Ezra Klein recently had a piece on Covid-19 in the NYT, which pointed out that Alex Tabarrok has been ahead of the curve on many issues:
[B]est as I can tell, Tabarrok has repeatedly been proved right, and ideas that sounded radical when he first argued for them command broader support now. What I’ve come to think of as the Tabarrok agenda has come closest to being adopted in Britain, which delayed second doses, approved the Oxford-AstraZeneca vaccine despite its data issues, is pushing at-home testing and permitted human challenge trials, in which volunteers are exposed to the coronavirus to speed the testing of treatments. And for now it’s working: Britain has vaccinated a larger percentage of its population than the rest of Europe and the United States have and is seeing lower daily case rates and deaths.
When I point this out to people, they often respond that he is not an expert and that we should rely on the opinions of those with expertise in the field. There are two problems with this argument:
1. The experts do not agree among themselves. Experts in the UK favor challenge trials. They favor the use of AstraZeneca vaccine. They favor the first dose first policy. Indeed you can find experts that agree with Alex on almost all of his Covid recommendations.
2. Alex is an expert on the subject area that he is discussing—public policy. He’s not an expert on how to design a new vaccine, but he is not offering advice on how to do so. Rather he’s offering advice on how to conduct public policy in an environment of uncertainty. He has expertise in this area.
If you look at all the opinions that Alex has offered over the past 15 months, it is hard to find a single one where a lack of scientific expertise has any bearing on his specific policy proposals. Alex looks at the statements made by public health leaders such as Dr. Fauci, and notices that the arguments are often flawed. And he’s right. He notices that countries that have followed his advice are doing better than we are. He looks at scientific estimates of the risks and benefits of various vaccine approaches. He understands that it hurts someone just as much when their family member dies of errors of omission as from errors of commission. Many experts do not understand this point.
If I am wrong, please show me where I’m wrong. Show me an example of the advice Alex offered that was later shown to be wrong because he was unaware of technical scientific information.
READER COMMENTS
Jon Murphy
Apr 11 2021 at 12:58pm
Great post. One of the main points Roger Koppl, Abby Devereaux, Nathan Goodman, and I have been hammering on over the past year is “who is an expert” is a vague term. No single expert possesses all the knowledge and information necessary to direct a pandemic response (or anything else, for that matter).
Folks like to claim “this is a public health issue first and only an economic (or policy or whatever) issue secondarily!” But that fundamentally misunderstands the world in which we live. It’d be like saying to an objection that humans would need air in space by responding “The moon landing is an astronomy issue first and only secondarily a biological issue!” Scientific laws do not change just because they become inconvenient.
BC
Apr 11 2021 at 3:39pm
Even more to the point, “public health” is about policy, not medical science. Some public health officials might also happen to be medical doctors, but they aren’t acting in their capacity as doctors when dealing with public health. As one public health “expert” put it — when defending public health officials’ political advocacy — it’s called *public* health, not private health. One can’t have it both ways: one can’t venture into the domain of politics, then try to claim dominion on the basis of scientific expertise. There is no science of values.
Ditto for climate policy by the way. Climate science is not climate policy.
Jerry Brown
Apr 11 2021 at 1:10pm
Alex Tabarrok has been right about a lot of things regarding the vaccines and distribution. One thing that he has suggested that I am not at all sure about is reducing the dose of each shot in an effort to stretch supply of the vaccines. Maybe a half shot would be effective but maybe it would not. I would rather defer to a technical expert on vaccines than an expert on public policy as far as the dose in each shot goes.
Dylan
Apr 11 2021 at 1:16pm
Scott,
I think you raise a valuable question about who the experts are, and that there isn’t anything like uniform agreement from experts. However, I think it is important to distinguish between people like the head of the CDC and Dr. Fauci, and people less in the public eye but that have deep domain expertise. The story I heard from those types of experts told a story with a lot more nuance.
Take a couple of examples from this post:
First, human challenge trials. I remember three main class of arguments, 1) ethical issues with challenge trials, 2) there unlikely to give particularly useful data in the populations we really need it in (partially because of the 1st issue), and 3) in the world we live in, they won’t actually be faster than traditional trials.
#3 certainly seems to be proven out at this point, I don’t think the UK even started their challenge trials until January 2021 (?). I haven’t head of data coming out of them yet, so don’t know about #2, and the first objection isn’t really open to being proven wrong. I’m in favor of challenge trials in theory, and maybe working to change public perception and policy so that if/when this comes up again, we can actually do challenge trials in a way that makes them useful. But, the world we lived in at the start of Covid was apparently not that world.
Second example, rolling out first dose first. Again, I think this is probably a good idea. The people I read who were experts thought it was possibly a good idea…but the big unknown was how much (not if) this would speed up an escape variant. Of the people I read, some fell down favoring one side, some the other, but most said that there really wasn’t enough data to know which side was riskier and said it was a hard call.
What I generally dislike about pitting one type of expert against an expert in a different field, is mostly the complete disinterest there seems to be to actually talking to each other. I know this is just a blog, but have any of the authors here taken the time to have an actual conversation with some experts in say drug development or immunology or even molecular biology, and run their ideas by them and ask “why is this wrong?” I don’t read Marginal Revolution all that often, does Alex do that? That’s opposed to just taking apart public statements or having arguments on Twitter. There’s a decent chance you’d still be right, but I’d have a lot more conviction if you had the opportunity to steelman the opposing arguments first.
Scott Sumner
Apr 11 2021 at 2:57pm
You said:
“The people I read who were experts thought it was possibly a good idea…but the big unknown was how much (not if) this would speed up an escape variant.”
I’m not sure I agree. I believe some experts think an escape variant is more likely if lots of people are not vaccinated at all. It’s not one vs. two doses, it’s largely one vs. no doses.
Dylan
Apr 11 2021 at 4:36pm
The way I understand it (and I could be getting this all wrong) is that it works in a similar way to not taking your full course of antibiotics. You’re putting additional selection pressure on the virus and making it more likely that you’ll get an escape variant. So, one dose could be worse than no dose in the near term, but two doses in the mid-term.
I’ve got a little unwanted first hand experience of this. My wife and I got our first shot two weeks ago, and both came down with Covid this week (her symptoms showed up 8 days after vaccination, mine 11 days, got our positive test results back yesterday). I’d also had a positive antibody test from a few months ago, but I didn’t have any symptoms the first time around.
Jasper
Apr 11 2021 at 7:59pm
That’s not really how it works. Antibiotics function in a very different way to vaccines; they circumvent rather than supplement your immune system. The mutation rate of the virus is much more linked to the number of viral particles that exist in the world; first-dose-first immunization reduces that number and therefore reduces the mutation rate. To my understanding, vaccination is by and large a binary process – you either develop antibodies or you don’t, and the booster shot simply makes it more likely that you do. We should thus be less worried about selection pressure and more worried about the direct ramifications of first-dose-first – less people will have the virus, there will be fewer deaths, and “normal” can return sooner.
Scott Sumner
Apr 12 2021 at 12:17pm
That’s also my understanding.
Dylan
Apr 12 2021 at 12:28pm
I don’t have the requisite background to debate the science, but will note that at least some “experts” disagree with you on the selection pressure and suggest that the worst case for pushing new vaccine resistant variants is like what happened to me, getting infected after the first dose of vaccine.
https://www.womenscollegehospital.ca/assets/jama_moore_2021_vp_210037_1615418423.49932 (1).pdf
Mark Z
Apr 13 2021 at 2:38am
Dylan, from the quoted paragraph (the link isn’t working for me) it still isn’t clear the second dose increases intensity rather than probability of response. If the reason the first dose is less effective at neutralization is because sometimes it fails to induce proliferation of neutralizing antibodies, and sometimes it does, then the times when it doesn’t, it is no more conducive to vaccine resistance than if the person weren’t vaccinated at all.
To show that a single dose causes a less intense immune response than 2 doses (as opposed to having a lower probability of inducing the same immune response), they would have to show that it causes the same antibodies to be produced, but in lower quantity. So this question hinges on whether ‘less effective’ means lower intensity response, or lower probability of the same response. I think the latter may be more intuitive because adaptive immune response is more binary (either an antigen finds the B-cells that react to it and they proliferate explosively, or it doesn’t) than antibiotic treatment (where the more antibiotic I take, the more bacteria it kills).
Dylan
Apr 14 2021 at 8:56am
@Mark, If you copy the entire line including the .pdf and paste into the URL bar, you will open the paper. Don’t know why the comment software truncated the link here. The paper gives a more full explanation than my short quote (although the entire paper is itself pretty short, just 2 pages)
Jens
Apr 12 2021 at 4:22am
The success of a mutant is based on its environment. Current escape may be better adapted to the current environment than future escape mutations, because the current environment (with a relatively large amount of virus and little vaccination) is different from the future environment (with relatively little virus and a lot of vaccination).
The mutations that are currently emerging all have similar characteristics. SARS-CoV-2 does not have a segmented genome (unlike influenza). There is no reassortment. These are arguments that there will be no extremely successful mutations that can circumvent high vaccination coverage and future vaccine reformulations.
I think a good argument for “First Doses First” can be made simply from an egalitarian argument. And possibly also from a market-oriented one (what would you pay for your first dose, for your second dose and for a combination dose [first dose with guaranteed two dose at a defined interval] here and now?).
Scott Sumner
Apr 11 2021 at 2:54pm
Dylan, You said:
“I know this is just a blog, but have any of the authors here taken the time to have an actual conversation with some experts in say drug development or immunology or even molecular biology, and run their ideas by them and ask “why is this wrong?” ”
I’m married to one.
On challenge studies, the reason it took a year to get them going is that there was so much opposition. I agree that it’s now too late to do much good.
And yes, Tabarrok provides extensive discussion of why some experts disagree with him.
Dylan
Apr 11 2021 at 4:47pm
I didn’t know that! Would be very interested to hear how her expertise has influenced your thinking on this topic in general or more specific ways. You haven’t happened to write something on that already, have you?
Yeah, and I think it would be good to examine the reasons for that opposition and see if minds can be changed on that for the next time. Maybe this experience was such a large and visible example for the world that minds can be changed…or maybe it’s like kidney markets and people have too strong of a distaste for the idea for a utilitarian calculus to hold sway.
I feel like I’ve seen a little of this and it felt like countering arguments from a distance, as opposed to having an actual conversation with back and forth. But, I might not have come across the right pieces, as I said, I tend to not read MR very regularly.
Scott Sumner
Apr 12 2021 at 12:19pm
I don’t think she’s had a major influence, because her views on the technical questions are similar to the views I read in the media when experts are interviewed.
Ken P
Apr 11 2021 at 8:36pm
That’s one of the problems with challenge studies in general but especially with Covid. Despite the IFR being extremely small for healthy people (it’s likely smaller than flu for healthy people), there is a lot of hysteria. Also, I believe human respiratory syncytial virus is the only virus with recent challenge studies in humans.
There is also not much known about the impact of dose on pathogenesis. In general, outcome is believed to more severe with increasing dose, which makes dose choice critical in a challenge study.
My expectation would be some detailed discussions/agreement on route of administration and dosing. What best mimics natural infection for this particular virus? Use a nasal atomizer? Are you artificially favoring mucous membranes that would have higher antibody levels? Will you be required to have entire protocol defined up front or will you be allowed to do challenge dosing trials in parallel so that you can define the dose that results in reproducible effects across the unvaccinated patient population? Will you get timely approval by FDA of your dose target (within one week) since your study will be ongoing in parallel and so you are ready to administer challenge 2 or 4 wks post final vaccine dose?
I have no problem with challenge trials, just skeptical about getting approval, and whether it actually saves time.
Todd Kreider
Apr 12 2021 at 10:02am
Dylan wrote: “I feel like I’ve seen a little of this and it felt like countering arguments from a distance, as opposed to having an actual conversation with back and forth.”
You are correct and that has been a main problem I’ve had with Alex’s posts on this. I have thought First Dose First has a 70% of being correct (a guess based on those who disagree) but Alex has been a 99.9% sure where I’ve had to read different sources to see what 1) the problems might be and 2) that it might not make that much of a difference.
Three weeks ago, Alex wrote that Covid-19 was more than ten times as deadly as the flu where the CDC estimated last year that Covid-19 was about twice as deadly (infection fatality rate) and probably somewhat less than that.
Scott Sumner
Apr 12 2021 at 12:22pm
You said:
“I have no problem with challenge trials, just skeptical about getting approval, and whether it actually saves time.”
This is exactly my point. The problem is that these tests need approval. We need to deregulate so that they don’t need approval, just informed consent. They should have been done last spring; it could have saved hundreds of thousands of lives.
Ken P
Apr 11 2021 at 8:44pm
I’m skeptical on this. Pretty much everyone blogging about Covid “notices that country outcomes agree with their predictions”.
Anyone making such a comparison is assuming there would be no difference in the absence of policy differences. Was the 2018 flu evenly distributed across states and countries? I think the noise is bigger than any policy signal.
robc
Apr 12 2021 at 10:29am
Agreed. What is clearly bigger than the noise is demographics. Rich, old, and fat countries are harder hit. I would go so far as to say that policies didnt matter at all. If your effect is lost in the noise, was it an effect?
Scott Sumner
Apr 12 2021 at 12:24pm
You don’t think the first dose first policy in the UK is saving lots of lives relative to our approach? I strongly disagree; the evidence overwhelmingly suggests it does save lives.
robc
Apr 12 2021 at 5:40pm
The 2nd wave UK vs US looks exactly like the first wave. The UK success now is exactly the same as in July.
I see no vaccine effect. Maybe it is there, but I cant tease it out. The difference is that the UK doesnt have multiple states with differently times waves flattening the peaks and raising the valleys.
Ken P
Apr 13 2021 at 11:31pm
I absolutely think first-dose-first policy saves lives. I just think it is fooling myself to say the UK death chart proves that. The tail of the UK chart had the same shape a year ago but even if it didn’t the noise is really high. The flexible criteria in US for counting deaths as Covid without a positive test might create a lower baseline. Should I expect to be able to clearly separate signal from noise between two countries just because one group had a one month lead getting to 35% of their population having one dose?
The UK is about a month ahead with 1st dose but seems to have plateaued. The US is vaccinating 50% more people per day currently.
Thomas Lee Hutcheson
Apr 11 2021 at 9:13pm
The public health experts have repeatedly failed to follow the science.
MikeP
Apr 11 2021 at 11:39pm
Excellent article. But does it go far enough?
I think the biggest lesson from the reaction to the pandemic is that experts are utterly not to be trusted.
Experts, it turns out, are monomaniacal.
Experts consider nothing beyond their pet topic. And how could it be different? Due to a lack of attention and lack of institutional intelligence, government and media are incapable of weighing alternatives. If an expert does not go all in on his pet topic, he will not be invited back to the conversation and will no longer be recognized as an expert.
This was already clear with, for example, climate change. As one case of particularly interest in this forum, climate scientists cannot conceive of the costs born by our descendants due to aggressive efforts to address greenhouse gas emissions. Climate scientists show a preference for a global path that leads to a third less GDP per capita at the end of the century, yet think predicted costs that amount to a few percent of GDP per capita at the end of the century due to unrestrained global warming are an irrefutable argument for urgent decarbonization of the economy.
From the beginning the pandemic has played out like climate change in fast motion. Terrible modeling. Massive overreaction. Far too much credence given to experts. Complete incapacity for government or media to consider anything past step one down the road to actual policy. A priesthood whose words becomes the authority on all things science. And a vicious shouting down of any contrary opinions and effectively a suspension of the scientific discovery process.
The hindsight, we as a society must realize that the state’s reaction to coronavirus is among the greatest self-inflicted disasters in history. And we must learn that the role of exports is to give arguments and evidence. They must not make policy.
Scott Sumner
Apr 12 2021 at 12:25pm
That’s way too sweeping a generalization. Lots of experts advocated a carbon tax, which is a great idea.
MikeP
Apr 12 2021 at 2:14pm
Lots of people you and I would call experts advocated a carbon tax, set at a gradually increasing value that would minimize overall damage due to climate change over time.
But those are not the experts in the conversation today.
Today the IPCC explicitly pushes the notion that the policy target should be a temperature, not a cost-benefit curve. And the proposals coming out of Washington and Sacramento are more aggressive than even the most expensive proposal William Nordhaus thought to model, where carbon neutrality was achieved in 2050.
The CLC and the CCL are both TLAs with the same three letters. The former appears to advocate the optimal carbon tax. The latter claims the mantle of all the economists who signed onto the former’s statement while advocating an insanely steep rise in the carbon tax.
At least from my vantage point, the latter appears to get all the attention and do all the visible lobbying.
Do I hope that experts in costs and benefits who understand opportunity cost and exponential growth can weigh in on greenhouse gas policy? Yes. Am I seeing it today? No
MikeP
Apr 12 2021 at 2:25pm
Shorter version: It’s not who you or I call experts that matters. It’s who the government and media call experts that matters.
Jeremy N
Apr 12 2021 at 8:13am
There’s an element of being a non-expert that actually helps make good judgments. For those like Tabarrok and others in the Econ blogosphere, not knowing what conventional wisdom was, they had to focus on facts and statistics and the evidence that was available. Being new to the issues, they did not get caught up in any politics or historical kludge from the field but were much more clear-sighted.
Scott Sumner
Apr 12 2021 at 12:26pm
Good point.
Thomas Lee Hutcheson
Apr 12 2021 at 5:37pm
The problem is applying expertise outside its domain. Epidemiology is about how disease spreads. Which policies incentivize people to behave in ways to reduce the spread at least cost calls for inter alia, economic expertise.
Nick Ronalds
Apr 14 2021 at 5:50pm
This past year is an object lesson in why relying on “experts'” solutions is a fool’s choice. Any public policy solution affects many things and no “expert” is an expert in all those things. Thomas Sowell’s remark that “there are no solutions, only tradeoffs” is apposite here. Or as others have said, you can’t do just one thing. An “optimal” solution advocated by experts such as those at the CDC is only optimal by some narrow criteria, e.g., eradicating a virus as quickly as possible. They ignore costs and knock on effects. A partial list, as we know, might include income losses, psychological harms, other harm to health, increased domestic abuse, lost educational opportunity, and on an on.
Now at to the above Public Choice considerations. The “experts” have other goals besides the general welfare, e.g, garnering public approval and fame they can then monetize. And what makes someone an “expert” anyway? A Ph.D. degree? A career in government, industry, or academia? How about a track record of being mostly wise and right in their previous decisions and actions?
Michael Sandifer
Apr 15 2021 at 6:51am
I think the author of this post and Tyler Cowen also deserve a lot of credit. Mercatus, in general, has quite a solid group of economists.
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