Category: Current Affairs
My Conversation with Michael Kremer
Self-recommending, here is the transcript, audio, and video. Here is part of the summary:
Michael joined Tyler to discuss the intellectual challenge of founding organizations, applying methods from behavioral economics to design better programs, how advanced market commitments could lower pharmaceutical costs for consumers while still incentivizing R&D, the ongoing cycle of experimentation every innovator understands, the political economy of public health initiatives, the importance of designing institutions to increase technological change, the production function of new technologies, incentivizing educational achievement, The Odyssey as a tale of comparative development, why he recently transitioned to University of Chicago, what researchers can learn from venture capitalists, his current work addressing COVID-19, and more.
Here is one excerpt:
COWEN: I’ve seen estimates — they’re actually from one of the groups you founded — that a deworming pill could cost as little as 50 cents a year per person in many parts of Africa. So why isn’t deworming done much more?
KREMER: You could say the glass is half empty, you can say it’s half full, or you can say it’s almost three-quarters full. I think it’s about three-quarters full. When I first got involved in deworming, it was testing a small NGO program. We found phenomenal effects of that. The original work found health gains and education gains. Now we’ve tracked people over 20 years, and we’re seeing people have a better standard of living or earning more.
Following the early results, we presented the results of the government of Kenya to the World Bank. Kenya scaled this up nationally, in part with assistance from the World Bank, primarily just in conveying some of that information.
Indian states started doing that, and then the national government of India took this on. They’re reaching — a little bit harder to know the exact numbers — but probably 150 million people a year. Many other countries are doing this as well, so it’s actually quite widely adopted.
COWEN: But there’s still a massive residual, right?
KREMER: That is for sure.
COWEN: What’s your best explanatory theory of why the residual isn’t smaller? It would seem to be a vote winner. African countries, fiscally, are in much better shape than they used to be. They’re more democratic. Public health looks much better. The response to COVID-19 has probably been better than many people expected, say, in Senegal, possibly in Kenya. So why not do deworming more?
KREMER: The people who have worms are pretty poor people. The richer people are less likely to have worms within a given society. Richer people are probably more politically influential.
There’s also something about worms — they gradually build up in your body, and one worm is not going to do that much damage. The problem is when you’ve got lots of worms in your body, and even there, it’s going to take time.
I’ve had malaria. I don’t think I’ve had worms. I hope I haven’t. When you have malaria, you feel terrible. You go from feeling fine to feeling terrible, and then you take the medicine. You feel great afterwards. With worms, it’s much more like a chronic thing, and when you expel the worms from your body, that’s sort of gross. I don’t think, even at the individual level, do you have quite the demand that would be commensurate with the scale of the problem. That’s a behavioral economics explanation.
I think there are political issues and then there are behavioral issues. I would actually say that a huge, huge issue . . . This sounds very boring, but this falls between the Ministry of Health and the Ministry of Education, and each one of them has different priorities. The Ministry of Health is going to be worried about delivering things through clinics. They’re worried about HIV and malaria, tuberculosis, as it should be.
The Ministry of Education — they’re worried about teacher strikes. It’s very easy for something to either fall between the cracks or be the victim of turf wars. It sounds too small to be, “How can that really get in the way?” But anybody who’s spent time working in governments understands those things can very easily get in the way. In some ways, it’s surprising how much progress has been made.
Here’s one way the political economy works in favor. You mentioned democracy — I think that’s a factor. I actually find — and I don’t want to be necessarily a big fan of politicians — but in some ways, politicians hear how much this costs, and they think they can affect that many people for that small amount of money, and they’re like, “Hey, I want to get on that. Maybe this is something I can claim as an achievement.” We saw that in Kenya. We saw that in India.
And:
COWEN: Let’s say the current Michael Kremer sets up another high school in Kenya. What is it that you would do that the current high schools in Kenya are not doing? What would you change? You’re in charge.
KREMER: Right. We’ve learned a lot in education research in recent years. One thing that we saw in Kenya, but was also seen in India and many other places, is that it’s very easy for kids to fall behind the curriculum. Curricula, in particular in developing countries, tend to be set at a fairly high level, similar to what you would see in developed countries.
However, kids are facing all sorts of disadvantages, and there are all sorts of problems in the way the system works. There’s often high teacher absence. Kids are sick. Kids don’t have the preparation at home, often. So kids can fall behind the curriculum.
Whereas we’ve had the slogan in the US, “No Child Left Behind,” in developing countries, education system is focused on kids at the top of the distribution. What’s been found is, if you can set up — and there are a whole variety of different ways to do this — either remedial education systems or some technology-aided systems that are adaptive, that go to where the kid is . . . I’ve seen huge gains from this in India, and we’re starting to see adoption of this in Africa as well, and that can have a very big impact at quite low cost.
Intelligent throughout.
How much does it matter who dies from Covid-19?
In this latest Bloomberg column, I am referring in particular to the ages of the victims. The subtext of course is that many of the herd immunity theorists repeat (again and again) that most of the victims are quite old, which is indeed correct. Here is one excerpt:
By contrast [to 9/11], about 3,500 Americans die each year in fires. To repeat: That is each year. Yet Americans have not responded to deaths by fire as they did to 9/11, nor has a major public discussion ensued.
To be clear, the U.S. probably should do more to limit the number of fire deaths. But they do not threaten the nation and constitutional order in the way that terrorist attacks do. How people die is crucial in helping a nation and society scale its response and frame the debate over what to do.
Covid-19 is obviously more like 9/11 than it is like the annual toll of fire deaths. It commands the headlines every day, has created a global economic depression, is reshaping global politics and the balance of power, causes extreme stress for millions and has significantly harmed America’s global reputation. Yes, there have been some anxiety-driven overreactions, but it is inevitable that humans will respond dramatically to a major worldwide pandemic.
To be sure, the number of U.S. victims is high — 220,000 and counting, plus some number of excess deaths from broader causes. But the event itself is so cataclysmic that “downgrading” those deaths by saying many of the victims were elderly doesn’t make a big difference in terms of formulating an optimal response.
And to close:
Pandemics have been civilization-altering events since the beginning of human history, and they still are — especially if we do not respond properly. The need to get the response right, not the relative worth of the young to that of the old, is the main thing that we should be obsessing about.
Recommended.
Stagnation is the real risk
The accelerated economic growth also accelerated our path along the inverted-U shape of risk. Faster growth means people are richer sooner, so they value life more sooner, so society shifts resources to safety sooner—and ultimately we will begin the decline in risk sooner. As a result, the overall probability of an existential catastrophe—the area under the risk curve—declines!
…The model also suggests a broader insight. Making people richer doesn’t improve their well-being, but it can also change what they value. In this case, people value life more as they grow richer, and valuing life more leads them to care more about reducing existential risk.
That is from a very useful essay by Leopold Aschenbrenner. It is from the newly appeared second issue of Works in Progress, an excellent on-line journal. And here is Samuel Hughes defending pastiche.
*Poet of Revolution: The Making of John Milton*
That is the new book by Nicholas McDowell, and it is one of my favorite non-fiction works this year. Milton is today more relevant than he has been in a long time, excerpt:
Milton’s political development is shaped by his evolving understanding of the ways in which ‘tyranny’ — defined initially in ecclesiastical and clerical terms but which grows to encompass political organization — retards the intellectual and cultural progress of a nation. This understanding was shaped not only by historical experience of the unprecedented political turbulence of mid-seventeenth-century Britain, but by the interaction between that experience and his intellectula life. Milton’s period of intensive and almost entirely orthodox reading in political and religious history in the mid-1630s, the record of some of which survives in the notebook that was rediscovered in 1874, revealed to him how clerical censorship and heresy-hunting had suppressed intellectual and literary life in other countries. Milton regarded the cultural decline of Italy under the Counter-Reformation and Inquisition from the glory days of Dante and Petrarch, two of his pre-eminent post-classical models of the poetic career, as the starkest instance of this process. His tour of Italy in 1638-9 confirmed the lessons of his reading: that in nations where ‘this kind of inquisition tyrannizes,’ as he put it in Areopagitica, learning is brought into a ‘servil condition’ and the ‘glory ‘ of ‘wits’ is ‘dampt.’
Recommended! Every page is enjoyable, and you can profit from this book no matter your prior knowledge of Milton may be. A sure thing for the year end’s “best of” list.
You can pre-order here.
The AstroZeneca saga, according to one source
This seems unconfirmed, and do note some sources in the story do not believe this account, but here goes:
AstraZeneca, whose Phase 3 coronavirus vaccine clinical trial has been on hold for more than a month, did not get critical safety data to the US Food and Drug Administration until last week, according to a source familiar with the trial.
The FDA is considering whether to allow AstraZeneca to restart its trial after a participant became ill. At issue is whether the illness was a fluke, or if it may have been related to the vaccine.
The source said the root of the delay is that the participant was in the United Kingdom, and the European Medicines Agency and the FDA store data differently.
“They had to convert data from one format to another format. It’s like taking stuff off a PC and putting it onto an Apple. They had to spend a lot of hours to get what they wanted,” the source said.
On Friday, a federal official hinted there might be some word this week on the trial’s future.
Or maybe they just fooled CNN with it?
Otherwise, good thing we are kept safe from such dangerous data formats! Would it really not be better to move to reciprocal recognition procedures? Not to mention a unified data format, or perhaps some FDA methods to read data produced for the EU?
For the pointer I thank Jackson Stone.
And yet the American trial remains suspended
Those nasty, reckless Brits:
The NHS is preparing to introduce a coronavirus vaccine soon after Christmas. Trials have shown it will cut infections and save lives, Jonathan Van-Tam, the deputy chief medical officer, has privately revealed.
He told MPs last week that stage three trials of the vaccine created at Oxford University and being manufactured by AstraZeneca mean a mass rollout is on the horizon as early as December. Thousands of NHS staff are to undergo training to administer a vaccine before the end of the year.
The government changed the law this weekend to expand the number of health professionals able to inoculate the public. The regulations will enable pharmacists, dentists, midwives and paramedics to administer jabs.
C’mon U.S. public health authorities, let’s get on this one and demand a resumption of the suspended AstraZeneca trial. You are advocates of science, right? You don’t actually want to make Donald Trump correct, do you? (Maybe that one will work.)
You don’t have to make it the vaccine, as the Brits seem to be doing, you just have to resume the trial, as the even more reckless Japanese did weeks ago. How about it?
Here is the article from Times of London (gated, but a cheap and worthwhile subscription for foreigners), via Linda Yueh.
Why I reject the Great Barrington Declaration
Here is my 2x normal length Bloomberg column on that topic, as had been requested by Daniel Klein. The argument has numerous twists and turns, do read the whole thing but here is one bit (I will indent only their words):
“Here are the key words of the Great Barrington Declaration on herd immunity:
The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.
What exactly does the word “allow” mean in this context? Again the passivity is evident, as if humans should just line up in the proper order of virus exposure and submit to nature’s will. How about instead we channel our inner Ayn Rand and stress the role of human agency? Something like: “Herd immunity will come from a combination of exposure to the virus through natural infection and the widespread use of vaccines. Here are some ways to maximize the role of vaccines in that process.”
And the close:
“In most parts of the Western world, normal openings for restaurants, sporting events and workplaces are likely to lead to spiraling caseloads and overloaded hospitals, as is already a risk in some of the harder-hit parts of Europe. Reopenings, to the extent they work, rely on a government that so scares people that attendance remains low even with reopening.
In that sense, as things stand, there is no “normal” to be found. An attempt to pursue it would most likely lead to panic over the numbers of cases and hospitalizations, and would almost certainly make a second lockdown more likely. There is no ideal of liberty at the end of the tunnel here.
Don’t get me wrong: The Great Barrington strategy is a tempting one. Coming out of a libertarian think tank, it tries to procure maximum liberty for commerce and daily life. It is a seductive idea. Yet consistency of message is not an unalloyed good, even when the subject is liberty…
My worldview is both more hopeful and more tragic. There is no normal here, but we can do better — with vigorous actions to combat Covid-19, including government actions. The conception of human nature evident in the Great Barrington Declaration is so passive, it raises the question of whether it even qualifies as a defense of natural liberty.”
MR Tyler again: You will note I do not make the emotional, question-begging argument that herd immunity strategies will kill millions (though I do think more people die under that scenario). If you argue, as many herd immunity critics do, that the elderly cannot be isolated, it seems you also should not be entirely confident that the currently non-infected can be isolated. The brutal truth is simply that a Great Barrington strategy put into practice would lead to rapidly spiraling cases and a rather quick and oppressive second lockdown, worse than what the status quo or some improved version of it is likely to bring. Total deaths are likely higher, along with more social trauma, due to the more extreme whipsaw effects, but no not by millions.
Let’s accelerate those biomedicals, people!
From the comments, on AstraZeneca vaccine trial resumption
*American Purpose*
…a new magazine, media project, and intellectual community called American Purpose is launching at www.americanpurpose.com, and can also be found on Twitter at @americanpurpose.
American Purpose, through digital publishing, conversation and convening, and podcasts, will offer a spirited examination of politics and culture. Our aim is to support the revitalization of liberal democracy at home, while addressing the authoritarian challenges to liberal democracy abroad. And we will offer lively and engrossing discussion of history and biography, arts and culture, science and technology.
“American Purpose is committed to building an intellectual community and a space for much-needed dialogue about the United States’ role as the vanguard of classically liberal ideas and institutions around the world,” said Francis Fukuyama, chairman of the American Purpose editorial board.
Solve for the rational Bayesian equilibrium
I now read quite a few public health experts on matters of the day, and I have noticed that none of them have condemned the British government for proceeding with the AstraZeneca vaccine trial, even after two adverse health events experienced by participants, noting that those events presumably have been examined and considered by the oversight committee.
At the same time, the American trial for AstraZeneca has remained halted. I also have not read any public health experts criticizing that decision either.
What is the most likely equilibrium to be holding here?
1. Public health experts don’t express many opinions, especially these days.
2. Plenty of commentators think the British decision to resume is rash, Tyler just isn’t reading enough of them.
3. Most public health experts think it is fine for the British to keep on going. But they won’t criticize the American trial halt, because their incentives and natural temperamental tendencies are to express mainly the risk-averse opinions, and rarely if ever say that the regulatory process should allow for more risk to be taken.
4. The mainly American experts actually are happy to see America free-riding upon British data, so they are content with things as they stand, but don’t want to quite come out and admit they enjoy exploiting the Brits.
5. In reality the commentators think the whole trial is so risky it never should have been started in the first place.
6. What they really enjoy writing is philosophical pieces about how social process have all these twists and turns, and natural bumps in the road, and so they don’t wish to work too hard to remove those bumps.
7. The public health experts think that Americans and British have optimally different tolerances for risk, and the split regulatory outcomes reflect that difference.
Your choice?
The public is fine with Human Challenge Trials
A vaccine for COVID-19 is urgently needed. Several vaccine trial designs may significantly accelerate vaccine testing and approval, but also increase risks to human subjects. Concerns about whether the public would see such designs as ethically acceptable represent an important roadblock to their implementation, and the World Health Organization has called for consulting the public regarding them. Here we present results from a pre-registered cross-national survey (n= 5; 920) of individuals in Australia, Canada, Hong Kong, New Zealand, South Africa, Singapore, the United Kingdom, and the United States. The survey asked respondents whether they would prefer scientists to conduct traditional trials or one of two accelerated designs: a challenge trial or a trial integrating a Phase II safety and immunogenicity trial into a larger Phase III efficacy trial. We find broad majorities prefer for scientists to conduct challenge trials (75%, 95% CI: 73-76%) and integrated trials (63%, 95% CI: 61-65%) over standard trials. Even as respondents acknowledged the risks, they perceived both accelerated trials as similarly ethical to standard trial designs, and large majorities characterized them as “probably” or “definitely ethical” (72%, 95% CI:70-73% for challenge trials; 77%, 95% CI 75-78% for integrated trials). This high support is consistent across every geography and demographic subgroup we examined, including people of diverging political orientations and vulnerable populations such as the elderly, essential workers, and racial and ethnic minorities. These findings bolster the case for these accelerated designs and can help assuage concerns that they would undermine public trust in vaccines.
Here is the paper by David Broockman, et.al.
Samuel Brittan has passed away
At the age of 86, he was one of Britain’s great liberals. He wrote columns for the FT for almost fifty years, defended capitalism, and also was an early advocate of an ngdp approach. From the FT:
Brittan had a wonderful, restless intelligence which made him an ideal, if demanding, companion…Peter Jay wrote that when he was economics editor of The Times, he was “haunted by the spectre . . . of Brittan endlessly at work, morning, noon and night, reading, reading, reading, while I tried ineffectually to reconcile the demands of work and family life”.
His Capitalism and the Permissive Society is now but a shell of a listing on Amazon, but I can recall Roy Childs excitedly telling me about the book. Back then, it seemed like the way forward for liberalism, a way to develop a truly emancipatory vision of free market capitalism. Now all that seems so long ago.
Here is Sam’s Wikipedia page, note the badly “off” and misrepresentative second sentence: “He was a member of the Academic Advisory Council of the Global Warming Policy Foundation, a non-profit organisation “restoring balance and trust to the climate debate” that has been characterised as promoting climate change denial.”
Here was Sam in the 2009 Spectator:
I have no expertise on the subject of global warming; nor do I have a strong view about it. But I do know attempted thought control and hostility to free speech when I see it; and I find these unlovely phenomena present among all too many of the enthusiasts for climate action. Words such as ‘denial’ are intentionally brought into the debate and recall those who deny the reality of the Nazi Holocaust.
Here is John McDermott’s Ode to Sam upon Sam’s retirement in 2014. And here is Cardiff Garcia on Sam.
Herd immunity seems to be failing Manaus
For a short time the Brazilian city of Manaus, in the heart of the Amazon rainforest, offered a glimmer of hope in the search for herd immunity from Covid-19.
After a devastating wave in May killed about 3,400 people and infected many more, the prevalence of the virus subsided rapidly, leading some scientists to theorise that the city of 2m had reached a form of collective immunity.
That hypothesis is now in doubt as a resurgence in cases in Manaus poses fresh challenges to the authorities and difficult questions for the scientists and policymakers worldwide who have been edging towards herd immunity policies as an alternative to harsh lockdowns.
“How do you explain the number of [daily] deaths being in the 30s yesterday and the 50s today?” said Arthur Virgilio, the mayor of Manaus. “What has caused the death rate in Manaus to increase?”
Here is more from the Financial Times.
Model this
Nancy Pelosi warned that a Covid-19 vaccine should not be authorised for use in the US based on data from British trials, amid fears that the Trump administration is planning to rush out an inoculation before election day.
The Democratic speaker of the House of Representatives on Friday cast doubt on the British system for testing and approving medicines, further politicising the race to develop a vaccine for Covid-19.
“We need to be very careful about what happens in the UK. We have very stringent rules in terms of the Food and Drug Administration here, about the number of clinical trials, the timing, the number of people and all the rest,” Ms Pelosi told reporters in Washington.
Here is the full FT story, and here is a nice NYT piece, by Zeke Emanuel and others, on the superiority of the British clinical trials system, especially with respect to Covid-19.
The decline in pandemic sports viewership
It is not mainly about NBA politics:
- US Open (golf) final round: down 56%
- US Open (tennis) was down 45% and the French open is down 57% so far
- Kentucky Derby: down 43%
- Indy 500: down 32%
- Through four weeks, NFL viewership is down approximately 10%
- NHL Playoffs were down 39% (Pre Stanley Cup playoffs was down 28% while the Stanley Cup was down 61%).
- NBA finals are down 45% (so far). Conference finals were down 35%, while the first round was 27% down. To match the viewership, activity on the NBA reddit fan community is also down 50% from the NBA finals last year.
That is from Daniel Frank, here are a few of his hypotheses:
- Sports are very social. People love talking about sports with their peers and without interacting with as many people, people have less opportunities to talk about sports with others. This has the effect of making fans feel less engaged and more casual fans less likely to start watching, creating a cascading effect on engagement.
- Watching sports is a great way for people to tune out, relax and distract themselves from normal life. With so many people working from home, having a less defined break from work to non-work, and potentially working less hard, watching sports feels like less of an escape than it used to.
- People have started consuming politics like they do sports and their interest in sports has been cannibalized by political fanaticism.
- Lots of people are experiencing mental health challenges and struggling and don’t have the same interest in things they used to enjoy like sports.
My intuitions are quite close to Daniel’s — what do you all think?
That is from Easy-Peasy. And I did google to ensure that those claims about foreign trial resumption are correct, for instance Japan resumed no later than October 2. This is one reason — not the only! — why I am puzzled when Derek Lowe claims on Twitter that American perhaps cannot go any faster with its vaccine. If you think Japan and the Brits are irresponsible, by all means let us know. Otherwise…it is time to speak up in favor of maximizing expected value.