Vaccination alone won't help...
This article was originally published on 10/10/2020 for my informal email list. I’m re-posting some of my earlier newsletters here as a gradual process to shift to Substack.
We’ve heard the saying that “vaccines don’t save lives; vaccination saves lives.” So my previous conception was that mass vaccination would be the real hurdle next year when we get vaccines, and only if we can vaccinate people, can we actually return to normalcy. One policymaker I recently met at a conference disagreed: you would need both the mass vaccination and a change of policy.
The exit strategy
By policy, he means the national pandemic strategy in 2021, which will de facto be our economic policy. To some sense, the Fed’s policies in the past half a year is not monetary policy; it’s a tactic that aims to help mitigate the effect of a series of public health policies. Interesting angle.
By policy, he also means the “exit strategy” for our current set of non-pharmaceutical interventions (NPI) such as economic lockdown, business & school closure, social distancing, masks wearing etc. The main issue is that our current NPIs weren’t designed to be economically and financially sustainable to last more than a year. We initially adopted this current policy framework with the intention to hold off the virus until we have a vaccine, meaning we expected to exit the current NPIs as soon as the vaccination is complete.
However – here comes the shocking punchline – public health experts are saying that we still have to continue the current NPI even if we have mass vaccination. Why? I’m not a biology/pre-med guy but I tried my best understanding his reasoning: The kind of vaccines we have for flus and Covid-19 is essentially an intra-muscular shot that causes an immuno-response in your body. It will help you develop some kind of antibody, but it won’t cause any antibody in your lungs and membranes. In other words, it won’t reduce the amount of virus in your mouth, nose, mucous membranes if you were to contract Covid. The vaccine shot will reduce your chance of dying, and it will make your symptoms less severe, but you’ll still be almost just as likely to infect others. Many people will still die even after mass vaccination.
So, in the most optimistic case, say we have the entire country vaccinated by next summer, it does not mean we can fully return to normalcy, and it doesn’t mean we no longer need to make the tradeoffs between economics and public health.
The tradeoffs will continue to haunt us
Then, the question comes back to the “exit strategy” – how can we gradually ease out of NPI? With the country vaccinated, the calculation and criteria should change. Instead of focusing on controlling case counts like we currently do, should we perhaps focus on overall death counts? For instance, you can normalize everything subject to the condition that normalcy can only continue if we don’t reach this number of death count… or a similar framework as such.
In other words, the argument that “we cannot return to normalcy until everyone is protected” is a non-starter – because you won’t even be able to return even with mass vaccination. People will continue to die, and you cannot simply let the economic and social harms to accumulate indefinitely. That will have a horrible outlook for the economy with millions of job losses and damages that cannot be recovered in years. Remember, by economy we don’t mean the stock markets; we mean Main Street small businesses, women with children, minorities, and many groups of people who will continue to suffer disproportionately under lockdowns.
As you can see, there are a much more nuanced and complex set of policy questions than just “life vs. economy.” What I consider to be the central question here is:
Do you maximize health outcomes subject to economic and social cost constraints (save as many people as possible so long as we’re under this number of unemployment, this number of mental health problems, and this number of school closures)?
Or, do you maximize social and economic utility under public health constraints (resume pre-Covid life as much as possible so long as the death count is under this number)?
Questions for the President
You cannot do this without presidential leadership. Trump didn’t deal with this choice, and he didn’t confront the tradeoff. He just made a bunch of symbolic decisions without answering the real set of questions for exit strategy.
There are four deeper questions that Biden would have to seriously answer about the exit strategy for 2021 to make the case that he is more thoughtful about the national pandemic strategy than Trump:
If we have vaccines, will you push states to relax social distancing?
Will you change the public health criteria from reducing infection case counts to reducing deaths and severe illnesses?
Will you maximize health outcomes subject to economic and social cost constraints, or will you maximize social and economic utility under public health constraints? Or do you balance both to find some interior solution?
Will you re-centralize decision making to the federal government level? Or will you continue to let the hundreds of local officials to make their own different judgements for those tradeoffs?