s one thing we’ve learned in this epidemic: we’re always being surprised by stuff.
Obviously TC’s numbers look right, and it’s great that he’s raising the issue. The ire with which he’s pushing a thing that simply isn’t a problem at this present time is… unwarranted, I think. He’s also got plenty of ire for the people who are messing it up, all the links in the vaccine delivery chain. That’s warranted.
Mark Z
Jan 6 2021 at 8:20am
A) are you suggesting Tyler Cowen is a pseudonym of Ben Bernanke’s? Otherwise this doesn’t make much sense to me.
Anonymous
Jan 6 2021 at 1:53pm
Is your position that we shouldn’t think more than a few days into the future? Because those second dose appointments are coming up real soon. And we know lots of places are holding back doses for the second dose, so it’s likely that some places which have been able to administer doses quickly could have immunized many more people without this policy.
Scott Sumner
Jan 7 2021 at 1:52pm
Phil, You said:
“Oh, great, unsolicited advice from the guys who brought us 2008.”
If economists cause economic problems (rather than study them), do health care professionals cause health care problems, rather than cure them)?
I’m having trouble with your logic.
D.O.
Jan 7 2021 at 5:53pm
Economic profession didn’t cover itself in glory by giving a solid advice during the last crises either…
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