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First100-021521
Same vaccine, same vial, more doses... 10 weeks to retool?
It’s February 15, 2021 and welcome to a Web-only edition of First 100. You can sign up to have First 100 delivered to your email, as it normally is, by clicking here.
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The Chief
The vaccine rollout is going well. There’s no other way to describe it. Distribution has averaged close to 1.7 million shots per day over the past week and has been headed in a pretty consistent upward direction over the past month. Two days last week hit 2 million. When supply catches up I fully expect the U.S. to consistently hit 3 million. Most of the shots delivered (77 percent now) have been distributed. On the current pace 75 percent of the country would be vaccinated by October; summertime is a likelier target. And these vaccines are quite effective, including against the variants, and because they cut viral load they appear to significantly slow down transmission as well.
This is worth celebrating. From a standing start, without any plan from the previous administration beyond “give this stuff to the states and see what they can do with it,” there’s now a much more engaged federal government, and states have gotten up to speed as well. But there’s a cottage industry coming out of the libertarian movement, which has picked up influence among well-intentioned liberals, castigating mostly the Food and Drug Administration for essentially consigning people to their death.
They have a whole host of complaints. Everyone should get one dose and delay the second dose as long as possible, giving the maximum number of people some protection. Those who’ve already suffered from coronavirus need only one shot. Or you could give half-doses to everyone to stretch the supply further. More vaccines, particularly Johnson & Johnson and AstraZeneca, should be authorized immediately. Prioritization should be scrapped and shots should go into whatever arms present themselves. (This goes against the idea of different rules for those who’ve contracted the virus, for what it’s worth.)
It’s not that these are bad ideas. I think the Johnson & Johnson vaccine should be approved immediately. (AstraZeneca had a significant setback against the South African variant and we probably need more studies there.) But this caterwauling presents a myopic picture of the rollout for purely ideological ends. The loudest people about vaccine delays at the federal regulatory level are the quietest people about vaccine delays at the private sector level. Here’s a case in point.
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As shipments began, Moderna placed 10 doses in vials, as is customary. It suffered a bottleneck at the “fill/finish” stage, unable to fill enough vials to meet production goals. Moderna wanted to alleviate it by adding additional doses to each vial, allowing the company to use the same vials (therefore not changing production there) and moving the assembly line along more rapidly.
The FDA had to weigh whether more doses per vial could lead to more spoilage or contamination from additional jabs. Ultimately, it approved a 14-dose vial in less than two weeks. And here’s the punch line: “Two people familiar with Moderna’s manufacturing, who spoke on the condition of anonymity, said retooling the company’s production lines to accommodate the change could conceivably be done in fewer than 10 weeks, or before the end of April... In statement on Friday, Moderna estimated modifications could be made in two to three months.”
Now, my knowledge of factory retooling is obviously limited, and maybe there’s a good reason that it will take two and a half months to add four units of vaccine to each vial. Presumably there’s not a dial listing how many vaccines from the vaccine machine to spurt out. But we are in an emergency, and if the FDA is held to a higher standard of immediately approving anything in the name of accelerating delivery, I think we can easily hold Moderna to a far higher standard. After all, the vials are the same. Everything about the process is the same. It is really just a higher dosage at the fill/finish stage.
Despite this, none of the libertarians angrily shouting at the FDA to stop killing people have said a word about this. Alex Tabarrok doesn’t mention it in this ur-text of vaccine acceleration. And we know why. Tabarrok is part of a political project that is less concerned with saving lives in an emergency and more concerned with delegitimizing food and drug inspection and if possible disbanding the FDA. If that wasn’t true Moderna would come in for some criticism.
Maybe the rationalist case can be made that moving to one dose or half-doses would double or quadruple the vaccine supply, while Moderna’s retooling only increases vaccine flow by 40 percent. And sure, Johnson & Johnson is way behind in its production schedule, but that marginal increase doesn’t match the gains of whatever they want the FDA to do. But if we really want to be rationalist about it, the resistance to open-source intellectual property on the vaccines is 10-15 times more consequential than anything the Food and Drug Administration could ever do, just as a mathematical reality.
Only 4 percent of the vaccines distributed have gone to the developing world, almost all of them in India. (The fact that the one guy in India making vaccines is dismissing this problem is not dispositive; just 22 percent of India’s population is estimated to be covered in a year.) Pfizer’s CEO is already talking about raising prices on the vaccine for countries without bargaining leverage like the U.S. The world is relying on the U.S. being able to donate excess supply, in a perverse form of trickle-down.
All of us will suffer from this lack of global vaccine access. One study puts the global cost at $9 trillion, half of that borne on rich countries that won’t have trading partners in a developing world still riven with COVID-19. It’s one of the cruelest catastrophes really in history, and our libertarian friends should be outraged by it. But there’s not enough government demonization in condemning manufacturers for protecting profits on life-saving medications, I guess.
There was a government mistake made, of course. It lied in not pre-manufacturing enough vaccine, and supporting that with every dollar possible. Even if some of the doses produced proved ineffective, the cost of throwing them out would have been trivial compared to using the ones that were efficacious and accelerating the end of the pandemic. That was a political failure of the Trump administration but also an industry failure to resist free distribution of the patents and get the whole world to work on early production.
Libertarians believe in a world without government interference of private industry. They believe that the magic of the market unfettered by annoying rules will provide any bounty. They don’t think food and drug inspection has much value. They demand originality and creativity in a crisis, right up to the point that it makes demands on a private company to deliver on its promises or sacrifice a dollar of profit. Liberals who join with libertarians in common cause to demonize the FDA are signing up for this, too.
What Day of Biden’s Presidency Is It?
Day 27.
Today I Learned
- A flurry of articles like this suggests that the Biden team is happy to put impeachment behind them and likely drove the process to shorten the trial. (New York Times)
- State budgets are better than expected, but jobs have been cut at four times the level of revenues, suggesting that an infusion of funds is warranted. (Slate)
- You can read the CDC’s guidance for reopening schools. (CDC)
- A Morning Consult study contradicts the Opportunity Insights proposal to tighten eligibility for direct payments. (The Hill)
- Seems like a mistake to not neutralize the debt limit in the first bill you can. (Wall Street Journal)
- The Taliban is “closing in” on Afghan cities. Everyone knows how this ends. (New York Times)
