In a recent essay in the journal Monash Bioethics Review, oncologist Vinay Prasad and health researcher Alyson Haslam provide a comprehensive after-the-fact assessment of the federal government’s rollout of the COVID-19 vaccines.
Their basic takeaway is that the vaccines were a “scientific success”tarnished by flawed federal vaccine policy.
The two argue the tremendous benefits of the COVID-19 vaccines for the elderly were undercut by government guidance and messaging that pushed vaccines on the young, healthy, and previously infected when data suggested that wasn’t worthwhile (and was in some cases counterproductive).
Worse still, the government even pushed vaccine mandates when it was increasingly clear the vaccines did not stop COVID-19 transmission, they argue.
To correct these errors for future pandemic responses, Prasad and Haslam recommend performing larger vaccine trials and collecting better data on vaccine performance in lower-risk populations. They also urge policy makers to be more willing to acknowledge the tradeoffs of vaccination.
That’s sound advice. We’ll have to wait and see if the government adopts it come the next pandemic.
There is one policy that they don’t mention and doesn’t totally depend on the government getting better at judging the risks of new vaccines: Charge people for them.
Had the government not provided COVID-19 vaccines for free and shielded vaccine makers and administrators from any liability for adverse reactions, prices could have better rationed vaccine supply and better informed people about their risks and benefits.
Without prices, people were instead left with flawed government recommendations, incentives, and rationing schemes.
Those who recall early 2021 will remember the complex, often transparently silly eligibility criteria state governments set up to ration scarce vaccine supplies. This often involved prioritizing younger, healthier, often politically connected “essential workers” over elderly people.
Prasad and Haslam criticize this as a government failure to prioritize groups at most risk of dying from COVID-19.
“While the UK prioritized nursing home residents and older individuals…the US included essential workers, including young, resident physicians,” write Prasad and Haslam. “Health care workers face higher risks of acquiring the virus due to occupation (though this was and is offset by available personal protective equipment), but this was less than the elevated risk of death faced by older individuals.”
Yet if the government hadn’t assigned itself the role of distributing vaccines for free, it wouldn’t have been forced into this position of rationing scarce vaccine supplies.
Demand for the vaccine is a function of the vaccine’s price. Since the vaccine’s price was $0, people who stood to gain comparatively less from vaccination and people for whom a vaccine would be lifesaving were equally incentivized to receive it.
Consequently, everyone rushed to get in line at the same time. The government then had to decide who got it first and predictably made flawed decisions.
Had vaccine makers been left to sell their product on an open market (instead of selling doses in bulk to the federal government to distribute for free), the elderly and those most at risk of COVID-19 would have been able to outbid people who could afford to wait longer. Perhaps more lives could have been saved.
Over the course of 2021, the supply of vaccines outgrew demand.
At the same time, as Prasad and Haslam recount, an increasing number of people (particularly young men) were developing myocarditis as a result of vaccination. Nevertheless, the government downplayed this risk, continued to urge younger populations to get vaccinated, and failed to collect data about the potential risks of vaccination.
That’s all a failure of the government policy. Even if the government was slow to adjust its recommendations, prices could have played a constructive role in informing people about their own risk-reward tradeoff of getting vaccinated.
If a 20-year-old man who’d already had COVID-19 had to spend something to get vaccinated, instead of nothing, fewer would have. Prasad and Haslam argue that would have been the right call healthwise.
Without prices, that hypothetical 20-year-old’s decision was informed mostly by government guidance, and, later, government mandates.
The government compounded this lack of prices by giving liability shields to vaccine makers. As it stands right now, no one is able to sue the maker of a COVID-19 vaccine should they have an adverse reaction. (Unlike standard, non-COVID vaccines, people are also not allowed to sue the government for compensation for the vaccine injuries.)
If pharmaceutical companies had to charge individual consumers to make money off their vaccines, and if those prices had to reflect the liability risks of the side effects some number of people would inevitably have, consumers would have been even better informed about the risks and rewards of vaccination.
One might counter that individual consumers aren’t in a position to perform this risk-reward calculation on their own.
That ignores the ways that other intermediaries in a better position to evaluate the costs and benefits of vaccination could contribute to the price signals individuals would use to make their own decisions.
One could imagine an insurance company declining to cover COVID-19 vaccines for the aforementioned healthy 20-year-old while subsidizing their elderly customers to get the shot. (This is, of course, illegal right now. The Affordable Care Act requiresmost insurance plansto cover the costs of vaccination for everyone.)
Instead, the financial incentives that were attached to vaccination were another part of the federally subsidized vaccination campaign.
State Medicaid programs paid providers bonuses for the number of patients they vaccinated (regardless of how at risk of COVID-19 those patients were). State governments gave out gift cardsto those who got vaccinated and entered them in lotteries to win even bigger prizes.
Leaving it up to private companies to produce and charge for vaccines would have one added benefit: It would make it much more difficult for the government to mandate vaccines or otherwise coerce people into getting them.
One of the things that made it easy for local and state governments to bar the unvaccinated from restaurants and schools was that they also had a lot of free, federally subsidized doses to give away. People didn’t have a real “excuse” not to get a shot.
Had people been required to pay for vaccines, it would have been more awkward and much harder (politically and practically) to mandate that they do so.
Economist Alex Tabarrok likes to say that a “price is a signal wrapped up in an incentive.” They signal crucial information and then incentivize people to act on that information in a rational, efficient way.
By divorcing COVID-19 vaccines from real price signals, we were left with an earnest, government-led vaccination effort. That effort got a lot of lifesaving vaccines to a lot of people.
But it also encouraged and subsidized people to get vaccinated when it was probably not a necessary or even good idea. When not enough people got vaccinated, governments turned to coercive mandates.
