An entirely new perspective on the vaccine situation, thanks to John Cochrane of Stanford University.
COVID 19 is not a disease like Ebola or Smallpox which are highly infectious, visibly symptomatic and have very high mortality rates. COVID 19 is infectious but not as much as Ebola or Smallpox, it is possible to be asymptomatic, and mortality rates nowhere near as deadly as ebola/smallpox.
The public health response has been to ask people to quarantine and isolate until such time as a vaccine comes along. While mortality amongst the young and the relatively healthy is very low, the virus affects the older, the weaker and those with poor health more adversely, causing morbidity and prolonged suffering. However since the young and the old are all in quarantine, the infection rate may slow but the economy – which pays for development of the vaccine – is in a downward spiral. Every government is borrowing money to pay for COVID relief.
Now that the vaccine is here, it is being distributed to the elderly, the vulnerable and to those on the front lines of health care first.
One can argue this is an inefficient allocation mechanism. The elderly and the infirm are relatively isolated (in the medical sense) than the young. They are at home, at care homes or in nursing homes, being looked after. They get the disease because the infected visit them. On the other hand, the young and healthy who are also isolated are the ones who need to man the shops, the farms and the factories, run the trains, fly the aircraft, and otherwise make the economy work. These are the people who are very likely to be asymptomatic or are not very badly affected by the virus in majority of the cases.
If those are young and healthy get the vaccines first, shops and establishments can re-open and people can go to work. Schools can re-open. Teachers can go back to teaching kids. Asking these people to stay at home has disastrous results for the economy. If these people are emboldened to go to work, with the vaccine, the economy will recover.
Why not let companies buy these vaccines and inoculate their employees? It need not be an auction – it can be an allocation on first come first served basis. After all this is in their direct interest. The same privilege can be extended to utilities, to transport, to education – to pretty much any government department. Empanel a set of delivery companies to fetch and send the vaccine, and empanel any local GP to administer the vaccine. Allocate a percentage – I would say 20% – to go to the old and the infirm, and health care workers.
The vaccine is a “Leave Home and Go To Work” pass. Those who have to go to work, should get the vaccine first.
Administrators and governments need to look beyond the (correct) moral impulse and look at how to achieve a re-opening and cut the R rate. COVID 19 may have come under control to an extent, but this will not be the only pandemic.
4 thoughts on “Distributing vaccines”
The adverse effects of the lockdown will far outweigh that of the pandemic
Our ability to successfully innovate solutions has resulted in a proportionate increase in our fear of mortality
I agree completely.
The amazing little factoid I picked up is that the mRNA Pfizer/German vaccine was ready in ONE weekend in January 2020! As soon as the gene sequence of the new virus was published, a small tweak to a vaccine intended for Ebola resulted in the Pfizer vaccine.
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Yes, but ……
This is just an issue of prioritisation for a few months. One inarguable priority for me is health care workers. They get it first. Period. After that its going to be a difference of 6-9 months for all groups; thats all. Can you imagine the political battle that will have to be fought if any government tried to do what you are saying ? Especially in the US of A. Death Panels, etc etc
So easier than fighting that battle is to help multiple vaccines get developed and ramp production. That’s exactly what most governments are doing. And in terms of priorities, however imperfect they may be, governments are better than markets – markets will only prioritise ability to pay. So better to go the way India is doing – emapnel lots of private providers but dictate priorities for the first 6 months centrally. After that, it will become a free market with the government taking care of the needy.
But underneath your post is a much bigger issue – where should healthcare investments be made – for the elderly or for the young. That is a much much more complex subject. Is it OK to have Medicare for the over 65 but no insurance for a child ? On that I am opinionated as hell ; so if you every write a post there …..
I know. There is logic, and there is political logic. The two are very often not the same.
Note that I did not intend for allocation by ability to pay. Without intending to get into full marketplace design, I wanted the vaccines to be able to go to those who need to get out of home and work. This is the highest priority – even for the elderly and infirm who are often cared for by their younger relatives.
Greater availability of the vaccine thanks to technology, and the reducing infectivity of the virus (thanks to a number of factors notwithstanding the S African variant) may make this problem redundant.
But it does not negate the principle, in my view.
My feelings on universal health care are aligned to yours. We should debate that!