I thought I was done talking about Vaccines on here. But as it turns out, there is probably no way to underestimate the vaccines’ importance to our country’s immediate future, given our country's tremendous health and economic consequences. It would appear that our country’s vaccine distribution is going about as poorly as feared. At the beginning of December, we had a goal of having 20 million people vaccinated. As of today, from the best data I can find from this NY Times article (which could suffer from a lag), we have distributed 12 million vaccines. Only a little over 3.1 million of those have been administered (and keep in mind, that is just the first of 2 doses). Vaccines are literally expiring because the administrative process of distributing them is taking so long.
This is crazy. For months, we have known that this vaccine exists, that it is safe, and that it will almost certainly be approved. The Trump administration’s strategy on COVID can be charitably called “laissez-faire,” but vaccines were supposed to be our one shining proactive success amid COVID. But it appears that amid the process of speeding up developing a vaccine (which, to be clear, I think was an excellent thing), the process of speeding up the distribution of vaccines appears to have been neglected. The Federal Government has largely left it up to the states, which is not bad in itself. Some states have really done quite well: Washington, Maine, DC, Connecticut, West VA, and South Dakota appear to have already given out close to half of their vaccines. But the vast majority of states appear to be doing an abysmal job of getting the vaccine out to people, mostly because the logistics are being coordinated by the totally overwhelmed local public health departments.
“Throwing money at the problem” is often seen as a derogatory critique of the assumption that just spending more money will lead to better outcomes. Often I think this critique is meritorious, but COVID vaccines is one case where “throwing money” should have absolutely been done. We have known for almost all of 2020 that distributing vaccines would be the hardest part of this process, and yet somehow, we have no dedicated funding effort to getting them out faster. It was entirely predictable that state and local public health departments would not be up to the task, yet in all the squabbling among the president and congress, this did not rise to the top of the priority list. The recent relief bill included $8 billion for vaccine distribution (out of 900 billion total). Before that, it would appear that only $340 million has been spent on helping with vaccine distribution. This is crazy! We have millions of Americans out of work. Why not hire 1 million people who are currently unemployed to do the paperwork to free up nurses/public health officials to focus on the harder part of vaccines? And vaccinate people 24/7, including on Christmas? I have a hard time believing that there aren’t people who would volunteer to get a Christmas vaccine.
To me, the failure to figure this out has to be seen as a colossal failure of our state’s capacity to achieve its goals. We should have put more money into this process months ago: austerity on vaccines makes no sense. Almost 300 people died of COVID Yesterday in LA County alone (3,808 people died in the US). The US federal department of transportation values a statistical life at about 10 million dollars, which basically means that a 10 million dollar transportation program is justified if it saves one life. Spending 8 billion on vaccine distribution looks like quite a bargain in this light, given that faster distribution will likely save thousands of lives.
That said, federal dysfunction is hardly the only thing going on. As Tyler Cowen points out, collectively, state and local governments have huge budgets: state and local spending is about ~4 trillion in the US each year (not as far off from federal spending as most people believe). Now it is true that most of that funding is locked into existing programs. Still, one might think that states might realize that the effectiveness of some of their most expensive public services (say, for instance, public schools) are very dependent on vaccinating people, that maybe some of the education budgets could be spent on vaccinating people?
Two posts ago, I talked about how part of the drawback to the byzantine complicated process for prioritizing vaccines amongst disparate groups is that complexity breeds opportunities for gaming the system. As it turns out, the bigger problem is that complexity also breeds slowness in the distribution process. Part of the argument for making vaccine distribution by age was that it was simple, hard to game, easy for the general population to comply with, and could be done quickly. Isreal has used the vaccinate by age (+ healthcare workers) strategy and has already vaccinated 9% of its population.
In my last post, I talked about some of the errors made when we leave huge social problems up to expert specialists (specifically, public health experts alone). In theory, creating a rigorously complex priority list for making sure vaccines are going out in the fairest possible way is great! But in the real world, simple strategies almost always beat complex ones. Businesses often prioritize the simplicity of strategy to improve speed and eliminate errors in the uncertain expansion process. When still a young company, Airbnb created an expansion strategy that basically boiled down to 3 rules:
Enter prestigious international destination cities (like Paris or Cape Town) first
Recruit the best possible hosts in those cities
Share best practices with those hosts: have new soap in the bathroom, take high-quality photos of your room.
This strategy did take some time to develop a simple set of rules. But once it was codified, it allowed AirBnB to make what should have been a terribly complex international expansion process much simpler and achievable. You cannot expect middle managers. You can see how different this is than our strategy for distributing vaccines in California, which involved creating a very detailed tier list of priorities, which is fairly unintelligible to a layperson:
Philosopher Joseph Heath wrote one of my favorite books on economics, “Filthy Lucre,” in which he outlines common fallacies on both the political right and the left. In the book, one of the fallacies he talks about is the left-wing economic fallacy of “leveling down,” in which your efforts to try to make things fairer end up making everyone worse-off rather than making the disadvantaged better off. He describes it thus:
We are inclined to think that in order for an outcome to be classified as better, from the moral point of view, there must be someone for whom it is better. Naive Formulations of the principle of equality violate this principle: they classify more egalitarian distributions as better even if these outcomes are achieved in a way that doesn’t make any actual person better off.
Now, this is not to say that all attempts at promoting equality are counterproductive. Even conservative economics have argued that creating a social safety for low-income kids pays for itself in the long-run, because not only does redistribution to poor kids help them, but all of society benefits from the better life outcomes and social contributions they make. However, in the case of vaccine distribution, it seems that the ethics of trying to create a complex system for pinpointing who exactly should get the vaccine first (and to make sure no one “jumps the line”) are really just delaying the date at which everyone will eventually get the vaccine. It seems that we would be better off if we accepted a simpler system for determining proximate fairness of the vaccine distribution queue (instead of perfect fairness) and focused a lot more on the speed with which we will get through the queue. It seems that the vast majority of people would end up getting vaccinated at a much earlier date if we had gone with this approach.