Category: Current Affairs
Here is an excellent Reason segment on vaccine policy and First Doses First including extensive interview with me.
Britain has fully vaccinated more people against #COVID19 than every other nation on earth combined.
Link and picture here. That is as of January 13, at least. You may recall my previous and much-attacked July Bloomberg column suggesting that along a number of dimensions the UK pandemic response actually was quite good.
Addendum: Numerical correction from Alex on America, though you still can praise the British.
From Ben Casselman: “…unlike with most measures of the economy, retail sales are actually ABOVE their prepandemic level. Up 2.6% from February, and 2.9% over the past year. So not a clean story like with jobs.”
And from Larry Summers: ” Total household income is 8% above what anybody thought it would be before Covid.”
There are very real macroeconomic problems right now, but please keep the following in mind while drawing up a “demand-based” stimulus plan. Focus on public health!
According to the Guardian the First Minister of Wales explained their policy of doling out the Pfizer vaccine evenly over the next six weeks:
the Pfizer vaccine has to last us until into the first week of February.
…We won’t get another delivery of the Pfizer vaccine until the very end of January or maybe the beginning of February, so that 250,000 doses has got to last us six weeks.
That’s why you haven’t seen it all used in week one, because we’ve got to space it out over the weeks that it’s got to cover.
Bonkers! A vaccine isn’t like a limited supply of water that needs to be rationed until you arrive at the next oasis. The sooner you get the vaccine out the better! Start lowering R now! If you run out of vaccine, well scarcity is bad but running out means that at least one part of your system is working well! It’s a bad idea to kill people to make it look like you are following some sort of numerically neat plan.
One year into the pandemic and people still don’t understand vaccines or viral growth.
Hat tip: Arthur Baker.
That is the topic of my current Bloomberg column, here is one bit:
Put aside U.S. politics for a moment and view the events of the last week from a global perspective. Without backing from the military, a crowd entered the Capitol building and disabled the U.S. Congress, and almost succeeded in achieving more violent goals yet.
The question is not what people should infer, or what most people will think. It’s what the people at the extremes will think and do. Even if many foreign citizens conclude that the events of last week were not a big deal, the most determined and rebellious observers might give them a different and more radical gloss. (Besides which, it actually was a big deal.) As the
Now imagine you live in Hungary, Uganda, Myanmar or any country that is experiencing political turmoil. If you had a violent plan against your own government, do you now rate your chances of success as lower or higher? Organizing a storming mob may have just become more appealing, especially since your adversary is almost certainly less formidable than the U.S. government.
And what if you express your surprise over recent events?:
Yet this very surprise, while justified, may itself induce a dangerous contagion effect. The surprise carries an implicit message: “It may not seem like you have many allies, but in fact you do, including in some powerful places.” So you can imagine how a supporter of say QAnon might come to believe that there are secret allies everywhere. And those beliefs may in turn encourage political violence.
One implication is that the media needs to be very careful about how they portray the perpetrators of the Jan. 6 events. Most media organizations have been publicizing the identities and deeds of these criminals, as they should. A lot of Americans need to be shocked out of their complacency about what happened, or at least nudged out of various theories of false equivalence. The more information becomes public, the more it becomes clear that at least part of the Capitol-storming group was conspiring and intent on violence and mayhem — and for very bad political ends: in essence, the destruction of American democracy.
Yet there is such a thing as too much information. In other contexts, the news media withhold the names, images and causes of many terrorists and criminals. To the extent those individuals are doing it for recognition, denying them that recognition may discourage future wrongdoers.
There are further arguments at the link.
As pharmacists began vaccinations using the Pfizer vaccine some of them discovered that it was possible to extract a 6th or even 7th dose from a standard 5-dose vial. Where were the extra doses coming from? The fortuitous discovery was not due to over-filling. The vials contained just 5 doses when using standard syringes. But some of the vaccine distribution sites had access to low dead-volume syringes, syringes that leave less vaccine trapped between the plunger and needle — the “dead volume” — after a shot is given. Thus, less vaccine was wasted in the syringe and more available for putting into arms using the low dead-volume syringes.
This is quite remarkable. Increasing vaccine supply by 20% by building more factories could cost billions. We should do that, it would be worth it. But in this case, we managed to increase supply by at least 20% use a relatively inexpensive redesign of the syringe. What this indicates is the importance of thinking along the entire supply chain for opportunities for optimization.
The catch? Not all syringes provided by Operation Warp Speed and Pfizer are low dead-volume syringes so not every vaccine distribution site is getting the extra doses. We do need to invest more in the syringe supply chain.
That is the topic of my latest Bloomberg column, here is one excerpt:
Consider bad economic news, which is relatively unambiguous. With stock market returns, volatility is correlated over time, and it is higher in bear markets. To some extent the bad mood is contagious, and the bad events behind the volatility may be interlinked as well.
To be clear, the stock market has done fine lately. The latest bad news is about politics and public health, not corporate earnings. Still, the stock market is readily measurable and can offer clues about how broader social processes are connected over time — and one obvious conclusion is that volatility tends to feed upon itself, not usually in positive ways.
Another problem is what my colleague Bryan Caplan has labeled “the idea trap.” Social science research indicates that in troubled times people are more likely to turn to bad ideas. The distressed German economy of the 1920s and early 1930s, for example, helped to breed support for the Nazis.
More recently, the global economy has been very much a mixed bag since the financial crisis of 2008. So people might begin to embrace worse ideas, which in turn will breed subsequent volatility. Such a cycle can worsen over time, and a ragged recovery from the Covid-19 deep recession could exacerbate this dynamic. It simply isn’t good for decision-making if everyone is feeling frazzled and stressed.
Pepvar’s first goal should be supporting the production of enough doses to vaccinate the entire world within a year. It is estimated that building such capacity for an mRNA vaccine like Moderna’s would cost less than $4 billion — that’s significantly less than the U.S. government already spends each day on Covid-19 relief — with the cost about $2 per dose. Of course, making the vaccines is just the first step: Pepvar must
People, even if that estimate is off by a factor of ten or more…etc. Here is the NYT link, bJames Krellenstein, Peter Staley and .
Among his other achievements, he is the Chairman and co-founder of Moderna. Here is the audio and video and transcript. Here is part of the summary:
He joined Tyler to discuss which aspect of entrepreneurship is hardest to teach, his predictions on the future of gene editing and CRISPR technology, why the pharmaceutical field can’t be winner takes all, why “basic research” is a poor term, the secret to Boston’s culture of innovation, the potential of plant biotech, why Montreal is (still) a special place to him, how his classical pianist mother influenced his musical tastes, his discussion-based approach to ethical dilemmas, how thinking future-backward shapes his approach to business and philanthropy, the blessing and curse of Lebanese optimism, the importance of creating a culture where people can say things that are wrong, what we can all learn by being an American by choice, and more.
Here is one excerpt:
I should point out, Tyler, what these people don’t yet realize is that mRNA, in addition to being unique in that it’s really the first broadly applied code molecule, information molecule that is used as a medicine and with all the advantages that come with information — digital versus analog — or where you actually have to do everything bespoke, the way drugs usually work.
The other major advantage that it has is that it is something that is actually taking advantage of nature. There was a lot of know-how we had going into this around how the process could be done. In fact, let me tell you the parallel that we used.
We have a program in cancer vaccines. You might say, “What does a cancer vaccine have to do with coronavirus?” The answer is the way we work with cancer vaccines is that we take a patient’s tumor, sequence it, obtain the information around all the different mutations in that tumor, then design de novo — completely nonexistent before — a set of peptides that contain those mutations, make the mRNA for them, and stick them into a lipid nanoparticle, and give it back to that patient in a matter of weeks.
That has been an ongoing — for a couple of years — clinical trial that we’re doing. Well, guess what? For every one of those patients, we’re doing what we did for the virus, over and over and over again. We get DNA sequence. We convert it into the antigenic part. We make it into an RNA. We put it in a particle. In an interesting way, we had interesting precedents that allowed us to move pretty quickly.
And at the close:
Imagine if all of us were also born imagining a better future for ourselves. Well, we should be, but we’ve got to work to get that. An immigrant who comes here understands that they’ve got to work to get that. They have to adapt. The problem is, if you’re born here, you may not actually think that you’ve got to work to get that. You might think you’re born into it.
This will be a funny thing to say, and I apologize to anybody that I offend. If we were all Americans by choice, we’d have a better America because Americans by choice, of which I’m one, actually have a stronger commitment to whatever it takes to make America be the place I chose to be, versus not thinking about that as a core responsibility.
Definitely recommended, he is working to save many many lives, and with great success.
Ireland B.1.1.7 sequences of total assayed:
week of Dec 27th: 9%
week of Jan 3rd: 25%
Jan 10th: 46%
UK evolution https://t.co/WXfABI6PaZ
How long will it take for the US to get to >40% B.1.1.7?
less than 12 weeks pic.twitter.com/Bjwga41hpW
— Eric Topol (@EricTopol) January 12, 2021
Some experts estimate this could mean, if we do not accelerate the pace of vaccination, one million deaths for the United States.
Mask use is near 100% here in Northern Virginia. I am surprised, however, how many people continue to use simple cloth masks when much better N95s and KN95s (Chinese equivalent to N95s) are widely available. Gold standard appears to be the Respokare N95s which are NIOSH approved (under Innonix) but are quite expensive. I also like these cheaper KN95s from Kingfa which are not NIOSH approved. Some of the Chinese masks are garbage but limited testing by the CDC suggests the Kingfa are pretty good. No guarantees. Use your own judgment.
As many of you will expect, I am fine with their decision. Furthermore I think they made it at exactly the right moment.
Questions for those who think that Twitter made the wrong decision:
1. Can you state your margin? That is, what would Trump have to do for you to think that Twitter should suspend his account?
2. Robert Nozick called for an archipelago of polities, each autonomously setting their own rules. Isn’t Twitter’s action quite consistent with this vision? Is the optimal libertarian equilibrium really one that adds centralized government regulation of tech platform speech codes? If so, does that induce you to reject libertarian doctrines more generally?
3. If you favor regulation to avoid this deplatforming, which many are calling for, is the optimal libertarian equilibrium really one that adds centralized government regulation of tech platform speech codes? Where else do you think technology companies should be more regulated when it comes to speech issues?
4. Do you think that the US is the only government that should regulate the speech codes of technology companies or are you in favor of the evolution that would actually occur, i.e. dozens of different countries regulating platform speech in heterogeneous fashion? If you don’t favor the latter, shouldn’t you be stridently on the side of tech platform independence here? Do you think that the modal government has more or less Millian liberal tendencies than say Jack Dorsey or Mark Zuckerberg?
Questions for those who think that Twitter made the right decision:
5. Why not ban the CCP or Ayatollah Khomenei or many of the other odious and even genocidal characters who populate Twitter today? This tweet still stands: https://twitter.com/khamenei_ir/status/1263551872872386562. (My view would be to ban the violence-promoting Ayatollahs and leave the CCP, albeit with labeling that it is state propaganda.)
6. This summer, Slate and many other media organizations condoned violence in explicit terms. Murders are in fact up a great deal this year. Given that incitement to violence is manifestly acceptable to Twitter in many cases, can you articulate the relevant standard in more detail?
Here’s something from a paper that I am working on. The context is why first doses first makes more sense the greater the uncertainty but the point made is larger. No indent.
An important feature of First Doses First (FDF) and other policies such as fractional dosing is that they are reversible. In other words, FDF contains an option to switch back to Second Doses First (SDF). Options increase in value with uncertainty (Dixit and Pindyck 1994). Thus, contrary to many people’s intuitions, the greater the uncertainty the greater the value of moving to First Doses First. Indeed, the value of the option can be so high that one might want to move to First Doses First even if it were worse in expectation. For example, if the expected efficacy of the first dose were just 45% then in expectation it would be worse than Second Doses First (95% efficacy) but if there were lots uncertainty around the 45% expected efficacy it might still be better to switch to First Doses First. If there was a 75% chance that the efficacy of the first dose was 30%, for example, and a 25% chance that it was 90% (.75*.3+.25*.90=45%) then under reversibility one would still want to switch to First Doses First to learn whether the true efficacy was 30% or 90%.*
Put differently shifting away from the default strategy to an alternative such as FDF or fractional dosing might be considered to be “risky”. But in this context, learning requires risk. When learning is desirable, it is also desirable to take on risk. Risk aversion can prevent learning and thus can be dangerous.
If FDF is worse in expectation than SDF then it would be optimal to switch to the most minimal form of FDF necessary to learn about the true efficacy rate. In other words, to run an experiment. If FDF is superior in expectation to SDF then it might also be better to run an experiment before switching but not necessarily. If FDF is superior in expectation to SDF then the cost of running the experiment is keeping the policy with lower expected value while the experiment is running. If these costs are high then switching immediately is better.
It would take at least 16 weeks, for example, to run an experiment on extending dosing from 3 weeks to 12 weeks (including, optimistically, just 1 week to setup the experiment). As of early January 2021, confirmed cases in the United States are increasing at the rate of 200,000 per day or 1,400,000 per week. Thus there could be 22,400,000 new confirmed cases in the time it takes to run the experiment. At a case fatality rate of 1.7% that means 380,800 new deaths. If First Doses First reduces the infection rate in expectation by 10% that would imply that running the experiment has an expected cost of 38,080 lives.
At these rates, more lives could be saved in expectation by switching to the policy with higher expected value and simultaneously running experiments. Randomized trials that explicitly test the impact of dosing timing, fractional dosing and different timings of additional doses on severe, symptomatic and asymptomatic infections, and also on transmission should be incorporated as part of roll-out plans (Kominers and Tabarrok 2020, Bach 2021). However, roll-out of modified plans should not wait until these trial results are known; instead, plans should be adjusted as new information emerges. Most notably the British moved to First Doses First and they approved the AstaZeneca vaccine on December 30, 2020 and the consequences of both of these decisions should be monitored very closely to help improve decisions in other countries.
*This assumes that one could learn the true efficacy rate quickly enough relative to the ongoing pandemic to benefit from the new information. One might respond that in principle SDF also contains an option to switch to FDF but this option is valueless since Second Doses First provides no opportunity to learn. Only under First Doses First do we learn valuable new information.
Here’s Marty Makary, M.D., a professor of surgery and health policy at the Johns Hopkins University School of Medicine:
Finally, the FDA needs to stop playing games and authorize the Oxford-AstraZeneca vaccine. It’s safe, cheap ($2-$3 a dose), and is the easiest vaccine to distribute. It does not require freezing and is already approved and being administered in the United Kingdom.
Sadly, the FDA is months away from authorizing this vaccine because FDA career staff members insisted on another clinical trial to be completed and are punishing the company for inadvertently giving a half-dose of the vaccine to some people in the trial.
It’s like the FDA is holding out, pontificating existing excellent data and being vindictive against a company for making a mistake while thousands of Americans die each day.
Ironically, those in the Oxford-AstraZeneca trial who inadvertently received half the initial vaccine dose had lower infection rates. And this week Dr. Moncef Slaoui, the chief adviser to Operation Warp Speed, acknowledged that using half a dose might be a good broader strategy for the U.S. to double our supply as long our supply is severely constrained. That’s a good strategy that makes sense.
See also my post The AstraZeneca Factory in Baltimore. Thousands of people are dying every day. We have a vaccine factory ready to go. The FDA should lifts its ban on the AstraZeneca vaccine.
The government this week proposed an emergency law that would allow it to lock down large parts of society; the first recommended use of face masks came into force; and the authorities gave schools the option to close for pupils older than 13 — all changes to its strategy to combat the pandemic.
“I don’t think Sweden stands out [from the rest of the world] very much right now,” said Jonas Ludvigsson, professor of clinical epidemiology at Karolinska Institutet in Stockholm. “Most of the things that made Sweden different have changed — either in Sweden or elsewhere.”
…Sweden has reported more than 2,000 Covid-19 deaths in a month and 535 in the past eight days alone. This compares with 465 for the pandemic as a whole in neighbouring Norway, which has half the population. As Sweden’s King Carl XVI Gustaf said just before Christmas: “We have failed.”
Here is more from the FT. U.S. Covid deaths per day have now exceeded 4,000 for some days, and they are running at about 50% of the normal number for total daily deaths. And no, it is not that the payments to classify these as Covid deaths have increased, rather the virus and the deaths have increased. So the “no big deal” question we now can consider settled? The new and more contagious strains haven’t even started playing a major role yet in the United States.