Shruti Rajagopalan asked a very important question on Twitter earlier this week:
Vaccines: The Committee recommended that a vaccine should pass all phases of clinical trials before it is made public. Further, it recommended that the whole population should be vaccinated. In this regard, the Committee suggested that: (i) the cost of the vaccine should be subsidised for weaker sections of society, (ii) the cold-storage system across the country should be upgraded, and (iii) vaccines should be administered as per the World Health Organization’s strategic allocation approach or a multi-tiered risk-based approach.https://www.prsindia.org/sites/default/files/parliament_or_policy_pdfs/Report%20summary%20COVID.pdf
Long story short, the answer to Shruti’s question is: nobody. None of us were prescient enough in 2020, and that is a failure on our part.
What Shruti is really asking for is this: who is India’s Alex Tabbarok?
Why do I say this? Because Professor Tabarrok was recommending/demanding large purchase orders…
We don’t want to find ourselves with a working vaccine but too little manufacturing capacity. From an economic point of view, it would make sense to install enough capacity so that everyone in the U.S. who wanted could be vaccinated within a month. Normally, new vaccines cannot be produced so quickly and in sufficient supply. Each step of the manufacturing process must be verified and tested, and inputs to the process may face their own supply chain bottlenecks. Just as shortages of swabs and reagents delayed the rollout of testing, shortages of glass vials, bioreactors or adjuvants (a substance that increases immune stimulation) may delay vaccines. For want of a vial, the vaccine could be lost. To stand a reasonable chance of having a substantial supply of vaccines in 2021, we need to plan for capacity and reinforce supply chains now.https://www.nytimes.com/2020/05/04/opinion/coronavirus-vaccine.html
…on the 4th of May. That is the 4th of May 2020.
He had a post praising the idea of advance market commitments (AMC’s) out in February. Again, 2020.
And while the first excerpt up above was a plan for the USA alone, he and his collaborators expanded upon this plan, outlining what a globally coordinated plan may have looked like:
I’ve been working with Michael Kremer, Susan Athey, Chris Snyder and others to design incentives to speed vaccines and other health technologies. AcceleratingHT is our website and now features a detailed set of slides which explain the calculations behind our global plan. The global plan is similar in style to the US plan although on a larger scale. The key idea is that the global economy is losing $350 billion a month so speed pays. One way to speed a vaccine is to invest in capacity for 15-20 vaccine candidates before any candidates are approved, so that the moment a candidate is approved we can begin production (one can store doses in advance of approval). Most of the capacity will be wasted but that is a price worth paying. As Larry Summer says if you will die of starvation if you don’t get a pizza in two hours, order 5 pizzas. Human challenge trials are another way to speed the process.https://marginalrevolution.com/marginalrevolution/2020/05/acceleratinght.html
A global plan is ideal since there are significant benefits to coordination. If each country invests in vaccines independently they will each choose the vaccine candidates most likely to succeed but that means all our eggs are a few baskets. There are over 100 vaccine candidates and they have different scientific and production risks so you want to choose the 15-20 which maximize the probability of success for the portfolio as a whole. To do that efficiently you need countries to agree that ‘I will invest in lots of capacity (more than I need) in candidate X if you invest in lots of capacity (more than you need) for candidate Y’, even knowing that the probability that X succeeds may be less than that of Y.
The website AcceleratingHT provides many more instances that reinforce my point, and as a student, reading the material there is genuinely useful.
A while ago, I wrote a post for students who want to work in the field of public policy. Alex Tabbarok’s work this past year is a great example of what that advice might look like in practice.
I do not know who India’s Alex Tabbarok is in 2021 – there may not even be one. But as a student, the correct question to ask is this:
What do I need to do to acquire the ability to be ahead of the curve when the next crisis comes around?
Here is my list in response to that question:
- Read, and write. Everyday, read and write. If you are a student of the humanities (and if you think about it, who isn’t?), you should be reading and writing everyday. It compounds, trust me.Don’t be afraid
- Learn the art of working backwards from the solution you want to get to. In this specific case, if you want the world to be vaccinated by the end of 2021 (let’s say), then begin by asking yourself what needs to be done to get there, but in reverse.
7 billion vaccines will be needed – which are the manufacturers that are most likely to supply them – what do they need to get the job done – how can we get them what we need – what are the regulatory, financial, supply-chain-related hurdles they will face – how can these be removed – and so on…
My point here is not the specifics of the exercise, whether in the case of vaccines today or something else tomorrow. My point is to learn and apply the art of working backwards from where you want to eventually be. I don’t know what you’re supposed to call this in consultant/management speak, but for starters, read about the game 21 flags in The Art of Strategy.
- Learn the art of being unafraid to ask big picture questions. Whenever you get that feeling of “Surely somebody somewhere must have thought to ask this question already?” – especially if you have been serious about pt. 1 above – ask the question. Repeatedly, furiously and publicly.
- Consume as much content as you can about crisis management from the past. (I’m working on this for my own self, and recommendations are welcome)
- Do not be afraid of putting out your potential solution out there. Your worst case scenario is that it is a wrong solution. As a society, we’re still better off rejecting wrong solutions than waiting for the perfect one. For rejecting a solution as being the wrong one forces us to learn more about the problem at hand.
- Most difficult of all: once you have offered a solution, remember that your job is to solve the original problem. Your job is to not defend your solution at all costs. This is hard.
One thought on “Asking And Answering Important Questions”
Your points at the end are great, but the insinuation of her tweet (which she may not be trying to insinuate) is one I’ve heard lately and I don’t really buy. Not ascribing this to her, but the argument is that the severity of the second wave would have been hard to predict and thus scolding the government ex-post for not pursuing an aggressive vaccine acquisition plan is unfair.
Economics teaches us that talk is cheap; behavior matters much more. So those of us who basically didn’t change our already cautious but sustainable (e.g. wear mask indoors, be outdoors if with other people, etc.) behavior even till this day implicitly knew that the vaccine was the only way out. I’m not a vaccine expert, so I didn’t really have the detailed knowledge to publicly call for an aggressive production/procurement scale-up. But the overarching goal, of being prepared to vaccinate as many as possible as quickly as possible, was plainly obvious many months ago. All it took was doing some cursory reading of all sorts of people from all over the world. That’s a pretty low bar, hence why people like me with little knowledge or expertise in vaccine production have been behaving the way we have.
I suspect the social/group psychology angle is a more powerful explanatory factor here than the “20/20 is hindsight” angle.