How poor is US vaccine response by comparison to other countries?

by aphyer3 min read17th Feb 20219 comments

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Covid-19
Personal Blog

Epistemic status: unapologetically US-centric.  Noticing that I am confused, and hoping the internet will explain things.

SECTION I: OBSERVATIONS

Many places I follow have been saying for a long time that US vaccine procurement and distribution is very poor, and that we could have many more people vaccinated if we would not drag our feet so much/not prosecute people for giving out vaccines when we decide they shouldn't have/etc.  (I won't reiterate details.  For examples, start with e.g. Zvi's post here).  

I'll admit that I am predisposed to this viewpoint, and began with a very negative view of e.g. the Food and Drug Administration, but even taking that into account they seem to have very strong points that the US response has been very very bad.

However, Zvi's post included an image of a graph 'daily COVID-19 vaccines doses administered per 100 people' that confused me by showing the US very near the top:

This is only a 7-day average rather than a longer-term one, but still shows the US doing better than most countries.  I believe I tracked the data source down to https://ourworldindata.org/covid-vaccinations.

When I sort a list of countries there by total # of vaccinations per 100 people, I get the following list of countries above the US:

Gibraltar77.0
Israel76.3
Seychelles56.9
United Arab Emirates51.4
Cayman Islands23.6
United Kingdom23.3
Jersey20.8
Turks and Caicos Islands16.6
Isle of Man16.1
Bermuda16.1
United States15.8

followed by 75 more countries with lower numbers and a bunch more with no data.

Overall, there are 10 countries ahead of the US.  One is the UK (a fairly similar country which is also facing a more dangerous local strain).  One is Israel (commentary withdrawn).  And the other eight, at the risk of seeming like a stereotypical American, are tiny places I didn't even think were countries.  (Isn't the Isle of Man part of the United Kingdom? Why does it get its own row?)

I notice that I am confused.  If the US rollout of vaccines has been this botched, why are we so far ahead of, say, Germany (5.0)?  Or Singapore (4.4)?  Or Switzerland (5.6)? 

SECTION II: EXPLANATIONS

Five explanations spring to mind:

  1. The data for the US is mistaken (too high).  Perhaps we are fraudulently inflating our numbers to look good.
  2. The data for other nations is mistaken (too low).  Perhaps they are not publicizing their vaccine efforts/are distributing through informal networks/otherwise haven't made Our World In Data aware.
  3. The things the US is doing that look like they should be slowing down vaccine deployment are not actually slowing it down.  The Very Serious People are smarter than me and a handful of mostly-libertarian bloggers I follow, and correctly took reasonable safety precautions that did not materially slow the vaccine deployment.
  4. The things the US is doing that look like they should be slowing down vaccine deployment are indeed slowing it down, but almost every other nation is doing just as many things like this (or more) that are just as bad (or worse), I simply haven't heard about e.g. all the things that are going wrong with the vaccine deployment in Italy.
  5. The things the US is doing that look like they should be slowing down vaccine deployment are indeed slowing it down, but we have enough other advantages that this hasn't hurt us that much.  As a large, rich country, and one that infamously pays a lot for medical stuff, we attract substantial investment from medical companies even when we put barriers in their way.  As a result, we can get away with making Pfizer's life very inconvenient, because we're such a big market that we're still more lucrative than e.g. Italy.

Overall I think #4 and #5 sound like the most likely ones - I'm going to be assuming below that the argument is between #4 and #5, though if people want to tell me that obviously #3 is correct I guess I'll listen.

SECTION III:  WHY DOES IT MATTER?

I think there's a substantial difference between these.  In particular, #4 and #5, while they both admit that US policy has been bad, seem to advocate for very different reactions.  

If the FDA is terrible but still far better than its equivalents in almost all other countries, that seems to advocate for a more measured and positive response, and less criticism of them.  

If the FDA is terrible but this is being papered over by our status as a wealthy country and major consumer market, that seems like much worse news.

I don't know how to distinguish these cases from one another, though.  

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Under evidence for #5, the US preordered a large portion of the world's supply of mRNA vaccines for the first half of this year. The EU isn't having trouble with approval or distribution of these vaccines because they can't get them anyway.

Also under probably-#5, the US is sitting on tens of millions of AZ vaccines and waiting for approval, but:

  • Most countries don't have tens of millions of doses of known-good vaccines sitting around
  • Most countries don't have a large supply of the even better mRNA vaccines

Basically, the US did so well on the planning ahead/throwing money at it phase (at least compared to the even worse planning in most countries) that we have a good supply of vaccines despite doing really badly on the "actually using everything available" part.

Interesting.  To be honest, I'd gotten almost the opposite impression regarding our throwing-money-at-it phase.  Here is one article (found recently with Google, but it seems fairly representative of the sort of things I have been reading about our vaccine acquisition):

Just as thousands of Brits were lining up to get Pfizer’s mRNA COVID-19 vaccine yesterday, a troubling question emerged in the U.S.: Did the United States government fail to lock in enough doses of the vaccine to ensure a broad and quick rollout here?

The short answer appears to be yes.

Pfizer struck a deal with the U.S. government for 100 million doses of its COVID vaccine over the summer, but when the company offered more, [the US] administration declined, according to anonymous sources who spoke to the New York Times.

...

Pfizer and BioNTech went on to lock up supply pacts with other countries. They struck a deal with the U.K. government for 30 million doses in July, and in November nabbed a contract with the European Union for 300 million doses, promising the first deliveries by the end of the year.

It sounds like maybe our throwing-money-at-it phase was #4 (we did badly but other people did even worse), which has led our distribution phase to be #5 (we're doing badly but we have enough of a head start that we're still doing better than most)?  

I think korin43 has it right.

Notably, the article you quote cites the US as doing more poorly than the UK, one of the only large countries to outperform the US in both your rankings. I agree that I've seen a number of articles in that vein, but none of them seem to compare the US to countries other than Israel and the UK.

In comparison with the EU however, US vaccine procurement looks incredible. I'll cite a relatively neutral google news search (https://www.google.com/search?q=EU+vaccine+procurement&hl=en&source=lnms&tbm=nws). For future readers: at the moment this shows many news sources saying things like "why has EU procurement been so bad".

And the other eight, at the risk of seeming like a stereotypical American, are tiny places I didn’t even think were countries. (Isn’t the Isle of Man part of the United Kingdom? Why does it get its own row?)

In fact, most of those eight are part of the UK. Seychelles and the UAE are the only actual countries, the rest are British overseas territories. Not that I can tell you exactly what that means for vaccine rollout, but it does seem pretty relevant. (And your inner stereotypical american gets geography points.)

Presumably the relevant question for vaccine rollout is 'are these places running their own vaccine distribution program, or are they covered under the umbrella of the UK's program.'  My guess would be the latter, leaving a total of four distinct vaccination programs of which one is fairly large, two are medium-sized and one is tiny (the UK, Israel, the UAE and Seychelles) as ones that outperform the US.

Part of the reason the US did well compared to other countries is that they defected and banned exports. US policy that slowed down vaccination in other countries shouldn't be counted in favor of US leadership.

EU policy was really horribe. There's a general believe among EU leaders that they are not supposed to pay as high of a price for drugs as the US does. As a result they negotiated companies down and made their purchase orders to late. European laws often produce stronger regulation then US laws. 

Russia is a sad story. Their policy of both developing a more sophisticated adenovirus vaccine (first and second doses use different adenovirus strains - which means less adverse reactions on the second dose) then the Oxford vaccine and being first to market registering the vaccine early. On the other hand the Russian public doesn't believe the Russian government is good at providing a safe vaccine so despite the vaccine being available to everyone they have low vaccination rates.

I'm disappointed in China. I would have expected the Chinese to ignore the bioethics people, do human challenge trials and bring a vaccine to market relatively soon.

When it comes to Isreal and the United Arab Emirates, it's worth noting that cooperation on vaccines was part of their peace deal. 

I agree that the export ban is not cooperative policy, but I'm unclear if it has an effect.  If the US is banning exports of vaccines, but also paying more for vaccines than the EU, it seems unlikely that vaccines will be exported from the US to the EU anyway?

This (US export ban) is news to me. Can you link to a source for that?

https://www.dw.com/en/opinion-with-covid-vaccines-joe-biden-keeps-america-first-stance/a-56483371 is an article that discusses it. Trump created the export controls and Biden is continuing them.