I could not agree more with your sentiment, but the “We did ok” side has a point: If there was a much better policy or intervention, why was it done by no country, and no philanthropist? As a country, not much was stopping you a year ago to unilaterally prepurchase tons of vaccines and start manufacturing them. Getting 20 million doses manufactured early is much easier than 2 bn, you do not need to spend time coordinating with others etc., so what happened? From memory:
China only really started to vaccinate its citizens in March (but is doing it really fast now), despite approving the Sinopharm vaccine for EUA in July. Phase 3 data for their vaccines came in at the end of 2020, and seeing how urgent China is vaccinating now, it really does seem like manufacturing was their bottleneck. Russia approved its Sputnik Vaccine in August and started mass production immediately, but appears to only have been able to produce 2 million doses instead of the estimated 30 million by 2020 because of manufacturing problems.
But you do not have to design your own vaccine, you could just prepurchase a comparatively low amount of vaccines. There are enough oil states with no democratic decision making, so why did nobody say to Pfizer: “Here are 100 dollars per dose (9 times what the EU pays you) to start producing them now. The same day you publish your Phase 3 trial results, we expect the doses at our doors so that we can vaccinate our citizens.”? E.g. Qatar only has 2 million citizens, so surely they could have procured enough early on, from different manufacturers?
And that is just the procurement/manufacturing side of things. There’s also population wide rapid screening tests (AFAIK only Slovakia and Germany), pool testing (China and Rwanda), large, multicenter drug trials (only UK with the RECOVERY trial) as things that seem like extremely low hanging fruits but were neglected almost anywhere, despite strong economic incentives to get things right.
I am noticing my confusion: Are our institutions really so bad at dealing with crises? Or is it much more difficult than it looks to implement changes and react to completely novel situations?
My ideology-of-all-public-officials guess is pretty weak compared to an obvious alternative: simple public-choice herding at the executive level. (200 units instead of a million.)
If governments were each minimising their own reputation loss by (correctly) predicting that they wouldn’t be punished for doing what everyone was doing, this could be enough to prevent ~all innovation. As much as you want safety in numbers, you doubly don’t want to be the first to risk and lose. No entrainment needed, let alone intentional coordination.
(What could explain Israel’s contract being redacted? The dodgy data-sharing agreement? No, that came out. The reputational risk of being seen to have rushed something out in [Autumn 2020]? No: it worked, so why not unredact now?)
I place >60% on the herding belief fwiw, especially if we limit to countries that have enough power to actually shake things (eg China, US, UK, Russia etc).
An additional piece of evidence for this is the degree of correlated beliefs about things like HCTs and genetic enhancement.
I am also very confused. The incentives for politicians to move as fast as they could were so vast.
Besides just vaguely accusing them of lacking courage: Another possibility is a profound entrainment of world elite opinion. One globalised and very narrow Overton window for public professionals. University is the obvious place for this to propagate, but I don’t really know. What is its content? “Don’t be hasty”? Could a philosophical accommodation really prevent every defection?
(There were some—Hungary vs EU on vaccines, Israel. I actually just tried to find out the date of Israel’s Pfizer contract—and it’s redacted!)
I think this is currently the strongest objection to the ideal timeline, even if it just points to the space where a concrete objection might well be.
I could not agree more with your sentiment, but the “We did ok” side has a point: If there was a much better policy or intervention, why was it done by no country, and no philantrophist?
Because philantrophists like Stoecker got sued and fordidden from deploying better interventions.
August 28, 2020: “Production has started at a new plant in Beijing with an annual capacity of roughly 300 million doses. Sinovac has agreed to supply 40 million doses to Bio Farma, an Indonesian state-owned company, between November and March. Sinovac started building the factory in late March and finished the project in July.”
So this is in fact a little piece of the happy timeline.
But shouldn’t this update our priors towards mostly being on the happy timeline, in the West as well? Given that it took Sinovac/China one year from last March to this March to scale up, and that their vaccines are easier to manufacture than mRNA vaccines, and if we assume high investment from the start in China (so their timeline is close to optimal), it really starts to look like we could not have done much better on manufacturing (because the West does not differ strongly in available doses compared to China)?
I.e. we could have approved a few months earlier, but even in December the UK and the US (I think?) were mostly bottlenecked by supply issues, so an earlier approval should not have changed much by this intuition.
Not mostly happy, I think. China apparently needed a new factory, but other places didn’t (to the tune of 3bn wasteful doses or ~12bn real ones).
Also fast approval was only one prong of the fix, along with 2) an order of magnitude more investment, 3) invested much earlier, as pre-Phase I pre-purchases, 4) HCTs, and 5) pivoting away from 80%+ waste as soon as we realise we’re doing that.
(HCTs are still relevant here because some of the vaccines have a shelf life < 6 months, and HCTs could thus allow May-June 2020 production to dampen the second or third waves.)
Half a trillion dollars should really make some dent in the known and unknown bottlenecks. Not sure how to shrink my estimate to account for the immovable remainder.
“Someone please ensure that they have the 530k within 24 hours from now and report back to me it’s been sent,” Cummings wrote to the chief executive of NHSX. “No procurement, no lawyers, no meetings, no delay please – just send immediately,” he continued. The funding request had the backing of the health secretary, Matt Hancock, who was copied in on the email chain at this point...
After a flurry of communication between top civil servants, money for Our World in Data was approved within days and put on NHSX’s budget, the Guardian understands.
… the grant was not even wanted by the not-for-profit in the form being offered… The group chose to follow its own due process and later applied formally to DHSC and was awarded a grant.
“What a waste of time when we were at that position in the pandemic. I think it was unethical, immoral, and an abuse of power,”
It’s interesting that (being from the Guardian), that article presents the story as being a scandal, with the implication that Cummings was being corrupt.
I could not agree more with your sentiment, but the “We did ok” side has a point: If there was a much better policy or intervention, why was it done by no country, and no philanthropist? As a country, not much was stopping you a year ago to unilaterally prepurchase tons of vaccines and start manufacturing them. Getting 20 million doses manufactured early is much easier than 2 bn, you do not need to spend time coordinating with others etc., so what happened? From memory:
China only really started to vaccinate its citizens in March (but is doing it really fast now), despite approving the Sinopharm vaccine for EUA in July. Phase 3 data for their vaccines came in at the end of 2020, and seeing how urgent China is vaccinating now, it really does seem like manufacturing was their bottleneck. Russia approved its Sputnik Vaccine in August and started mass production immediately, but appears to only have been able to produce 2 million doses instead of the estimated 30 million by 2020 because of manufacturing problems.
But you do not have to design your own vaccine, you could just prepurchase a comparatively low amount of vaccines. There are enough oil states with no democratic decision making, so why did nobody say to Pfizer: “Here are 100 dollars per dose (9 times what the EU pays you) to start producing them now. The same day you publish your Phase 3 trial results, we expect the doses at our doors so that we can vaccinate our citizens.”? E.g. Qatar only has 2 million citizens, so surely they could have procured enough early on, from different manufacturers?
And that is just the procurement/manufacturing side of things. There’s also population wide rapid screening tests (AFAIK only Slovakia and Germany), pool testing (China and Rwanda), large, multicenter drug trials (only UK with the RECOVERY trial) as things that seem like extremely low hanging fruits but were neglected almost anywhere, despite strong economic incentives to get things right.
I am noticing my confusion: Are our institutions really so bad at dealing with crises? Or is it much more difficult than it looks to implement changes and react to completely novel situations?
One last guess:
My ideology-of-all-public-officials guess is pretty weak compared to an obvious alternative: simple public-choice herding at the executive level. (200 units instead of a million.)
If governments were each minimising their own reputation loss by (correctly) predicting that they wouldn’t be punished for doing what everyone was doing, this could be enough to prevent ~all innovation. As much as you want safety in numbers, you doubly don’t want to be the first to risk and lose. No entrainment needed, let alone intentional coordination.
(What could explain Israel’s contract being redacted? The dodgy data-sharing agreement? No, that came out. The reputational risk of being seen to have rushed something out in [Autumn 2020]? No: it worked, so why not unredact now?)
I place >60% on the herding belief fwiw, especially if we limit to countries that have enough power to actually shake things (eg China, US, UK, Russia etc).
An additional piece of evidence for this is the degree of correlated beliefs about things like HCTs and genetic enhancement.
I am also very confused. The incentives for politicians to move as fast as they could were so vast.
Besides just vaguely accusing them of lacking courage: Another possibility is a profound entrainment of world elite opinion. One globalised and very narrow Overton window for public professionals. University is the obvious place for this to propagate, but I don’t really know. What is its content? “Don’t be hasty”? Could a philosophical accommodation really prevent every defection?
(There were some—Hungary vs EU on vaccines, Israel. I actually just tried to find out the date of Israel’s Pfizer contract—and it’s redacted!)
I think this is currently the strongest objection to the ideal timeline, even if it just points to the space where a concrete objection might well be.
Because philantrophists like Stoecker got sued and fordidden from deploying better interventions.
August 28, 2020: “Production has started at a new plant in Beijing with an annual capacity of roughly 300 million doses. Sinovac has agreed to supply 40 million doses to Bio Farma, an Indonesian state-owned company, between November and March. Sinovac started building the factory in late March and finished the project in July.”
So this is in fact a little piece of the happy timeline.
But shouldn’t this update our priors towards mostly being on the happy timeline, in the West as well? Given that it took Sinovac/China one year from last March to this March to scale up, and that their vaccines are easier to manufacture than mRNA vaccines, and if we assume high investment from the start in China (so their timeline is close to optimal), it really starts to look like we could not have done much better on manufacturing (because the West does not differ strongly in available doses compared to China)?
I.e. we could have approved a few months earlier, but even in December the UK and the US (I think?) were mostly bottlenecked by supply issues, so an earlier approval should not have changed much by this intuition.
Not mostly happy, I think. China apparently needed a new factory, but other places didn’t (to the tune of 3bn wasteful doses or ~12bn real ones).
Also fast approval was only one prong of the fix, along with 2) an order of magnitude more investment, 3) invested much earlier, as pre-Phase I pre-purchases, 4) HCTs, and 5) pivoting away from 80%+ waste as soon as we realise we’re doing that.
(HCTs are still relevant here because some of the vaccines have a shelf life < 6 months, and HCTs could thus allow May-June 2020 production to dampen the second or third waves.)
Half a trillion dollars should really make some dent in the known and unknown bottlenecks. Not sure how to shrink my estimate to account for the immovable remainder.
Datum about process over speed in the civil service and civil society (and also about OWID being far more savvy about optics than Cummings):
It’s interesting that (being from the Guardian), that article presents the story as being a scandal, with the implication that Cummings was being corrupt.