The article linked for Covid being leading cause of death in under 55 actually says “leading medical cause of death”, which is different. I was trying to reconcile it with the big NYT feature, which said amongst other things that more under 25s died of car accidents than Covid.
Dems gave all the money to state and local governments because they were fighting the last war. The continuous shedding of state and local jobs in the Great Recession was a huge drag on the economy. It's just they were very wrong about that happening this time and don't want to admit it.
"It is true that if everyone had the same values, preferences, and worldviews as public health academics, public health outcomes would improve." But at wat economic cost?
We don't hire public health officials for their values, preferences and worldviews -- they are as entitled to them as anyone else -- we hire them to give individuals and policy makers information about the time and space varying trade-offs of the spread of infections and their consequences with different interventions -- NPI, vaccines, antivirals, etc.
"The great under-appreciated irony of 2020 is that progressives simultaneously took a sharp move to be much more skeptical of heavy-handed enforcement of rules while also wanting a bunch of new rules."
Under-appreciated in some quarters, maybe, but not here in Slowboringland!
"...the need for public health academics to reconcile themselves to things like the existence of public opinion and electoral democracy."
Except that the source of the resistance to sound public health advice was not "public opinion" or "electoral democracy" in the abstract.
After all, there was plenty of both those things in America when we rolled out the campaigns to eliminate polio and small pox. There has always been plenty of public opinion and electoral democracy when kids lined up every year for their shots at school and new recruits got their shots at basic training.
What you are white-washing under the benign names of "public opinion" and "electoral democracy" is something very different: a coldblooded campaign of lying and deceit for the sake of partisan gain, undertaken with the knowledge that it would kill many extra thousands of people.
It did not have to play out this way: nothing about "the existence of public opinion and electoral democracy" mandated that grifters and monsters should rev up the QAnon machine and turn it into a campaign to kill Americans. That's on Fox News and the Republicans. Name them specifically, don't help their deceit by waving vaguely at "public opinion" and "electoral democracy".
"To get out of this cycle, we’re going to need to develop a more general vaccine. Ideally, that means one that targets the shared properties of the entire coronavirus family and gets out of playing whack-a-mole with variants."
I don't disagree, but in fact we have NOT been playing whack a mole. My fourth booster had the the same mRNA in it as my first vaccine 18 months ago. I think we could have done better than that for not a lot of extra cost. And developing a system of rapidly "mutating" the vaccine (as we do and could do better with flu) will be useful for different families of viruses where a family vaccine is not so easy.
It's worth pointing out that BioNTech is just as much a small startup as Moderna and - similar to Moderna - received a large amount of money from an external source to develop their vaccine that they too could not afford to bring to mass production alone.
BioNTech's external funder was Pfizer, and it would make more sense here to compare Pfizer to BARDA rather than to Moderna.
That comparison makes BARDA look even better - Big Pharma like Pfizer have developed very little in the way of vaccines or treatments for any viral disease, which has almost always been either public sector or startup, and Big Pharma funding startups is really unusual - the Pfizer/BioNTech pair up is a really unusual example (far more often the Big Pharma buys the startup rather than partnering with it).
"I keep hoping that at some point the really good reporters will stop publishing tell-all Trump books"
I want a "tell-all" about how and why the DFA and CDC made the decisions they did about test development, asymptomatic testing, not creating a surveillance system, not using human challenge trials, not doing the research to continually update the public and policy makers about the tradeoffs of NPIs and transmission, why the message that NPIS and vaccines are to protect other people, too, was never emphasized, etc. Most of these are now recognized as mistakes, but we have only a vague idea of why they made them.
What amazes me is humanity’s awesome and awful ability to adapt to a new normal. Objectively, things have *somewhat* improved in the pandemic compared to its start: vaccinations and previous infection mitigate outcomes to an extent, and hospitals are better at treatment. HOWEVER, they’re not nearly as radically better as public attitude and official policy have shifted. I still remember the NYT front page “100,000 COVID deaths, an unimaginable loss” and it *was* horrifying and unimaginable *at the time*. And yet Eric Topple’s post (linked by MY) informs us of 175,000 more Americans dying from COVID just from the start of 2022! And none of us bat an eyelid! I’m not pointing this out to say that we were wrong to lockdown in 2020 or wrong to go back to normal now , but rather to suggest that we are on the verge of potentially normalizing hundreds of thousands, perhaps a million, excess deaths annually (!) , and who knows how many long term debilitating conditions. That’s kind of chilling.
Great column—seems like a no-brainer to do this. The only thing I would add (slightly out of scope of your focus on clawback) is that getting the FDA to adopt a set of rules to enable more rapid adoption of multivalent/new variant vaccines also needs to happen. Additionally as you pointed out before, investing in more vaccine manufacturing capacity is critical since it just shouldn’t take 5-6 months to roll out a new vaccine variant. Seems strange that the Biden admin hasn’t really gone hard after this since it would allow them to lead on covid while also hitting on reshoring manufacturing capacity.
Great post. I went to med school and did residency with Jay Varma -- smart guy. I've been frustrated that the Covid vaccines weren't allotted to individual medical offices. We tried to get the them in our office, but the red tape was a nightmare. There were a good number of skeptical people that I convinced to get vaccinated but then didn't b/c we didn't actually have the vaccine in office. And what I don't get is that Medicare, in general, is getting stingier about paying for vaccines in the doctor's office. For example Medicare won't pay for Shingrix (shingles vaccine) in office, sometimes won't pay for pneumococcal vaccine. The patient has to get at the pharmacy. Then it's a nightmare trying to keep track of vaccine records. Why are they being stingy about vaccines -- one of the best preventative medicine strategies we have in our arsenal?
Anyway, from my perspective, the pandemic is getting way better. Yes -- cases are again surging, but I haven't had to hospitalize anyone for 6 months. And Paxlovid works really well and (at least in LA) is widely available. I'm generally loathe to make predictions after having been burned in the past re: Covid, but I do think this we will get to an endemic state -- just another cold virus in a few years as we are vaccinated and exposed/recover several times.
Regarding footnote #2, it exposed two things in my book. One is that there's a delusion among a sector of lefties that if they just make something a law, that alone will naturally induce people to follow it. That pretty clearly falls apart when you really need 100% compliance. The other is just how important highly visible forms of compliance are to these sectors, even if they're not the most effective.
“Operation Warp Speed” was terrible branding—the biggest reason I saw for vaccine hesitancy (among people who were not instinctively anti-vax) was “it was developed too quickly, I don’t know if it’s safe.” Trump had a hell of a time persuading people (other than his wealthy and elderly donors who didn’t need to be told) to take the vaccine.
"The great under-appreciated irony of 2020 is that progressives simultaneously took a sharp move to be much more skeptical of heavy-handed enforcement of rules while also wanting a bunch of new rules."
I was just saying the other day that that's been one of the more crazy-making things over the past few years.
Basically, use Advance Market Commitments and prize authority for vaccine development for next generation COVID-19 vaccines and/or neglected diseases in general.
Combining this with measures to reduce R&D costs, like human challenge trials, would be a nice addition as well.
Happy Birthday, Matt!
(he posted it on Twitter)
The article linked for Covid being leading cause of death in under 55 actually says “leading medical cause of death”, which is different. I was trying to reconcile it with the big NYT feature, which said amongst other things that more under 25s died of car accidents than Covid.
Dems gave all the money to state and local governments because they were fighting the last war. The continuous shedding of state and local jobs in the Great Recession was a huge drag on the economy. It's just they were very wrong about that happening this time and don't want to admit it.
"It is true that if everyone had the same values, preferences, and worldviews as public health academics, public health outcomes would improve." But at wat economic cost?
We don't hire public health officials for their values, preferences and worldviews -- they are as entitled to them as anyone else -- we hire them to give individuals and policy makers information about the time and space varying trade-offs of the spread of infections and their consequences with different interventions -- NPI, vaccines, antivirals, etc.
"The great under-appreciated irony of 2020 is that progressives simultaneously took a sharp move to be much more skeptical of heavy-handed enforcement of rules while also wanting a bunch of new rules."
Under-appreciated in some quarters, maybe, but not here in Slowboringland!
"...the need for public health academics to reconcile themselves to things like the existence of public opinion and electoral democracy."
Except that the source of the resistance to sound public health advice was not "public opinion" or "electoral democracy" in the abstract.
After all, there was plenty of both those things in America when we rolled out the campaigns to eliminate polio and small pox. There has always been plenty of public opinion and electoral democracy when kids lined up every year for their shots at school and new recruits got their shots at basic training.
What you are white-washing under the benign names of "public opinion" and "electoral democracy" is something very different: a coldblooded campaign of lying and deceit for the sake of partisan gain, undertaken with the knowledge that it would kill many extra thousands of people.
It did not have to play out this way: nothing about "the existence of public opinion and electoral democracy" mandated that grifters and monsters should rev up the QAnon machine and turn it into a campaign to kill Americans. That's on Fox News and the Republicans. Name them specifically, don't help their deceit by waving vaguely at "public opinion" and "electoral democracy".
"To get out of this cycle, we’re going to need to develop a more general vaccine. Ideally, that means one that targets the shared properties of the entire coronavirus family and gets out of playing whack-a-mole with variants."
I don't disagree, but in fact we have NOT been playing whack a mole. My fourth booster had the the same mRNA in it as my first vaccine 18 months ago. I think we could have done better than that for not a lot of extra cost. And developing a system of rapidly "mutating" the vaccine (as we do and could do better with flu) will be useful for different families of viruses where a family vaccine is not so easy.
It's worth pointing out that BioNTech is just as much a small startup as Moderna and - similar to Moderna - received a large amount of money from an external source to develop their vaccine that they too could not afford to bring to mass production alone.
BioNTech's external funder was Pfizer, and it would make more sense here to compare Pfizer to BARDA rather than to Moderna.
That comparison makes BARDA look even better - Big Pharma like Pfizer have developed very little in the way of vaccines or treatments for any viral disease, which has almost always been either public sector or startup, and Big Pharma funding startups is really unusual - the Pfizer/BioNTech pair up is a really unusual example (far more often the Big Pharma buys the startup rather than partnering with it).
"I keep hoping that at some point the really good reporters will stop publishing tell-all Trump books"
I want a "tell-all" about how and why the DFA and CDC made the decisions they did about test development, asymptomatic testing, not creating a surveillance system, not using human challenge trials, not doing the research to continually update the public and policy makers about the tradeoffs of NPIs and transmission, why the message that NPIS and vaccines are to protect other people, too, was never emphasized, etc. Most of these are now recognized as mistakes, but we have only a vague idea of why they made them.
What amazes me is humanity’s awesome and awful ability to adapt to a new normal. Objectively, things have *somewhat* improved in the pandemic compared to its start: vaccinations and previous infection mitigate outcomes to an extent, and hospitals are better at treatment. HOWEVER, they’re not nearly as radically better as public attitude and official policy have shifted. I still remember the NYT front page “100,000 COVID deaths, an unimaginable loss” and it *was* horrifying and unimaginable *at the time*. And yet Eric Topple’s post (linked by MY) informs us of 175,000 more Americans dying from COVID just from the start of 2022! And none of us bat an eyelid! I’m not pointing this out to say that we were wrong to lockdown in 2020 or wrong to go back to normal now , but rather to suggest that we are on the verge of potentially normalizing hundreds of thousands, perhaps a million, excess deaths annually (!) , and who knows how many long term debilitating conditions. That’s kind of chilling.
Great column—seems like a no-brainer to do this. The only thing I would add (slightly out of scope of your focus on clawback) is that getting the FDA to adopt a set of rules to enable more rapid adoption of multivalent/new variant vaccines also needs to happen. Additionally as you pointed out before, investing in more vaccine manufacturing capacity is critical since it just shouldn’t take 5-6 months to roll out a new vaccine variant. Seems strange that the Biden admin hasn’t really gone hard after this since it would allow them to lead on covid while also hitting on reshoring manufacturing capacity.
Great post. I went to med school and did residency with Jay Varma -- smart guy. I've been frustrated that the Covid vaccines weren't allotted to individual medical offices. We tried to get the them in our office, but the red tape was a nightmare. There were a good number of skeptical people that I convinced to get vaccinated but then didn't b/c we didn't actually have the vaccine in office. And what I don't get is that Medicare, in general, is getting stingier about paying for vaccines in the doctor's office. For example Medicare won't pay for Shingrix (shingles vaccine) in office, sometimes won't pay for pneumococcal vaccine. The patient has to get at the pharmacy. Then it's a nightmare trying to keep track of vaccine records. Why are they being stingy about vaccines -- one of the best preventative medicine strategies we have in our arsenal?
Anyway, from my perspective, the pandemic is getting way better. Yes -- cases are again surging, but I haven't had to hospitalize anyone for 6 months. And Paxlovid works really well and (at least in LA) is widely available. I'm generally loathe to make predictions after having been burned in the past re: Covid, but I do think this we will get to an endemic state -- just another cold virus in a few years as we are vaccinated and exposed/recover several times.
Regarding footnote #2, it exposed two things in my book. One is that there's a delusion among a sector of lefties that if they just make something a law, that alone will naturally induce people to follow it. That pretty clearly falls apart when you really need 100% compliance. The other is just how important highly visible forms of compliance are to these sectors, even if they're not the most effective.
This article (https://slate.com/news-and-politics/2022/05/abortion-activism-pro-choice-messaging-language-ireland-argentina.html) has nothing to do with this topic, but its last paragraph was just such a dead-on example of that type of mindset.
“Operation Warp Speed” was terrible branding—the biggest reason I saw for vaccine hesitancy (among people who were not instinctively anti-vax) was “it was developed too quickly, I don’t know if it’s safe.” Trump had a hell of a time persuading people (other than his wealthy and elderly donors who didn’t need to be told) to take the vaccine.
"The great under-appreciated irony of 2020 is that progressives simultaneously took a sharp move to be much more skeptical of heavy-handed enforcement of rules while also wanting a bunch of new rules."
I was just saying the other day that that's been one of the more crazy-making things over the past few years.
Great article. I argued something similar in a policy memo for the Institute for Progress a few months ago.
https://progress.institute/creating-advanced-market-commitments-and-prizes-for-pandemic-preparedness/
Basically, use Advance Market Commitments and prize authority for vaccine development for next generation COVID-19 vaccines and/or neglected diseases in general.
Combining this with measures to reduce R&D costs, like human challenge trials, would be a nice addition as well.