I haven't always agreed with Alex Tabarrok this year on the pandemic, but this is a good piece with some decent arguments and counter arguments about how we could optimize the vaccine rollout. And he avoids a lot of the hyperbolic statements I've seen from some libertarians on the constraints of vaccines and the vaccine rollout like pushing a vaccine out in February. Most of what he brings up here has been part of heated, informed debates between the experts, and many of them are reasonable, supportable moves. I find some of the suggestions very worthwhile.
Though I think he's a bit too dismissive of the risk of anti vaxxers. The strong true believers are a small group, but polling shows people hesitant about these vaccines are a larger group and at their peak they were near 50%. So it seems a bit too much to say that tweaking the vaccine process a lot will have negligible effects on vaccine confidence.
Also his half dosing idea is leaving out some large caveats. Moderna is the only one that showed data for half dosing of that cohort. Pfizer has a completely different dosing regimen (they aren't interchangeable vaccines exactly even if we often talk about them as though they are in terms of efficacy and effect). Pfizer is a lower dose vaccine compared to Moderna, such that half dosing it may not work the same as Moderna's. We'd need the data first.
Likewise here on the spacing argument. He's right that AstraZeneca has this data out to 12 weeks but the other vaccines don't. And again they aren't interchangeable vaccines on this point. We have no data that far out for the mRNA vaccines. For adenovirus vector vaccines the spacing may not be fatal, and may even be helpful, due to the adenovirus vector. We should be careful about extrapolating from that with non adenovirus vector vaccines. And even that data showed beyond 12 weeks actually was harmful on efficacy, so we do have to be cautious without specific data.
I don't think prioritization has cost us on speed. He mentions Hotez's point but that was in regards to compliance checking. States and jurisdictions aren't going on anything more than the honor system with prioritization, so Hotez's point isn't applicable. Hotez was talking about how it would slow things down if we actually did verify. Outside of NY's brief guidance that was retracted that didn't happen. I see nothing wrong with the honor system here. Prioritization isn't valueless and the honor system at least partially gets us there. And some prioritization like age isn't at all hard to verify.
And on variants, he mentions this briefly, but on spacing and half dosing and pushing out a potentially weaker vaccine, the variants and mutations in general lend themselves to both sides of these debates. In lab experiments to provoke mutations, scientists will weakly challenge a virus exactly in the fashion a weak vaccine would. It is why irresponsible antibiotic overuse and misuse are so dangerous. Escape mutations are the big existential threat here in this pandemic. Experts on the other side of this debate aren't making vacuous arguments about following the trial protocols and waiting for the data. There's legitimately huge potential risks at play beyond just the immediate vaccination coverage. Especially so with the SA and Brazilian variants that seem to have the most risk of evading natural infection immunity/a weak vaccine response.
I agree with a lot of the rest though. Sputnik should be considered in the US as an efficacious vaccine to use. J&J's vaccine makes a really good candidate for broad public access, and the lower efficacy isn't as much of an issue with a healthier, younger population as it is for the elderly and vulnerable. We should use PCPs and pharmacists more for vaccination with the vaccines that have less complex storage needs.
And AstraZeneca should have gotten the approval by now. The FDA should be a lot more comfortable with using non US data to make judgements. Though I think the main issue with AstraZeneca is that they flubbed the initial phase 3 trial regimens badly. It isn't just the US that has concerns and doubts about the data, especially for the key populations covered by the EUAs. And AstraZeneca hasn't been very clear with regulators. I think exposing how relatively inexperienced they are with vaccine deployments.
And surely pace can pick up but I'm not as severe as he is on the pace. The Flu vaccination comparisons give a good ceiling but given we are dealing with more complex storage, supply, distribution, and monitoring requirements I don't know if it is reasonable to be mad we didn't reach 3 million doses a day from the start even if we could reasonably hit that target in the near future. I think our rollout has actually been rather good under the circumstances. We've already hit 2.2 million doses a day levels.