Are the COVID Vaccines Effective at Preventing Death?

A recent analysis by the Kaiser Family Foundation of CDC data suggests that about 234,000 COVID deaths in the US could have been prevented if everyone was vaccinated. That’s about 25% of all COVID deaths throughout the pandemic, and about 60% of COVID deaths since June 2021 (roughly the time when most older adults in most states had had a chance to be vaccinated).

The first way to think of that death rate is tragic, given that so many lives could have been saved. Rather than being the high-income nation with the highest COVID death rate, the US could have been more in line with countries like Italy, the UK, and France. The US actually had a lower COVID death rate than Italy and the UK when the vaccine roll-out began, and today we could be at about France’s level with better vaccination rates.

But there’s a flipside to the KFF numbers. If 60% of COVID deaths since June 2021 were preventable, that means 40% weren’t preventable. Furthermore, the same data show that about 40% of COVID deaths in January and February 2022 were fully vaccinated or had boosters. That sounds like the vaccines might not work very well! So what does this all mean? Let’s dig into the data from the CDC a little bit.

The first, and most important thing, to recognize is that most American adults are vaccinated (about 78%), so unless vaccines are 100% effective (and they aren’t, despite some public officials overenthusiastic pronouncements early in the vaccine rollout), there are still going to be a lot of COVID deaths among the vaccinated. If 100% of the population was vaccinated, 100% of the deaths would be among the vaccinated. The key question is whether vaccines lower the chance of death.

And they do. Let’s see why.

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How to Get People Vaccinated for 93 Cents

We’ve talked a lot about vaccines on this blog, including both the benefits of vaccines and how to get people vaccinated. For example, last month I posted about Robert Barro’s estimate on the number of additional vaccines needed to save 1 life. Barro put it at about 250 vaccines. Using some reasonable assumptions, I further suggested that each person vaccinated has a social value of about $20,000. That’s a lot!

But how do we convince people to get vaccinated? Lotteries? Pay them? In addition to just paying them (the economist’s preferred method), another good old capitalist method is advertising (the marketer’s preferred method). And a new working paper tries just that, running pro-vaccine ads on YouTube with a very specific spokesman: Donald Trump.

Running ads on YouTube is pretty cheap. For $100,000, the researchers were able to reach 6 million unique users. And because they randomized who saw the ads across counties, they are able to make a strong claim that any increase in vaccinations was caused by the ads. They argue that this ad campaign led to about 104,000 more people getting vaccinated, or less than $1 per person (the actual budget was $96,000, which is how they get 93 cents per vaccine — other specifications suggest 99 cents or $1.01, but all of their estimates are around a buck).

Considering, again, my rough estimate that each additional vaccinated person is worth $20,000 to society (in terms of lives saved), this is a massive return on investment. Of course, we know that everything runs into diminishing returns at some point (they also targeted areas that lagged in vaccine uptake). Would spending $1,000,000 on YouTube ads featuring Trump lead to 1 million additional people getting vaccinated? Probably not quite. But it might lead to a half million. And a half million more vaccinated people could potentially save 2,000 lives (using Barro’s estimate).

I dare you to find a cheaper way to save 2,000 lives.

$5,000 Worth of Vaccines Saves One Life

I’ve written about the social benefits (in terms of the value of lives saved) of COVID mitigation measures, such as wearing face masks, before. But at this juncture in the pandemic (and really for the past 12 months), the key mitigation measure has been vaccines. How much does it cost to save one life through increased vaccination?

Robert Barro has a new rough estimate: about $5,000. In other words, he finds that it takes about 250 additionally vaccinated people in a state to save one life, and the vaccines cost about $20 to produce (marginal cost). So, about $5,000.

Barro gets this number (specifically, that 250 new vaccinated people saves one life) by using cross-state regressions on COVID vaccination rates and COVID death rates. Of course, there are plenty of potential issues with cross-state regressions. It’s not a randomized control trial! But Barro does a reasonable job of trying to control for most of these problems.

Another way to restate these numbers: if we assume that the VSL of an elderly life is somewhere around $5 million, then the social benefit from each person getting vaccinated is around $20,000. In other words from a public policy perspective, it would have made sense to pay each person up to $20,000 to get vaccinated!

Or thought of one more way: each $20 vaccine is worth about $20,000 to society. That’s an astonishing rate of return. And we’re not even including the value of opening up the economy earlier (from both a political and behavioral perspective) than an alternative world without the vaccines.

COVID and The Young

The CDC just approved vaccines from Americans aged 5-11. That’s great news! But today, I want to talk about another age group: mine.

A few months ago I wrote a post summarizing data for COVID-19 deaths among people in their 30s and 40s. While we have primarily thought of COVID as a disease impacting the elderly (and indeed in the aggregate, it is), there have been major health consequences for those under 65 too. Including major health consequences for the age group 30-49 (which I believe is the age range of all our bloggers here at EWED).

I wanted to update that data because a few new things have come to light. First, I highly recommend reading a recent paper by my friend Julian Reif and co-authors. They estimate the number of Years of Life Lost and Quality-Adjusted Years of Life Lost for different age groups from COVID-19. Their data runs through mid-March 2021, so before vaccines probably had much of a chance to impact the aggregate death numbers (though vaccines were being rolled out at the time).

Here’s their main result: while most of the deaths from COVID were among those aged 65 and older (80% through March 2021), most of the life lost in terms of years was for Americans under 65 (54% of QALYs). And even for very young adults, the risk in terms of years of life lost was not minimal. A comparison from the paper: “Adults aged 85 years or older faced 70 times more excess risk for death than those aged 25 to 34 years but only 3.9 times more individualized loss of QALYs per capita.” Compared to the 35-44 age group, the relevant factor is 2.8 times more individualized loss for the 85+ group.

It’s a great paper, but it only goes through March. What has happened since March 2021? While 80% of the COVID deaths up through March 2021 were among the elderly (65 and older), since April 2021 only 60% of the COVID deaths have been among the elderly. Part of this is because deaths are down among the elderly, but it’s also because deaths are up for the non-elderly. The table is my attempt to show this effect, looking at the period from March-September in both 2020 and 2021 (data is current as of October 27, so the September 2021 data is still not complete, but instructive).

For the oldest Americans, COVID deaths fell by 50%. That’s great! But for younger Americans, COVID deaths roughly doubled. Not good!

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Racial Gaps and Data Gaps

Are there racial gaps in the distribution of the COVID-19 vaccine? This is an important and interesting question in its own right. But I’ll talk about this question today because it’s an interesting example of how confusing and sometimes misleading data can be.

How do we answer this question? One is by surveying people. There are a number of surveys that ask this question, but a recent one by the Kaiser Family Foundation finds that among adults 70% of Blacks and 71% of Whites report being vaccinated. And given the sampling error possible with surveys, we would say that these are virtually identical. No racial gap! (Note: there was a racial gap when they did the same survey back in April, with 66% of Whites and 59% of Blacks vaccinated.)

But, surveys are just a sample, and perhaps people are lying. Maybe we shouldn’t trust surveys! And shouldn’t there be hard data on vaccines? Indeed, the CDC does publish data on vaccinations by race. That data shows a fairly large gap: 42.3% of Whites and only 36.6% of Blacks vaccinated. This is for at least one dose, and the percentages are of the total population (which is why it’s lower than the survey data). So maybe there is a racial gap after all!

But wait, if you look closely at the footnotes (always read the footnotes!), you’ll see something curious: the CDC admits that the race data are only available for 65.8% of the data. We don’t have the race information for over one-third of those in this data. Yikes! And given the exist disparities we know about in terms of income and access to healthcare, we might suspect that the errors are not randomly distributed. In other words, if there is probably good reason to suspect that Blacks are disproportionately reflected in the “unknown” category. But we just don’t know.

So what can we do? Since this data comes from US states, we can look at the individual state data and see if perhaps some of it is better (fewer unknowns). What does that data show us?

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Delta: Danger is Rising, but 2021 is not 2020

Covid cases are rising rapidly in the US thanks to the more contagious delta variant.

Based on the experience of 2020, this has many states, cities, and organizations considering a return to mask mandates and shutdowns. But our situation in the US has changed substantially since 2020 as we now have better knowledge, better masks, and above all abundant vaccines.

We can see this difference clearly when looking at countries hit by the Delta wave before us. It first devastated India, where less than 10% of the population was fully vaccinated, officially killing 400,000 people and unofficially perhaps 10 times that. In constrast the UK, where more than half the population was fully vaccinated, saw a major spike in cases that did not translate into a major spike in deaths:

The delta waves seem to come and go quickly, with cases rising more rapidly than previous waves, but also falling rapidly 6-8 weeks after they began to rise in India, the UK, and the Netherlands. Cases began rising in the US at the beginning of July, so if this pattern holds we have about 2-4 more weeks of rising cases before a rapid drop.

My worry is that a spike in cases just before the school year will lead schools to shut down just as the danger begins to recede, and when vaccines mean the danger was never as great as in previous waves. Externality-based arguments for shutdowns and mask mandates are now substantially less valid than in 2020 but I don’t know that policymakers have internalized this. The Biden admin actually does seem to get it, calling this a “pandemic of the unvaccinated“- i.e., if you’re worried, get vaccinated, and if other people don’t, that’s their problem. Even with delta the vaccines reduce covid’s danger to you by ~10x, and so also reduce the protection you gain from controlling others by ~10x.

The situation with masks has also changed. Cloth masks have limited effectiveness in protecting you from others, but decent effectiveness in protecting others from you, which meant there was a strong externality-based case for mask mandates. But now in 2021 high-quality KN-95 and even N-95 masks are easily available, and unlike cloth masks they offer excellent protection FROM others, as well as FOR others. Anyone who is vaccinated and wearing an N-95 really has nothing to worry about anymore, and little reason to force masks onto others.

The main externality-based arguments that could still work are for vaccine mandates and for restrictions in areas where hospitals are overwhelmed by unvaccinated Covid patients in a way that substantially worsens care for non-Covid patients. But outside of areas with low vaccination rates leading to overwhelmed hospitals, I no longer see a good case to impose mask requirements or restrictions on movement or events.

According to one set of projections, by the end of August adult ICUs (though not hospitals overall) will be over capacity in most low-vaccination states:

If you want to wear a mask and avoid crowds, you can, and in fact probably should do at least one of those during the Delta wave of the next month. But the externality-based case for restrictions is mostly gone, and governments would do better to focus on continuing vaccine rollout in the US and ensuring vaccines are available worldwide to help other countries and to prevent more variants from emerging and finding their way here. Personally I’m glad that my employer has a vaccine mandate but, at least currently, no mask mandate. For those who do still want Covid restrictions I ask- what are you waiting for? What event or number would make you say “ok, now we can go back to normal”? When do you expect that to happen? For me, what I was waiting for was vaccines available for everyone and now, at least in the US, we are lucky to have that.

Vaccine Innovation: A Marvel of Modern Science and Modern Markets

We’ve already talked about different methods for distributing the vaccine in the face of limited supply on this blog (see my post and Doug Norton’s post). But today I want to talk about something different: the speed at which this vaccine was developed. It is truly amazing.

Timeline showing a comparison of vaccine development timescales from Typhoid fever in 1880 to SARS-CoV2 in 2020.

This chart from Nature (adapted from the fantastic Our World in Data) dramatically shows just how quickly the COVID-19 vaccine was developed compared with past vaccines. What used to take decades or even a century was done in mere months (yes, even with all the regulatory barriers today).

Exactly how we developed this vaccine so quickly is a complex story that involves the advanced state of modern science, incentives offered by concerned governments, and the harnessing of the profit motive to advance the public good. We don’t know all the details yet, and likely won’t for a long time since, like a pencil, no one person knows how to make and distribute a vaccine.

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Allocating the vaccines: central planning or the free market?

In the short term, there are only a few million doses of the COVID vaccines available, but well over 100 million adults in the US that want to take the vaccine if offered for free to the consumer. There are also billions worldwide that would like the vaccine.

So who should get it first? In practice in the US, the allocation method has already been determined politically: the federal government will allocate vaccines to the states, and states will allocate them to individuals based on a priority list: health workers and the most vulnerable first, then teachers, etc. The NY Times has a tool that shows you your probable place in line.

But essentially the allocation method being used is central planning.

John Cochrane has proposed a “free market” solution: sell the vaccine to the highest bidder. Or at least, sell some doses to the highest bidder.

As an economist, there is always some appeal in thinking about a free market solution. But there is a problem in this case: there are positive externalities from taking the vaccine. It not only benefits me, but it also benefits others. My willingness to pay only reflects the benefit to me, the private benefit. The social benefit is mostly ignored by a simple auction, and in the aggregate for a vaccine most of the benefits are likely to be social benefits. But positive externalities don’t imply we need to use central planning!

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