Health officials say part of the problem with the vaccine is the rigidity of the guidance.
“I would strongly encourage that we move forward with giving states the opportunity to be more expansive in who they can give the vaccine to,” said FDA Commissioner Stephen Hahn during a recent policy event.
Changes in the rules might help. But it will not fundamentally fix the problem. The vaccine roll-out will be unavoidably dysfunctional so long as it is controlled by government bureaucracy. That is because the most a bureaucracy can do is replace one set of highly arbitrary rules with another.
“You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing,” economist Thomas Sowell once observed.
That is inescapably true, because bureaucrats are fundamentally disconnected from the social outcomes of their actions. Those social outcomes are extremely complex. Every decision about the distribution of a vaccine has innumerable impacts on the public. Prioritizing young health workers over the elderly will have many public benefits (more COVID patient care, etc.), but also many public costs (more direct risks to the most vulnerable population). There is no non-arbitrary way to balance the manifold public costs and benefits, or to incentivize bureaucrats to strike that balance.
Sowell is right. For bureaucrats, outcomes literally are nothing, because they have no way to make meaningful judgments about them. And for bureaucrats, procedure is necessarily everything, because it’s all they have to give their activity any kind of coherence.
“Public administration,” wrote Ludwig von Mises in his book Bureaucracy, “the handling of the government apparatus of coercion and compulsion, must necessarily be formalistic and bureaucratic.”
“Bureaucratization,” Mises added, “is necessarily rigid because it involves the observation of established rules and practices.”
The Entrepreneurial Alternative
Thankfully, this is not the case for private business and entrepreneurs.
For entrepreneurs, outcomes are everything, and procedure is, at most, a distant second. That is because the incentives of an entrepreneur have a tight and meaningful connection with social outcomes: namely, profit and loss.
Profit is often denounced as “selfish,” but it is actually a powerful and subtle way to tie private interest with public benefit. In fact, it is the only way to do so, given the extreme complexity of public benefits and costs discussed above.
A comparison of Texas and California suggests that legal edicts matter less than The New York Times thinks.
And it is odd that the Times wishes Trump had taken complete control of the situation, given his resistance to the sweeping social and economic restrictions that the Times favors. Any “unified national strategy” imposed by Trump almost certainly would have entailed overriding the lockdowns imposed by states such as California and New York, which the Times credits with saving many lives.
It’s not clear the Times is right about that. Quoting Jeffrey Shaman, an infectious disease expert at Columbia, it says “the rush to reopen” was “the opportune moment that was lost.” If so, states that imposed lockdowns early, lifted them gradually, and quickly re-imposed restrictions in response to surges in cases and deaths should have fared better than less cautious states. But a comparison of Texas and California, the two most populous states, does not provide much evidence to support that hypothesis.
Contact tracing data from New York indicate that “household/social gatherings” accounted for three-quarters of infections in that state this fall. Mobility data show that Americans sharply curtailed their public activities last spring before most states had imposed lockdowns and began moving around more before those lockdowns were lifted. The pattern in both Texas and California was similar to the nationwide trends, notwithstanding their markedly different policies. In both states, mobility peaked in the fall and has declined since then. These data suggest that government policy does not play as important a role in the behavior that drives virus transmission as the Times seems to think.
In a National Bureau of Economic Research paper published last August, UCLA economist Andrew Atkeson and two other researchers, after looking at COVID-19 trends in 23 countries and 25 U.S. states that had seen more than 1,000 deaths from the disease by late July, found little evidence that variations in policy explain the course of the epidemic in different places. Other analyses have reached different conclusions.
Do the benefits of lockdowns outweigh their costs? That question is crucial not just in setting current policy but also in deciding how to deal with future epidemics. Without the “fractured” approach that the Times decries, it would be a lot harder to answer.
The comments below are in response to a CDC article entitled, Operational Considerations for Humanitarian Settings. As citizens with sovereign rights, we need to be aware of the “operational considerations” being discussed by policymakers & influencers, because there is not ONE reference to, or acknowledgement of, the individual right of self-determination or rights of families to make decisions for themselves.
Leave it to the public health theorists, who truly believe it’s their job to war-game these scenarios (and then make our decisions for us) to miss the obvious.
Like, for instance, the fact that things rarely turn out optimally. Their planning should not only acknowledge that reality, but the ACTUAL final plan should assume bad stuff happens and reflect that reality in its design.
But alas, that’s not what we get with Green Zone Shielding Approach to those at high risk for COVID19.
As a person with common sense and a hopeful future, you would not store kindling in same box as flammable accelerants. Nor, would you stow all weapons & ammunition in same cache; or invest all funds in the same asset class. No, you wouldn’t protect your precious resources that way; you would minimize your risk by using strategies designed to diversify, shield, obscure your cargo from theft, devaluation or damage.
To be fair, the CDC acknowledges…“Inadvertent introduction of the virus into a green zone may result in rapid transmission among the most vulnerable populations the approach is trying to protect.” They seem confident that careful central planning can mitigate that risk.
So here’s an excerpt from a CDC article about humanitarian issues pertaining to shielding approaches for those at high-risk for COVID. The article’s stated purpose was to give the CDC’s perspective on and challenges to…“implementing the shielding approach in humanitarian settings as outlined in guidance documents focused on camps, displaced populations and low-resource settings.”1,2
It goes on to state, “High-risk individuals would be temporarily relocated to safe or “green zones” established at the household, neighborhood, camp/sector or community level…”
- “Neighbors “swap” households to accommodate high-risk individuals.”
- “A group of shelters such as schools, community buildings within a camp/sector (max 50 high-risk individuals per single green zone) where high-risk individuals are physically isolated together.”
- “No movement into or outside the green zone.”
- “Plan for an extended duration of implementation time, at least 6 months.”
- “Ensure safe and protective environments for all individuals, including minors and individuals who require additional care whether they are in the green zone or remain in a household after the primary caregiver or income provider has moved to the green zone.”
Note the focus on “camps, displaced populations and low resource settings.” No one should be comfortable with the historical images conjured up by that quote. Need I say more?
In the summary section, the CDC authors admit the shielding approach is “ambitious” but offer no proof of concept.
Specifically they state, “The shielding approach is an ambitious undertaking, which may prove effective in preventing COVID-19 infection among high-risk populations if well managed. While the premise is based on mitigation strategies used in the United Kingdom,24,25 there is no empirical evidence whether this approach will increase, decrease or have no effect on morbidity and mortality during the COVID-19 epidemic in various humanitarian settings.”
What could possibly go wrong?
The coronavirus lockdowns demonstrated our leaders’ ignorance of economic interdependence. After the riots, that ignorance has been shown to run far deeper. It is an ignorance about government’s most fundamental obligation: to safeguard life, liberty, and property. It is an ignorance about human nature and human striving.
Lots of truth in JP’s sardonic wit.
As represented by our cinema and other media, Western society expects too much of masks. In the public’s mind, the still-legitimate use of masks for source control has gone off-label; masks are thought to prevent infection. From here, another problem arises: because surgical masks are thought to protect against infection in the community setting, people wearing masks for legitimate purposes (those who have a cough in a hospital, say) form part of the larger misperception and act to reinforce it. Even this proper use of surgical masks is incorporated into a larger improper use in the era of pandemic fear, especially in Asia, where such fear is high.1 The widespread misconception about the use of surgical masks — that wearing a mask protects against the transmission of virus — is a problem of the kind theorized by German sociologist Ulrich Beck.
The surgical mask communicates risk. For most, risk is perceived as the potential loss of something of value, but there is another side to risk, memorably formulated by Beck in his Risk Society.2 Beck states that risk society is “a systematic way of dealing with hazards and insecurities induced and introduced by modernisation itself.”2 For Beck, risk occurs not only in the form of threat and possible loss, but also in society’s organized management and response to these risks, which create a forwarding of present risk into the future. Furthermore, Beck writes of the “symptoms and symbols of risks” that combine in populations to create a “cosmetics of risk.” He suggests that people living in the present moment conceive of risk in terms of the physical tools used to mitigate risk while still “maintaining the source of the filth.”
Three months ago, Dr. John Ioannidis of Stanford University predicted dire social consequences if states enforced social distancing measures to curb a virus scientists didn’t yet understand.
“I feel extremely sad that my predictions were verified,” Ioannidis said in a recent interview with Greek media.
“There are already more than 50 studies that have presented results on how many people in different countries and locations have developed antibodies to the virus,” Ioannidis, a Greek-American physician, told Greek Reporter. “Of course none of these studies are perfect, but cumulatively they provide useful composite evidence. A very crude estimate might suggest that about 150-300 million or more people have already been infected around the world, far more than the 10 million documented cases.”
Ioannidis said medical data suggest the fatality risk is far lower than earlier estimates had led policymakers to believe and “is almost 0%” for individuals under 45 years old. The median fatality rate is roughly 0.25 percent, however, because the risk “escalates substantially” for individuals over 85 and can be as high as 25 percent for debilitated people in nursing homes.
“The death rate in a given country depends a lot on the age-structure, who are the people infected, and how they are managed,” Ioannidis said. “For people younger than 45, the infection fatality rate is almost 0%. For 45 to 70, it is probably about 0.05-0.3%. For those above 70, it escalates substantially…”
“Major consequences on the economy, society and mental health” have already occurred. I hope they are reversible, and this depends to a large extent on whether we can avoid prolonging the draconian lockdowns and manage to deal with COVID-19 in a smart, precision-risk targeted approach, rather than blindly shutting down everything…”
There’s little question that the lock-downs have caused widespread economic, social, and emotional carnage. Evidence that US states that locked down fared better than states that did not is hard to find.
Though not yet certain, the COVID-19 pandemic may well turn out to be another example of central planning gone wrong.
As I previously noted, it’s a sad irony that many of the greatest disasters in modern history—from Stalin’s “kolkhoz” collective farming system to Mao’s Great Leap Forward and beyond—are the result of central planners trying to improve the lot of humanity through coercive action.
“This is not a dispute about whether planning is to be done or not,” Hayek wrote in The Use of Knowledge in Society. “It is a dispute as to whether planning is to be done centrally, by one authority for the whole economic system, or is to be divided among many individuals.”