From Are We Much Too Timid in the Way We Fight Covid-19? by Ezra Klein.
Here’s a question I’ve been mulling in recent months: Is Alex Tabarrok right? Are people dying because our coronavirus response is far too conservative?
I don’t mean conservative in the politicized, left-right sense. Tabarrok, an economist at George Mason University and a blogger at Marginal Revolution, is a libertarian, and I am very much not. But over the past year, he has emerged as a relentless critic of America’s coronavirus response, in ways that left me feeling like a Burkean in our conversations.
He called for vastly more spending to build vaccine manufacturing capacity, for giving half-doses of Moderna’s vaccine and delaying second doses of Pfizer’s, for using the Oxford-AstraZeneca vaccine, for the Food and Drug Administration to authorize rapid at-home tests and for accelerating research through human challenge trials. The through line of Tabarrok’s critique is that regulators and politicians have been too cautious, too reluctant to upend old institutions and protocols, so fearful of the consequences of change that they’ve permitted calamities through inaction.
All the received institutional "experts" have been headed in a direction conducive to coercive statists. You have to receive a vaccination. You have to mask up all the time, inside and out. You have to vaccinate children. You have to socially distance and lockdown.
None of these are inherently wrong strategies though past experience speaks against them and, indeed, pre-covid pandemic plans rejected all four. But in their desperation for relevance and their desire to be seen to be doing something, institutions and "experts" have fallen all over themselves to endorse these previously discredited approaches.
And as time has proceeded, the failures are racking up. Masks are pretty clearly inconsequential in stopping the spread of Covid-19 and serve no function in protecting one from coming down with the virus. Lockdown policies have exacted a very high health and economic well-being cost with no clear benefit in terms of effectiveness of slowing infections.
Vaccinations have been somewhat effective but for much shorter durations than was anticipated. And we are still just discovering the consequence of vaccines to the ill, the very young, the pregnant, the co-morbid, etc. and we certainly have little understanding of the long term impacts. They may still turn out to have been net beneficial but we do not know yet.
Much of our problem is due to a mismatch and asymmetry in trust. Government does not trust its citizens and citizens no longer trust the government. Citizen distrust of government is well founded. Pay attention and government (really, government agencies) routinely get policy wrong, implement good policy badly, or pursue policy goals not endorsed by the public. It would not be an outlandish claim that virtually all government action suffers from one or more of these defects.
Regardless of efficiency and effectiveness, we also know from past experience that all citizens should always view government with at least some modicum of skepticism, even if it is apparently pursuing some policy with which you agree.
Klein is essentially a statist, a proto-socialist. He is not, and has not ever been, particularly well grounded in the history of the Age of Enlightenment, Constitutional law, oddly detached from natural rights as enshrined in the Bill of Rights, and in general far more focused on perceived efficiency (and primacy) of government actions rather than the system of government and overarching constraints such as law, rights, authority, etc. For him, the ends usually justify the means.
Despite this, he finds common cause with libertarian Tabarrok.
But as best as I can tell, Tabarrok has repeatedly been proved right, and ideas that sounded radical when he first argued for them command broader support now. What I’ve come to think of as the Tabarrok agenda has come closest to being adopted in Britain, which delayed second doses, approved the Oxford-AstraZeneca vaccine despite its data issues, is pushing at-home testing and permitted human challenge trials, in which volunteers are exposed to the coronavirus to speed the testing of treatments. And for now it’s working: Britain has vaccinated a larger percentage of its population than the rest of Europe and the United States have and is seeing lower daily case rates and deaths.
But in this instance, Tabarrok has foresaken his commitment to libertarian principles as he acknowledges.
If all of this sounds as if it’ll require a lot of government action, well, it will. “Ninety-nine years out of 100, I’m a libertarian,” Tabarrok said with a laugh. “But then there’s that one year out of 100.”
Which is striking to me. I have a strong disposition towards constrained libertarianism but find some of Tabarrok's more extreme positions, such as open borders, impractical and destructive. But in this instance, when Tabarrok abandons his more extreme libertarian positions, now is the time when statist Klein is most disposed to side with him.
Klein seems to be stuck within a partisan mindset, merely thinking within the guidelines of the establishment and the Democratic party. He is not looking at the evidence and arriving at a reasoned and empirical conclusion.
This debilitating blindness shows up in the following two paragraphs.
Daniel Carpenter is a professor of government at Harvard and an expert on the F.D.A., and he thinks its critics underestimate the costs of a mistake. “Effective therapies depend upon credible regulation,” he told me. Mass vaccination campaigns work only if the masses take the vaccines. “In this way, it’s a deeply social technology, and so the credibility is everything.”
To Carpenter, the F.D.A.’s critics miss the consequences of regulators losing public trust. President Donald Trump publicly pressured the agency to authorize unproven drugs, like hydroxychloroquine, that proved useless and tweeted that the “deep state” in the agency was trying to delay a vaccine to hurt him politically. Stephen Hahn, then the F.D.A. commissioner, joined Trump at a briefing to tout an emergency-use authorization for convalescent plasma — and Hahn then had to apologize, and fire two staff members, after misstating the evidence. It looked to many as though the F.D.A.’s process was collapsing under Trump’s attacks.
A result was that from August to September, the share of Americans who told Gallup they were willing to take a vaccine fell to 50 percent from 62 percent, and among Democrats it fell even further, to 53 percent from 79 percent. Further polling showed that fears of a rushed, unsafe vaccine were driving the drop. It took months, and a series of stringent process announcements by the F.D.A. making clear that it would not be bullied into an early authorization by Trump, for confidence to recover. This, for Carpenter, is what the F.D.A.’s critics don’t understand. “Therapeutic credibility is the entire ballgame here,” he said.
Klein is endorsing the idea that loss of trust in FDA (and by extension, CDC) was completely due to Trumps' behaviors. Entirely missing from this indictment by Klein are the campaign statements from Biden and Harris that any vaccine developed under Trump was not to be trusted and that they would not consent to taking a Trump developed vaccine. Was trust lost because of FDA missteps, between the debates between the FDA and Trump, or from our current President and Vice President's loud and repeated denunciation of the "Trump" vaccines before they became available? Clearly Klein has lapsed into a partisan dreamworld, undermining his own credibility.
Which is strange since Klein includes information indicating that the loss of trust supersedes partisanship.
The share of Americans who told Gallup they were willing to take a vaccine fell to 50 percent from 62 percent, and among Democrats it fell even further, to 53 percent from 79 percent. Further polling showed that fears of a rushed, unsafe vaccine were driving the drop.
Democrats, Republicans and Independents have all lost trust in FDA and CDC. Earned trust is the issue, not behaviors on the part of Trump.
Klein additionally acknowledges that the low level of apparent competence on the part of the FDA in terms of testing likely also contributed to lost trust. He puts the best spin on it possible but at least acknowledges that FDA has been a significant contributor to its own difficult position.
Klein also highlights what I think is perhaps among the most important issues. Covid-19 is a novel virus. In many ways there are some things we can accurately forecast simply because it is a virus and we have a lot of knowledge of viruses. On the other hand, it is novel. We have done an abysmal job measuring the most salient points about its progress and impact, we have done an abysmal job communicating the limits of our knowledge, and we have substituted emotional conviction for clear evidence because there is not yet clear evidence.
And much what is emerging supports the critics rather than the establishment "experts."
Biden said he will “follow the science,” but that often means following the existing evidence, which is not the same thing. It’s wrong to assume that the dosing protocols that pharmaceutical companies proposed in their rush for authorization are optimal for society’s goals. “They wanted to get this going as soon as possible, so they didn’t explore other doses, and it’s very likely they overdosed the vaccine,” Topol said. There is, of course, a risk in attempting a dosing protocol that didn’t go through Phase 3 trials; perhaps immunity will fade faster, for instance. But holding to the current dosing schedules means a slower vaccination program and more deaths.
Follow the science is well and good when there is solid, widely shared, and well established consensus among a wide diversity of scientists, policy experts, and the public. Such a consensus, when it comes to Covid-19, does not exist and likely will not exist for some good time.
Statists, such as Klein, in the absence of consensus, have been very happy to advocate for coercive actions which strip citizens of inalienable rights. The intense, and continuing effort to
Force vaccinations despite citizen opposition.
Implement vaccine passports for population control.
Force mask wearing despite no evidence or disputed evidence regarding its efficacy.
Force cessation of free travel, employment, and other business and communal activities without constitutional authority.
Suppress religion by closing churches.
Coordinate with technology oligopolies in order to constrain free speech under the auspices of eliminating false or misleading information.
All speak to a complete disregard and cavalier attitude about civil rights such as freedom of assembly, freedom of speech, freedom of religion, body autonomy, freedom of individuals, etc.
Klein apparently still seems to believe that we can achieve herd immunity. A belief against which the tides of evidence and policy support are turning. Some of his coercive inclinations have at least an imprimatur of logic if you believe herd immunity is achievable. If, as many are coming to believe, Covid-19 cannot be defeated but will become endemic, then treatment and possibly natural immunity (from prior exposure) become more the focus than do vaccination and lockdowns.
The ultimate challenge, that which calls for the confidence and leadership which has been so lacking from our agencies and leaders is the tension between knowing too little and knowing enough.
Not doing something is a choice,” said Emily Oster, a health economist at Brown. “It’s not a safe harbor.”
But nobody knows where that line is. Something needs to be done, or we need to consciously choose to do nothing but no one can know when we know enough to choose.
Too many leaders and institutions have been shooting from the hip with little evidence that they are shooting at the right things. There will be loss of life and economic damage if you are too aggressive (rapid deployment of novel vaccines and coercive lockdowns) and possibly if you are too permissive (open environments, respect for civil rights, etc.)
Sweden is the only country of which I am aware which has systematically sought to bridge the gap between knowing and unknowing. They have made evidence available to the public as it is available and broadly held back from mandates and lockdowns. Putting decision-making in the hand of citizens has been widely condemned by institutions, "experts", pundits, government agencies, and the media.
Interestingly, despite that freedom to choose, Sweden has not been free from lockdowns, etc. At different times of the pandemic, differing volumes of the population have chosen to lock themselves down and/or wear masks. If you look at miles driven and stats on mask wearing, Sweden has often looked like many other countries with high compliance. The difference has been that Swedes made their own decisions rather than had decision forced upon them by distrusted "experts."
The result has been ambiguous. Sweden has had a higher death rate than Norway and Denmark (adjacent and culturally similar nations) but Sweden also has a much higher rate of refugee populations which seem to have also suffered disproportionately from Covid-19. On the other hand, compared to most other OECD countries, Sweden has now had several weeks with zero Covid-19 deaths. Is Sweden simply between cycles or has their policy of informing citizens of the best available knowledge and allowing them to decide for themselves worked better? We don't know but Sweden is an uncomfortable case study for the coercive statists wanting to coercively impose policies.
We still don't know what is going on with Covid-19 and the efficiency and effectiveness of all the different policy responses. I think the coercive statist approach is going to end up being discredited but we'll have to wait and see.
With what we know now, how can we better prepare for future surprises?
Focus on institutional and agency credibility.
Do what needs to be done to restore trust.
Avoid wherever possible resorting to blind coercion and punishment of citizens.
Focus on being transparent about decision-making and outcomes.
Focus on developing appropriate measures of diagnosis and performance. Relying solely on cases (which are substantially a function of degree of testing) and not focusing on deaths or excess deaths inclines one to suspect fear mongering rather than real intent to solve a problem.
Always incorporate cost-benefit analysis regardless of how uncomfortable that is.
Always acknowledge trade-off decisions regardless of how uncomfortable that is.
Acknowledge that there will always be a limit in verifiable knowledge when dealing with something novel. I.e. Be Humble.
Communicate more consistently and effectively.
Avoid authoritarian behaviors like limiting free speech.
Avoid mixing scientific debate, policy debate, and political debate.
Focus on points of consensus between "experts", academia, agencies, foundations, political leaders and the public and build on those points of consensus.
Follow the science and trust the "experts" can be reasonable heuristics but only when there is a well-founded consensus on the science (which can still be wrong), and when the "experts" have a track record warranting that trust.
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