Category: Medicine

One Billion Vaccinations in a Month!

The news on world vaccinations is good. As of late September of 2021 we have vaccinated 3.43 billion people (2.51 billion people with 2 doses). Even more impressive over the last 30 days the world vaccinated one billion people. That is a tremendous achievement. There are about 7.9 billion people in the world so 44% of the world has had at least one dose and nearly a third of the world population has  had two doses. We are on track to fully vaccinate 70% of all adults in 2021 and most of the world that wants a dose by early 2022. Judging by the US, demand will be more of a constraint than supply as we hit ~60% of the world population.

The NYTimes on the FDA and Rapid Tests

In July of 2020 I wrote in Frequent, Fast, and Cheap is Better than Sensitive:

A number of firms have developed cheap, paper-strip tests for coronavirus that report results at-home in about 15 minutes but they have yet to be approved for use by the FDA because the FDA appears to be demanding that all tests reach accuracy levels similar to the PCR test. This is another deadly FDA mistake.

…The PCR tests can discover virus at significantly lower concentration levels than the cheap tests but that extra sensitivity doesn’t matter much in practice. Why not? First, at the lowest levels that the PCR test can detect, the person tested probably isn’t infectious. The cheap test is better at telling whether you are infectious than whether you are infected but the former is what we need to know to open schools and workplaces.

It’s great that other people including the NYTimes are now understanding the problem. Here is the excellent David Leonhardt in Where are the Tests?

Other experts are also criticizing the Biden administration for its failure to expand rapid testing. Even as President Biden has followed a Covid policy much better aligned with scientific evidence than Donald Trump’s, Biden has not broken through some of the bureaucratic rigidity that has hampered the U.S. virus response.

In the case of rapid tests, the F.D.A. has loosened its rules somewhat over the past year, allowing the sale of some antigen tests (which often cost about $12 each). But drugstores, Amazon and other sellers have now largely run out of them. I tried to buy rapid tests this weekend and couldn’t find any.

The F.D.A.’s process for approving rapid tests is “onerous” and “inappropriate,” Daniel Oran and Dr. Eric Topol of Scripps Research wrote in Stat News.

For the most part, the F.D.A. still uses the same cumbersome process for approving Covid tests that it uses for high-tech medical devices. To survive that process, the rapid tests must demonstrate that they are nearly as sensitive as P.C.R. tests, which they are not.

But rapid tests do not need to be so sensitive to be effective, experts point out. P.C.R. tests often identify small amounts of the Covid virus in people who had been infected weeks earlier and are no longer contagious. Rapid tests can miss these cases while still identifying about 98 percent of cases in which a person is infectious, according to Dr. Michael Mina, a Harvard epidemiologist who has been advocating for more testing

Identifying anywhere close to 98 percent of infectious cases would sharply curb Covid’s spread. An analysis in the journal Science Advances found that test frequency matters more for reducing Covid cases than test sensitivity.

As I said on twitter what makes the FDA’s failure to approve more rapid antigen tests especially galling is that some of the tests being sold cheaply in Europe are American tests just ones not approved in the United States. If it’s good enough for the Germans it’s good enough for me!

Emergent Ventures India, new winners, third Indian cohort

Angad Daryani / Praan

Angad Daryani is 22-year-old social entrepreneur and inventor from Mumbai, and his goal is to find solutions for clean air at a low cost, accessible to all. He received his EV grant to build ultra-low cost, filter-less outdoor air purification systems for deployment in open areas through his startup Praan. Angad’s work was recently covered by the BBC here.

Swasthik Padma

Swasthik Padma is a 19-year-old inventor and researcher. He received his EV grant to develop PLASCRETE, a high-strength composite material made from non-recyclable plastic (post-consumer plastic waste which consists of Multilayer, Film Grade Plastics and Sand) in a device called PLASCREATOR, also developed by Swasthik. The final product serves as a stronger, cost-effective, non-corrosive, and sustainable alternative to concrete and wood as a building material. He is also working on agritech solutions, desalination devices, and low cost solutions to combat climate change.

Ajay Shah

Ajay Shah is an economist, the founder of the LEAP blog, and the coauthor (with Vijay Kelkar) of In Service of the Republic: The Art and Science of Economic Policy, an excellent book, covered by Alex here. He received his EV grant for creating a community of scholars and policymakers to work on vaccine production, distribution, and pricing, and the role of the government and private sector given India’s state capacity.

Meghraj Suthar

Meghraj Suthar, is an entrepreneur, software engineer, and author from Jodhpur. He founded Localites, a global community (6,000 members from more than 130 countries) of travelers and those who like to show around their cities to travelers for free or on an hourly charge. He also writes inspirational fiction. He has published two books: The Dreamers and The Believers and is working on his next book. He received his EV grant to develop his new project Growcify– helping small & medium-sized businesses in smaller Indian cities to go online with their own end-to-end integrated e-commerce app at very affordable pricing.

Jamie Martin/ The Queen’s English 

Jamie Martin and Sandeep Mallareddy founded The Queen’s English to develop a tool to help speak English. Indians who speak English earn 5x more than those who don’t. The Queen’s English provides 300 hours of totally scripted lesson plans on a simple Android app for high quality teaching by allowing anyone who can speak English to teach high quality spoken English lessons using just a mobile phone.

Rubén Poblete-Cazenave

Rubén Poblete-Cazenave is a post-doctoral fellow at the Department of Economics at Erasmus University Rotterdam. His work has focused on studying topics on political economy, development economics and economics of crime, with a particular interest in India. Rubén received his EV grant to study the dynamic effects of lockdowns on criminal activity and police performance in Bihar, and on violence against women in India.

Chandra Bhan Prasad

Chandra Bhan Prasad is an Indian scholar, political commentator, and author of the Bhopal Document, Dalit Phobia: Why Do They Hate Us?, What is Ambedkarism?, Dalit Diary, 1999-2003: Reflections on Apartheid in India, and co-author author (with D Shyam Babu and Devesh Kapur) of Defying the Odds: The Rise of Dalit Entrepreneurs. He is also the founder of the ByDalits.com e-commerce platform and the editor of Dalit Enterprise magazine. He received his EV grant to pursue his research on Dalit capitalism as a movement for self-respect.

Praveen Tiwari

Praveen Tiwari is a rural education entrepreneur in India. At 17, he started Power of Youth to increase education and awareness among rural students in his district. To cope with the Covid lockdown he started the Study Garh with a YouTube channel to provide better quality educational content to rural students in their regional language (Hindi).

Preetham R and Vinayak Vineeth

Preetham R. and Vinayak Vineeth are 17-year-old high-schoolers from Bangalore. Preetham is interested in computing, futurism and space; and Vinayak is thinking about projects ranging from automation to web development. They received their EV grant for a semantic text analysis system based on graph similarity scores. The system (currently called the Knowledge Engine) will be used for perfectly private contextual advertising and will soon be expanded for other uses like better search engines, research tools and improved video streaming experiences. They hope to launch it commercially by the end of 2022.

Shriya Shankar:

Shriya Shankar is a 20-year-old social entrepreneur and computer science engineer from Bangalore and the founder of Project Sitara Foundation, which provides accessible STEM education to children from underserved communities. She received her EV grant to develop an accessible ed-tech series focused on contextualizing mathematics in Kannada to make learning more relatable and inclusive for children.

Baishali Bomjan and Bhuvana Anand

Baishali and Bhuvana are the co-founders of Trayas Foundation, an independent research and policy advisory organization that champions constitutional, social, and market liberalism in India through data-informed public discourse. Their particular focus is on dismantling regulatory bottlenecks to individual opportunity, dignity and freedom. The EV grant will support Trayas’s work for reforms in state labor regulations that ease doing business and further prosperity, and help end legal restrictions placed on women’s employment under India’s labor protection framework to engender economic agency for millions of Indians.

Akash Bhatia and Puru Botla / Infinite Analytics

Infinite Analytics received their first grant for developing the Sherlock platform to help Indian state governments with mobility analysis to combat Covid spread. Their second EV grant is to scale their platform and analyze patterns to understand the spread of the Delta variant in the 2021 Covid wave in India. They will analyze religious congregations, election rallies, crematoria footfalls and regular daily/weekly bazaars, and create capabilities to understand the spread of the virus in every city/town in India.

PS Vishnuprasad

Vishnuprasad is a 21-year-old BS-MS student at IISER Tirupati. He is interested in the intersection of political polarization and network science and focused on the emergence and spread of disinformation and fake news. He is working on the spread of disinformation and propaganda in spaces Indians use to access information on the internet. He received his EV grant to build a tool that tracks cross-platform spread of disinformation and propaganda on social media. He is also interested in the science of cooking and is a stand-up comedian and writer.

Prem Panicker:

Prem Panicker is a journalist, cricket writer, and founding editor of peepli.org, a site dedicated to multimedia long form journalism focused on the environment, man/animal conflict, and development. He received an EV grant to explore India’s 7,400 km coastline, with an emphasis on coastal erosion, environmental degradation, and the consequent loss of lives and livelihoods.

Vaidehi Tandel

Vaidehi Tandel is an urban economist and Lecturer at the Henley Business School in University of Reading. She is interested in understanding the challenges and potential of India’s urban transformation and her EV grant will support her ongoing research on the political economy of urbanization in India. She was part of the team led by Malani that won the EV Covid India prize.

Abhinav Singh

Abhinav recently completed his Masters in the Behavioral and Computational Economics program at Chapman University’s Economic Science Institute. His goal is to make political economy ideas accessible to young Indians, and support those interested in advancing critical thinking over policy questions. He received his EV grant to start Polekon, a platform that will host educational content and organize seminars on key political economy issues and build a community of young thinkers interested in political economy in India.

Bevin A./Contact

CONTACT was founded by two engineers Ann Joys and Bevin A. as a low-cost, voluntary, contact tracing solution. They used RFID tags and readers for consenting individuals to log their locations at various points like shops, hotels, educational institutions, etc. These data are anonymized and analyzed to track mobility and develop better Covid policies, while maintaining user anonymity.

Onkar Singh Batra

Onkar Singh is a 16-year-old developer/researcher and high school student in Jammu. He received his first EV grant for his Covid Care Jammu project. His goal is to develop India’s First Open-Source Satellite, and he is founder of Paradox Sonic Space Research Agency, a non-profit aerospace research organization developing inexpensive and open-source technologies. Onkar received his second EV grant to develop a high efficiency, low cost, nano satellite. Along with EV his project is also supported by an Amateur Radio Digital Communications (ARDC) grant. Onkar has a working engineering model and is developing the final flight model for launch in 2022.

StorySurf

Storysurf, founded by Omkar Sane and Chirag Anand, is based on the idea that stories are the simplest form of wisdom and that developing an ocean of stories is the antidote to social media polarization. They are developing both a network of writers, and a range of stories between 6-300 words in a user-friendly app to encourage people to read narratives. Through their stories, they hope to help more readers consume information and ideas through stories.

Naman Pushp/ Airbound

Airbound is cofounded by its CEO Naman Pushp, a 16 year old high-schooler from Mumbai passionate about engineering and robotics, and COO Faraaz Baig, a 20 year old self-taught programmer and robotics engineers from Bangalore. Airbound aims to make delivery accessible by developing a VTOL drone design that can use small businesses as takeoff/landing locations. They have also created the first blended wing body tail sitter (along with a whole host of other optimizations) to make this kind of drone delivery possible, safe and accessible.

Anup Malani / CMIE / Prabhat Jha

An joint grant to (1) Anup Malani, Professor at the University of Chicago, (2) The Centre for Monitoring Indian Economy (CMIE), and (3) Prabhat Jha, Professor at University of Toronto and the Centre for Global Health Research, to determine the extent to which reported excess deaths in India are due to Covid. Recent studies show that that the pandemic in India may be associated with between 3 million to 4.9 million excess deaths, roughly 8-12 times officially reported number of COVID deaths. To determine how many of these deaths are statistically attributable to Covid, they will conduct verbal autopsies on roughly 20,000 deaths, with the results to be made publicly available.

And finally:

Aditya Dar/The Violence Archive

A joint grant to Aaditya Dar, an economist at Indian School of Business, Kiran Garimella, a computer scientist at Rutgers University and Vasundhara Sirnate, a political scientist and journalist for creating the India Violence Archive. They will use machine learning and natural language processing to develop an open-source historical record of collective public violence in India over 100 years. The goal is to create accessible and high-quality public data so civil society can pursue justice and governments can make better policy.

Those unfamiliar with Emergent Ventures can learn more here and here. EV India announcement here. More about the winners of EV India second cohort here. To apply for EV India, use the EV application click the “Apply Now” button and select India from the “My Project Will Affect” drop-down menu.

Note that EV India is led and run by Shruti Rajagopalan, I thank her for all of her excellent work on this!

Here is Shruti on Twitter, and here is her excellent Ideas of India podcast.  Shruti is herself an earlier Emergent Ventures winner, and while she is very highly rated remains grossly underrated.

Scott Gottlieb’s Uncontrolled Spread

Scott Gottlieb’s Uncontrolled Spread is superb. I reviewed it for the WSJ. Here’s one bit:

If there’s one overarching theme of “Uncontrolled Spread,” it’s that the Centers for Disease Control and Prevention failed utterly. It’s now well known that the CDC didn’t follow standard operating procedures in its own labs, resulting in contamination and a complete botch of its original SARS-CoV-2 test. The agency’s failure put us weeks behind and took the South Korea option of suppressing the virus off the table. But the blunder was much deeper and more systematic than a botched test. The CDC never had a plan for widespread testing, which in any scenario could only be achieved by bringing in the big, private labs.

Instead of working with the commercial labs, the CDC went out of its way to impede them from developing and deploying their own tests. The CDC wouldn’t share its virus samples with commercial labs, slowing down test development. “The agency didn’t view it as a part of its mission to assist these labs.” Dr. Gottlieb writes. As a result, “It would be weeks before commercial manufacturers could get access to the samples they needed, and they’d mostly have to go around the CDC. One large commercial lab would obtain samples from a subsidiary in South Korea.”

At times the CDC seemed more interested in its own “intellectual property” than in saving lives. In a jaw-dropping section, Dr. Gottlieb writes that “companies seeking to make the test kits described extended negotiations with the CDC that stretched for weeks as the agency made sure that the contracts protected its inventions.” When every day of delay could mean thousands of lives lost down the line, the CDC was dickering over test royalties.

In the early months of the pandemic the CDC impeded private firms from developing their own tests and demanded that all testing be run through its labs even as its own test failed miserably and its own labs had no hope of scaling up to deal with the levels of testing needed. Moreover, the author notes, because its own labs couldn’t scale, the CDC played down the necessity of widespread testing and took “deliberate steps to enforce guidelines that would make sure it didn’t receive more samples than its single lab could handle.”

Read the whole thing.

Addendum: My previous reviews of Michael Lewis’s The Premonition, Slavitt’s Preventable and Abutaleb and Paletta’s Nightmare Scenario.

Covid markets in everything

A pastor is encouraging people to donate to his Tulsa church so they can become an online member and get his signature on a religious exemption from coronavirus vaccine mandates. The pastor, Jackson Lahmeyer, is a 29-year-old small-business owner running in the Republican primary challenge to Sen. James Lankford in 2022.

Lahmeyer, who leads Sheridan Church with his wife, Kendra, said Tuesday that in the past two days, about 30,000 people have downloaded the religious exemption form he created.

And:

Some institutions request a signature from a religious authority, but Charles Haynes, senior fellow for religious freedom at the Freedom Forum in Washington, said that those institutions could be on a shaky ground constitutionally. Haynes said that if a person states a sincere religious belief that they want to opt out of vaccination, that should be enough.

“He’s not really selling a religious exemption,” said Haynes, who compared Lahmeyer’s exemption offer to televangelists who sell things like prayer cloths. “He’s selling a bogus idea that you need one.”

Here is the full story, via Brett D.

My January 2020 Bloomberg column on Covid

I thought this one worthy of a redux, here are a few segments:

First, most emergency rooms are not equipped to handle a very high volume of cases, especially infectious diseases…The general economic problem is that emergency rooms typically are not equipped with full surge capacity, nor are there enough emergency room add-ons or substitutes available on very short notice.

And:

Very often, when a pandemic breaks out, talk turns to macro remedies such as air travel bans and quarantines, as China is instituting. Yet often the more important factor is the strength, resilience and flexibility of local public health institutions, and those qualities cannot be created overnight. Just as the Chinese health-care system is undergoing a major test right now, there is a good chance that the U.S. will too.

And:

An additional test could concern child-care and telecommuting. Will U.S. schools need to be shut? At the very least it is something officials should have been planning for. Even if schools are not closed, some number of parents will keep their children at home, whether out of rational fear or not. Anti-vaccine sentiment is fairly high and rising, after all, and even the wisest parents will prefer to be safe than sorry.

Keeping one’s children at home means that fewer people will go to work. Even those with external child-care options, such as day care, may be reluctant to leave their children outside the home for the same reasons they fear the schools. The new question then becomes how robust are work plans, and U.S. supply chains, to a higher than usual rate of workplace absenteeism. There also may be an especially high level in China, which could strain U.S. and other supply chains relying on Chinese producers. Many businesses may need to amend their plans on the fly.

Once again, pandemic preparation is about the flexibility of decentralized institutions. These are not problems that can be solved by top-down planning. Instead, they rely on longstanding institutional capacities, high levels of social trust and improvisational skill.

If and when a good vaccine becomes available for the virus, that will again be about the improvisation and flexibility that will allow for scalability and eventual production and distribution. It is usually difficult to solve such problems quickly, but still there is better and worse performance — and that can make a big difference.

And:

The very first problem the U.S. is likely to face is one of risk communication. Of course the correct message will depend on how the data evolve, but in general there is tension between warnings that get people to take notice, and those that scare them underground or into counterproductive forms of panic.

If you tell people how terrible things are, they feel a loss of control. Many will retreat into conspiracy theories, spread mistrust of health-care institutions, or withdraw altogether from social or professional activity. Those who are sick may be afraid to seek medical attention, for fear of having their movements constrained, driving the disease further underground and distorting the data. Again, trust is of paramount importance.

Recommended.

What’s the Right Dose for Boosters?

The Biden administration says booster shots are coming, but the FDA hasn’t decided on the dose. Moderna wants a half-shot booster. Pfizer a full shot. But could the best dose for Americans and for the world be even less?

COVID-19 vaccines are the first successful use of mRNA vaccine technology, so a lot remains unknown. But identifying the smallest dose needed to provide effective boosting is critical to protect Americans from adverse effects, increase confidence in vaccines, and mitigate global vaccine inequity.

We’ve known since earlier this year that a half-dose of the Moderna vaccine produces antibody levels similar to the standard-dose and newer information suggests that even a quarter-dose vaccine may do the same. If a half or quarter dose is nearly as effective as a standard dose for first and second shots then a full dose booster may well be an overdose. The essential task of a booster is to “jog” the immune system’s memory of what it’s supposed to fight. Data from the world of hepatitis B suggest that the “reminder” need not be as intense as the initial “lesson.” And in the cases of tuberculosis, meningitis, and yellow fever vaccines, lower doses have been as good or better than the originals.

Lower doses could also reduce risks of adverse effects.

That’s myself and physicians Garth Strohbehn and William F. Parker on the Med Page Today. Strohbehn is an oncologist and specialist in optimizing doses for cancer drugs. William Parker is a pulmonologist and professor of medicine at the University of Chicago.

Covid and intertemporal substitution

That is the topic of my latest Bloomberg column, here is one bit:

Before the vaccines came along, it made great sense to enforce masking norms. If infections could be shifted into the future, an eventually vaccinated citizenry would be much better protected.

There is a less obvious corollary: Those same mask norms make less sense when large numbers of people are vaccinated. Masking still will push infections further into the future, but if the vaccines become marginally less effective over time, as some data suggest, people may be slightly worse off later on (they’ll also be a bit older). The upshot is that the case for masking is less strong, even if you still think it is a good idea overall.

Still, many people prefer to abide by fixed rules and principles. Once they learn them and lecture others about them, they are unlikely to change their minds. “Masking is good!” is a simple precept. “Exactly how good masking is depends on how much safer the near future will be!” is not. Yet the latter statement is how the economist is trained to think.

And this:

Some of the consequences of intertemporal substitution are a bit ghastly, and you won’t find many people willing to even talk about them.

For example: Say you are immunocompromised, and you either can’t or won’t get vaccinated. You might be justly mad about all the unvaccinated knuckleheads running around, getting Covid, and possibly infecting you. At the same time, you wish to minimize your required degree of intertemporal substitution.

So if you are (perhaps correctly) afraid to go out very much, you are better off if those same knuckleheads acquire natural immunity more quickly. Yes, it would be better if they got vaccinated. But barring that, a quick pandemic may be easier for you to manage than a long, drawn-out pandemic, which would require heroic amounts of intertemporal substitution.

Recommended.  And yes there is a “don’t overload your health system” qualifier (most of the U.S. is OK on this front right now), which I’ve written about multiple times including as early as January 2020.

Operation Warp Speed: A Story Yet to be Told

Operation Warp Speed was by far the most successful government program against COVID. But as of yet there is very little discussion or history of the program. As just an indication I looked for references in a bunch of pandemic books to General Perna who co-led OWS with Moncef Slaoui. Michael Lewis in The Premonition never mentions Perna. Neither does Slavitt in Preventable. Nor does Wright in The Plague Year. Nor does Gottlieb in Uncontrolled Spread. Abutaleb and Paletta in Nightmare Scenario have just two index entries for Perna basically just stating his appointment and meeting with Trump.

Yet there are many questions to be asked about OWS. Who wrote the contracts? Who chose the vaccines? Who found the money? Who ran the day to day operation? Why was the state and local rollout so slow and uneven? How was the DPA used? Who lifted the regulations? How was the FDA convinced to go fast?

I don’t know the answer to these questions. I suspect when it is all written down, Richard Danzig will be seen as an important behind the scenes player in the early stages (I was involved with some meetings with him as part of the Kremer team). Grogan at the DPC seems under-recognized. Peter Marks at the FDA was likely extremely important in getting the FDA to run with the program. Marks brought people like Janet Woodcock from the FDA to OWS so you had a nominally independent group but one completely familiar with FDA policy and staff and that was probably critical. And of course Slaoui and Perna were important leaders and communicators with the private sector and the logistics group but they have yet to be seriously debriefed.

It’s also time for a revisionist account of President Trump’s Council of Economic Advisors. Michael Kremer and I spoke to the DPC and the CEA early on in the pandemic and argued for a program similar to what would later be called OWS. The CEA, however, was way ahead of the game. In Sept of 2019 (yes, 2019!) the CEA produced a report titled Mitigating the Impact of Pandemic Influenza through Vaccine Innovation. The report calculates the immense potential cost of a pandemic and how a private-public partnership could mitigate these costs–all of this before anyone had heard the term COVID. Nor did that happen by accident. Thomas Philipson, the CEA chair, had made his reputation in the field of economic epidemiology, incorporating incentives and behavioral analysis in epidemiological models to understand HIV and the spread of other infectious diseases. Eric Sun, another CEA economist, had also written with Philipson about the FDA and its problems. Casey Mulligan was another CEA chief economist who understand the danger of pandemics and was influenced by Sam Peltzman on the costs of FDA delay. So the CEA was well prepared for the pandemic and I suspect they gave Trump very good advice on starting Operation Warp Speed.

In short, someone deserves credit for a multi-trillion-dollar saving government program! More importantly, we know a lot about CDC and FDA failure but in order to know what we should build upon we also need to know what worked. OWS worked. We need a history of how and why.

Immigration to the U.S. is correlated with quite high life expectancy

We find that immigration increases US life expectancy by 1.5 years for men and 1.4 years for women. Over half of these contributions occur at the prime working ages of 25–64. The difference between foreign-born and US-born mortality has grown substantially since 1990, with the ratio of US-born to foreign-born mortality rates nearly doubling by 2017. In that year, foreign-born life expectancy reached 81.4 and 85.7 years for men and women, respectively—7.0 and 6.2 years higher than their US-origin counterparts. These life expectancy levels are remarkable by most standards. Foreign-born male life expectancy exceeds that of Swiss men, the world leaders in male life expectancy. Life expectancy for foreign-born women is close to that of Japanese women, the world leaders in female life expectancy. The widening mortality difference between the US-born and foreign-born populations, coupled with an increase in the share of the population born abroad, has been responsible for much of the increase in national life expectancy in recent years. Between 2007 and 2017, foreign-born men and women were responsible for 44% and 60% of national life expectancy improvements. Between 2010 and 2017, immigrants experienced gains while the US-born experienced declines in life expectancy. Thus, nearly all of the post-2010 mortality stagnation is due to adverse trends among the US-born. Without immigrants and their children, national life expectancy in 2017 would be reduced to its 2003 levels. These findings demonstrate that immigration acts to bolster American life expectancy, with particularly valuable contributions at the prime working ages.

I will repeat what is to me the most striking excerpt:

Foreign-born male life expectancy exceeds that of Swiss men, the world leaders in male life expectancy. Life expectancy for foreign-born women is close to that of Japanese women, the world leaders in female life expectancy.

Many interesting results in there, for instance those immigrants sure are mighty!  I strongly suspect much of that is selection, and another big part lifestyle, but yet another implication is that the U.S. health care system maybe isn’t as terrible as what you have been hearing.  And that living in the U.S., over the generations, screws people up.

Here is the full piece by Arun S. Hendi and Jessica Y. Ho, via the excellent Kevin Lewis.

A new hurdle for vaccine development

Unless countries that have purchased vaccine doses and companies that have already brought vaccines into use agree to find ways to resolve the problem, manufacturers that trail the first wave of producers may not be able to prove that their vaccines work. Not only will that slow efforts to vaccinate the planet, it will block development of next-generation vaccines, and it will stymie efforts to answer key public health questions, like whether boosting with a different vaccine would generate better protection, or whether giving smaller — fractional — doses could protect more people more quickly…

The problem stems in part from the fact that at this point in the pandemic, it isn’t considered ethical to test new vaccines against placebos; instead they would have to be tested against one of the existing shots. But getting one’s hands on licensed or authorized vaccines for study purposes is nigh on impossible; all available doses have been snapped up by countries keen to vaccinate as many of their citizens as possible.

Contracts for those doses contain rigid stipulations about how the vaccines can be deployed. The doses often have to be used in the country that made the purchase; when the Biden administration wanted to share AstraZeneca doses with Canada and Mexico in March, it loaned the doses to get around the restrictions. Contracts also often stipulate that doses that have been purchased must be used for outbreak control, not for research purposes, Lurie said.

Here is the full story by Helen Branswell.  Obviously there is a market-oriented solution here, if only we care enough to implement it…

My Conversation with Ed Glaeser

I did David Cutler and Ed sequentially, based on their new co-authored book, here is the joint episode but there is also a separate link concerning Cutler.  Here is one excerpt from the general summary:

They joined Tyler for a special joint episode to discuss why healthcare outcomes are so correlated with education, whether the health value of Google is positive or negative, why hospital price transparency is so difficult to achieve, how insurance coding systems reimburse sickness over health improvement, why the U.S. quit smoking before Europe, the best place in America to get sick, the risks that come from over-treatment, the possible upsides of more businesses moving out of cities, whether productivity gains from remote work will remain high, why the older parts of cities always seem to be more beautiful, whether urban schools will ever improve, why we shouldn’t view Rio de Janeiro’s favelas as a failure, how 19th century fights to deal with contagious diseases became a turning point for governance, Miami’s prospects as the next tech hub, what David and Ed disagree on, and more.

And from my exchange with Ed:

COWEN: Let’s start with a simple question. All this enthusiasm about cities and agglomeration benefits — the pandemic comes along. A lot of people transition to work from a distance, and then we see big measured productivity gains. What has gone on there?

GLAESER: It reminds us that for many jobs, in a static sense, you can do this long-distance. You can make things work. I think many of us found this. We wrote this book in eight months over the pandemic year, distinctly away from each other, partially because there were no distractions, and all that was good.

However, you also need to recognize the limits of long-distance living. The most important of those limits is just it’s much less fun. It’s much less joyful, but while it seems as if it’s fine for static productivity, it seems distinctly more problematic for people learning and for onboarding new talent.

Let me just give you two types of studies, one of which is we have the call center studies. The father of that was the Nick Bloom paper, which was a randomized control trial in China. A more modern version is done by our students, Natalia Emanuel and Emma Harrington, which looks into American call centers.

Both of them find the same thing in terms of static productivity. If anything, it goes up, but the workers who go remote are much less likely to be promoted in both studies. One interpretation of this is that promotion in the call center work means that you actually are given the job of handling more difficult calls.

How would your boss know that you are good at handling difficult calls if they weren’t in the same room with you? How would you learn how to do those difficult calls if you weren’t around other people? So while the static productivity remains, you lose the dynamic benefits of being around other people.

Second piece of evidence it comes from Burning Glass Technologies and new hires. Even though Microsoft tells us that its programmers were just as productive, overall, new hires for programmers were down 42 percent between November 2019 and November 2020. Firms were clearly unwilling to take the same kind of risks of hiring new workers that they couldn’t inculcate in their corporate culture or screen them properly, or do any of those other things.

Even though measured productivity did well during the pandemic, there were still lots of disruptions. In particular, many younger workers who came of age really lost out as a result of this.

COWEN: If work from a distance goes fine in the short run, what’s the cross-sectional prediction about where it will persist in the future? Is it firms facing bankruptcy, firms with immediate projects now, possibly start-ups who will then later transition to all being together in one big happy family, but they’re afraid they’re going to fail before then? What should we expect?

GLAESER: I think we should expect young workers to be more likely to be brought together. Young firms, as well, because you’re very much at this learning, creative phase. I think the optimal work-from-home strategy is a couple of partners who are in an accounting practice and have decided they know each other perfectly well and are delighted to Zoom it in from wherever they are.

I think, unquestionably, working from home will remain a part of the economy. It may well be many workers end up spending 20 percent of their time working from home, even if they’re part of a generally full-time job. But for younger workers, for firms that are just getting started, I think being live is likely to continue being a major part of the work environment.

It also depends a lot on what your home environment is like. If you’re like us —  if you are a middle-aged professor who’s likely to have a comfortable home office, and maybe even not having kids at home anymore, certainly not kids who are crying all the time at home anymore — working at home is a lot more pleasant than if you’re a 23-year-old and live in a studio apartment in Somerville or New York or London.

Recommended!

My Conversation with David Cutler

I did Cutler and Ed Glaeser sequentially, based on their new co-authored book, here is the joint episode but I will create another link concerning Glazer.  Here is one excerpt from the general summary:

They joined Tyler for a special joint episode to discuss why healthcare outcomes are so correlated with education, whether the health value of Google is positive or negative, why hospital price transparency is so difficult to achieve, how insurance coding systems reimburse sickness over health improvement, why the U.S. quit smoking before Europe, the best place in America to get sick, the risks that come from over-treatment, the possible upsides of more businesses moving out of cities, whether productivity gains from remote work will remain high, why the older parts of cities always seem to be more beautiful, whether urban schools will ever improve, why we shouldn’t view Rio de Janeiro’s favelas as a failure, how 19th century fights to deal with contagious diseases became a turning point for governance, Miami’s prospects as the next tech hub, what David and Ed disagree on, and more.

And from David:

COWEN: But even if we adjust for that, education seems to matter a lot. It’s also puzzling to me — in your own work, it matters more at younger ages. You would think the returns are cumulative: it would really pay off when you’re 67 because you’ve invested in a stock portfolio for decades, but it matters most when you’re young. What’s your best micro account of that?

CUTLER: One of the things that’s super interesting is that, for example, people who live in cities — where there are more better-educated people — smoke less, even conditional on your own education. The same thing is true about age and so on.

I think it’s partly that cities and areas are run by upper-middle-class folks often. For example, the environment is set up in a way that’s more conducive to health when you have more upper-middle-income people. It’s much more difficult to smoke. There are healthier behaviors in general. There are parks and things like that. I think part of it is just that society is shaped by higher-income, higher-SES people, and that can be good for everyone who lives around those areas.

COWEN: To the extent education makes you healthier by lowering your stress and raising your relative status — which is a possible hypothesis — what are the policy implications of that? What should we do?

CUTLER: Part of what we’re learning over time is that social insurance programs are actually having a bigger and more sustained effect on health than we had thought they did. For example, we’ve always thought of Medicare and Medicaid as being the primary social insurance programs that affect health, but then there’s research that the WIC program — Women, Infants, and Children — affects health, that food stamp programs affect health, that TANF benefits affect health, that housing policies can affect health.

COWEN: And you think that’s through lowering stress as one mechanism?

Recommended!

Why the defenses of Australia do not persuade me

Alex laid out some complaints about Covid policy down under, I have been receiving emails and tweets arguing the following:

1. Australia is choosing a perfectly acceptable point on the liberty vs. safety frontier.

2. The Australian decision to do extreme lockdowns is democratic, and most Australians support it.

And sometimes I see a third point, which as far as I can tell is true:

3. Australia doesn’t have much in the way of ICU excess capacity, so a Covid surge would hit the country especially hard.

I think those responses, however, are missing the point of the critique.  I would stress that if Covid risk has you with your back against the wall and the government is forcing extremely restrictive measures on your citizenry, you should be implementing the following in an urgent manner:

a. Twice a week rapid antigen tests for everyone.  (Plenty of time to prep for this one.)

b. Much stronger incentives to vaccinate people more rapidly, including with the large stock (six million or so?) of AstraZeneca vaccines.  Demand side incentives, supply side incentives, whatever can be done.  Let’s throw the kitchen sink at this one.  But as it stands, I just don’t see the urgency.

c. Mobile monoclonal antibody units, as they are used in Florida (modest progress here).

d. Maybe other emergency measures too?  I’ve been hearing for decades that Australia has such a great health care system so surely they can make lots of progress on these and other fronts?

As far as I can tell from this great distance, Australia is doing none of these.  And, while there is some disquiet about lockdowns, few of its citizens are demanding that they do any of those positive measures.  Not many of its well-known politicians are proposing those ideas either.  (Please feel free to correct me if that is wrong!…but I just don’t see word of it on-line.)

If Australia implemented all of those policies, or even just one of them, they could attain a much better “liberty vs. lives” frontier, no matter where you think the government should end up on that frontier.  They could save lives, and enjoy more liberty.

And that is the great shame and indeed I would say crime.  There seems to be an incredible complacency that people in some parts of the country will put up with the current measures and not demand the government look for more practical measures to boost both liberty and security.

So when you write me and suggest “this is democratic and the people approve,” yes that is exactly the problem.

Our anti-science science advisors, yet again

Top federal health officials have told the White House to scale back a plan to offer coronavirus booster shots to the general public later this month, saying that regulators need more time to collect and review all the necessary data, according to people familiar with the discussion.

Dr. Janet Woodcock, the acting commissioner of the Food and Drug Administration, and Dr. Rochelle P. Walensky, who heads the Centers for Disease Control and Prevention, warned the White House on Thursday that their agencies may be able to determine in the coming weeks whether to recommend boosters only for recipients of the Pfizer-BioNTech vaccine — and possibly just some of them to start.

Here is more from the NYT.  I’ll say it again simply: they refuse to apply scientific reasoning under the heading of expected value theory.  I should note, however, that if they recommend it all be sent to Brazil I will agree, but even that decision they should be able to reach within the end of business day.