Economics of pandemic vaccination in Oxford Review of Economic Policy

Vaccine development and distribution during the Covid pandemic has had some notable successes and some significant shortcomings. 

Here's the latest issue of the Oxford Review of Economic Policy, which has collected articles by economists concerning some of those successes and failures and their lessons for future pandemics.

Volume 38, Issue 4, Winter 2022

Economics of Pandemic Vaccination

ARTICLES

Vaccines and the Covid-19 pandemic: lessons from failure and success 

Scott Duke Kominers, Alex Tabarrok

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 719–741, https://doi.org/10.1093/oxrep/grac036

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Expanding capacity for vaccines against Covid-19 and future pandemics: a review of economic issues 

Susan Athey, Juan Camilo Castillo, Esha Chaudhuri, Michael Kremer, Alexandre Simoes Gomes ...

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 742–770, https://doi.org/10.1093/oxrep/grac037

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Covid-19 vaccine supply chains and the Defense Production Act 

Chad P Bown

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 771–796, https://doi.org/10.1093/oxrep/grac026

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Clinical trials for accelerating pandemic vaccines 

Witold Więcek

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 797–817, https://doi.org/10.1093/oxrep/grac029

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The race that stopped a nation: lessons from Australia’s Covid vaccine failures 

Richard Holden, Andrew Leigh

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 818–832, https://doi.org/10.1093/oxrep/grac028

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Financing vaccine equity: funding for day-zero of the next pandemic 

Ruchir Agarwal, Tristan Reed

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 833–850, https://doi.org/10.1093/oxrep/grac032

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Is it possible to prepare for a pandemic? 

Robert Tucker Omberg, Alex Tabarrok

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 851–875, https://doi.org/10.1093/oxrep/grac035

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Seven finance and trade lessons from Covid-19 for future pandemics 

Ruchir Agarwal, Gita Gopinath

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 876–886, https://doi.org/10.1093/oxrep/grac031

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Covid in the nursing homes: the US experience 

Markus B Bjoerkheim, Alex Tabarrok

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 887–911, https://doi.org/10.1093/oxrep/grac033

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Optimal allocation of vaccines in a pandemic 

Joshua S Gans

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 912–923, https://doi.org/10.1093/oxrep/grac027

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Reserve system design for allocation of scarce medical resources in a pandemic: some perspectives from the field 

Parag Pathak, Govind Persad, Tayfun Sönmez, M Utku Ünver

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 924–940, https://doi.org/10.1093/oxrep/grac034

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Distributing a billion vaccines: COVAX successes, challenges, and opportunities 

Eric Budish, Hannah Kettler, Scott Duke Kominers, Erik Osland, Canice Prendergast ...

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 941–974, https://doi.org/10.1093/oxrep/grac038

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Covid vaccine coverage in middle and lower income countries, and preparations for future pandemics

 Vaccine rollout to lower and middle income countries left something to be desired.  Some of that has to do with initial distribution when vaccines were scarce, and some has to do with vaccine hesitancy in poor as well as rich countries.  Here are two related views in Science and Nature.

The global plan for COVID-19 vaccine fairness fell short. Will next time be different?  BY GRETCHEN VOGEL, Science, 13 DEC 2022 

"On 8 December, the board of Gavi, the Vaccine Alliance—a key partner in the project—voted “in principle” to phase out much of its support for COVID-19 vaccines in middle-income countries starting in 2024, and to incorporate COVID-19 vaccinations into its regular vaccine programs for the poorest countries—if they still want them.

"The decision isn’t final, but critics of COVAX—many from poorer countries—would not mourn its demise. The effort has delivered some 1.84 billion vaccine doses to 146 countries, but many, if not most, arrived too late to have a big impact. “COVAX was completely useless for developing countries,” says Claudia Patricia Vaca González, an expert on access to medicines at the National University of Colombia, Bogotá. “It was a failure and we should admit it,” says Christian Happi, a molecular biologist at Redeemer’s University in Ede, Nigeria.

"Others have a more positive take. “Gavi and COVAX were in my mind transformational and inspirational in their aims,” says Lawrence Gostin, an expert on global health law at Georgetown University. “It got a lot of shots in a lot of arms.” Still, “I totally understand Gavi’s reasoning,” Gostin adds. Demand for COVID-19 vaccines dropped sharply after the pandemic ebbed, and Gavi wants to refocus on campaigns that have lagged during the crisis, including vaccination against the cancer-causing human papillomavirus, and ensuring no child fails to receive routine childhood vaccinations.

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"Making vaccines where they are needed is the way forward, says Gostin, who thinks it’s unrealistic to expect wealthy countries not to put their own populations first. “Vaccine nationalism is a fact of life.” Vaca González agrees. She says COVAX’s basic premise—buying vaccines developed in wealthy countries from large pharmaceutical firms—was flawed from the start: “That was the original sin of COVAX.”

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Even after COVID, the world’s vaccine strategy is failing. Without a global, publicly funded strategy, the market will fail to deliver vaccines to stop pandemics before they surge. By Seth Berkley, Nature, 13 December 2022.

"Despite rallying to produce billions of doses of vaccines in the face of COVID-19, when it comes to developing vaccines to prevent a disease in the first place, the world is still asleep at the wheel. There is still no incentive for markets to deliver vaccines that can prevent outbreaks, even when the technology is available. If we can’t even have vaccines ready for known severe threats such as Ebola, then what hope is there for future unknown pandemic threats?

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"The World Health Organization keeps a list of nine priority pathogens with pandemic potential, including severe acute respiratory syndrome (SARS) and Ebola, as well as ‘disease X’, which represents a possible, as-yet-undiscovered pathogen. All nine deserve a full effort: development of several candidate vaccines through the animal-model and early clinical testing stages; vialed and quality-tested vaccines that are ready for immediate testing in an outbreak; and stockpiling of enough doses to control the disease if the vaccine is shown to be efficacious. For disease X, a set of viral vectors and messenger RNA delivery systems should be ready to carry the sequences of whichever antigens prove effective against the disease, and the manufacturing and clinical trials should be worked through as far as possible. By doing much of the preclinical and clinical work in advance, we can have doses as close to ready as possible when we need them.

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"A key first step is the establishment of an adequate, publicly subsidized market. This will enable a coordinated global strategy with the support of G20 governments to drive the research, development and flexible small-scale manufacturing needed to produce vaccines to prevent epidemics, even if, as we hope, they will not be needed."

Preparing for a drug-resistant bacteria pandemic---vaccines and challenge trials

 Axel Ockenfels recently alerted me that "The German National Academy of Sciences Leopoldina has established a working group to analyze the economic causes of the problem of global increase in pathogens resistant to antimicrobial agents, and develop better incentives for developing antibiotics and possible solutions. "

I sent him some quick thoughts, as follows:

"one direction that seems potentially worth exploring is vaccines for bacteria pathogens.  Most of our vaccines are antiviral, but there are some vaccines against bacterial infection, even though we mostly deal with bacteria through post-infection antibiotics.  But antibiotic discovery has lots of problems, both economic and technical. And it appears that vaccine technology has advanced a lot, given the speed with which Covid vaccines were developed.  So I wonder if it wouldn’t make sense to start now to develop vaccines against some of the bacteria that we think might be candidates for developing antibody resistance, so that when those variants show up, we’ll be able to protect lots of people from getting infected by vaccinating them. 

 And challenge trials would be very useful for that, since pre-pandemic it’s hard to do conventional trials of a vaccine against a disease that most people don’t get. Challenge trials wouldn’t necessarily be very hazardous if the relevant bacteria aren’t yet highly antibiotic resistant, since the diseases would be curable… (The assumption here is that a vaccine against say, conventional tetanus, would also be protective against antibiotic-resistant tetanus, which might be true since the evolutionary pressure to evade a new vaccine is likely very different from the long evolutionary path that leads to resistance to an existing antibiotic..)"

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Earlier posts, on antibiotics here, and vaccine challenge trials.

Biden Signs Bill to Protect Same-Sex Marriage Rights

 With little delay after the Senate passage of the bill, the House followed, and now President Biden has signed into law a bill protecting same sex marriage from easily reversing the decision of a previous Supreme Court to make it legal throughout these United States.  The new bill requires states to recognize marriages made legally in other states...

Here's the NYT on the story:

Biden Signs Bill to Protect Same-Sex Marriage Rights. Proponents of the legislation argued that Congress needed to be proactive in ensuring a future Supreme Court would not invalidate same-sex marriages around the country.  By Michael D. Shear

"President Biden signed the Respect for Marriage Act into law on Tuesday, mandating federal recognition for same-sex marriages and capping his own personal evolution toward embracing gay rights over the course of a four-decade political career.

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"The landmark legislation, passed by a bipartisan coalition in Congress, officially erases the Defense of Marriage Act, which a quarter of a century ago formally defined marriage as between a man and a woman. The new law prohibits states from denying the validity of out-of-state marriages based on sex, race or ethnicity.

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"For Mr. Biden, who voted for the Defense of Marriage Act as a senator in 1996 and wavered on letting gay men and lesbians serve in the military, the signing ceremony was an indication of how much the president has changed when it comes to championing L.G.B.T.Q. equality.

"It is also another example of how Mr. Biden’s gradual transformation as a politician more broadly has matched the evolution of his own party since he started in public life as a junior senator on Jan. 3, 1973.

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"Since the Supreme Court’s ruling in June to end the constitutional right to an abortion, Mr. Biden has been fervent in his condemnation of the decision in Dobbs v. Jackson Women’s Health Organization and has repeatedly called for legislation that would replace the 50-year-old court precedent with legal protections for the right of women to have an abortion.

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"no issue represents Mr. Biden’s tendency to adapt to societal and political change as well as gay marriage. Polls show a sea change in public opinion across the political spectrum in the past decade, with nearly 70 percent of Americans now saying they support the right of same-sex couples to be married, with all the rights that heterosexual couples have under the law.

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"But it is also a mark of ongoing fear that newfound gay rights may be fragile. The push for passage of the law was driven in part by the Supreme Court opinion overturning abortion rights, in which Justice Clarence Thomas raised the possibility of using the same logic to reconsider decisions protecting marriage equality and contraception rights."