Good post. A couple of small points that I feel you could emphasize a bit more when looking at the global situation:
- The US has instituted an export ban on vaccines. That may be understandable, but it also leaves other countries out in the cold - Canada, for example, had no choice but to order in Europe.
- The UK for its part has not instituted an official export ban, but its contract details with major manufacturers (especially AstraZeneca) amount to just that for the doses procured in the UK.
- The EU - for all its slow rollout - is the only major world region that currently permits large amounts of “Western” vaccine to be exported - Israel's vaccine miracle for example was only possible because Pfizer-Biontech provided the vaccines from their factory in Puurs, Belgium.
- Other vaccine exporters are China and Russia, but on a far, far smaller and more select scale.
- The USA is truly leading with mRNA technology, but arguably alongside Germany and thus Europe, home to Biontech (which developed the Pfizer-Biontech vaccine) and Curevac and others.
- There weren't really any major fights about vaccine distribution in the EU this time around, the joint vaccine procurement process was set up precisely to prevent that (successfully) and avoid pitting small countries against big counties (successful too) - where the EU failed is going big early for helping production to ramp up, no matter the cost. That's what's ailing its rollout now.
Overall, the US rollout was and is truly a success story, particularly the ability to scale up production early. But one shouldn't forget the still applying vaccine export ban and that its current main vaccine, the Pfizer-Biontech, was a European-American co-production.
I really appreciate hearing these kinds of even handed analyses that are realistic and yet leave me with a sense of optimism. I am glad I subscribe to Noah for these.
My impression is that distribution is completely outstripping supply, at least in California. The 78% dose usage rate does not mean that there are doses sitting in a freezer waiting for someone to simply use them; those doses are likely reserved for people with active appointments, often for their second dose.
Because supply isn’t growing exponentially, the distribution centers need to reserve doses for the second shot. If supply were growing sufficiently fast, they could rely on new deliveries to be available when people are ready for their second shot. But supply would need to be able to grow exponentially in order to cover all the 2nd doses as well as new 1st doses with just new deliveries.
San Francisco shut down new appointments for a week while they wait for a new shipment.
The critical fact in Israel's favor that doesn't get proper billing is that its leaders (actually, its leader) are focused on an election coming in March 2021. The other factors are obviously critical, as spelled out in the early story that you reference. But private negotiations between Netanyahu and Pfizer, plus a developing agreement to make as much population-wide information about the results available as possible in return for further sources, have led to adequate supply, which no other country has enjoyed. (Even though Moderna has not come through as yet.) So politics is still the governing factor. It appears to be behind much of the confusion that the UK is suffering.
The tension between over-managing the ethical and social fairness of the rollout against achieving the ultimate objective -- killing off the virus in circulation -- will be a case study in the future. Epidemiological studies that show the best transition between the short term goal of keeping ICUs from overflow and reducing immediate death and the longer term goal of eliminating the virus before it mutates to a more dangerous form have not been explained successfully to the population of talking heads that run modern countries.
2021 is a vindication of Bill Clinton's 1992 Inauguration speech. "There is nothing wrong with America that cannot be cured by what is right with America" proved to be quite literally prophetic.
Thanks for your reasonable and appropriate commentary. A minor quibble: You (along with many others) mention that the US success can be attributed largely to "science." Unfortunately, almost no journalists seem prepared to go beyond that, though you at least do credit government support for science. I hope that someone will be able to provide an accessible explanation, though it's not easy, since the roots of the knowledge required to create these vaccines go back over more than a century.
Thanks for this story. The latent US chauvinist in my soul is pleased we've done something well. You point to the issue, but I wish to emphasize further that the success is based on the strength of the sciences in the US. It's worth noting that the policies of the Republican party/Trump adminstration would have undermined that predominance in the long run. Their overt hostility towards academic institutions and immigration set the stage for future declines in the output of scientific discovery. The private sector has always been eager to accept developments of science which generate profit. However, results which suggest limits on private activities for social reasons are greeted with hostility. Praise the pharma companies for vaccine development, but remember they exercise substantial monopoly power across much of the marketplace.
One of the reasons the vaccine was distributed quickly is exactly because Trump left it up to the states. One of the WORST places for getting vaccine into arms was New York. Why? Because New York's governor Cuomo insisted on micromanaging the process. Other states sped ahead because they didn't follow complex rules promulgated by various government busybodies and focused on getting vaccine in arms.
If you look at Israel, or the UAE, the focus was on exactly the same thing - get vaccine in arms ASAP. A decentralized few rules system is the best possible way to do that.
So this is entirely Trump's triumph, and it is a triumph for a decentralized system that allows lots of solutions for individual problems in individual states.
And as the vaccine rolled out, states modified their system to copy what worked, and discard what didn't, very quickly.
This is the problem most government types don't realize - no one has to be in charge for things to happen in a free society. Things can just...happen. The emergent intelligence of a million little decisions can move faster and more effectively than any group of experts.
Just read an article about Israel's vaccine rollout at the Swedish television news site. Yes, Israel was far ahead of others in negotiating directly with Pfizer. Israel also paid twice the price European Union was "able" to negotiate, and Israel was willing to provide medical data on results that Pfizer wanted to have in the rollout. I also read in another earlier Swedish news article that everyone in Israel belongs to one of four medical provider organizations. That suggests to me that it is relatively easy to organize a vaccine program once the vaccine is available. Finally, today's SVT article noted that once you get both shots you get a green card in your moble app that allows you to go to concerts and other social events, thus incentivising getting the vaccine. So, there you go.
Could somebody convince me that the US is not primarily doing well because it's rich and was able to purchase all the vaccines without hesitation? That's the obvious narrative for me (I'm biased). As you write the EU delayed because they wanted a mass discount (I wonder how many people died for that), maybe that wouldn't have been necessary had they been richer.
FYI, the first table has zeroes for 1 and 2 dose data for UAE, which is probably why it's missing from the second table. I think the "1+" heading is also incorrect -- I'm pretty sure that's just 1 dose, not "any number of doses". Otherwise the doses per 100 people math doesn't work out.
Another smart thing that was done was to distribute supplies to the states on the basis of population. Unlike in Europe, there's been no fighting among the states for their share of the supplies. Sometimes the smartest thing to do is to do it the simplest way possible, even if not "optimal" e.g., in terms of sending more supplies to the hardest hit states (which is a moving target anyway).
One thing I didn't understand here was why speeding up FDA approval was a "victory for libertarianism." Is having a respected Federal agency move to speed up processes during an emergency while attempting to maximize safety a particularly libertarian principle, opposed by other philosophical approaches? Guess I'm a libertarian then.
Hey Noah,
Good post. A couple of small points that I feel you could emphasize a bit more when looking at the global situation:
- The US has instituted an export ban on vaccines. That may be understandable, but it also leaves other countries out in the cold - Canada, for example, had no choice but to order in Europe.
- The UK for its part has not instituted an official export ban, but its contract details with major manufacturers (especially AstraZeneca) amount to just that for the doses procured in the UK.
- The EU - for all its slow rollout - is the only major world region that currently permits large amounts of “Western” vaccine to be exported - Israel's vaccine miracle for example was only possible because Pfizer-Biontech provided the vaccines from their factory in Puurs, Belgium.
- Other vaccine exporters are China and Russia, but on a far, far smaller and more select scale.
- The USA is truly leading with mRNA technology, but arguably alongside Germany and thus Europe, home to Biontech (which developed the Pfizer-Biontech vaccine) and Curevac and others.
- There weren't really any major fights about vaccine distribution in the EU this time around, the joint vaccine procurement process was set up precisely to prevent that (successfully) and avoid pitting small countries against big counties (successful too) - where the EU failed is going big early for helping production to ramp up, no matter the cost. That's what's ailing its rollout now.
Overall, the US rollout was and is truly a success story, particularly the ability to scale up production early. But one shouldn't forget the still applying vaccine export ban and that its current main vaccine, the Pfizer-Biontech, was a European-American co-production.
Best,
Ben
Does that mean the US actually gets at least something for spending twice as much on healthcare as everything be else?
I really appreciate hearing these kinds of even handed analyses that are realistic and yet leave me with a sense of optimism. I am glad I subscribe to Noah for these.
My impression is that distribution is completely outstripping supply, at least in California. The 78% dose usage rate does not mean that there are doses sitting in a freezer waiting for someone to simply use them; those doses are likely reserved for people with active appointments, often for their second dose.
Because supply isn’t growing exponentially, the distribution centers need to reserve doses for the second shot. If supply were growing sufficiently fast, they could rely on new deliveries to be available when people are ready for their second shot. But supply would need to be able to grow exponentially in order to cover all the 2nd doses as well as new 1st doses with just new deliveries.
San Francisco shut down new appointments for a week while they wait for a new shipment.
I think supply is the major bottleneck.
On Twitter people are talking about how Covid rates are declining more than expected.
I think it’s due to medical workers being a significant vector in transmission.
Their vaccination rates have an outsized effect on transmission.
The critical fact in Israel's favor that doesn't get proper billing is that its leaders (actually, its leader) are focused on an election coming in March 2021. The other factors are obviously critical, as spelled out in the early story that you reference. But private negotiations between Netanyahu and Pfizer, plus a developing agreement to make as much population-wide information about the results available as possible in return for further sources, have led to adequate supply, which no other country has enjoyed. (Even though Moderna has not come through as yet.) So politics is still the governing factor. It appears to be behind much of the confusion that the UK is suffering.
The tension between over-managing the ethical and social fairness of the rollout against achieving the ultimate objective -- killing off the virus in circulation -- will be a case study in the future. Epidemiological studies that show the best transition between the short term goal of keeping ICUs from overflow and reducing immediate death and the longer term goal of eliminating the virus before it mutates to a more dangerous form have not been explained successfully to the population of talking heads that run modern countries.
2021 is a vindication of Bill Clinton's 1992 Inauguration speech. "There is nothing wrong with America that cannot be cured by what is right with America" proved to be quite literally prophetic.
https://www.youtube.com/watch?v=Qszv668rN20
Thanks for your reasonable and appropriate commentary. A minor quibble: You (along with many others) mention that the US success can be attributed largely to "science." Unfortunately, almost no journalists seem prepared to go beyond that, though you at least do credit government support for science. I hope that someone will be able to provide an accessible explanation, though it's not easy, since the roots of the knowledge required to create these vaccines go back over more than a century.
Thanks for this story. The latent US chauvinist in my soul is pleased we've done something well. You point to the issue, but I wish to emphasize further that the success is based on the strength of the sciences in the US. It's worth noting that the policies of the Republican party/Trump adminstration would have undermined that predominance in the long run. Their overt hostility towards academic institutions and immigration set the stage for future declines in the output of scientific discovery. The private sector has always been eager to accept developments of science which generate profit. However, results which suggest limits on private activities for social reasons are greeted with hostility. Praise the pharma companies for vaccine development, but remember they exercise substantial monopoly power across much of the marketplace.
‘Mercia (in a non ironic way)
Now if I can just last until critical infrastructure workers qualify.
On another plane today.
One of the reasons the vaccine was distributed quickly is exactly because Trump left it up to the states. One of the WORST places for getting vaccine into arms was New York. Why? Because New York's governor Cuomo insisted on micromanaging the process. Other states sped ahead because they didn't follow complex rules promulgated by various government busybodies and focused on getting vaccine in arms.
If you look at Israel, or the UAE, the focus was on exactly the same thing - get vaccine in arms ASAP. A decentralized few rules system is the best possible way to do that.
So this is entirely Trump's triumph, and it is a triumph for a decentralized system that allows lots of solutions for individual problems in individual states.
And as the vaccine rolled out, states modified their system to copy what worked, and discard what didn't, very quickly.
This is the problem most government types don't realize - no one has to be in charge for things to happen in a free society. Things can just...happen. The emergent intelligence of a million little decisions can move faster and more effectively than any group of experts.
Just read an article about Israel's vaccine rollout at the Swedish television news site. Yes, Israel was far ahead of others in negotiating directly with Pfizer. Israel also paid twice the price European Union was "able" to negotiate, and Israel was willing to provide medical data on results that Pfizer wanted to have in the rollout. I also read in another earlier Swedish news article that everyone in Israel belongs to one of four medical provider organizations. That suggests to me that it is relatively easy to organize a vaccine program once the vaccine is available. Finally, today's SVT article noted that once you get both shots you get a green card in your moble app that allows you to go to concerts and other social events, thus incentivising getting the vaccine. So, there you go.
Could somebody convince me that the US is not primarily doing well because it's rich and was able to purchase all the vaccines without hesitation? That's the obvious narrative for me (I'm biased). As you write the EU delayed because they wanted a mass discount (I wonder how many people died for that), maybe that wouldn't have been necessary had they been richer.
FYI, the first table has zeroes for 1 and 2 dose data for UAE, which is probably why it's missing from the second table. I think the "1+" heading is also incorrect -- I'm pretty sure that's just 1 dose, not "any number of doses". Otherwise the doses per 100 people math doesn't work out.
Another smart thing that was done was to distribute supplies to the states on the basis of population. Unlike in Europe, there's been no fighting among the states for their share of the supplies. Sometimes the smartest thing to do is to do it the simplest way possible, even if not "optimal" e.g., in terms of sending more supplies to the hardest hit states (which is a moving target anyway).
One thing I didn't understand here was why speeding up FDA approval was a "victory for libertarianism." Is having a respected Federal agency move to speed up processes during an emergency while attempting to maximize safety a particularly libertarian principle, opposed by other philosophical approaches? Guess I'm a libertarian then.
So many people died, while someone is declaring victory. The US governance is absolutely a failure.