Conventional wisdom says that once a COVID vaccine is introduced, infections will quickly disappear and we will return to a pre-COVID economy. However, a vaccine can have little effect on infections – although mortality can drop dramatically. It is important not to be driven by the large number of new infections that remain after the introduction of a vaccine to a continued government response – a risk that is greater under a President Biden than under a President Trump.
The demand for the vaccine is likely to increase as the risk of infection is reduced and the risk of side effects is lower. There is almost certainly a high demand for the vaccine among workers in vital areas whose work exposes them to a greater risk of infection, the elderly or other vulnerable groups. Evidence to date suggests that lower-risk populations have a lower need for a vaccine and are likely to be more sensitive to possible side effects and may therefore be awaiting better safety data from the large-scale introduction of vaccines in higher-risk populations.
These predictable demand patterns imply that infections may not decrease significantly or even increase immediately after the introduction of a vaccine. However, a vaccine will significantly reduce mortality. The high-risk population over the age of 65 accounts for less than 12 percent of COVID infections but 85 percent of mortality from the disease. After the introduction of a vaccine, infections are likely to continue in the large low-risk population, while mortality in the small high-risk population will decrease.
If vaccination rates in the small high-risk population are higher than in the large low-risk population, infection rates will decrease less than mortality rates. Finally, seasonal influenza is preventable and comparable in the event of a death risk for low-risk COVID populations through vaccination. However, people still choose not to be vaccinated against seasonal flu and there are an estimated 30 million estimated annual flu infections, compared to about 8 million confirmed COVID cases since March.
There are two types of incentives that could dampen vaccine demand in low-risk populations and lead to persistent infections. First, many of the young people are engaged in prevention to protect their beloved older family members. This incentive will be greatly reduced if parents or grandparents at high risk are vaccinated.
Second, and more importantly, the demand for prevention ultimately depends on the risk of disease. This means that if some people increase prevention, the risk of disease will decrease, prompting others to reduce prevention. Disease risk prevention is a common phenomenon in many infectious diseases and lags behind the COVID cycles at home and abroad. Incentives to contain the risk increase with new COVID outbreaks, prompting people to take measures to contain the disease, and decrease with a lower case load, leading to new outbreaks.
The incentives that drive this cycle mean that when the high-risk population demands a COVID vaccine, the incentives for the low-risk population to demand it decrease. An extreme example of these incentives is the anti-Vaxxer, which does not vaccinate against polio when the disease does not exist – due, of course, to the high demand for the polio vaccine by others. This means that public subsidies for prevention “crowd out” private prevention because more public prevention for some leads to less private prevention for others.
In fact, economists have long argued that government intervention has less impact on disease outcomes when the risk of infection thus drives private prevention. This would explain why similar cycles of COVID outbreaks occur in states or countries with very different forms of government intervention.
In the short term, public prevention often has a neutral effect because private prevention responds to the risk of disease faster than governments. Public and private prevention are usually interchangeable – the government can lock you up, but so can you, so speed is more important. The late response of President Reagan to HIV and of President Obama to H1N1 is an extreme example, but there is evidence that governments’ COVID mandates by the states also responded more slowly than those of the private sector. Put simply, restaurants were already empty when eating out was banned.
In the long term, the incidence of disease can be politically neutral, because if a policy temporarily reduces the number of cases, as was the case when the restaurants were closed, prevention is lower thereafter, so the disease reappears.
The spread of the disease is largely determined by the behavior of the private sector. The reasons why COVID is still among us are similar to the reasons why a large part of the US population is obese: people trade health for other activities. So, given the subdued ability of governments to keep a running disease under control, what should be the focus of future policy?
The American people have made it clear that they are focusing on mortality and not on infections. As more was learned about the greater mortality risks for the elderly, private containment responded accordingly, and the average age of those infected fell sharply. Low-risk young people valued participation in the economy to earn a living, while pensioners and other high-risk groups took greater protective measures.
The Americans’ correct focus on mortality suggests that government policy should push for treatments and vaccines. President Trump’s initiative on Operation Warp Speed is therefore essential. It seems unlikely that career politicians such as Vice President Biden or Senator Harris would have launched a program like Operation Warp Speed, which uses government funding but is driven by the private sector.
Instead of worrying about mortality, the Biden campaign and its media allies focus on infection for political reasons. The focus on the number of cases – after more than seven months of living with COVID – leaves science in the lurch, as does the Americans’ insistence on listening to medical experts who have no expertise on how to measure and assess the losses caused by a disease, what policy trade-offs need to be made to contain the disease, or what incentives trigger pandemics.
Elected representatives who try to balance the compromises of their constituents are urged not to be influenced by the “politics” of health bureaucrats who focus on COVID infections. Leaders who dare to advocate policies that reduce the mortality of high-risk populations but allow economic activity for others are shamed by so-called experts without the appropriate expertise. If the misguided focus of policy on infections continues after the introduction of a successful vaccine, even more harm will be done in the name of “science”.
Tomas J. Philipson is Professor of Public Policy at the University of Chicago. He was a member of the White House Council of Economic Advisors from 2017 to 2020 and its acting chairman from 2019 to 2020.
The views expressed in this article are those of the author.