Covid 5/6: Vaccine Patent Suspension

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Covid-19
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The Biden administration’s latest strategy for the pandemic is to suspend the vaccine patents without compensation. Our life expectancies are lower than they were last week.

It’s a shame. I like the idea of rewarding those who do amazing things for myself and for the world. I like people out there knowing that if they produce amazing things for myself and for the world, they would get rewarded for them. I like the idea of not dying for as long as possible thanks to future developments in medical science. I like being a nation of laws, where the executive doesn’t just take stuff when he feels like it. And I’d like, when nice things are taken away and we mortgage our future, to at least get something out of the exchange.

Alas, the man in charge does not agree, and the government was not content with its previous efforts to sabotage the vaccination effort. That’s how it goes sometimes. You can’t always get what you want. Nor, when no one is given the incentive to produce what you need, are you likely to get that either. 

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: Positivity rate of 3.9% (down 0.5%) and deaths decline by 6%.

Result:

Nailed the positivity rate. Johns Hopkins has us down from 3.9% to an all-time low of 3.6%.  Deaths rising makes no physical sense and the move up doesn’t show up in the Wikipedia data, so this has to be a data fluctuation one way or another. I’m going to guess that it will revert.

Prediction for next week: Positivity rate of 3.5% (down 0.4%) and deaths decline by 7%.

Deaths

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Mar 25-Mar 311445976256412626247
Apr 1-Apr 71098867178911604914
Apr 8-Apr 1410701037162111454873
Apr 15-Apr 21883987174711684785
Apr 22-Apr 287521173160911104644
Apr 29-May 5943122014409714574

The bump up in the West comes from California, which makes it harder to dig in deeply. The bump in the Midwest is more curious, but should reverse soon. Overall we see a disappointingly small decline, but still a decline, and it should pick up speed.

Cases

DateWESTMIDWESTSOUTHNORTHEAST
Mar 18-Mar 2447,92172,81099,568127,421
Mar 25-Mar 3149,66993,690102,134145,933
Apr 1-Apr 752,891112,84898,390140,739
Apr 8-Apr 1460,693124,161110,995137,213
Apr 15-Apr 2154,778107,700110,160119,542
Apr 22-Apr 2854,88788,97397,48278,442
Apr 29-May 552,98478,77885,64168,299

Progress in the West remains slow, but improvement in all regions, with many states seeing large declines. We didn’t sustain the giant improvement rate in the Northeast but we still see pretty great improvement. This is what the endgame looks like. 

India

Things continue to get worse in India, but the graph no longer looks as fully vertical as it did previously, so this continues to count as good news relative to the range of possible outcomes. If things peak not too long from now, it will still be the biggest disaster of the pandemic, but it won’t be anywhere near as bad as things could have gotten.

Vaccinations

We all know how it started. 

How’s it going? Keeping up the momentum?

As a reminder, we were once over 3 million doses, and we’re giving out more second doses now than we were then.

Every week, the graph of vaccinations looks more like the electoral college maps:

I found this chart enlightening when I first saw it:

The problem is that this isn’t what I thought it was. I thought it was what percent of each group did each thing. Instead, it was what percent of everyone who did the thing was in each category. That forces us to consider base rates, which makes the whole thing complicated.

The good news is that even now only 55% or so of all adults are vaccinated, which means that people who are vaccinated are indeed doing more things. Yay!

Indian Strain Does Not Escape from Vaccines

The situation in India is terrible, but at least there is this bit of good news – the vaccines will continue to function, at least against the current strain:

Mutations not being additive seems like very reassuring news, implying that there could be a maximum amount of infectiousness or vaccine escape that a Covid-19-type thing is capable of easily achieving. I don’t see why we would stop using the term double mutant, but it makes it a lot less scary. 

If there’s one place I’m most worried about engaging in motivated reasoning, it’s the possibility of vaccine escape. I notice a much larger flinch away from looking here than I do elsewhere. I think I’ve overcome that flinch, but I could be wrong about that, and it’s a super important thing to not make an effort to avoid seeing. So while I’m confident, I want to task my readers with keeping me honest on this one even more than usual. 

P.1 Is The Medium-Term Infection

In many ways it is better to think of Covid-19 as a series of different infections from different variants. When the English strain shows up, it starts again from patient zero, starts again in each nation and region, and grows. When P.1 shows up and shows it is a more fit strain yet, it does this once again. 

If you’re looking at the endgame scenario, the question is whether we’re seeing an increase or decrease in the most dangerous variant’s numbers in absolute terms rather than relative to the overall number of cases. Thus, in a place like New York, the ‘real’ graph of our future situation is the graph in P.1. 

This is delayed due to how long it takes to do sequencing, but it looks like this:

Compare that to the graph of New York City’s cases, which looks like this:

Things had stabilized for P.1 by early April, when regular cases started cratering. Now, with regular cases declining even more rapidly in percentage terms, things are clearly improving even on the P.1 front, at least somewhat. We’ve passed the next test here, not only the previous one. As additional vaccinations come fully online, things will only improve, and I expect other areas to also hit this target. 

The last month has been far more impressive than it has looked on its surface. We went from mostly the old strain to mostly new strains, and we are still steadily improving overall. The news really is quite good.

I worried last week that in relatively hesitant areas, we might run out of willing arms before we get to herd immunity. That is still a real worry, but I am not worried that large other areas won’t get to New York’s current effective immunity level given how many vaccinated people aren’t yet finished being vaccinated. That doesn’t allow a safe return to normal, but it does allow suppression when combined with moderate levels of precaution from the unvaccinated. My trip to New York this week revealed a city still taking its precautions deeply seriously, despite the majority of people being post-vaccination. I was clearly taking below average amounts of precaution, which was a new experience. 

Exploring Vaccine Hesitancy 

As a reminder, and to avoid any possible misunderstandings, as I keep saying week after week, the vaccines are very safe and super effective. 

If you’re reading this, you almost certainly know this. If you’re reading this somewhere you can get vaccinated, and you haven’t done so yet, stop reading now, go get your first shot. We’ll wait.

Not everyone, unfortunately, is in your epistemic position. Thus, we have vaccine hesitancy. 

What are the real reasons for vaccine hesitancy? There are lots of theories out there, and I’m confident someone cares about any given justification one could come up with, but what are the most common true objections? 

There’s a lot of plausible candidates for the most common true objection.

A survey about vaccine hesitancy in the army has some good data on this, and is worth looking at in detail. I wish the data was better and came with numbers attached, but it’s still good to have a look at the slide of the Top 12 reasons soldiers are refusing vaccinations (it’s pasted here, but it’s a lot easier to read at the link.)

Or in written list form:

  1. It’s not FDA approved.
  2. It hasn’t been proven safe.
  3. What’s the point? I’d still need to wear a mask.
  4. This is the first time I get to tell the army NO!
  5. I am not in a high-risk population.
  6. I already had Covid-19.
  7. The vaccine symptoms are worse than the virus.
  8. The virus has the same morbidity rate then the flu.
  9. I don’t want to get my family sick.
  10. I am being safe. It has kept me healthy so far.
  11. The vaccine may impact my pregnancy.
  12. I just feel skeptical and don’t know what to believe.

It’s also worth taking in the perspective of the writer of the article and of the writer of the slide. Both writesr take it as common knowledge that the reasons to not take the virus are stupid and wrong, and that the job is to fix what’s wrong with these soldiers who are refusing. 

There’s no acknowledgement that maybe we’ve messed up in how we handled this whole thing, or that some of the concerns might be reasonable, or that maybe we treat our enlisted soldiers like garbage or worse and they might really, really want to tell the army where to go. It’s a volunteer army, but the recruiter can lie to you, and once you sign the contract you definitely can’t quit.

Consider this whole thing, as I will do from here, from the perspective of the hesitant soldier.

There are a few categories of objections here.

The first category (1,2,9 and 11) are the straightforward safety concerns. These concerns are wrong, but I say that as someone who knows they are wrong. And the responses suggested here other than to #9 are… not great.

The FDA didn’t approve your energy drink? How is that relevant or in the appropriate reference class? If the vaccines have undergone such a rigorous process as you say, then why hasn’t the FDA approved them? 

The clinical trials were three times as large as normal? How about the one hundred million Americans who got fully vaccinated? Maybe mention that? And again, what’s your answer to the obvious: If it’s so damn safe why hasn’t the FDA fully approved it?

There aren’t any obvious problems with pregnancy? Gee, mister, that makes me feel way better. No idea why we’re voluntarily going with this weaksauce over much stronger alternative arguments. If I’m listening for bullshit, guess what I’m thinking right now? 

In related news, Stat News argues that the emergency use status of the vaccines shouldn’t interfere with vaccine mandates by employers and schools. As a matter of law I think they’re probably right (although of course I Am Not a Lawyer and all that) but as a matter of practicality this is a strong argument that it’s important that the FDA needs to issue a full approval. We’ve just had the biggest Phase 4 in history. Taking at least Pfizer and Moderna from ‘emergency’ use to full approval would do a lot to reduce hesitancy and free the hands of those who want to mandate vaccinations, without being coercive. 

If you want to solve this issue, the FDA should simply approve the vaccines, full stop, not simply emergency use. Problem solved. 

If not, the response to a soldier should be that the FDA are a bunch of ass-covering assholes who would prefer never to actually approve anything, and maybe that would get through to them in a language they can understand. 

The second category (7, 8 and 10) are claims that Covid-19 isn’t that big a deal compared to the cost of getting the vaccine. 

Here we see that response #10 says both “masks and social distancing work” and then goes straight to “but they don’t ‘directly combat’ the virus” implying they don’t count. When you’re lying about everything, it’s hard to keep your lies consistent, so I guess I’m somewhat sympathetic to this local predicament, but man it’s glaring. 

The answer to #7 isn’t going to convince actual anyone. The ‘mild symptoms lasting 24-72 hours’ are exactly what the soldiers are complaining about, and the response is to tell them they’re imagining things, which they most definitely aren’t. Smooth. 

For #8 they quote some statistics and it seems fine, I guess, although it leaves some ammo on the table. It’s kind of bending over backwards to be maximally generous to the flu’s deadliness. I’d have gone with different wording, but mostly this one is fine. 

It’s interesting when they strengthen the answer to the point of deception, and when they weaken the response to the point where it doesn’t respond to the concern. 

The third category (3, 5, 6) are claims that it’s not in the soldier’s personal interest to get vaccinated, because they’re young and healthy, as most active soldiers are, so why should they get sick for several days and maybe face risks they don’t know about? This also overlaps with 7. 

The response to #6 isn’t an outright lie exactly, since the word ‘may’ does a lot of work. The sun might have just exploded. But in practice, yeah, this is lying.  

The response to #3 is, and I quote, “F*** you.” If you all mostly comply, we’ll lift the outdoor mask mandate? That’s your pitch?

The response to #5 is, and I quote, “F*** you.” Or, technically, ‘it’s not about you.’ It completely accepts the (incorrect) premise that the soldier doesn’t benefit, which doesn’t seem like the approach I would take.  

Then there are two standalones.

There’s the remarkable #4: This is the first time I get to tell the army, NO!

And oh my is the answer to that one “F*** you.”

Which leaves #12, which is the most interesting of the responses. 

That’s because the soldier has spoken The Words, and has spoken them rightly.  

Rather than voice a specific and explicit concrete objection, to which the answer of necessity is going to be some combination of ‘you’re wrong’ and ‘F*** you,’ the soldier has given a general feeling of uncertainty without any concrete objection. Thus, there’s no way to say they are wrong, and no basis to curse them out. 

Instead, “I just feel skeptical and don’t know what to believe” elicits this response:

“The choice to get vaccinated is a personal decision and should not be taken lightly. Talk to a medical professional, consult the FDA Factsheet, and review the educational materials available at www.carson.army.mil and from the CDC to weigh risks and benefits.”

Suddenly we’re acting like this is a Very Reasonable and Responsible Position, which needs to be solved by consulting official sources and doing further research. Only after that, when the soldier comes back with an actual concern, can we know which of our two responses to use, and justify using it. I mean, there’s no way this person is skeptical after talking to all the Responsible Authority Figures, right?

NPR claims that lower rates of vaccinations among blacks and latinos are entirely due to accessibility issues and have nothing to do with hesitancy. I completely buy that the access issues are doing a lot of work here, but it seems odd to attempt to suddenly shift from “here are all the legitimate and sympathetic reasons why these groups would be hesitant” into “they are not and have never been hesitant, it’s that we didn’t give them access and made access depend on things that systematically excluded them.”

It’s a claim that we’ll be able to evaluate soon enough. As appointments become widely available via walk-ins in more places, with essentially no hoops involved, either the rates will converge or they won’t. I am skeptical because it seems like it’s a motivated shift in explanation rather than an attempt to track the truth – we want to make skepticism more blameworthy, so we need to not identify these increasingly blameworthy motives in the wrong places, hence the shift. I am only somewhat skeptical because it seems clear that providing easier access has a dramatic effect on vaccination rates. 

Overall, that evidence means that the article seems like very good news. What it does make a strong case for is that there is a lot of ‘soft demand.’ The bad scenario for where we are would be that 60% of eligible people have already been vaccinated, and most of the remaining 40% are actively having none of it. They are like the soldiers. They won’t accept the shot unless convinced or heavily coerced. 

Instead, this new picture finds evidence that what we have are a lot of people who prefer being vaccinated to not being vaccinated, but don’t prefer it enough to jump through a bunch of hoops. That’s great! All we have to do is get rid of the hoops and the need to jump through them, and offer them easy access. Now that we have abundant supply, that is relatively easy. Certainly I buy the anecdote that Asians have relatively low levels of hesitancy when given good access. 

As someone who spent a substantial amount of time and effort to get vaccinated earlier rather than later, and to get those around him vaccinated earlier rather than later, I think those unwilling to do so are setting their price too low. We can separate this setting of a low-price into a few different components. 

One explanation, which is the most hopeful with respect to the vaccines, is that their circumstances mean that paying the relevant costs is more expensive, and they have less ability to pay such costs. They care, but as the article claims, they are simply unable to take even a few hours off of work, or figure out how to navigate the barriers previously required. There is some of this, but we have some evidence that is then hard to explain if this is the main thing happening, such as the failure of J&J shots to rebound, and the distribution of shots on different days of the week. 

J&J shots are going, well, not great:

If people simply cannot miss work, and are worried about side effects causing them to miss work in addition to the appointment itself, this suggests people will plan their shot around not missing work. That means getting a shot on Friday or Saturday, and yes we see giant spikes in shots given on Fridays and Saturdays, including during periods when supply constraints looked like they were binding. That seems like strong support. We’ll see if this can be sustained; if this theory is correct, Friday and Saturday throughput should continue to bind. 

A second explanation is that this is shallow demand, pure and simple. If someone wouldn’t be willing to spend much time, let alone much money, to get a vaccine, that’s a revealed preference that they don’t value the vaccine much. This seems highly plausible to me, that there are essentially three camps rather than two camps. There’s the people who want the vaccine enough to ‘bid’ on it in various ways and make it a priority. There’s the people who actively don’t want the vaccine, often violently so. But then there’s also a large group, plausibly larger than the second group, who are fine with it but are mostly trying to live their lives and value the vaccine at some positive but small number. 

I wonder how much of that is because we’ve set the price of the vaccine, and much of health care, to $0, thus sending the implicit message that such services are, in emergencies, not that valuable. And also the general instinct to not think about one’s health when one isn’t forced to. We do seem to see a pattern of people who have the ability to get expensive medical care that they ‘should’ want, but not to spend small amounts of time (and aggravation) to collect it. 

What’s The Worst Possible Thing You Could Do?

If you’re the President of the United States, in terms of actual impact the answer is presumably ‘launch all the nuclear warheads.’ 

If one restricts to the pandemic, the answer would be to sabotage vaccine production and distribution. Nothing else comes close. One could plausibly argue that nothing else even much matters.

How would one sabotage vaccine production and distribution? 

Sabotaging distribution means doing things like not approving known-to-be-safe-and-effective vaccines, or suspending existing approvals and sending the message the vaccines are unsafe, or holding up distribution to worry about things like equity, or holding onto vaccine doses for extended periods with no intent of approving them ever. 

Oh, wait. Those are all things done by the Federal Government during the Biden administration, with no visible attempt to prevent them from happening or even regret expressed about them. You could even add, during the campaign, questioning the vaccine development process as ‘rushed’ or ‘politically motivated,’ plausibly being the cause of vaccines not getting approved a month earlier and creating much additional vaccine hesitancy.  

You’d also give doses to children who don’t need them rather than those in other countries that badly need them, so naturally Pfizer is on that one and soon will be applying for approval for children as young as two years old. And of course you’d continue not to do the first doses first, and continue to use full way-too-big doses of Moderna, and so on and so forth. 

None of that means one couldn’t have done or in the future do more of those things, so actions haven’t been maximally destructive. But they’ve been quite destructive. 

The other half of the worst thing you could do is sabotaging production. The easy way to do this is to screw up distribution. If things aren’t approved yet, at best then that’s going to slow down production until after approval. So are all the regulations involved in production, like needing to apply for permission and wait substantial time for permission for things like ‘put more of the vaccine into each vial because we’re short on vials.’ 

That’s all passive resistance to lifesaving medicine. Could we kick this up a notch or two?

The ultimate way to hurt vaccine production, not only now but indefinitely into the future, would of course be to destroy the financial incentive to produce vaccines. The less you’re willing to pay, and the less you let companies profit, and the less you reward those companies for quick scaling up and delivery of production, the less doses you’ll get. This starts with not paying for building production capacity, and its central action is not paying much per dose or paying more for early delivery. If you want to go for bonus points, you can be like Europe and hold up negotiations for weeks to drive down the price even lower. 

That’s all negative actions, though. It’s easy to sabotage efforts by not doing the right thing, especially when the right thing costs tiny amounts of money and looks like rewarding corporations, and is an action rather than inaction and thus blameworthy. 

So it’s a big step-up in the civilizational sabotage game to actively take away the incentive to create vaccines, by stripping away intellectual property protections without any compensation, in the middle of a pandemic:

There’s a simple solution to the problem of intellectual property if you wanted to make the situation better rather than worse. You could buy the intellectual property rights from the companies involved. So, basically, this:

It’s not that much money, everyone would be happy, and the precedent would be excellent. Pay enough, and they’ll even aid you in technology transfers. Even better, you could repeat this process with other drugs. Buy out the monopoly at its economic value, remove protections, and the people save many times that much money in costs. It’s a great idea.

Doing this without compensation is about the worst thing one could do. If your new ideas outright save the world, we’re going to reward you by confiscating them, voiding the contracts and promises agreed upon and informing you that we are not a nation of laws. That’s exactly how not to get vaccines next time there’s a crisis, or anything else next time there’s a crisis, or really anything else useful at any time for any reason.

The message we’ve sent, loud and clear, is that we are not a nation of laws and we do not reward those who deliver the goods for us. Instead, we retain protections on things like insulin that are pure rent seeking, while taking away protections that are doing exactly what patents are designed to do: reward those who produce world-changing positive innovations via temporary ability to profit. 

We are a nation of a person in charge, and if that person decides to confiscate your property because it’s good politics, well, tough. 

It’s a horrible, horrible precedent. We will pay for it in money, will pay for it with our freedom, and we will ultimately pay for it in blood.

mRNA vaccine technology is potentially a full cure for infectious disease, and plausibly also a cure for cancer. The federal government sabotaged all that, big time.

What did we get in exchange? What’s in the box?

NOTHING!

Unless, of course, they are not so stupid In which case the destruction of the rule of law and of private incentives, and the signaling that political expediency is the most important thing, was the point.

You see, this will not increase vaccine production (MR link with full explanation, recommended), for two reasons, even if vaccine ingredients didn’t prove to be limiting factors. MR also recommends this Barron’s column. Here’s another confirmation that no, this won’t improve short term supply.

Many people have this idea that all the knowledge and skill required to produce the vaccines lies in the patents. Once you lift the patents, lots of other companies can go start producing vaccines. Except, that’s not actually true because

  1. The vaccines require technical expertise not included in the patents, which is expensive and slow to transfer, and which would also transfer valuable knowledge that can be used for other R&D and other production and thus which the vaccine producers are not going to transfer without compensation.
  2. Moderna explicitly already said they wouldn’t enforce the patents, and no one really expected the others to either.

Read that second one again, if it’s new to you. The greedy capitalists whose rights you took away without compensation were already voluntarily giving those rights away. If there was already clearly no intent to enforce the patents, what good does lifting those patents do?

It sends the message that the United States is willing to confiscate property for political gain, when it feels like it, on the basis of the executive’s say so. 

Even though that won’t produce anything useful, yes, it’s still bad for business and still punishes exactly who we should be rewarding, or at least demonstrates that such punishments should be expected, as measured by the stock market. Remember Moderna already waived its rights:

As usual, the usual suspects wasted actual zero time demonstrating exactly the slipperiness of the associates slopes, as they quote the decline in shareholder value as a good thing:

What makes such a statement so maddening is that she’s right. We should totally do insulin! It’s completely insane that we’ve allowed regulatory capture and rent seeking via intellectual property protections on “inventions” like insulin. The congress should get together, write a bill and pass a law that stops such things from happening now or in the future via changing protections, ideally without confiscating private property, and then the President should sign it, and then the bill should become law. Then do copyright.

Won’t Someone Please Think of the Children?

The minds of many parents I know are turning to the question of summer camp. Is it safe to send your young child? 

Are all the people you care about that will be in contact with that child either other young children or fully vaccinated by the time the camp starts?

If the answer to that question is yes, then yes. 

If the answer to that question is no, then given that vaccinations are now available to everyone pretty much on demand, why isn’t the answer yes? 

If the answer to that question is that someone is seriously immunocompromised, or otherwise super important to the child’s life and won’t get vaccinated (for whatever reason), then and only then is it time to look at the camp’s procedures to see whether you’re comfortable with the level of risk being taken. In particular, you’ll need to ask how many children and unvaccinated adults will be in contact with your child, how close that contact will be, and how much time will be spent indoors, and do a calculation.

I still think that calculation should almost certainly be ‘yeah, it’s fine’ but at that point, as they say in the advertising business, it’s up to you. 

My general answers regarding children generalize this. Young children are not at enough risk from Covid to let this change how they live their lives, so them catching it only matters to the extent that they would pass it on to vulnerable others. 

By the end of May, with notably rare exceptions, patience with those in the United States who are still vulnerable can reasonably be at an end. Those who decline the opportunity to be vaccinated can manage their risk however they choose, but life beckons.

Speaking of life beckoning: I strive not to use the word evil, I avoided using it in the previous section, but this is evil in its purest form:

Anyone who doesn’t recognize this as such has lost their soul. Any parent or teacher who enforces this should be treated as the mustache-twirling villain they are. I am deeply sorry to any child who has been so absurd and tortured, or living in so much fear, that they are tempted to put up with this. 

If you do not think school’s primary nature is ‘child prison’ and/or that those running it are pro-children, then you have new data your model needs to somehow explain. 

In Other News

V-NY day approaches, and Cuomo fully opens up stadiums, opens up Broadway, offers subsidized vaccinations at Mets and Yankees games. Took everyone on Broadway by surprise, so it’ll be a while before they can actually get on with the show. Remember, you’ll want to wait to get vaccinated until you attend a game at the stadium, together with tens of thousands of other people. That way you get free tickets! 

Alternatively, you can show up at the local CVS and maybe pick up a gift as well :

In many cases, Walmart too. Basically everywhere at this point. No excuses!

South Korea says AstraZeneca shot 87% effective after one dose. Which would be pretty good after two doses. First doses first, indeed.

Police have low rates of vaccination, endangering those around them who they forcibly interact with and likely killing them (WaPo), but no one is able to make them do the right thing and stop endangering the public. A little on the nose, if you ask me.

Airline boarding procedures were already worse than random, and changes in response to the pandemic made them worse still. It seems that looking like a good procedure is more valued than being an actually good procedure. There seems to be a strong match between ‘this is a quick boarding procedure’ and ‘this is a safe procedure,’ so the problem is purely that good procedures don’t look good and/or don’t feel ‘fair’ somehow, or miss out on some opportunity for price discrimination. Is there an improvement that would also look and feel like one?

MIT requires vaccinations, although so far only for students. I expect most colleges to follow suit if only to avoid potential liability concerns. Not spreading the requirement to faculty and staff seems like a clear mistake.  

New higher estimate of true number of Covid deaths via MR, not enough data to know how much credit to give this.

The Covid Response Project chronicles the Covid-related experiences of people across different states. I’ve sampled and it seems like a good source of real people’s anecdata. There will definitely be surprises.

Twitter thread and paper discussing origin of variants of concern. Not sure there’s practical updates to be had, but interesting information.

Pfizer begins shipping some vaccine doses manufactured in the United States abroad, starting with Mexico.

Potential universal coronavirus vaccine proposal. From what I can tell this is highly unlikely to work but you never know.

Vaccination availability site of the week, Vaccinate the States

Marginal Revolution points us to a study of future work-from-home (WFH) patterns (paper), and finds dramatic effects the study expects to linger beyond the pandemic. I hope to check this out in detail in the future, but the headline impacts are gigantic. They expect WFH to go from 5% of full workdays to 20%, and for this to be a 5% productivity boost, most of which will be due to reduced commuting. Commuting is much worse than people think it is, so this is a really, dramatically large effect, in the range of ‘potentially a bigger long term deal than the pandemic.’ This isn’t a fake productivity boost, it’s literally getting rid of purely wasted unpleasant time (that also burns a bunch of carbon to boot). Given the amount of time being saved, it also implies that on the margin there’s still going to be a dramatic underutilization of WFH as an option. If a change to 15% of the workforce produces a 5% productivity boost by saving useless time (and it’s still an if, the story has to check out), clearly we are not using anywhere near enough of it. 

Not Covid, therefore… we’re coming back, baby! HYPE!

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"If your new ideas outright save the world, we’re going to reward you by confiscating them, voiding the contracts and promises agreed upon and informing you that we are not a nation of laws."

OK, that's a little much. The U.S. is not itself doing the waiver. The administration expressed its support for negotiating  waiver language to be submitted to the WTO. They're 100% deferring to the WTO's jurisdiction over international intellectual property law. So it's a bit of a stretch to say that they're "confiscating" anything simply for operating pursuant to Article 31(b) of the TRIPS agreement which states that the requirement to make "efforts to obtain authorization from the right holder on reasonable commercial terms and conditions and that such efforts have not been successful within a reasonable period of time...may be waived by a Member in the case of a national emergency or other circumstances of extreme urgency..." There you have it - it's right there in the language of the trade agreement. Trade agreements  are a legitimate "source of law" and if a contract is consummated in a jurisdiction that's party to an existing trade agreement, the trade agreement wins. That's the antithesis of the kind of anarchy you're suggesting. 

The companies knew that TRIPS allowed for exceptions in cases of global emergencies when they developed the vaccines. Indeed, the fact that they were so quick on the draw with talking points suggests that they had contingency plans for exactly this scenario. Heck, there are probably surplus insurance lines that cover stuff like this.

Look, reasonable people can disagree about whether it's shrewd to waive intellectual property rights - whether it's the U.S. or the WTO doing the waiving. But please don't conflate jurisdictions.

 

P.S. "Waiver" is a bit of a term of art when talking about statutes, treaties, etc. (in contrast to words like "suspension"). It generally suggests that there's already language in the underlying law that allows for exceptions under certain circumstances. Usually it's accompanied by a specific citation which evolves into some sort of shorthand (kind of like the way people talk casually about their 401(k)'s). It probably would have been better if this had been communicated earlier, and we could have a more prosaic conversation about the merits of a "31(b)". 

I also think that, even assuming that the US was unilaterally "confiscating" these companies' IP, it's not clear what the actual impact on future innovation would be, since:

  1. This is clearly a unique situation. It's unlikely that these corporations would make the assumption that all future IP would also be "confiscated"
  2. Even if they made that assumption, what are they supposed to do? Stop investing in future developments, and slowly go out of business? A much better option would be to just not get any IP protections at all, but instead rely on trade secrets to protect investments. This would probably end in a more competitive market; since the consensus among economists who specifically do research on this topic seems to be that IP laws hurt more than they help.

It should also be noted that these corporations profit from voided IP protections, since they all also produce generic medicinal products.

This is clearly a unique situation. 

No, that's like saying: Needing stock-pilled masks is a unique situation that nobody could forsee. 

There might be another pandemic and we want to be prepared for that. We want companies to invest in being able to produce vaccines on short notice in case of a future pandemic and that won't happen if it's not lucrative to be able to produce vaccines on short notice in future pandemics. 

Stop investing in future developments, and slowly go out of business? 

No, just stop investing in pandemic preparedness (or not start to invest).

Even looking more broadly we also prefer that big pharma invests into research instead of investing into stock buybacks. 

It's unlikely that these corporations would make the assumption that all future IP would also be "confiscated"

Do you have a good explanation to Moderna's market price drop?

Even if they made that assumption, what are they supposed to do? Stop investing in future developments, and slowly go out of business?

Borrow less, invest less, or, as you say in your last line, focus on other ways of making money that don't require innovation and IP?

Neither the Moderna nor the Pfizer stocks dropped very dramatically - both had solid upward trends throughout the past month, and the prices are already bouncing back. Investors make mistakes too.

Do you have a good explanation to Moderna's market price drop?

 

1 - it was tiny compared to recent changes

2 - the efficient market hypothesis is quite quite false.

Using the efficient market hypothesis to access what the true price of a security should be doesn't work. On the other hand the stock price is a good reflection of what Wall Street thinks and that's what's important for how capital gets allocated. 

I am a strong believer in reading a short-term reaction to news as the stock market's true opinion about a development, whether or not one believes the underlying price was reasonable.

When my dad worked at GE, sometimes they would hire people who had worked at Pratt and Whitney. When there was a meeting and the topic started to veer towards trade secrets that the former P&W employee knew, they would "self police."

Generally speaking trade secrets are much more important than patents.

I think you may have misread the "Unvaccinated and undeterred" graph (which is terrible and misleading). 

All the numbers in each section add up to 100%, so it's saying "53% of people who dined in restaurants were unvaccinated" not "53% of unvaccinated people dined in restaurants". So you have to consider base rates. The numbers for half-vaccinated people were lower mostly because there are fewer half-vaccinated people than there are of the other groups.

(Saw this on twitter but I don't remember from who.)

Yep, good catch, updated original. Mods, please reimport.

The Biden administration’s latest strategy for the pandemic is to suspend the vaccine patents without compensation. Our life expectancies are lower than they were last week. [...]

Many people have this idea that all the knowledge and skill required to produce the vaccines lies in the patents. Once you lift the patents, lots of other companies can go start producing vaccines. Except, that’s not actually true because

  1. The vaccines require technical expertise not included in the patents, which is expensive and slow to transfer, and which would also transfer valuable knowledge that can be used for other R&D and other production and thus which the vaccine producers are not going to transfer without compensation.
  2. Moderna explicitly already said they wouldn’t enforce the patents, and no one really expected the others to either.

Read that second one again, if it’s new to you. The greedy capitalists whose rights you took away without compensation were already voluntarily giving those rights away. If there was already clearly no intent to enforce the patents, what good does lifting those patents do?

It feels odd to me to simultaneously argue that patents were unimportant and unenforced anyway so this will produce no benefit, and that the decision to suspend patents will hurt the drug companies so much that in the future they have less of an incentive to invest in drug development?

Seems like "this will kill people" is premised on the assumption that the next time something like COVID happens, drug companies will remember what happened last so will be less incentivized to invest. But if the thing that they remember the next time is "governments did this purely symbolic gesture that didn't really affect our profits in any way but made their voters happier", then it would seem like they should have no particular reason to act any different?

It feels odd to me to simultaneously argue that patents were unimportant and unenforced anyway so this will produce no benefit, and that the decision to suspend patents will hurt the drug companies so much that in the future they have less of an incentive to invest in drug development? 

I was also confused by this, but I can imagine the following scenario: 

There are 5 companies in the world with the necessary institutional knowledge to manufacture vaccines. Because of IP laws, the only way for them to manufacture a vaccine is to either license it or invent it. So by now, all of those companies have done one of either.  Voiding the patents now would not make a difference. 

However, if there is a new pandemic with the understanding that all vaccine patents will be voided as soon as they are filed (as an extreme case), why would Pfizer sink money into research when they know that Moderna definitely has the knowledge to manufacture mRNA vaccines and thus would copy it immediately. 

Basically (bad metaphor incoming), the first mover disadvantage does not occur when the moves are only seen after everybody has moved already.

Again, it needs to be stressed: nobody is voiding international intellectual property at this time. The only thing that's at issue is whether the WTO should grant a waiver pursuant to Article 31(b) of TRIPS. (Even the waiver doesn't "void" or "confiscate" IP). This is probably inevitable with or without the US, since a solid majority of member states have already endorsed this. So this gesture means that the US can at least have a say in the final language, minimizing the worst case scenario. It's arguably the best thing the US can do for pharmaceutical companies. Having the pharmaceutical companies make a fuss about it will also help (and I wouldn't be at all surprised if the administration gave them the heads up).

Seems like "this will kill people" is premised on the assumption that the next time something like COVID happens, drug companies will remember what happened last so will be less incentivized to invest.

We don't want drug companies to wait for a pandemic to hit to invest into drugs that would be useful for the pandemic. 

Before the pandemic we had drug companies not investing much into research that would be very helpful when a Coronovirus pandemic hit. The kind of research that CEPI financed largely wasn't of interest to big pharma. It would be great if that would change so that in case a future pandemic hits we are better prepared. 

Making it lucrative to have vaccine in this pandemic would be a justification for big pharma to invest into research that helps in the next pandemic. It's very important for Big Pharma to justify research expenses to their shareholders. 

The reaction of the financial markets does show that the event matters to shareholders and that's what drives decisions in Big Pharma.

I had that same question. But is there a middle ground, where these companies wouldn't enforce parents during a global emergency, but would expect to profit from the patents once the emergency is over? And that this expectation of delayed profits is a factor in their original decision to innovate?

It's always an emergency, lives are always at stake. That's just the nature of the pharmaceutical business. 

The stock market disagrees.

Is it disagreeing with the OP's original premise of "lifting the patents doesn't do anything", or with my inference of "if lifting the patents doesn't do anything, then it won't change future drug company behavior either"? I'm not sure how I'd tell, but I'd presume the more near-term premise of "lifting the patents does(n't) do anything" would have a bigger effect on immediate stock prices.

I think it's mostly the setting of a precedent of stripping away intellectual property rights for political expediency that is worrisome. It's a small step in undermining the rule of law, but a step nonetheless. The symbolic gesture is the problem; it signals to the public that such moves are now not only acceptable, but applaudable.

They were already acceptable under TRIPS.

It's the perception that matters.

That's on impulsive investors who didn't bother familiarizing themselves with international trade agreements.

A little more context on the Army vaccine reticence, based on an enlisted experience 2007-2012:

The base level of trust among soldiers is much lower than among civilians with respect to vaccines. There are a few reasons for this:

  • Huge victories like smallpox are not factors in our thinking, because we still get the smallpox vaccine. This is because it still exists in weapons stockpiles.
  • The military in general and Army in particular are super awful about messaging. Partially this is a matter of institutional ignorance, but mostly this is a matter of the communication arms being staffed by people who are chosen for the relevant training largely by lottery among the least qualified people available, and then assigned also largely by lottery. Most jobs that aren't combat-related are like this.
  • They bitterly bungled their last major vaccine push, the Anthrax Vaccine Immunization Program.

I was there through the tail-end of the Anthrax fiasco. For clarity I took the vaccine without objection, but it was clearly being managed poorly; they went light on medical justification and heavy on threats and non-judicial punishment while issuing blanket rejections of any kind of bad facts and not being able to articulate anything positive. I have no source for this, but the rumors going around at the time said that 4000 guys in the first wave got erectile disfunction, which couldn't have been more effective at terrifying a bunch of 18-25 hard-living dudes if it had been designed by a civilization with far more knowledge of group behavior than we now possess.

I fear I might have lost my soul as I don't understand why NYC  having remote days instead of snow days is "evil".  Snow days are usually made up at the end of the school year, while I presume remote days will not be.  So why is it evil to extend summer vacation at the expense of having a few remote days?

My read on it is that even if snow days don't actually mean less school since the days are made up, it's still something that is really exciting for kids. And so taking away a huge amount of excitement and joy in exchange for keeping things "on schedule" is a bad tradeoff.

That still makes the OP sound rather extreme, though:

If you do not think school’s primary nature is ‘child prison’ and/or that those running it are pro-children, then you have new data your model needs to somehow explain. 

"The people running the school system genuinely think that school is for education and learning, and are happy to have found an option that would allow children to keep learning even on days when they otherwise wouldn't have" seems like a perfectly reasonable explanation, even if one disagrees with that reasoning.

Yeah, it seems extremely easy to incorporate this into a pro-school model, and I'm confused as to why someone might think it isn't.

Like, if you think school is actually good (on average), of course you think that finding a way to let kids not miss school is plausibly good.

Presumably the fact that kids miss out on the joy of snow is a cost, which is why I only said "plausibly good" above, but now we're arguing about the optimal trade-off, at which point we're firmly in Policy Debates Should Not Appear One-Sided territory.

Thanks, I had forgotten the joy kids experience from having snow days.

"Snow days are usually made up at the end of the school year"

They what?! That seems like an extended prison sentence...

My experience with elementary and middle school was that small numbers of snow days were not made up at the end of the year, but if more than a week or so was lost due to snow days, then the year would be extended. This appears to be the case in at least some other parts of the country as well. From a quick search: in Michigan "schools can be closed for up to six days before they must make up time to receive full funding from the state."

The graph in the CNBC tweet seems pretty misleading without context, and I've seen it criticized elsewhere for this reason. Since roughly the start of 2020, NovaVax stock is up 4300%, Moderna is up 730%, and BioNTech is up 460%. (Pfizer is only up 6%, but it's also about an order of magnitude larger, so a single product line would not have the same effect on the stock price.) Three of the four are still higher than they were in just mid-April; NovaVax is about the same as it was. And I'm trying to be conservative here, and attribute all the recent price drops to the patent issue, but the biggest drops happened in the week before 5/5, and are not visible on the graph in the tweet.

Granted, the stock prices have recovered a bit since you wrote this, which is information you didn't have, but even still -- the price drop depicted in that tweet is a pretty minor fluctuation in the context of even a week or two of price movements, and even considering the total drop from most recent peak to now (which has different timing for each stock, so presumably they aren't 100% from a common cause) you're looking at drops of 3-25%, which is obviously not tiny, but it hasn't come anywhere near wiping out the tremendous growth in the value that the market has placed on these companies since the start of COVID. The market doesn't love this news, but it still likes all four companies pretty well regardless.

Another great article! I just want to slightly correct the statement on Broadway (source: I am a techie in the NYC area). 

Broadway has been shooting for a fall opening for some time before Cuomo's press conference (source), even while smaller Off-Broadway theatres have already started.  A full Broadway production, especially the expensive spectacle-driven musicals (Lion King, Wicked, etc.), can not run at a profit for long (source for those interested in a breakdown of just how expensive Broadway is to produce) with anything less than 100% capacity. Industry reasoning is that September/October is when people (especially tourists, which are the bulk of audiences) are willing to return to theatres.

Essentially, while Cuomo's announcement was a surprise, nobody was looking to open in May regardless of Cuomo. A delay implies being slower than originally planned, and Broadway productions are currently still on schedule for a fall opening.

"stripping away intellectual property protections without any compensation"

Isn't the AstraZeneca vaccine almost entirely financed with government funding? Even the ostensibly privately funded vaccines depend heavily on funding provided by taxpayers.

So as a taxpayer, not only am I funding the development of these vaccines, I'm also then funding government force to protect private monopolies on these vaccines. Regardless of the short-term implications of IP waivers, it seems clear to me that this is not a sound system, and that the incentives for creating these vaccines were strongly dependent on taxpayer funds, not by the possible long-term value of any IP generated by this research.

Police have low rates of vaccination, endangering those around them who they forcibly interact with and likely killing them (WaPo), but no one is able to make them do the right thing and stop endangering the public. A little on the nose, if you ask me.

Can someone run the numbers of the expected number of Blacks killed by the police this way? I imagine an article titled: How the police is killing Black people.

Since black people are about five times as likely to be stopped by the police (and thus probably more likely to have close contact with police officers), and since there seems to be more vaccine hesitancy among black people than white people, it is indeed likely that this will affect black people more than it will affect white people.

After thinking about this some more, part of the reason I'm having trouble with the point on IP waivers being made in this post is that it assumes that one thing will be done (in this case, IP waivers), and that everything else will remain the same. But that's not usually how things work out. Every change we make has follow-on effects, which also have follow-on effects, and so on. If IP waivers cause biotech companies to not be incentivized to create vaccines, but if there is a huge need for vaccines, public funding will take the place of IP incentives. This could end up being a huge improvement over the current incentives, which prioritize the most profitable investments, rather than the most needed ones.

If IP waivers cause biotech companies to not be incentivized to create vaccines, but if there is a huge need for vaccines, public funding will take the place of IP incentives. 

How well does public funding for antibiotics where selling newly developed one's for profit is effectively outlawed work at the moment?

It seem to me that it works pretty poorly and I see no reason for it to be different with government funded vaccines. 

That's...not a great comparison. There are pretty good public health reasons NOT to be hasty in developing new antibiotics, regardless of the funding model.

I don't think any new drug development (outside developing vaccine's against a targeted that's easy to vaccinate against because of prior research) is well described as 'hasty'. While I think it's worth arguing that developing antibiotics is stupid, the policy circles who care about the topic do think that it's valuable to develop new antibiotics. 

If they would change the regulations to allow for phage therapy and fund it I would also be okay with that, but they do neither. 

absurd -> abused

With certain states having much higher rates of vaccination than others, eg Vermont being up around 60%, I feel like that should give us some really good info on when herd immunity happens. Especially if you dig deeper into counties. Anyone have any insight here?

What is the best data source for the reduced danger among children that I can use to help assure my wife that the kids will be OK in camps despite not being vaccinated? We're both double-dosed and will do so for them when possible, but if these things can be done safely then I want to push hard for them to do so. They've endured enough.

Quick Googling for long covid in children brings me to Children with long covid:

Evidence from the first study of long covid in children suggests that more than half of children aged between 6 and 16 years old who contract the virus have at least one symptom lasting more than 120 days, with 42.6 per cent impaired by these symptoms during daily activities.

That study is exactly as useless as the totally implausible sounding result would lead you to think. It has no control group (so it's counting the 10% of children who have problems like "headache" or "lack of concentration" months after infection as having a COVID symptom), the methodology of how children were selected is a total mystery (but 5% of them were hospitalized, so it's clearly biased towards dramatically more severe cases than the general population) and the sample size is tiny.

I don't know the best way to figure out how much kids are at risk but it doesn't have anything to do with reading that.

Yeah, this is the problem I'm having with data on children - the simple cases/hospitalizations/deaths numbers are obviously good, but I'm struggling to find a robust study that more conclusively assures the risk rate in the younger age range. It's easy to otherwise dismiss it as a simple matter of most kids being shut in over the past year versus the necessary adult workforce.

I think that the actual cost and effort in many forms of biotech is rapidly declining. Meanwhile, the medical moloch is only growing. We have already passed the cutoff point for some diseases, in that the cost and effort of getting a cure approved is higher than the cost and effort of making a cure. (I think this was at least true for covid vaccines) I think we might get to a point where back bedroom biohackers can cure cancer (or some other major diseases) and no cure has been approved. The companies will be prioritizing the most profitable and easiest to get approval for treatments. The biohackers are going for anything cool. The result is a world where american doctors offices look similar to today, but you can buy working cancer cures from shady foreign websites, or make your own if you can follow online instructions well and buy a few $100 of equipment and supplies.

Doing this without compensation is about the worst thing one could do. If your new ideas outright save the world, we’re going to reward you by confiscating them, voiding the contracts and promises agreed upon and informing you that we are not a nation of laws.

The US is partly a nation of laws, so we will have years of court battles till the Supreme Court rules on the issue. You probably a year till the Supreme Court decides during which no other company will want to move in because the Supreme Court might very well side with the companies.

SCOTUS doesn't have jurisdiction over the WTO.

Both writesr take it as common knowledge that the reasons to not take the virus are stupid and wrong, and that the job is to fix what’s wrong with these soldiers who are refusing. 

"writers" and "not take the vaccine", no?

I had a somewhat strong reaction that seemed mindkillingly ideological (for and in my mind against) so i had a cool-off period and didn't immidietly reply. I am not confident or comfotable to make global judgement so some of the local issues I have with messing with IP rights.

Being allowed to do an error

Everybody has a button but has promised not to press their button. If their word is reliable then taking the button away should not change the amount of buttons pressed. Usually when arguing for freedom it is because in some important case exercising that right gives a good outcome. If everybody agrees that the button is bad why is the right important? You don't put the Petrov day button to the hands of as many people as you can. I guess the Petrov day button is a trust exercise so this would signal distrust. Also not exercising a right doesn't give the right away.

Writing down to an agreement and living it

The WTO thing invokes an already written option. Drug companiens expectations and projections should change when it is undersigned. If the projections change after undersigning it is becuase there is doubt whether it will be actually followed though. Sure it can feel like theorethical hypotheticals if the conditions being considered are likely but there is no place to sulk if the agreement is old and the condition is clearly established.

Public vs private rights

I get this vibe where that if a private entity has a right then it can' tbe morally questioned when exercising those but decisions of public entities are subject to additional rules on how to use the rights bestowed. In a nation of laws it should be possible for a public entity to hold up a private party to their end of a deal.

Hopes vs rights

A company might want to assume or hope for that its functional rights will hold in even a little extreme circumstances. In a fictive dystopia like a Deus Ex a party holding a cure against grey death might be able to hold peoples lives as a bargaining chip. But a state enabling extortion to death could be politically unviable. If there were serious issues of using existing companies to produce lifesaving technology and the goverment could more functionally step in to save more lifes then the expectation of promoting the life of the citizens would probably mean that there would be an expectation for the public actor to step in. This line can be blurry and hard to see and somewhat arbitrary. But the businesses are not entitled to "market mechanics at all costs".

Markets as a survival strategy in emergencies

It is pretty hardline to expect to handle even the most extreme circumstances with market mechanics. Taken to the extreme this could mean setups where soldiers could run out of bullets because of lack of personal funds. Markets are a way to get things done and it has many desirable properties but it is not the only way to get things done.

Precedent vs explicit negotiation

If there were nothing agreed and then the more powerful party just dictated conditons that would be authoritarian. But when there is conditonal cluases in agreements those have been settled. What constituted a "pandemic" might be a bit nebolous but if there are clauses concenring such states then the parties should understand that in some conditons those might actually get triggered. I wouldn't be surprised if drug compaines have extensive risk-anylyses with explicit numbers for pretty far-off scenarios and public administrators have lengthy plans and regulations to cover all sorts of contingencies but in ideologial discussions a more general "peoples rights" vs "corporations rights" would be apparent. For a system working throught law and agreement this should all be in ink rather than social pressure.

It is just stupid to pay too much

Americans have the most costly healthcare with pretty lackluster upkeep on peoples health. The relationship between incentive and output can be questioned. Having a culture of "expected incentives" could mean that people argue why they have the right to the profit instead of doing extra things. Caring too much for the proxy might mean that carrying over several proxies the total outcome is still quite lackluster.

Intellectual property is not literal property, it is a metaphor. When we say that you have intellectual property, what we mean is that the government will use its monopoly on force to prevent other people from doing something similar to what you do. To say that Pfizer has a patent is the same as saying that the government will stop other people from manufacturing the Pfizer vaccine. So removing the vaccine patents is the government saying that it will not prevent people from manufacturing vaccines. Which, I believe, is something you have been (rightly) advocating in other contexts for months.

Right, and in this case the US government is not removing/revoking patents.

Isn't that true of all property though?

Ownership is not an innate property of physical objects. It's just saying that the government will use force etc.

It's true that all notions of property involve some kind of social norm to enforce, usually a social norm in the form of a law backed by government force. What's different is that in the case of literal property, the scarcity is already out there in the world before the government shows up. It is a fact of the world, independent of social norms, that there is only one of each physical thing. If more than one person wants to decide what to do with a given physical thing, then there is an inherent conflict there. All the government is doing is stepping in to resolve that conflict.

Intellectual property is different, which is why I say it is only a metaphor. With intellectual property, the scarcity is not out there in the world, it is created by the government. My copying your computer code to my hard drive and running it on my processor doesn't deprive you of your hard drive, your processor, or even your code. You can still run your copy of your code, you haven't lost anything. The scarcity isn't a fact of the world, there is no conflict until the government comes in and tells me to stop. And creating artificial scarcity is just an objectively bad thing to do. Especially when the thing you are artificially making scarce is a life-saving vaccine.

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