Vanquished Vaccines and Vetocracies
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A friend of mine spent some time as a consultant for the Utah Department of Human Services. Which included things like foster care and child protective services. And he tells the story of a sign which had been put up outside one of the cubicle farms which said, “If we can save just one child it will all be worth it.” Or something to that effect. Upon seeing that sign he thought to himself, “No, if this department, which employs dozens of people, and costs millions of dollars to operate, can only save one child, it will not all have been worth it, it will have been an enormous misallocation of resources. To save only one child would be a failure of epic proportions.”
We’re seeing another example of strangely mis-aligned government goals playing out in Europe. (By the way, for those who read my last post, just as I finished it I got an email saying that my European river cruise this summer had indeed been cancelled.) This second example concerns the AstraZeneca (AZ) vaccine, which has run into all kinds of problems in Europe and still hasn’t been approved in America which has left tens of millions of doses sitting around, unused.
Just in the last week the European Medical Agency concluded that there was a link between the AZ vaccine and blood clots. But went on to say that the benefits outweigh the risks. Despite this many countries have suspended the AZ vaccine for people under 60, and suggest they should take a different vaccine. This suspension might seem only prudent, but before making that decision let’s look at the actual risk. I grabbed some applicable quotes from an article in Business Insider (which is a weird mix of horrible ads and decent information)
"The risk of dying in an air crash is just astronomically higher than the risk of clotting after the vaccine dose, and yet we all get on a plane without a second thought," Johan Bester, director of bioethics at the University of Nevada, Las Vegas School of Medicine, told Insider.
Wednesday's announcement came after European medical officials reviewed fewer than 100 blood-clotting cases reported among more than 25 million people in the EU who've gotten AstraZeneca's shot. That's a rate of roughly 4.6 clot cases per 1 million shots — higher than expected, the review found, but still extraordinarily rare.
Although even a minuscule chance of a fatal blood clot sounds scary, no medicine carries zero risk. After a year of taking birth-control pills, about one in 1,000 women will develop blood clots. (The risk is about 1 in 10,000 for all young women, so it's elevated nearly 10-fold in birth-control takers.)
Now I haven’t exhaustively looked into all the numbers I just quoted, so I don’t know if the “fewer than 100” cases (it looks like it was actually 86) they looked at represented most if not all of the cases or if there could be a lot more out there. On the other hand, out of those 86 cases only 18 people died, so the actual confirmed death rate would be less than 1 in a million. Even with this number in hand it can be difficult to compare it to the other numbers they mentioned
One clotting death for every one million shots is certainly less than 1 in 10,000. Which would initially seem to indicate that the risk of blood clots from the AZ vaccine is less than the default risk of clots mentioned in connection with young women. But I’m assuming that the 1 in 10,000 number is over a woman’s entire lifetime or since they say “young women” perhaps it’s over a span of 10-20 years, while the AZ numbers are compressed into the space of a few months.
Regardless of the default rate what is clear is that taking birth-control pills for a year is probably more dangerous than getting vaccinated. And yes, I understand that the vaccine risks must be balanced against the risks of not getting vaccinated, which for young people is pretty low, so let’s look at another statistic: On a 500-mile road trip, the risk of dying is about 1.2 in 200,000. And yet which young adult would balk at a 500 mile road trip? Or to put it in economic terms, how much additional would they pay to avoid the risk of the road trip and fly instead? Based on my experience with young people and road trips, the answer is, not very much.
I spent so much time on the AZ vaccine both because it’s so interesting but also because we have a pretty good idea of how many deaths the vaccine can prevent, and a pretty good idea of how many deaths the vaccine might cause and it’s clear that the number of deaths it could have prevented is vastly higher than the number of deaths it causes. Nowhere is this more true than in America which has been sitting on at least 30 million doses of the vaccine since at least early March, and almost certainly longer than that. But for some reason the AZ vaccine still has yet to be approved. And here’s where we circle back to that sign. In the case of the Utah Department of Human Services success was saving even one kid. In the case of the AZ vaccine it appears that failure is causing even one death (or more accurately 1 death in a million doses, but you get the idea).
At first glance it may seem like the two standards are precisely the opposite of one another, the one is about saving a single life while the other is about causing a single death, but they both stem from the same impulse. The impulse I mentioned in my last newsletter, of turning the knobs as far as they can to one side or the other. On the one hand we have the bureaucrats who believe that their job is so important and the value of saving children is so superlative, that even if they can only do it once, it will all have been worth it. On the other hand bureaucrats who believe that causing even one death due to something they authorized is so bad, that even if it only happens once, none of it will have been worth it. But in both cases they’ve turned the dial of individual importance as high as it will go.
Now of course this is something of a strawman for what they actually believe. I’m sure that the Utah Department of Human Services knows that it’s not enough to only save one child, even if that sign did hang in their offices. And the Europeans are still administering the AZ vaccine, even if they have attached restrictions and warnings to it. But the US still hasn’t started, and given what we know now about the blood clots, what’s your bet on whether they ever will? Mine is that they won’t. That best case scenario those doses will be shipped off to some country in need (some already have been) and worst case scenario they’ll languish in a warehouse, before eventually being tossed out. And what sort of trajectory would you project for the administration of the AZ vaccine in Europe? Would you predict that concerns over blood clots will fade, and the restrictions will be lifted? Or would you predict that each instance of someone dying from blood clots will be major news? That people will grow increasingly reluctant to take it and that eventually European governments will stop distributing it? I’m predicting the latter. As usual I hope I’m wrong, but I guess we’ll see. (In between writing this paragraph and finishing the post Denmark banned the AZ vaccine entirely, and the US paused Johnson and Johnson.)
These examples and others tell us something important about the way western governments work these days. And moreover that they are not working as they should. Western governments should not be restricting the distribution of the AZ vaccine based on a handful of deaths, or consider saving only one child a metric for success. I say western governments because we’re not seeing the same thing happening in China or Russia. And I say “these days” because we didn’t see this sort of thing historically. Can anyone imagine a similar fuss over blood clots happening in Russia, China or 1930?
What is this quality that separates us from these other countries and our past selves? Would you define it as a form of government? Is this what I was talking about in all those posts when I was criticizing technocracies? Perhaps a little bit, but here’s where I pull in the book Where’s My Flying Car by J. Storrs Hall (which I promised to expand on in my last post) because the book convinced me that I had perhaps been too hasty in using the term technocracy to describe what’s going on. I’m not sure technocracy is the right term for the form of government which obsesses over saving children and preventing blood clots. But nor do I think people use it to describe the opposite of that, a government which clears away safety regulations around flying cars and nuclear power, which is what Hall proposes. Which is to say in arriving at this point I may have made some mistakes in terminology, but that’s how these sorts of things work, and at no point in this journey did I claim to have all the answers. So let’s pull back a little bit, and rather than trying to say what a technocracy is let’s look at various problem solving approaches. Since we’re already talking about vaccines let’s continue to use that as an example..
Of course, with vaccines there are several countries that can afford to be as cautious as they want. Countries which stopped the spread of COVID and therefore don’t need to engage in a massive vaccination effort. The most notable of these success stories is China, which suffered the disadvantage of not only having a huge population and giant land borders, but worst of all, it was where the virus started. If their numbers can be believed they have suffered just 4,636 deaths from COVID, which is only about twice the number of my home state of Utah, at 2,159, despite having a population 400 times smaller. The US, as a whole, is currently at 564k deaths. Now I’m guessing that China’s number is low, that far more than 4k people died from COVID. But it’d have to be off by two orders of magnitude for their deaths to be as bad as the US’s and it’d have to be off by a factor of 500 for the per capita rate to be as bad.
How did China do it? They did it by taking a different approach than we did, one enabled by having a different form of government. They did it through a draconian authoritarianism which allowed them to put into place a comprehensive lockdown of a breadth which was unimaginable nearly anywhere else. This is an authoritarian approach and it’s the first one we’ll put on our list.
The second approach takes us in the opposite direction, but before we can get into the details of the approach, we need to get into the details of the Moderna vaccine. (I got my second shot yesterday.) And the most important of these details is that it was developed in two days. Once this was known people started wondering, what would have happened if we had immediately started using the vaccine as soon as it had been developed? Well obviously inventing something is a long way from producing it in quantity, and presumably, given the nature of the crisis Moderna didn’t wait too long before they started ramping up production. They were presumably building out factories, and putting logistics into place long before FDA approval. But even in the unlikely event that we couldn’t have gotten doses any faster than we did, we still could have started administering those doses a lot sooner. And clearly many people who died between January 13, 2020 when the vaccine was developed and December 18, 2020 when the vaccine was approved could have been saved. And even if you want to argue about how much faster the Moderna vaccine could have been deployed, you can’t argue with the 30 million or more AZ doses which haven’t been used.
This approach, this system, this world — the one where we started administering doses of Moderna as soon as it had been developed — this is the world of Where’s My Flying Car. It’s a world where we put our faith in technology and plunge boldly forward, not necessarily heedless of the dangers, but convinced that what technology breaks, technology is best at fixing. Now to a certain extent this is also a strawman. I doubt Hall was a proponent of administering the Moderna vaccine on the day it was developed, but I’m sure he was a proponent of going a lot faster than we did, and of doing things we mostly avoided like human challenge trials. And even if he wasn’t there were people who were. Perhaps the best example of what I’m talking about is Alex Tabarrok, who has been a perpetual advocate of all sorts of tactics for speeding up vaccination (e.g. having the US approve the AZ vaccine as soon as Europe did, first doses first, rapid at home tests, and human challenge trials). Essentially pushing for our approach to be closer to the world as described by Hall. We will call this second approach, which mostly doesn’t exist in the wild, technolibertarianism.
The third approach I want to consider might be called the historical. It’s the system we had in place during the last pandemic, the 1918 Spanish Flu, and the system we continued to operate under in the decades which followed. Under this system there were masks, and things closed down, but neither intervention was nearly so widespread as it is today. Beyond that the authoritarianism on display by the Chinese was inconceivable back then. Though I know some imagine that things were more authoritarian back then, but at least in this case, no 1918 government had the wherewithal to lock things down to the extent China did in 2020. Nor did they probably ever even consider it.
On the vaccine side of things, would they have waited 11 months between developing a vaccine and trying it out? That’s harder to know. When the smallpox vaccine was developed by Edward Jenner in 1796 he just immediately tested it out on the 9 year-old son of the gardener. On the other hand by 1935 when John Kolmer was experimenting with the smallpox vaccination the fact that five out of 10,000 children died and 10 were paralyzed led to a pretty severe pushback, so severe that it was another 20 years before a smallpox vaccine was approved by the government. (Side note: these numbers are orders of magnitude higher than the AZ blood clot numbers.) Would it have been different 17 years earlier at the time of the Spanish Flu? If the years wouldn’t have made a difference would the speed and the severity of the disease have made a difference? Particularly as compared to the slower more chronic progression of polio? That’s also tough to say, but there is one thing we can confidently say, and it’s something I’ve wondered about before in this space: Whatever the disruption and the deaths caused by the Spanish Flu, in the decades that followed it was largely forgotten. It had almost no impact on the psyche of the nation. It’s hard to imagine the same thing being said of COVID.
Why is this? Why did the 1918 Pandemic, which by any measure was far more horrible than what we’re going through now, have such little impact? In the course of writing this post a thought occurred to me. WWI is far better remembered and studied than the Spanish Flu despite fewer people dying (particularly in America). But war is always an existential threat, there is always the chance that the nation itself might perish, and as a result it’s important to the nation that it learn from those times in which it almost died. The Spanish Flu, despite its lethality, was never existential. There was never a chance that it would end nations. WWI might have, it never had the potential to end the US, but it could have been the effective end of France, with whom we have quite a bit of civilizational overlap. This was part of the reason we entered the war. (“Lafayette, we are here!”)
Given that the current pandemic has made far more of an impact on our national psyche, and will be a far greater part of our history, does this mean we view it as an existential threat? That’s a good question, and this whole idea is somewhat embryonic, but if I was going to push it just a little bit farther, historically, people felt the existence of a nation was ensured by subsequent generations, that if they were having children and raising them to carry on their and their nation’s ideals that the existence of that nation was not threatened, but increasingly existence is not about subsequent generations or our children, it’s about ourselves, and while even a bad pandemic has a hard time eradicating subsequent generations, there’s always a chance of it eradicating any given individual. All of which is to pose the question, is COVID more existential because we’re more selfish?
All we’re left with is whatever approach we actually did take. The thing I’ve spent so much effort over the last few essays trying to get at. How did we do at fighting COVID?
Now that we can look back on things it seems clear that our approach wasn’t as successful as the authoritarian approach taken by China and it wasn’t as successful as a “caution to the wind” technolibertarian approach would have been. Was it more successful than the historical approach? The one taken by the US of 1918 when they were faced by the Spanish Flu? That’s a tougher question, and it’s going to be awhile before that’s clear. At this point it does seem safe to assert that it has been more damaging to our confidence. Beyond that things are still up in the air. Will the enormous amount of government spending cause any problems down the road? Will we have a tranche of kids who are permanently behind academically? Will we be quicker to draw on our “COVID toolkit” in the future? That is, quicker to throw trillions of dollars at our problems or even more likely to shut things down in whole or in part. We’ll have to see, but from where I’m sitting the early signs aren’t encouraging.
If on an even longer time horizon it becomes apparent that the historical approach would have also been better, then we will be in the unenviable position of having ended up with the worst approach of all. And if so how did that happen? It certainly seemed like we really wanted to do whatever it took to beat COVID, and yet, it’s already clear that we could have done a lot better. It’s understandable that we don’t want to mimic the authoritarianism of China. And it would have probably been impossible for the government to make us. And in a similar fashion I understand why it would have been hard to use the same approach we used in 1918, though I think there were elements there that we should have been paying attention to, but this is not the time to get into that, as I have spent enough time arguing that point, both here and in other posts. The big question I have after reading Where’s My Flying Car is why was it so difficult to take the technolibertarian approach? And is that approach a true technocracy? If not what is?
Before proceeding to the next section we should give this final approach, the one we actually took, a label. Based on what’s happening with the vaccines, and elsewhere, vetocracy seems appropriate, but I acknowledge that this doesn’t quite cover all of the complexities. Because it’s not like everything gets vetoed. Some things still happen, some laws still get passed. What can we learn from an examination of what does get done vs. what doesn’t.
One of the reasons this discussion has wandered quite a bit is that there’s a lot of ambiguity in defining what a technocracy is. I actually don’t think most people use it to describe Hall’s vision of flying cars, nanotechnology and nuclear power. I think it’s proponents make the claim that it’s the system which “follows the science”. Certainly the proponents of the current administration made that claim — whether or not they label themselves technocrats — and yet this is the administration which hasn’t released the AZ vaccine and just barely “paused” the Johnson and Johnson vaccine. (It’s amazing how things have changed just in the time it took me to write this post.)
The most consistent definition of technocracy, at least from my perspective, is the idea not of following the science, but of following the macroeconomists. And here I assume that some of my hardcore socialist friends would say that technocracy is just the latest euphemism for the way entrenched capitalist interests always manage to remain entrenched. Or put more simply it’s just the latest way for the rich to get richer. And this point is not without merit, whatever the success of our COVID fighting efforts we have definitely succeeded in adding a lot of wealth to those who already had it.
Socialist critiques aside, it does seem that the term technocracy as it is commonly used is far more likely to concern money and monetary policy than technology. You hear it used to explain the explosive growth of South Korea and the rise of the chaebol’s (which literally means rich family). You heard the term used during the Greek financial crisis to refer to those most committed to doing what the IMF stipulated. Moving forward to our own time and place, even though we never got around to distributing the AZ vaccine (and probably never will) our own politicians had very little problem passing two huge COVID stimulus bills. And nothing is more technocratic than stimulus bills.
As another example I think people like Matt Ygelsias and Ezra Klein are viewed as current day technocrats, and while they are interested in the Hall/Tabarrok form of technocracy, their primary focus has always been on economic policy — scolding deficit hawks, and pushing for large stimulus bills. But this gets to one of the key questions of the post:
How is it that we’re so bold when it comes to spending trillions and trillions of dollars, but so timid when it comes to vaccine safety? Or the safety of other technologies?
Here it’s useful to bring in some of these other technologies, since up until this point I’ve mostly been talking about vaccines, but Hall describes essentially the same thing happening with nuclear power. Vaccines are being banned despite clear evidence that fewer people will die if we use them than if we don’t use them, and this is precisely what happened with nuclear power. It’s very easy to show that it’s the power source which causes the lowest number of deaths per unit of energy produced. And that, already low statistic, is based on reactors which were almost entirely built in the 70’s and 80’s. When it comes to next gen nuclear that number will certainly be even lower. So here you have a source of power that’s safer than even wind and solar, doesn’t emit any carbon, and uses as its power source elements which are all but inexhaustible (estimates are that uranium and thorium could power the world for 100,000 years) and yet, according to Where’s My Flying Car:
The startup company NuScale is intent on developing modular reactors, small enough to be built in a factory and thus cutting costs, construction times, and so forth significantly. NuScale has to date spent $505 million dollars just to produce the 12,000 pages of paperwork the NRC requires simply for an application. The company estimates that the regulatory process will delay actual production until 2026.
If that isn’t a vetocracy I don’t know what is.
Of course when it comes to nuclear power people immediately jump to the problem of waste, that we are creating waste which will still be around thousands of years from now. And in a similar fashion people who object to vaccines will often concede that it saves more lives in the short term, but you can never be sure what harms it might cause in a few months, a few years, or a few decades. And this is true, you can never be sure what harms the future holds. (BTW the historical response was straightforward, have as many children as possible.) But what approach or framework or system of knowledge causes us to be so unsure about the future harms and benefits of the AZ vaccine, but yet so confident about the beneficial effects and lack of any harm from massive government spending? It seems very possible that we are bold when we should be cautious and cautious when we should be bold. That in more areas than just vaccination we have ended up with the worst approach of all.
When I originally conceived of this post I thought I would spend most of my time talking about why we are so cautious, and also a lot more space on Where’s My Flying Car, but here we are 4300 words in and the references to the book have been sparse, and the examination of our caution has been almost non-existent. I think some of that discussion will take place in an abbreviated form in my next end of month newsletter, because it was my last newsletter that gave us a framework for understanding it. In that space I talked about the knobs technology had given us for controlling society, and how the temptation is to turn them all the way to one side or the other. And thinking of it this way is very clarifying. Let’s look at some potential knobs and their settings.
One of the first things you might try to get to the bottom of is the enormous disparity between how careful we are with vaccines vs. how careful we are with cars (see the statistics from earlier in the post). Or in a similar fashion why so little effort is being spent to reduce the amount of coal (100 deaths/terawatt hour) and how much effort is spent blocking nuclear (0.09 deaths/terawatt hour). And here we might say that with older technologies that the knob is stuck. Cars and coal are too entrenched for anything to be done.
Similarly you might try to get at the disparity between deaths caused by COVID and deaths caused by the vaccine. Between the deaths we might have caused and deaths nature might have caused. In essence this is the Trolley Problem. Is it better to let some external force kill five people or is it better to save those five people but to directly kill one person? Of course here we’re dealing with thousands if not tens of thousands of people saved for every one who dies. Also I think it’s very easy to count the one, but harder to count the thousands.
Thus every potential blood clot caused by a vaccine is rigorously documented, but how many people have any sense of how many people die from natural blood clots (or blood clots from birth control pills)? We rigorously dissect and document and mythologize every nuclear accident, but how many people die from coal mining or pollution? We are obsessed with every child we can save (“if we can save just one it will all have been worth it”) but relatively unconcerned with the millions we can’t save.
You might say that our knob for counting harms we’ve caused is turned all the way up. And why wouldn’t it be? And our knob for safety is turned all the way up. Again, why wouldn’t it be? But in consequence, the minute we become aware of one death we’re responsible for we turn that knob, the one that caused it, (say the AZ vaccine) all the way to zero. Unless it’s stuck of course. This is the nature of our vetocracy.
I’m aware that this is not caused by a handful of bureaucrats imposing these regulations and restrictions and bans on an unwilling population, that this is a decision society as a whole has taken. That we don’t want the kind of authoritarianism that locks us down so tight COVID has no chance to spread, but we do want the kind of authoritarianism that makes new nuclear plants require a 12,000 page application. That we don’t want a technocracy that actually gives us new cool technology, but we’re fine with a technocracy that gives out lots of money. That we can’t imagine living like we did in the past because that’s terrifying, but we’re fine with a host of new, trivial terrors. That if we can prevent even a single death or save even a single child it will all have been worth it. Even if it has led us to a world entirely geared around avoiding risks rather than taking them.
Of course I often say that if my blog is read and appreciated by even one person it will all have been worth it. If you find that declaration to be similarly asinine and you would like me to read and appreciated by all people in need consider donating.