Category: Current Affairs
So what is the Japan model? First, it is a cluster-based approach, derived from a hypothesis obtained from an epidemiological study based on Chinese data and conducted on the Diamond Princess cruise ship that entered the port of Yokohama on February 3, 2020. This hypothesis accounts for the many passengers who were not infected with the coronavirus despite having had close contact with infected persons. It posits that the explosive increase in infected persons is a result of the high transmissibility of certain infected individuals, which forms a cluster. Infected individuals with even higher transmissibility appear from these clusters to form more clusters and infect many others. Based on this hypothesis, under the cluster-based approach, each cluster is tracked to the original infection source and persons with high transmissibility are isolated to prevent the spread of infection. For this reason, pinpoint testing is carried out and broad testing of the population is not required, in contrast to the approaches taken in other counties.
This cluster-based approach is conditioned on an environment in which there are only a few infected persons and clusters are detectable at an early stage. In February 2020, when the spread of infection was observed in Hokkaido, a cluster-based approach was adopted. As a result, Hokkaido was successfully able to contain its outbreak.
For the cluster-based approach to be effective, protective measures at airports and ports are important. Hokkaido has the advantage of being an island, making it comparatively easy to control the inflow of infected people. Behavioral changes are also required. On February 28, 2020, acting without legal basis, Hokkaido Governor Naomichi Suzuki declared a state of emergency and called on residents to refrain from going outside. Residents took the call seriously, and are responsible for the success of the cluster-based approach. Following its success in Hokkaido, the cluster-based approach was adopted nationally. On February 25, 2020, a Cluster Response Team was established in the Ministry of Health, Labour and Welfare.
Here is more from Kazuto Suzuki, with other points of note.
That is the topic of my latest Bloomberg column, here is one excerpt:
The immediate future of my region thus appears to be a major demand shock to the stores, acceptable continuing employment for the upper middle class, and economic devastation for lower-income individuals. The traditional mix of government-connected employment and retail will swing heavily in the direction of government. In essence, the federal government will pay its employees to click on Amazon while working from home.
The ethnic dimension of Covid-19 in Fairfax County is especially noteworthy. Latinos make up 16.8% of the county’s population, but account for 62.7% of the diagnosed Covid-19 cases. And if you assume that perhaps lower-income Latinos are less willing or able to go to a doctor, the true percentage of the Latino cases may be higher yet.
I thus foresee a future where people are more reluctant to hire Latino immigrants for housework or for child care, and thus additional home responsibilities will fall on parents, probably disproportionately on women. In turn, I expect many Latinos to leave the area, at least temporarily, unable to afford the higher rents when there is little work. There may also be greater employer discrimination against Latino applicants, as unfair or unjust as that would be.
Those developments will lead to Fairfax County becoming whiter. (If you are wondering, blacks are a slightly lower Covid-19 case share in the county than population share).
Recommended, for all those who care.
Interesting throughout, here is the audio and transcript. Here is the summary:
Paul Romer makes his second appearance to discuss the failings of economics, how his mass testing plan for COVID-19 would work, what aspect of epidemiology concern him, how the FDA is slowing a better response, his ideas for reopening schools and Major League Baseball, where he agrees with Weyl’s test plan, why charter cities need a new name, what went wrong with Honduras, the development trajectory for sub-Saharan Africa, how he’d reform the World Bank, the underrated benefits of a culture of science, his heartening takeaway about human nature from his experience at Burning Man, and more.
I liked the parts about charter cities and the World Bank the best, here is one excerpt:
COWEN: How optimistic are you more generally about the developmental trajectory for sub-Saharan Africa?
ROMER: There’s a saying I picked up from Gordon Brown, that in establishing the rule of law, the first five centuries are always the hardest. I think some parts of this development process are just very slow. If you look around the world, all the efforts since World War II that’s gone into trying to build strong, effective states, to establish the rule of law in a functioning state, I think the external investments in building states have yielded very little.
So we need to think about ways to transfer the functioning of existing states rather than just build them from scratch in existing places. That’s a lot of the impetus behind this charter cities idea. It’s both — you select people coming in who have a particular set of norms that then become the dominant norms in this new place, but you also protect those norms by certain kinds of administrative structures, state functions that reinforce them.
COWEN: If you could reform the World Bank, what would you do?
ROMER: Oh, that’s an interesting question. I think the Bank is trying to serve two missions, and it can’t do both. One is a diplomatic function, which I think is very important. The World Bank is a place where somebody who represents the government of China and somebody who represents the government of the United States sit in a conference room and argue, “Should we do A or B?” Not just argue, but discuss, negotiate. On a regular basis, they make decisions.
And it isn’t just China and the US. It’s a bunch of countries. I think it’s very good for personal relationships, for the careers of people who will go on to have other positions in these governments, to have that kind of experience of, basically, diplomatic negotiation over a bunch of relatively small items because it’s a confidence-building measure that makes it possible for countries to make bigger diplomatic decisions when they have to.
That, I think, is the value of the World Bank right now. The problem is that that diplomatic function is inconsistent with the function of being a provider of scientific insight. The scientific endeavor has to be committed to truth, no matter whose feathers get ruffled. There’s certain convenient fictions that are required for diplomacy to work. You start accepting convenient fictions in science, and science is just dead.
So the Bank’s got to decide: is it engaged in diplomacy or science? I think the diplomacy is its unique comparative advantage. Therefore, I think it’s got to get out of the scientific business. It should just outsource its research. It shouldn’t try and be a research organization, and it should just be transparent about what it can be good at and is good at.
And toward the end:
COWEN: Last question thread, what did you learn at Burning Man?
ROMER: Sometimes physical presence is necessary to appreciate something like scale. The scale of everything at Burning Man was just totally unexpected, a total surprise for me, even having looked at all of these pictures and so forth. That was one.
Another thing that really stood out, which is not exactly a surprise, but maybe it was the surprise in that group — if you ask, what do people do if you put them in a setting where there’s supposed to be no compensation, no quid pro quo, and you just give them a chance to be there for a week. What do they do?
For purposes of contrast, here is my first Conversation with Paul Romer.
That is the topic of my latest Bloomberg column, here is one excerpt:
Demand for in-restaurant dining is likely to fall as well, though estimates vary. Since the average small business carries less than a month’s worth of liquid reserves, and the wait for a vaccine is likely to be at least a year, many restaurants will simply be unable to survive the shrinking of the market.
I call these places ghost restaurants because they are still walking around, so to speak, visible to us and listed on Yelp, but not really alive and without much of a future.
In a few months’ time, a significant number of these ghost enterprises will be gone. My drive around Northern Virginia, rather than being rich with culinary choice, will soon become fairly desolate — and the overall economic landscape will indeed be much emptier.
What else in our current capital structure might qualify as “ghost”?
And while an all-but-certain death awaits some businesses, others can look forward to mere stagnation. If you are a 23-year-old entrepreneur, how easy will it be to build up the network of “soft ties” that will help you launch the next phase of your career?
As many marginal businesses are going under, it is quite possible that the public-health situation will improve. Civic spaces will repopulate as commercial ones depopulate, giving urban landscapes a confusing feel. And because there will be fewer businesses to choose from, it will be all the harder for those remaining to enforce social distancing.
Many Americans have been clamoring lately for more freedom, and those desires are understandable. But as they emerge from lockdown, they might well be disappointed to discover that, above all else, what people will be exercising is the freedom to go out of business.
If you start by using the word “ghost” (better than zombie, in this setting), don’t be surprised if the column turns out a bit gloomy!
Prospera, Honduras just launched on the island of Roatan. It is a ZEDE (Zona de Empleo y Desarollo Economico), the legacy of Paul Romer’s time in Honduras promoting charter cities. It has substantial autonomy, different taxes, different courts, different labor law, and more. It is one of the most innovative jurisdictions in the world.
First, a bit of history. The ZEDE legislation was passed in 2013. It allows for the creation of a special jurisdiction with an almost unprecedented amount of autonomy. The only recent comparison is the Dubai International Financial Center, which, as the name suggests, focuses exclusively on finance. The ZEDE legislation allows for different labor law, environmental law, business registration, dispute resolution, and more. It is more analogous to Hong Kong, or at least the Hong Kong ideal, of one country, two systems.
In 2013 and 2014 rumors swirled about ZEDE projects, including a port in the Gulf of Fonseca, but nothing materialized. I even moved to Honduras in 2014, at the time the murder capital of the world, to be closer to the action. As late as 2017, the Honduran government was saying projects were about to begin.
The ZEDE legislation is the successor to the RED (Regiones Especiales de Desarrollo) legislation, which Romer helped introduce to build charter cities. Romer had a falling out with the Honduran government in 2012. Shortly after his departure, the RED legislation was declared unconstitutional. The ZEDE legislation was passed to address the constitutional shortcomings of the RED legislation, though it also benefitted from seeing the Supreme Court judges who ruled against the RED legislation fired. To be fair, the government claims they were fired for a ruling on a police brutality case, which I am wont to believe. If there was sufficient government support behind ZEDEs to fire Supreme Court justices, it would not have taken seven years for the first ZEDE to be launched.
I worked with much of the Prospera team under the previous incarnation, NeWAY Capital (I’m not sure of the formal relationship between the two). I left around the time they pivoted to Honduras, 2.5 years ago. I was skeptical, as Honduras was the place projects went to die. Years had gone by without projects gaining meaningful traction and I expected them to run out of funding before launching. I’m happy to have been proven wrong.
Congratulations to Erick Brimen and the team. It is a lot of work to create a new jurisdiction, especially one as innovative as Prospera. The Charter Cities Institute has two team members spending approximately two thirds of their time on developing a “Governance Handbook,” a guide to the governance of a new jurisdiction. It will likely take about 9 months to complete, and that is just for the handbook, not implementation…
Residency costs $1300 annually, unless you’re Honduran, in which case it costs $260. Becoming a resident also requires signing an “Agreement of Coexistence,” a legally binding contract between Prospera and the resident. Prospera, therefore, cannot change the terms without exposing itself to legal liability. Most governments have sovereign immunity, this goes a step beyond removing that, with a contract that clearly defines the rights and obligations on both sides.
After signing the Agreement of Coexistence, all residents are required to buy general liability insurance which will ensure themselves against both civil and criminal liability. General liability insurance, as well as criminal liability insurance, has been proposed by economist Robin Hanson, among others.
That is from an email by Mark Lutter, Founder and Executive Director of the Charter Cities Institute. I thank Massimo for drawing my attention to this.
I am happy to announce two further winners of the Emergent Ventures prizes to fight Covid-19.
The first is to Statnews.com for their excellent and intelligent reporting on public health, including the coronavirus, with the latter articles being ungated.
This is not only a prize for past achievement, but also resources to allow them to continue into the future. As most of you know, journalism is a highly precarious enterprise these days.
And to be clear, this is a one-time prize and it involves absolutely no editorial control or influence over what they publish.
Here is a recent NYT article on Statnews.com. the headline reads: “The Medical News Site that Saw the Coronavirus Coming Months Ago.”
The second winner is Tina White and Covid Watch, for their work on track and trace apps, you will note that Tina and her group were earlier winners of a (smaller) Emergent Ventures fellowship. This is an Early Response prize, for their critical and timely work to boost the quality of these apps and to make them more privacy-friendly and more palatable to civil liberties concerns. Here is some coverage:
Quick update on Curative, the COVID19 testing co – they are currently running 6% of entire US COVID19 testing capacity – from being a sepsis co six weeks ago
— Celine Halioua (@celinehalioua) May 15, 2020
Emergent Ventures is pleased to have been their very first funder, and to have consummated the entire grant process, including the wire of funds (at the time critical for materials purchase), in less than 24 hours.
I’ve had about five of you write me about this point in the last day. Hundreds of thousands of people worldwide die from falls each year, what about car accidents, cancer, heart attacks, etc.? Why is this new risk so special?
I think you need to keep clear monthly vs. yearly rates of death. Covid-19 very likely has killed over 100,000 Americans over the last two months or so.
It either will continue at that pace or it won’t. Let’s say that pace continues (unlikely in my view, but this is simply a scenario, at least until the second wave). That is an ongoing risk higher than other causes of death, unless you are young. You don’t have to be 77 for it to be your major risk worry.
Alternatively, let’s say the pace of those deaths will fall soon, and furthermore let’s say it will fall by a lot. The near future will be a lot safer! Which is all the more reason to play it very safe right now, because your per week risk currently is fairly high (in many not all parts of America). Stay at home and wear a mask when you do go out. If need be, make up for that behavior in the near future by indulging in excess.
A few of you also have asked me how all this Covid history has changed my view of the world. If nothing else, I am realizing that people are worse at intertemporal substitution than I had thought.
I know some people who react very fearfully each time a package comes to the door, or when a jogger passes ten feet away.
Maybe those people are right to have that response! (Suspend judgment for the time being.) But if they are right, and the risk is real rather than truly tiny, it is hard to imagine lockdown working. We can’t eliminate all risk, and we will end up with a fairly high percentage of the population infected fairly quickly. After all, danger is almost everywhere (in this view). If you run a pretty high risk of getting infected over the next month or two anyway, you might as well go buy some shoes at Nordstrom for your trouble.
What is noteworthy is that these fearful people tend to be very supportive of lockdown.
On the other side of the coin, some individuals defend the Swedish model. Presumably they believe that herd immunity can be achieved relatively quickly, and with a high upfront cost the medium- and long-term can be fairly safe, with a net gain overall.
Yet if you accept those presuppositions (suspend judgment for the time being), in fact you ought to behave in a very fearful manner. Just stay at home and wait until herd immunity arrives in late summer or whenever, and then go out and have all of your fun. Let the Nordstrom shoes wait!
Yet advocates of the Swedish model also seem quite interested in going out and frolicking in the shorter run.
In reality, mood affiliation may be playing a role here. People side with either “caution and fearfulness,” or with “openness and boldness,” and then both their theories and behavior follow accordingly.
In reality, the Swedish model advocates ought to behave quite cautiously and lockdown advocates should be willing to take more chances.
After mounting criticism and thousands of deaths in New York nursing homes—including several individual facilities that have lost more than 50 residents—the state on Sunday reversed the mandate, which said nursing homes couldn’t refuse to accept patients from hospitals who had been diagnosed with Covid-19. New York now says hospitals can send patients to nursing homes only if they have tested negative for the virus.
Here is the WSJ article, via John F.
Let’s say its 1990, and you are proposing an ambitious privatization plan to an Eastern bloc county, and your plan assumes that the enacting government is able to stay on a non-corrupt path the entire time.
While your plan probably is better than communism, it probably is not a very good plan. A better plan would take sustainability and political realities into account, and indeed many societies did come up with better plans, for instance the Poland plan was better than the Russia plan.
It would not do to announce “I am just an economist, I do not do politics.” In fact that attitude is fine, but if you hold it you should not be presenting plans to the central government or discussing your plan on TV. There are plenty of other useful things for you to do. Or the uni-disciplinary approach still might be a useful academic contribution, but still displaced and to be kept away from the hands of decision-makers.
Nor would it do to claim “I am just an economist. The politicians have to figure the rest out.” They cannot figure the rest out in most cases. Either stand by your proposed plan or don’t do it. It is indeed a proposal of some sort, even if you package it with some phony distancing language.
Instead, you should try to blend together the needed disciplines as best you can, consulting others when necessary, an offer the best plan you can, namely the best plan all things considered.
That might fill you with horror, but please recall from Tetlock that usually the generalists are the best predictors.
Ignoring other disciplines may be fine when there is no interaction. When estimating the effects of monetary policy, you probably can do that without calculating how many people that year will die of air pollution. But you probably should not ignore the effects of a major trade war, a budgetary crisis (“but I do monetary policy, not fiscal policy!”), or an asteroid hurtling toward the earth.
If that is too hard, it is fine to announce your final opinion as agnostic (and explain how you got there). You will note that when it comes to blending economics and epidemiology, my most fundamental opinion is an agnostic one.
This is all well-known, and it has been largely accepted for some time now.
If a public health person presents what is “only an estimate of public health and public health alone” to policymakers, I view it as like the economist in 1990 who won’t consider politics. Someone else should have the job. Right now public health, politics, and economics all interact to a significant extent.
And if you present only one of those disciplines to a policymaker, you will likely confuse and mislead that policymaker, because he/she cannot do the required backward unthreading of the advice into its uni-dimensional component. You have simply served up a biased model, and rather than trying to identify and explain the bias you are simply saying “ask someone else about the bias.”
If an economist claims he is only doing macroeconomics, and not epidemiology (as Paul Krugman has said a few times on Twitter), that is flat out wrong. All current macro models have epidemiology embedded in them, if only because the size of the negative productivity and negative demand shock depends all too critically on the course of the disease.
It is fine to be agnostic, preferably with structure to the opinion. It is wrong to hide behind the arbitrary division of a discipline or a field.
We need the best estimates possible, and presented to policymakers as such, and embodying the best of synthetic human knowledge. Of course that is hard. That is why we need the very best people to do it.
Addendum: You might try to defend a uni-disciplinary approach by arguing a decision-maker will mainly be fed other, biased uni-disciplinary approaches, and you have to get your discipline into the mix to avoid obliteration of its viewpoint. But let’s be clear what is going on here: you are deliberately manipulating with a deliberately non-truthy approach (I intend those words as a description, not a condemnation). If that’s what it is, I wish to describe it that way! I’ll also note I’ve never done that deliberately myself, and that is along many years of advising at a variety of levels. I’d rather give the best truthful account as I see it.
That is the topic of my latest Bloomberg column, here is one excerpt:
There has been surprisingly little debate in America about one strategy often cited as crucial for preventing and controlling the spread of Covid-19: coercive isolation and quarantine, even for mild cases. China, Singapore and South Korea separate people from their families if they test positive, typically sending them to dorms, makeshift hospitals or hotels. Vietnam and Hong Kong have gone further, sometimes isolating the close contacts of patients.
I am here to tell you that those practices are wrong, at least for the U.S. They are a form of detainment without due process, contrary to the spirit of the Constitution and, more important, to American notions of individual rights. Yes, those who test positive should have greater options for self-isolation than they currently do. But if a family wishes to stick together and care for each other, it is not the province of the government to tell them otherwise.
What I observe is people citing those other countries as successes, wishing to “score points,” but without either affirming or denying their willingness to engage in coercive quarantine. Here is another bit:
Furthermore, all tests have false positives, not just medically but administratively (who else has experienced the government making mistakes on your tax returns?). Fortunately, current Covid-19 tests do not have a high rate of false positives. But even a 1% net false positive rate would mean — in a world where all Americans get tested — that more than 1 million innocent, non-sick Americans are forcibly detained and exposed to further Covid-19 risk.
Coercive containment was tried during one recent pandemic — in Castro’s Cuba, from 1986 to 1994, for those with HIV-AIDS. It is not generally a policy that is endorsed in polite society, and not because everyone is such an expert in Cuban public health data and epidemiological calculations. People oppose the policy because it was morally wrong.
And what about uncertainty? Is it really a safe bet that America’s quarantine policy would be executed successfully and save many lives? What if scientists are on the verge of discovering a cure or treatment that will lower the Covid-19 death rate significantly? Individual rights also protect society from the possibly disastrous consequences of its own ignorance.
Here are a few points that did not fit into the column:
1. I am not opposed to all small number, limited duration quarantine procedures, such as say holding Typhoid Mary out of socializing. This same point also means that a society that starts coercive quarantine very early might be able to stamp out the virus by coercing relatively small numbers of people. (It is not yet clear that the supposed successes have achieved this, by the way.) That is very different from the “mass dragnet” to be directed against American society under current proposals.
2. I am familiar with the broad outlines of American quarantine law and past practice. I don’t see that history as necessarily authorizing how a current proposal would have to operate, and on such a scale. In any case, I am saying that such coercive quarantines would be wrong, not that they would be illegal. I believe it is a genuinely open question how current courts would rule on these matters.
3. From my perch from a distance, it seems to me that Human Challenge Trials for vaccines are more controversial than is mass forced quarantine. I could be wrong, and I would gladly pursue any leads on the current debate you might have for me. Who are the philosophers or biomedical ethicists or legal scholars who have spoken out against such policies?
A number of commentators suggest that the real problem is President Trump, rich people overly concerned with tax cuts, a Republican Party with a deregulatory ideology, and so on.
Instead I have been repeating insistently that “our regulatory state is failing us.” The FDA and CDC, for instance, have through their regulations made it harder for testing and also widespread mask supply to get off the ground.
I don’t see how you can blame (supposed) deregulatory fervor for the presence of too many regulations, as we have been observing in these instances.
I do think you can blame President Trump, along multiple dimensions, for a poor response to the pandemic, see my grades here. (If there were a separate risk communication grade, Trump would get an F minus for that.) Nonetheless a regulatory state cannot be said to work well if it requires such extraordinary attention from a sitting president.
It can be the case that both Trump and the permanent bureaucracy are at fault. If something takes a long time to get done for reasons relating to preexisting rules, regulations, and laws, usually the current president is not directly at fault for that particular problem. Was it only Trump’s fault, for instance, that the permits to build a mask factory can take months to acquire? Or that the HHS did not respond to inquiries about gearing up mask production in Texas? Or that a law had to be changed to allow industrial companies to sell quality masks to hospitals? Or that so many a-legal or extra-legal activities (e.g., rich people arranging deliveries by plane, etc.) had to occur to sneak masks into this country? That the trade barriers on masks persisted for so long? (And yes likely the Trump administration is at fault for de facto toughening restrictions on masks from China.)
It is fine to say “the buck stops here,” and to criticize Trump for not having erected processes to be more aware of these problems and to dissolve them more quickly. I would agree with some of those criticisms, while noting the Trump administration also has tried to ease many of the regulations hampering adjustment.
This is more something on the horizon, but how do these apples make you feel? Comforted? The fault of plutocratic Republicans most of all?
And in both cases, vials and stoppers, a vaccine manufacturer cannot just switch to a slightly different product or another brand. They typically have to run manufacturing changes by FDA first, which could make quick supplier changes to curb shortages a difficult prospect.
The FDA can decide how flexible it will be about this type of change, says Sklamberg. The agency said in a December 2017 draft guidance that companies could note some changes in their annual reports rather than waiting for approval, but it has not finalized the policy.
The ability to switch products could be crucial as the entire world readies for a possible vaccine and vies to secure their supplies.
If you wish, consider a simple question. When the CDC pooh-poohed masks early on, or botched their testing kit thereby delaying U.S. testing by weeks or maybe months, did the permanent staff of the CDC rise up and rebel and leak howling protests to the media, realizing that thousands of lives were at stake? That is surely what would happen if say the current FDA announced it was going to approve thalidomide.
Those are still cases of our regulatory state failing us.
Germany is being closely watched worldwide as the most successful large European country in curbing the spread of the virus, partly thanks to massive testing, which has prompted a partial reopening of the economy. Merkel has frequently said the reproduction rate of the new coronavirus must be held below 1 to prevent the health system from being overwhelmed.
But the Robert Koch Institute for public health said the rate hovered above this critical threshold for the third consecutive day with an estimated value of 1.07 on Monday, after 1.13 on Sunday.
That Germany does not have its R below one is, in a nutshell, why short-run measurements of coronavirus responses are not very reliable. And why “we need to lock down until full testing is up and running” is not necessarily convincing. Here is the full story.
What if we develop a vaccine for COVID-19 but can’t find enough patients to run a randomized clinical trial? It sounds absurd, but this problem has happened in the past. Ebola was identified in 1976, and candidate vaccines were proven safe and effective in mice and primates in 2004 and 2005, respectively. But no human vaccine was produced [at that time] because it was extremely difficult, bordering on impossible, to trial an Ebola vaccine. The problem? Ebola is so deadly that people take precautionary measures long before a vaccine can be tested.
A few pieces have been written about human challenge trials, clinical trials in which healthy people are infected with a disease in order to see if a treatment or vaccine works, but most of them focus on the ethical issues. I don’t think there are serious ethical issues so writing at The National Interest I focus on why challenge trials are useful statistically and why they may even be necessary.
Even health care workers, however, have a low enough infection rate that you either need many months to determine if there is a significant effect, or you need large populations. In Italy, about 6,000 doctors were infected over two months, out of a population of about 241,000 Italian doctors. This is a monthly infection rate of 1.2 percent. If the vaccine is 50 percent effective, then to detect this within a month, you need a sample size of 7,776 people equally divided between a vaccinated group and a non-vaccinated group. You could run the test in a smaller sample of 1,322 but then the trial would take six months. A more effective vaccine would make detecting an effect easier, but flu vaccines work at 40 to 60 percent effectiveness, so an assumption of 50 percent is not unreasonable.
But will Italian doctors still be getting infected at a rate of 1.2 percent per month when a vaccine becomes available for trial in six months or a year? We hope not. The hope is that social distancing and the use of personal protective equipment will have greatly lowered the infection rate. A low infection rate is great, unless you want to properly test a vaccine.
…The virtue of a challenge trial is that the results would be available very quickly, within a few weeks, and using only a small population. If the vaccine is 50 percent effective, for example, then we would need around 100 volunteers or perhaps even fewer depending on how many people exposed to the virus in laboratory conditions contract the disease.
By advancing a vaccine by many months, a challenge trial could save many thousands of lives and spare the world the huge economic costs of the lockdowns and social distancing that we will be using to combat the virus.
Challenge trials, however, don’t solve all problems. In particular, to limit the risk we would want to restrict the patients in a challenge trial to be young and healthy. But that raises a problem of external validity. We also want the vaccine to be safe and effective in less healthy and elderly people which requires secondary challenge trials or field testing in that population. Nevertheless, as Athey, Kremer, Synder and myself argue in our NYTimes op-ed, the high risk of vaccine failure means that we would like 15-20 vaccine candidates and challenge trials could help us whittle this number down to the best two to three substantially speeding up the vaccine discovery process.
One more point is worth bearing in mind.
[A]n ordinary vaccine trial is not without risk—a vaccine could backfire and make the disease worse—so exposing fifty or so volunteers to the virus in a challenge trial must be balanced against exposing thousands to a potentially dangerous vaccine in an ordinary clinical trial.
Thus, the total risk may be lower with a combination of challenge trials and longer, larger field trials.
Challenge trials have a long history in medicine and their statistical advantages make them powerful and even necessary. As The Guardian notes:
Scientists, however, increasingly agree that such trials should be considered, and the WHO is the latest body to indicate conditional support for the idea.
“There’s this emerging consensus among everyone who has thought about this seriously,” said Prof Nir Eyal, the director of Rutgers University’s Center for Population-Level Bioethics in the US.
No, I am not referring to the preventive measures taken in California, Washington state, and parts of the Tri-state area. Those made good sense to me at the time and in retrospect all the more.
I mean when the whole country started to shut down, including the South, Midwest, and other parts of the West. And yes I know the legal lockdowns were not always the biggest factors, arguably it was when governments started scaring people.
Let’s say you have a simple model of political sustainability where Americans will tolerate [???] months of lockdown — shall we say two? — but not much more. (Maybe three months if we had Merkel as president.) Then, if you scare/lock down in parts of the country where the virus is not yet evident, you create economic misery but not many public health gains. Who after all thinks that Seattle should have been locked down last September? Right?
Many parts of America now hate the lockdown, as they see the economic devastation, are not witnessing overloaded hospital systems, and just don’t quite “get it.” And they are now taking off the lockdown, through both legal and informal means, before it is optimal to do so. One loyal MR reader emailed me this:
The smaller town I am in was never hit hard, and therefore most people are somewhere on the spectrum between COVID is a bad flu and you should wash your hands to pick whatever conspiracy theory (plandemic). People do not believe in the severity of the virus. Not one family we know is social distancing. The ICU never got overrun, the only apocalypse to arrive is an economic one. This is the fundamental point. Most people’s only pain and sadness stems from loss of job, security, future NOT from sickness and death. People here don’t work for big companies or the government.
Oddly, Trump’s big speech when he found “pandemic religion” may have been one of his biggest mistakes. I fully understand that Denmark and Austria did well because they locked down early (and took other measures). There is good evidence that NYC should have locked down earlier yet, but maybe (and I do mean maybe) other parts of the country — most of all rural America — should have locked down later, so they would have their lockdown active “when it really matters.”
In the meantime, we could have restricted or somehow taxed travel out of NYC, which seems to have been a major national spreader.
This is one reason why I am skeptical about models of epidemiology (and economics!) that do not consider political sustainability. I am by no means sure that the claims in this post are correct, but they could be correct. And a model that does not consider political sustainability and time consistency won’t even pick up these factors as concerns. It will simply indicate that a lockdown should happen as quickly as possible. But that was perhaps one of our big mistakes, namely to shut down many of the less dense parts of America before their problems were sufficiently acute, thereby rendering the whole program less sustainable.
And moralizing and blaming our current predicament on “Trump,” or “the yahoos who watch Fox News” is — even if correct — washing one’s hands of the responsibility to incorporate political sustainability into the model.
I fully admit, by the way, that I did not myself appreciate the import of this factor at the time. This is all a sign of how backward our science is in this entire area.
By the way, here is a 55 pp. Powerpoint-like survey of lockdown models. Many references, not much public choice or political economy to be seen.