Vaccine supply, and delivery, a call to increace production capacity, in Science

 The latest issue of Science has a call  by a very distinguished roster of economists, to invest in additional vaccine capacity, urgently, to shorten the time needed for the economy to fully reopen. The authors note that the savings from accelerating economic recovery are vastly larger than the costs of increasing vaccine production capacity.

Market design to accelerate COVID-19 vaccine supply  by Juan Camilo Castillo1, Amrita Ahuja2, Susan Athey3,4, Arthur Baker5, Eric Budish4,6, Tasneem Chipty7, Rachel Glennerster8, Scott Duke Kominers4,9,10, Michael Kremer4,5,*, Greg Larson11, Jean Lee12, Canice Prendergast6, Christopher M. Snyder4,13, Alex Tabarrok14, Brandon Joel Tan10, Witold Więcek

Abstract: "Build more capacity, and stretch what we already have"

Here's one among many thoughtful bits:

"Cross-country vaccine exchange

"As more vaccines are approved, given the scramble to secure bilateral deals, the nature of the fair allocation protocol adopted by COVAX (a global initiative to promote access to COVID-19 vaccines), and rapidly changing circumstances, some countries may end up with vaccine allocations that are not optimally matched to their needs. For example, some countries may have difficulty handling vaccines requiring ultracold storage or may be willing to trade off a small reduction in efficacy for a large increase in quantity. Countries allocated several vaccines may prefer to simplify logistics by consolidating on one or two.

"To facilitate efficient allocation across countries, a vaccine exchange mechanism is under consideration by COVAX. The mechanism will enable countries to engage in mutually beneficial trades of vaccine courses. Centralized market clearing will help aggregate the willingness of all countries to trade, thus maximizing gains from trade and minimizing waste of scarce vaccine courses.

"Similar mechanisms have been used successfully in other contexts where gains from trade are substantial, yet traditional cash markets are inappropriate and fairness concerns are paramount (10, 11). This setting, however, offers specific challenges. Allowable trades must satisfy regulatory approval, indemnification at the country level, and COVAX goals for population coverage. By incorporating such safeguards, an exchange can maximize efficiency, minimize waste, and ensure an equitable allocation."

Human infection challenge trials for Covid vaccine to move forward in UK

 The BBC has this story:

Covid-19: World's first human trials given green light in UK

"Healthy, young volunteers will be infected with coronavirus to test vaccines and treatments in the world's first Covid-19 "human challenge" study, which will take place in the UK.

"The study, which has received ethics approval, will start in the next few weeks and recruit 90 people aged 18-30.

"They will be exposed to the virus in a safe and controlled environment while medics monitor their health.

...

"The Human Challenge study is being delivered by a partnership between the UK government's Vaccines Taskforce, Imperial College London, the Royal Free London NHS Foundation Trust and the company hVIVO, which has pioneered viral human challenge models.Clive Dix, interim chair of the Vaccines Taskforce, said: "We have secured a number of safe and effective vaccines for the UK, but it is essential that we continue to develop new vaccines and treatments for Covid-19.

"We expect these studies to offer unique insights into how the virus works and help us understand which promising vaccines offer the best chance of preventing the infection."

...

"Initially, the study will use the virus that has been circulating in the UK since the pandemic began in March, which is of low risk to healthy adults, to deliberately infect volunteers.

"In time, a small numbers of volunteers are likely to be given an approved vaccine and then exposed to the new variants, helping scientists to find out the most effective jabs - but this phase of the study has not yet been given the go-ahead."

HT: Tom Darton

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And here's a story from the NY Times, which touches on the issue of compensation for participants (and the associated debate about whether that is repugnant):

U.K. Approves Study That Will Deliberately Infect Volunteers With Coronavirus. Researchers hope to learn things about how the immune system responds to the coronavirus that would be impossible outside a lab.  By Benjamin Mueller

"After being exposed to the virus, the participants will be isolated for two weeks in the hospital. For that and the year’s worth of follow-up appointments that are planned, they will be paid 4,500 pounds, or about $6,200. The researchers said that would compensate people for time away from jobs or families without creating too large an economic incentive for people to participate."

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Related posts on challenge trials:   https://marketdesigner.blogspot.com/search/label/challenge

Equity v. efficiency in vaccination

Here's a sad story from the NY Times, as we struggle with getting people vaccinated, while making sure that everything is fair and square:

The Vaccine Had to Be Used. He Used It. He Was Fired.  By Dan Barry

"The Texas doctor had six hours. Now that a vial of Covid-19 vaccine had been opened on this late December night, he had to find 10 eligible people for its remaining doses before the precious medicine expired. In six hours.

...

"The doctor figured that if he returned the open vial to his department’s almost certainly empty office at this late hour, it would go to waste. So as he started the drive to his home in a neighboring county, he said, he called people in his cellphone’s contact list to ask whether they had older relatives or neighbors needing to be immunized.

...

"The next morning, he said, he submitted the paperwork for the 10 people he had vaccinated the previous night, including his wife. He said he also informed his supervisor and colleagues of what he had done, and why.

"Several days later, the doctor said, that supervisor and the human resources director summoned him to ask whether he had administered 10 doses outside of the scheduled event on Dec. 29. He said he had, in keeping with guidelines not to waste the vaccine — and was promptly fired.

"The officials maintained that he had violated protocol and should have returned the remaining doses to the office or thrown them away, the doctor recalled."

Congestion in decentralized vaccination

 The news is full of stories of people obsessively refreshing web pages, hoping to get an appointment for a Covid vaccine.

The Washington Post has this story:

Tipsters, tech-savvy kids, pharmacy hopping: How Americans are landing coronavirus vaccines.  ‘It feels like I’m trying to get a Beyoncé ticket,’ said a woman trying to get her mother an appointment  By Fenit Nirappil, Karin Brulliard and Sarah Fowler

"Those searching for a shot face a decentralized system of vaccine distribution operated by cash-strapped public health departments and a disparate network of clinics and medical providers, all crushed by unprecedented demand for a shield against the virus decimating American life.

"While many Americans have had no problem getting shots, others like Cohen have spent hours trying to get vaccinated, to no avail. The challenges in vaccinating people mirror the botched rollout of coronavirus testing as a mix of government and private providers navigate unfamiliar terrain while communicating with the public in different ways.

"Some vaccine appointment websites crashed almost as soon as they launched. Older Americans are enlisting their kids and grandchildren to stay on the phone and keep refreshing websites until they land an appointment. Tiny intelligence networks are forming around the country to scour for morsels of information on how to get a leg up on the vaccine search.

"Claire Hannan, executive director of the Association of Immunization Managers, said these struggles are unavoidable as the federal government defers distribution to localities without the resources to create a centralized sign-up for vaccines or to hold mass inoculation drives.

...

"The Centers for Disease Control and Prevention plans to encourage people to use VaccineFinder as a national resource for finding shots, but a public search function has not launched while supplies are still limited."

Pandemic inspired changes in the economy that may last--real estate and medicine

 In academia, Zoom seminars may coexist with in-person seminars long after the pandemic has ended. They aren't as nice as in-person seminars, but they involve much less air travel.

Business meetings too can more easily be conducted remotely these days, through Zoom, Google Meet, Microsoft Teams, etc. Once again, there's something missing compared to in person meetings, but that's counterbalanced by the skipped travel.

Exercise has changed--fewer visits to the gym, but internet companies like Peloton and Mirror combine home gym equipment with workouts in internet gym classes.

Here are some other items that have caught my eye:

Real Estate Transactions Go Virtual--The traditional real estate closings with a room full of people and stacks of documents are becoming a memory, as much of the process is now online.  By Sydney Franklin in the NY Times

"Real estate transactions have gone largely digital as the pandemic has disrupted nearly every aspect of home buying, from house hunting to securing a mortgage, getting an appraisal, notarizing documents and signing the final closing documents.

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"While some clients continue to prefer in-person closings, others are giving their lawyers power of attorney to sign the final documents for them or they’re executing closings on virtual platforms like DocuSign.

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"By the time New York’s real estate market reopened in June after several months of coronavirus restrictions, most buyers were prioritizing virtual tours before reaching out for an in-person visit.

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"Since March 31, an executive order by Gov. Andrew M. Cuomo has allowed notaries in New York to sign documents using audio-video technology instead of signing and notarizing documents in person.

"Dawn Pereyo, an underwriter and past president of the New York State Land Title Association, says this work flow is the way of the future. Twenty-nine states, not including New York, have already enacted permanent remote online notarization (RON) legislation. “The executive order has allowed us to start down the road of RON,” she said.

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And this:

20 Ways 2020 Changed How We Use Technology Forever--Our reliance on technology while isolated at home these past months—whether Zooming into weddings or FaceTiming with doctors—has permanently altered our relationship to gadgets.   By Matthew Kitchen in the WSJ

"telemedicine and teletherapy visits became the norm. According to a survey by the American Psychiatric Association, the percentage of patients regularly using some form of telehealth with a professional rose from 2.1% pre-pandemic to more than 84.7% as of this summer."

What do we know about the effects of payments to participants in challenge trials for vaccines, and other public spirited activities?

There is starting to be an empirical literature associated with payments for socially productive activities, such as participating in challenge trials of vaccines, donating plasma, etc.

Here's a blog post in the Medical Ethics blog of the Journal of Medical Ethics:

Is it acceptable to pay nothing or little to challenge trial participants?  By Sandro Ambuehl, Axel Ockenfels and Alvin E Roth.   October 30, 2020

Here's a paragraph (with some links).:

"we hope that the debates about payments in medical research, and on other transactions subject to restrictions on payments such as blood plasma donations, will converge as empirical results accumulate. To date, there is empirical evidence on the underlying motivations for volunteering, on the impact of high payment on human risk taking, on decision quality and well-being, on the signal value of small payments, on strategies to evade regulation, and on the general public’s assessment of appropriate activities and  payments. Moreover, there are studies that document biases affecting normative judgment in general, and biases affecting paternalistic restrictions and moral intuitions in particular.

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This blog post was written in connection with our paper in the JME:

Payment in challenge studies from an economics perspective 

by Sandro Ambuehl, Axel Ockenfels, and Alvin E. Roth

published online early, Oct 28, 2020. http://dx.doi.org/10.1136/medethics-2020-