Has Excessive Caution Undermined the COVID-19 Vaccine Rollout?

Democracy Examined

There’s a lot to celebrate about America’s vaccination campaign: it exceeded expectations and has been one of the most successful rollouts in the world, promising a path to liberation from a virus that’s killed more Americans than all our country’s wars over the past 75 years. However, it’s worth asking whether the U.S. could be doing even better. Has the government been too timid, eschewing promising, novel interventions in the name of “sticking to the science”?

George Mason University economists Alex Tabarrok and Tyler Cowen contend that examples of excessive caution include: 

  • Not utilizing the “first doses first” vaccination strategy, which would mean prioritizing giving first doses of vaccines to as many people as possible before administering second doses to stretch out our scarce supply of vaccines. The approach has had promising results in Britain, which has given 15% more of its population first doses and therefore reduced cases and deaths more effectively than the U.S.
  • Setting an unnecessarily high bar for the approval of the AstraZeneca vaccine even though the extra doses are needed, 111 other countries have approved it, there is substantial evidence it is safe and effective, and a factory in Baltimore is currently producing it.
  • Failing to authorize at-home rapid testing, which Harvard and UCLA researchers conservatively estimate could have saved 10,000 lives (see also).
  • Not using human challenge trials, which test treatments on willing volunteers to accelerate progress, and somespeculate could have significantly accelerated the development of vaccines.

Is excessive caution a real problem or a phantom menace?

On the one hand, maintaining a certain level of caution remains important. 

Whenever we discuss medical decisions that could affect the entire population, a single mistake could have significant repercussions affecting millions of people. Furthermore, blunders like Dr. Fauci’s assertion at the beginning of the pandemic that people did not need to wear masks can undermine the trust at the foundation of successful public health efforts. (Notably, Fauci made this misstatement in an effort to conserve masks for healthcare workers.)

However, it is important to note that waiting has costs as well. Tyler Cowen writes that in its overriding focus to avoid making errors of commission, the American government has instead made grievous errors of omission. In other words, in trying to avoid making incorrect decisions for which it could receive blame, health authorities have forfeited chances to save lives.

Thinking this way forces us to reckon with hard questions: Had the AstraZeneca vaccine been approved, or human challenge trials used, or more at-home rapid testing been approved faster, how many lives could we have saved? The FDA waited weeks to schedule Emergency Use Authorization hearings, a decision which Dr. Fauci publicly defended. Had they acted quicker, how manyfewer people might have lost friends or loved ones?

What does this say about how we as a society grapple with risk?

Nothing good. 

To be sure, there was a time when greater caution was warranted. At the pandemic’s outset, we lacked information on the nature of the virus. In this context, the inept federal response, the refusal of the President to model appropriate behavior, the lack of honest communication, and a host of other mistakes had tragic consequences. However, more than one year into the pandemic, armed with more information, leaders and institutions should not be afraid to take reasonable risks to help as many people as possible. Instead, out of a fear of committing sins of commission, many leaders have chosen the “wait-and-see” approach, limiting our ability to improve (and possibly save) many lives. At the same time, an obsessive focus on avoiding risk in one area, may blind us to considerable downsides in another. 

For instance, despite the significant evidence demonstrating that opening schools is safe, many areas have been hesitant to do so at great cost both to the students (particularly lower-income students) and their parents. Or consider the messaging that people who have been vaccinated should essentially not change their behavior. With vaccine hesitancy already a growing problem, this could further depress demand for the vaccine among certain populations. This approach can also lead to misallocation of resources. Some organizations emphasize sanitizing all surfaces even in the face of strong evidence that they are not a significant vector of transmission, while failing to invest in other areas that might have a greater impact.

As a society, we must prioritize cost-benefit analysis that soberly weighs the risks and relative likelihoods of different outcomes. This path offers an escape from the reductionist rhetoric of the false dichotomy between scorched-earth laissez-faire and reflexive caution. As a society, we must make trade-offs; they will be hard, but approaching them honestly is vital.