Category: Current Affairs

How sad that our regulatory state is still failing us

When Pfizer representatives met with senior U.S. government health officials on July 12, they laid out why they thought booster shots would soon be necessary in the United States. Data from Israel showed the vaccine’s effectiveness waned over time, especially in older and immunocompromised people.

But officials from the Centers for Disease Control and Prevention disagreed, saying their own data showed something quite different, according to four people with direct knowledge of the meeting who spoke on the condition of anonymity.

Other senior health officials in the meeting were stunned. Why hadn’t the CDC looped other government officials on the data? Could the agency share it — at least with the Food and Drug Administration, which was responsible for deciding whether booster shots were necessary? But CDC officials demurred, saying they planned to publish it soon.

That episode, say senior administration officials and outside experts, illustrates the growing frustration with the CDC’s slow and siloed approach to sharing data, which prevented officials across the government from getting real-time information about how the delta variant was bearing down on the United States and behaving with greater ferocity than earlier variants — an information gap they say stymied the response…

“It’s not acceptable how long it takes for this data to be made available,” said a senior CDC official, who spoke on the condition of anonymity to discuss internal matters. “It’s done in a very academic way. Cross every ‘t,’ and dot every ‘i,’ and unfortunately, we don’t have that luxury in a global pandemic. There’s going to be a need to have a significant cultural shift in the agency.”

Here is the full Washington Post story by Yasmeen Abutaleb and Lena H. Sun.

A reader’s wishes for Covid coverage

From my email:

“In the last 18-19 months why have these stories not been written:
•       Why no stories on hospice care in the United States relating to covid19 statistics (hospice has been removed from our common lexicon)? I’ve asked you this before, I know.
•       Why no stories on the earnings of publicly held life insurance companies ?
•       Why no stories about strategies written about the myriad of home health care providers in this country? What is their role in lessening hospital stays in the last 18 months. Did they play a role?
•       Why know detailed explanation of how excess deaths are calculated – what are the excess death estimates for the next 5 years? I assume the data is easily found.
•       No actuaries providing keen information and insights?
•       Detailed investigations and stories of the traveling nurse industry ?  I know several, interesting stories to say the least. Mostly regarding compensation.
•       No keen insights from the coroners industry? The inexact science of “cause of death” in the last 100 years.

Would love you thoughts on my questions and why have there been no stories about the above?”

Those new service sector jobs? — drive your own kid to school

Bus drivers are in such short supply that EastSide Charter School in Wilmington, Del., is offering parents $700 to drop off and pick up their children for the school year.

The article is interesting throughout.  It turns out there is a shortage of bus drivers, a shortage of buses with working AC (chip issues), and some schools are flush with cash due to government stimulus.

Afghanistan thoughts

From my Bloomberg column, here is only one part of the argument, at the close:

The hawks I know, especially those with a politically conservative bent, typically will admit or perhaps even emphasize that the American electorate lacks the stomach for long-term interventions. But rather than consider the practical implications of such an admission, they too quickly flip into moralizing. We hear that the American citizenry is not sufficiently committed, or perhaps that non-conservative politicians are morally bankrupt, or that the Biden administration has made a huge mistake. But those moral claims, even if correct, are a distraction from the main lesson at hand. If your own country is not morally strong enough to see through your preferred hawkish policies, maybe those policies aren’t going to prove sustainable, and thus they need to be scaled back.

I still largely agree with most of the hawk worldview: America can be a great force for good in the world, the notion of evil in global affairs as very real, America’s main rivals on the global stage are up to no good, and there is an immense amount of naivete and wishful thinking in most of those who do not consider themselves hawks. What I do not see is a very convincing recipe for hawk policy success over time.

That all said, I still think the Biden withdrawal from Afghanistan was a policy mistake. The U.S. has allowed a very certain evil to rule about 38 million people, without constraint, and has damaged America’s credibility.

And:

This debate involves a host of untenable views. One camp condemns America’s Afghan interventions but offers few constructive alternatives. Another affiliates with hawkish values, but cannot enforce America’s will. Yet another recognizes the fragility of the current situation, but does not wish to turn over the keys to evil right now and hopes to straggle toward a different set of alternatives.

Very reluctantly, I’ve signed up for the last option.

I don’t by the way agree with Alex’s claim that we got nothing from our involvement in Afghanistan.  We used it to bring down the Soviet empire, at a high benefit to cost ratio, noting that we have subsequently not handled the fallout very well.

The FDA and CDC Standards on the J&J Vaccine and the Immunocompromised are Unintelligible

Last week the FDA authorized and the CDC now recommends a third mRNA booster for the immunocomprimised. The CDC says:

Who Needs an Additional COVID-19 Vaccine?

Currently, CDC is recommending that moderately to severely immunocompromised people receive an additional dose. This includes people who have:

  • Been receiving active cancer treatment for tumors or cancers of the blood
  • Received an organ transplant and are taking medicine to suppress the immune system
  • Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response

That’s very reasonable but the headline is inaccurate because the CDC then goes on to say:

The FDA’s recent EUA amendment only applies to mRNA COVID-19 vaccines, as does CDC’s recommendation.

Emerging data have demonstrated that immunocompromised people who have low or no protection following two doses of mRNA COVID-19 vaccines may have an improved response after an additional dose of the same vaccine. There is not enough data at this time to determine whether immunocompromised people who received the Johnson & Johnson’s Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.

So if you got one dose of J&J and are immunocompromised then you can’t get a second dose. But if you got two doses of an mRNA (which is already more effective than one dose of J&J) and are immunocompromised then the CDC recommends a third dose. None of this makes any sense. The weasel words there ‘isn’t enough data to determine’ indicate a typical failure to think in Bayesian terms and use all the information available and a typical failure to think in terms of patient welfare and expected cost and benefits.

Notice also the illiberal default. Instead of saying ‘we don’t have data on the J&J vaccine and the immunocompromised so we are not at this time recommending or not recommending boosters but leaving this decision in the hands of patients and their physicians’ they say ‘we don’t have data and so we are forbidding patients and their physicians from making a decision using their own judgment.’

Hat tip: Pharmacist CB.

Shame. Shame. Shame.

May be an image of text that says 'Afghan Refugees Resettled in U.S. 35 3000 2317 2000 1683 1453 1000 1311 959 902 TS9 441 576 349 515 428 481 661 753 910 1198 805 604 494 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 YTD 2021'The Afghanistan war was an epic disaster. Nothing good came of it. The least we can do as we evacuate, however, is to help all the Afghanis who helped us and who are now under death threat from the Taliban. But our record on Afghan refugees is shameful. At right from Daniel Bier is a chart of Afghan refugees resettled in the United States–604 last year 494 this year (data here). There are more Afghan immigrants accepted under other programs (not just the refugee program) and we have made motions to accept more but it may now be too late.

Canada in contrast is accepting 20,000 refugees.

Canada plans to resettle more than 20,000 vulnerable Afghans including women leaders, human rights workers and reporters to protect them from Taliban reprisals, Immigration Minister Marco Mendicino said on Friday.

The effort is in addition to an earlier initiative to welcome thousands of Afghans who worked for the Canadian government, such as interpreters, embassy workers and their families, he told a news conference.

“As the Taliban continues to take over more of Afghanistan, many more Afghans’ lives are under increasing threat,” he said. He did not provide a timetable.

Defense Minister Harjit Sajjan said some Canadian special forces were in Afghanistan taking part in the relocation effort but gave no details.

“The challenges on the ground are quite immense,” he said.

Is Africa losing its growth window?

The macro side of the story here is underreported, alas:

One of the saddest stories of the year has gone largely unreported: the slowdown of political and economic progress in sub-Saharan Africa. There is no longer a clear path to be seen, or a simple story to be told, about how the world’s poorest continent might claw its way up to middle-income status. Africa has amazing human talent and brilliant cultural heritages, but its major political centers are, to put it bluntly, falling apart.

Three countries are more geopolitically central than the others. Ethiopia, with a population of 118 million, is sub-Saharan Africa’s second-most populous nation and the most significant node in East Africa. Nigeria has the most people (212 million) and the largest GDP on the continent. South Africa, population 60 million, is the region’s wealthiest nation, and it is the central economic and political presence in the southern part of the continent.

Within the last two years, all three of these nations have fallen into very serious trouble.

And:

Based on size and historical and cultural import, Democratic Republic of the Congo ought to be another contender as an influential African nation. But the country has been wracked by conflict for decades. It is not in a position to fill the void created by the failings of Ethiopia, Nigeria and South Africa.

The last few decades have been a relatively propitious time for Africa. There have been a minimum of major wars in the world, and a dearth of major new pandemics (until recently). China was interested in building up African infrastructure, and across the continent countries made great advances in public health.

Could it be that this window has shut, and the time for major gains has passed? And that is not even reckoning with the likelihood of additional damage from Covid on a continent with a very low level of vaccination.

These sub-Saharan political regressions might just be a coincidence in their timing. But another disturbing possibility is that the technologies and ideologies of our time are not favorable for underdeveloped nation-states with weak governments and many inharmonious ethnic groups. In that case, all this bad luck could be a precursor of even worse times ahead.

Here is the link to the full Bloomberg column.

That was then, this is now, climate change edition the median voter theorem remains underrated

“Higher gasoline costs, if left unchecked, risk harming the ongoing global recovery. The price of crude oil has been higher than it was at the end of 2019, before the onset of the pandemic. While Opec+ recently agreed to production increases, these increases will not fully offset previous production cuts that Opec+ imposed during the pandemic until well into 2022. At a critical moment in the global recovery, this is simply not enough. President Biden has made clear that he wants Americans to have access to affordable and reliable energy, including at the pump. Although we are not a party to Opec, the United States will always speak to international partners regarding issues of significance that affect our national economic and security affairs, in public and private.”

That is, um…not from the Trump administration, rather…

Pigou Club getting smaller!

The TGA is Worse than the FDA, and the Australian Lockdown

I have been highly critical of the FDA but in Australia the FDA is almost a model to be emulated. Steven Hamilton and Richard Holden do not mince words:

At the end of 2020, as vaccines were rolling out en masse in the Northern Hemisphere, the TGA [Therapeutic Goods Administration, AT] flatly refused to issue the emergency authorisations other regulators did. As a result, the TGA didn’t approve the Pfizer vaccine until January 25, more than six weeks after the US Food and Drug Administration (FDA), itself not exactly the poster child of expeditiousness.

Similarly, the TGA didn’t approve the AstraZeneca vaccine until February 16, almost seven weeks after the UK.

In case you’re wondering “what difference does six weeks make?“, think again. Were our rollout six weeks faster, the current Sydney outbreak would likely never have exploded, saving many lives and livelihoods. In the face of an exponentially spreading virus that has become twice as infectious, six weeks is an eternity. And, indeed, nothing has changed. The TGA approved the Moderna vaccine this week, eight months after the FDA.

It approved looser cold storage requirements for the Pfizer vaccine, which would allow the vaccine to be more widely distributed and reduce wastage, on April 8, six weeks after the FDA. And it approved the Pfizer vaccine for use by 12 to 15-year-olds on July 23, more than 10 weeks after the FDA.

And then there’s the TGA’s staggering decision not to approve in-home rapid tests over reliability concerns despite their widespread approval and use overseas.

Where’s the approval of the mix-and-match vaccine regimen, used to great effect in Canada, where AstraZeneca is combined with Pfizer to expand supply and increase efficacy? Where’s the guidance for those who’ve received two doses of AstraZeneca that they’ll be able to receive a Pfizer booster later?

In the aftermath of the pandemic, when almost all of us should be fully vaccinated,there will be ample opportunity to figure out exactly who is to blame for what.

But the slow, insular, and excessively cautious advice of our medical regulatory complex, which comprehensively failed to grasp the massive consequences of delay and inaction, must be right at the top of that list.

You might be tempted to argued that the TGA can afford to take its time since COVID hasn’t been as bad in Australia as in the United States but that would be to ignore the costs of the Australian lockdown.

Article 13 of the Universal Declaration of Human Rights states that

  1. Everyone has the right to freedom of movement and residence within the borders of each state.
  2. Everyone has the right to leave any country, including his own, and to return to his country.

Australia has now violated each and every clause of this universal human right and seemingly without much debate or objection. It is deeply troubling to see people prevented from leaving or entering their own country and soldiers in the street making sure people do not travel beyond a perimeter surrounding their homes. The costs of lockdown are very high and thus so is any delay in ending these unprecedented infringements on liberty.

My Conversation with Andrew Sullivan

Here is the audio, video, and transcript.  Here is part of the overview:

Andrew joined Tyler to discuss the role of the AIDs epidemic in achieving marriage equality, the difficulty of devoutness in everyday life, why public intellectuals often lack courage, how being a gay man helps him access perspectives he otherwise wouldn’t, how drugs influence his ideas, the reasons why he’s a passionate defender of SATs and IQ tests, what Niall Ferguson and Boris Johnson were like as fellow undergraduates, what Americans get wrong about British politics, why so few people share his admiration for Margaret Thatcher, why Bowie was so special, why Airplane! is his favorite movie, what Oakeshottian conservatism offers us today, whether wokeism has a positive influence globally, why he someday hopes to glower at the sea from in the west of Ireland, and more.

And here is one excerpt:

SULLIVAN: Well, and so you get used to real conversations about people, and you don’t mistake credentials for intelligence. You realize that people outside of the system may be more perceptive about what’s going wrong with it than people buried within it. I honestly find life more interesting the more variety of people you get to know and meet. And that means from all sorts of different ways of life.

The good thing about being gay, I will tell you, is that that happens more often than if you’re straight — because it’s a great equalizer. You are more likely to come across someone who really is from a totally different socioeconomic group than you are through sexual and romantic attraction, and indeed the existence of this subterranean world that is taken from every other particular class and structure, than you would if you just grew up in a straight world where you didn’t have to question these things and where your social life was bound up with your work or with your professional peers.

The idea for me of dating someone in my office would be absolutely bizarre, for example. I can’t believe all these straight people that just look around them and say, “Oh, let’s get married.” Whereas gay people have this immense social system that can throw up anybody from any way of life into your social circle.

Interesting throughout.  And again, here is Andrew’s new book Out on a Limb: Selected Writing, 1989-2021.

Our Regulatory State Isn’t Learning

Outsourced to John Cochrane:

Delta is the fourth wave of covid, and amazingly the US policy response is even more irresolute than the first time around. Our government is like a child, sent next door to get a cup of sugar, who gets as far as the front stoop and then wanders off following a puppy.

The policy response is now focused on the most medically ineffective but most politically symbolic step, mask mandates. An all-night disco in Provincetown turns in to a superspreader event so… we make school kids wear masks in outdoor summer camps? Masks are several decimal places less effective than vaccines, and less effective than “social distance” in the first place.* Go to that all night disco, unvaccinated, but wear a mask? Please.

If we’re going to do NPI (non pharmaceutical interventions), policy other than vaccines, the level of policy and public discussion has tragically regressed since last summer. Last summer, remember, we were all talking about testing. Alex Tabarrok and Paul Romer were superb on how fast tests can reduce the reproduction rate, even with just voluntary isolation following tests. Other countries had competent test and tracing regimes. Have we built that in a year? No. (Are we ready to test and trace the next bug? Double no.)

What happened to the paper-strip tests you could buy for $2.00 at Walgreen’s, get instant results, and maybe decide it’s a bad idea to go to the all night dance party? Interest faded in November. (Last I looked, the sellers and FDA were still insisting on prescriptions and an app sign up, so it cost $50 and insurance “paid for” it.) What happened to detailed local data? Did anyone ever get it through the FDA’s and CDCs thick skulls that even imperfect but cheap and fast tests can be used to slow spread of disease?

…And then we indulge another round of America’s favorite pastime, answers in search of a question. Delta is spreading, so… extend the renter eviction moratorium. People who haven’t paid rent in a year can stay, landlords be damned.

All true. I got dispirited on testing. It’s insane that we don’t have cheap, rapid testing and good ventilation ready for a new school year. As I wrote about earlier, even the American Academy of Pediatrics is shouting from the rooftops that the FDA is deadly slow. The eviction moratorium is a sick joke. Just a backhanded way to redistribute wealth without a shred of justice or reason. Disgusting.

Here’s one more bit (but read the whole thing there is more.)

To learn from the mistakes, and institutionalize better responses would mean to admit there were mistakes. One would think the grand blame-Trump-for-everything narrative would allow us to do that, but the mistakes are deeply embedded in the bureacracies of the administrative state. Unlike bad admirals in WWII, nobody less than Trump himself has lost their job over incompetent covid response. The institutions have an enormous investment in ratifying that they did the best possible job last time. So, as in so many things (financial bailouts!) we institutionalize last time’s mistakes to keep those who made them in power in power — which means we do not learn from mistakes.

Covid dispatch from a relatively non-Straussian country

Most people will end up contracting the coronavirus, the head of the Health Ministry’s advisory committee for infectious diseases predicted on Monday.

“The [real] question is whether the infected person is vaccinated or not. It’s unavoidable that the pandemic will infect the majority of the population. It won’t disappear in another half a year,” Dr. Tal Brosh told the Kan public broadcaster.

Brosh, who also heads the infectious disease department at Assuta Medical Center in Ashdod, said he doesn’t see a reason to shutter Ben Gurion Airport, arguing that would distract “from the main problem — morbidity within in the country.”

WWAFS?  How many of our mainstream public health experts would even consider addressing such a question at this point?  Do you think they are telling you the truth?

p.s. Which again is the country with the best data?

Addended p.p.s.: “Between 90% and 94% of British adults have some degree of immunity to coronavirus from full or partial vaccination, or prior infection, the U.K. statistics office estimates, based on statistical analysis of blood samples.”

Here is the full story.  Via Rich B.

At this point, do you wish to simply not look too closely at the Delta data?

The delta Straussians also don’t want to debate safety claims very much. They fear that studying the data more closely will worry and paralyze us more, without much limiting the overall number of infections. In their view, vaccines have made things about as safe as they are going to get, and the contagiousness of delta will create lots of infections, albeit mostly relatively safe ones.

That’s what the proprietor of one of my favorite local restaurants believes. He is aware of the delta strain, and knows it is worse, though without being up on the numbers or the details. Earlier in the summer, he lifted the mask mandate for his restaurant, and he isn’t interested in restoring it. He is not a “Covid denialist,” but he figures normal business has to continue at some point and that point is now. Someone may well catch Covid in his restaurant, but those people might well have caught Covid anyway.

Our school reopenings face a similar paralysis-inducing dilemma. If we test every child every day, it will seem as if we have far too many cases of Covid, and the schools will shut again quickly. Nonetheless, given that delta is highly contagious, many of those children will catch Covid whether or not they go to school…

I do not rue the growth of delta Straussianism among my fellow citizens. If you can’t do anything about delta, if your institution needs to reopen sooner or later, if the booster shots in large numbers are not right around the corner, and yet another new variant might be coming along anyway, maybe you really do just need to get on with things. Restaurant reservations are robust, and the gym industry is surging back. I do not wish to reverse those trends, and it is hard to believe those customers are only the Covid denialists.

Here is the full Bloomberg column, which also offers a take on the British test and trace system.

The labor market ran hot, real wages fell

You may remember that I’ve been predicting that repeatedly, while much of “Twitter economics” was suggesting that “running the labor market hot” would boost real wages, I was claiming it was far more likely that rising employment would be correlated with falling real wages.  (Try here.)  This did not represent any great insight on my part, rather I was simply refusing to make the mood affiliation move of denying the tradeoff, and I had read Keynes’s General Theory.  Here is the latest:

Companies big and small are raising wages to attract workers and hold onto employees as the economy revs back into gear.

But those fatter paychecks aren’t going as far, thanks to rising inflation.

In fact, compensation is now lower than it was in December 2019, when adjusted for inflation, according to an analysis by Jason Furman, an economics professor at Harvard University.

The Employment Cost Index — which measures wages and salaries, along with health, retirement and other benefits — fell in the last quarter and is 2% below its pre-pandemic trend, when taking inflation into account. (Wages and salaries are growing at a faster pace than benefits.)

Score one for Keynesian economics > Twitter economics.

Or maybe they didn’t run the labor market hot enough.

VTEKL.