Access to COVID-19 vaccines

In less than one year from learning of this virus, we now have two approved safe and effective covid-19 vaccines with at least one more on the way. Millions of doses have already been produced. This is a near miracle. Thank you pharmaceutical industry and the governments (and their tax payers) that are paying for it.

Getting the vaccine into our bodies is quite another thing. This has several elements. The first is distributing the vaccines to each state/county and site of vaccinations. The second (or first and a half) is staffing these sites with professions able to administer the shots with the necessary equipment (refrigeration, syringes and needles, etc.). The third is determining who can receive the shot this week and getting them to the right place. The need for these three elements has been known for as long as the need for a vaccine has been known. And officials have known the likely vaccines for at least half a year. But planning for delivering the vaccine to your arm (or the lack of it) has been totally botched.

Focusing on the United States, the federal government promised to vaccinate 20 million people by the end of the year (last week). “Of the more than 12 million doses of vaccines from Moderna Inc. and Pfizer Inc. with BioNTech SE that have been shipped, only 2.8 million have been administered, according to federal figures….  The federal government is sending vaccines to states based on their populations, and it has provided guidelines, but no rules, about how they should be distributed…. On Friday [Jan 1, 2021], Sen. Mitt Romney (R., Utah) criticized the vaccine rollout, saying in a statement that the lack of a comprehensive federal plan to be shared with states “is as incomprehensible as it is inexcusable.”  WSJ: Covid-19-vaccines-slow-rollout-could-portend-more-problems”

Priority

Beyond the above fiasco, it is necessary to determine the priority for receiving the shots and communicating that information to you and me.  As we have already seen it will take a while–many months–to vaccinate everyone even without the above mess. So, who should get them the first month and the second month etc.? I discussed this issue last May. https://wcoats.blog/2020/05/18/the-vaccine-who-gets-it-first/

One criterion for establishing inoculation priorities is to allocate the vaccines so as to maximize the lives saved. I suggest that a better criterion is to maximize the life saved. The difference between the number of lives saved and the amount of life saved can be explained with a simple example. If there is only one dose and it is given to an 85 year old woman otherwise in good health, she might live another healthy year. If given to a 40 year old nurse, he might live another 46 healthy years. In both cases only one life has been saved but in the second case much more life has been saved (46 years of life rather than only one). But this potentially understates the case for giving the jab (as the British call it) to the nurse. One nurse that has been immunized against covid-19 can safely treat more patients that have covid-19 thus saving even more lives and more life. An argument in the other direction of inoculating the elderly first is to flatten the curve (i.e., reduce the inflow of covid-19 patients into overflowing hospitals).

In my view there is a strong case for maximizing the life saved rather than the number of lives saved. We older people should not crowed out younger people who as a result of the vaccination might enjoy much longer lives, something we have already enjoyed. The case, in my view, is overwhelming for critical workers (healthcare workers, grocery store workers, delivery people, etc.) of all ages to receive priority. “Many states are following CDC guidelines to start with front-line medical workers and people in long-term care facilities, but not all. Florida Gov. Ron DeSantis on Dec. 23 extended eligibility to people aged 65 and older.  Because each county and hospital in the state implemented its own approach, many people didn’t know whether to call, log on or show up in person to secure a spot.” [Same WSJ article] 

 A single dose of Moderna and Pfizer’s vaccines “appears to provide strong protection against the coronavirus…. With supplies of the vaccines limited — and hundreds of millions of people waiting for inoculation — this leaves epidemiologists grappling with a complicated question. Should the nation vaccinate fewer people with the best protection possible, or provide twice the number of people with a single shot, covering more of the population but with slightly weaker protection?”  “Coronavirus-vaccine-single-dose-debate”

But if the government can get itself organized (I know that that asks a lot) the existing and rapidly expanding supply of vaccines can be administered in a relatively modest number of months after which the priority issue vanishes.

Information

Whatever your priority turns out to be, how do you know where and when to show up? Do you need a prescription or approval and if so where do you get it? My insurance company is sending regular updates on what I should do. My Maryland county (Montgomery) website has information on the priority phase they are in (phase 1 at the moment) and that is about all (probably because every dispensary–hospitals, doctor’s offices, CVS–sets its own rules). I plan to contact my Primary Care Physician (PCP) for instructions next month when the situation might be a bit clearer.  What should people without medical insurance or a PCP do?  I have visited Kenya many times with the IMF and suspect that they are doing a better job with this than we are. How and why is this such a mess?

About wcoats

I specialize in advising central banks on monetary policy and the development of the capacity to formulate and implement monetary policy.  I joined the International Monetary Fund in 1975 from which I retired in 2003 as Assistant Director of the Monetary and Financial Systems Department. While at the IMF I led or participated in missions to the central banks of over twenty countries (including Afghanistan, Bosnia, Croatia, Egypt, Iraq, Israel, Kazakhstan, Kenya, Kosovo, Kyrgystan, Moldova, Serbia, Turkey, West Bank and Gaza Strip, and Zimbabwe) and was seconded as a visiting economist to the Board of Governors of the Federal Reserve System (1979-80), and to the World Bank's World Development Report team in 1989.  After retirement from the IMF I was a member of the Board of the Cayman Islands Monetary Authority from 2003-10 and of the editorial board of the Cayman Financial Review from 2010-2017.  Prior to joining the IMF I was Assistant Prof of Economics at UVa from 1970-75.  I am currently a fellow of Johns Hopkins Krieger School of Arts and Sciences, Institute for Applied Economics, Global Health, and the Study of Business Enterprise.  In March 2019 Central Banking Journal awarded me for my “Outstanding Contribution for Capacity Building.”  My most recent book is One Currency for Bosnia: Creating the Central Bank of Bosnia and Herzegovina. I have a BA in Economics from the UC Berkeley and a PhD in Economics from the University of Chicago. My dissertation committee was chaired by Milton Friedman and included Robert J. Gordon.
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4 Responses to Access to COVID-19 vaccines

  1. 27rpringlegmailcom says:

    Hi Warren,
    I had my first jab on the British NHS free last week. Why? Because I am on a priority list being over 80. I agree there is not much ethical sense in this ordering and support your preference for maximising life saved rather than the number of lives saved. At the start of the epidemic my wife and I advocated voluntary self-isolation by the elderly. But we received a uniformly negative – indeed, hostile – response from everybody (young and old) we mentioned this to; so we gave up. You mentioned protecting the heath service. But if you fasten onto that, as the UK government has done, the rest logically follows, including vaccination for the elderly. It is not for my good that I was given the jab but for the sake of the NHS – which, as Nigel Lawson once remarked, is the closest thing the British have to a religion.

  2. Joe Cobb says:

    I agree that your metric of total life-years saved vs. lives avoiding premature death is better than what has been discussed and sets policy. There is also another point of view about what should be the primary focus, and I would think it also would maximize the total years of life in a population. That would be to focus on who is most likely to pass an infection along, keeping the Reproduction rate above 1.0
    See the contributions on this argument by John H. Cocrane, https://johnhcochrane.blogspot.com/2021/01/nothing-matters-but-reproduction-rate-r.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+TheGrumpyEconomist+%28The+Grumpy+Economist%29
    And he cites Alex Tabrock at https://marginalrevolution.com/marginalrevolution/2021/01/the-new-strain-and-the-need-for-speed.html
    And he mentions some article in the Atlantic.

  3. Jim Roumasset says:

    Estimates of the economic cost of the pandemic use an age distribution of lives lost and assign different values of statistical lives lost to different age groups. Maximizing the statistical value of life saved would seem to follow along the same lines. Another factor is the cost of risk avoidance. Most retired people (albeit not in nursing homes) can avoid risk at low cost.
    P.S. Bureaucracy according to Heartbreak Ridge. General: “What’s your assessment of the situation, Sergeant?”
    Clint Eastwood: “It’s a cluster f***, sir. Men shouldn’t be sitting on their sorry asses filling out forms for equipment that they should already have.”

  4. wcoats says:

    One of my friends pointed out (above) that my suggested criteria for prioritizing vaccine jabs is very similar to the methodology used for estimating costs and benefits of the same. Another friend has pointed out that the calculation is more complicated than my simple example suggests (because the covid-19 death rate for younger people is much lower than for older one and they are more likely to live long lives even without the vaccine). What is most important here in my view is transparency (as in so many other areas as well). The criteria for establishing vaccination priority should be clearly and explicitly stated along with the methodology for applying it. That should be the basis of a productive public discussion of the choices made. https://www.washingtonpost.com/opinions/lockdowns-needed-a-warning-label-too/2020/12/31/c2cbc63e-4ada-11eb-a9f4-0e668b9772ba_story.html

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