If you have health insurance in the United States, you can usually get a flu vaccine for nothing. But for the 28.9 million Americans who are uninsured, a flu vaccine can cost up to $50. For a population that is often hard pressed, this can be unaffordable. And if you have a family of 4 to vaccinate, the numbers are even worse.
Meanwhile, COVID vaccines cost absolutely nothing, whether you have insurance or not. Why aren’t we doing the same for flu vaccines?
Medicare pays $10-60 for flu vaccines, with an average price of $36 across all the vaccines they cover. If the federal government bought one for every uninsured American, the price would be $1.04 billion.
In the midst of the COVID pandemic, it’s easy to forget just how deadly the common flu can be. But the flu has killed between 12,000 and 61,000 Americans per year since 2010.
How do we decide if a policy is worth it compared to the number of lives it could save? The government uses a figure called the “statistical value of a human life” to measure whether many policies, such as environmental regulations, are worth it or not. That figure is about $10 million.
At that rate, giving a free flu shot to every uninsured American would only have to save 100 lives a year in order to pay for itself entirely. That’s just 0.2% to 0.8% of all flu deaths. Offering free flu vaccines to 8.8% of the entire population would probably prevent a lot more than a fraction of a percent of flu deaths.
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As the Biden administration pushes for a $2 trillion infrastructure bill, I dug into some numbers on federal research funding today. Most basic scientific research is funded by the federal government, including the critical advances in mRNA technologies that laid the groundwork for COVID vaccines. But this funding has fallen by more than 1/3 since the 1970’s, measured as a percentage of GDP:
In absolute dollar terms, funding has increased, but far below the rate one would predict given our burgeoning economy. Meanwhile, the infrastructure bill contemplates $110 billion in funding for road repair. This despite the US having some of the best roads in the world (slightly better than those of Switzerland) and among the world’s lowest commute times. Even in the New York area, which many single out for having poor road infrastructure, I see mostly smooth pavement wherever I go.
Science funding will never be as visible as road repair. You don’t see men in orange jackets out there with big trucks. But without basic research, we will find ourselves falling behind competitors like China and left without the tools we need to meet future challenges. What if we had faced the COVID pandemic without the scientific groundwork laid by massive research funding in decades past?
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Life is beginning to get back to normal. Masks are no longer required outside, curfews are gone, and bars and restaurants are full. Even sporting events have resumed:
Events have also returned to the Rock as Gibraltar hosted what’s thought to be the first fully vaccinated major sporting fixture in the world on Saturday.
Five hundred spectators, each tested for Covid-19 prior to the event, were able to witness British heavyweight fighter Dillian Whyte claim victory over Russia’s Alexander Povetkin at Gibraltar’s Europa Sports Complex.
The fight, called the Rumble on the Rock, was originally meant to take place at the Matchroom HQ, a venue in southeastern England, but was switched to Gibraltar thanks to its Covid-19 safe environment.
Soccer fans were also allowed to witness sporting matches starting with Gibraltar’s World Cup qualifier clash against the Netherlands on Tuesday.
Victoria Stadium welcomed 600 attendees who had previously received two doses of the vaccine and tested negative for the virus on the day of the match.
Only 3% of residents refused the vaccine, which may be one reason why Gibraltar’s results are so good. That may be difficult to recreate in the US or other nations, but Gibraltar provides a welcome view of what life could look like soon as the world races to vaccinate.
I encourage you to get your shot if you haven’t already. Let’s get back to normal life!
For more on COVID and vaccines, check out these posts:
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Pfizer Inc and BioNTech SE said on Wednesday that real-world data from Israel suggests that their COVID-19 vaccine is 94% effective in preventing asymptomatic infections, meaning the vaccine could significantly reduce transmission.
If you don’t even have an asymptomatic infection, you shouldn’t be able to transmit the disease to others. That said, this data is preliminary and is not yet peer reviewed.
The problem with real world application of this knowledge is that anyone can say they’re vaccinated. At a grocery store, for example, it would be hard to check everyone given constraints on time and manpower. So, I expect to see masks continue in public places until case rates are very low and everyone who wants a vaccine has had a chance.
That said, this data can inform our actions in private settings. I look forward to being able to wear one less frequently!
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We keep hearing scary stories about people getting sick or dying shortly after getting a COVID vaccine. But we shouldn’t confuse correlation with causation. From the mathematician Gary Cornell’s excellent blog:
For example, within one week after vaccinating 10,000,000 people, you will likely have around 98 people keel over and die for no apparent reason and if all of them were pregnant women, almost 27,800 miscarriages.
In this post, he has a table with the expected rate of many diseases we often hear are associated with vaccines, such as Guillain-Barre syndrome. It turns out, a substantial number of people are going to get those illnesses anyway, with or without a vaccine.
My wife made an excellent analogy on this subject recently. “Someone might have drank tea and had a stroke in the same day. But it probably wasn’t the tea.”
Same idea here. And with the US having given out over 90 million shots, mostly to the elderly and frail, the fact is some people are going to die shortly thereafter. But it doesn’t say anything about the vaccine.
The clinical trials carefully compared the vaccinated and unvaccinated groups in the trial and found no higher rate of complications amongst the vaccinated. And that’s the data to act on.
Photo: Me getting the Moderna vaccine on February 22. I am alive and well as of this writing.
For more on COVID and vaccines, check out these posts:
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Lufthansa is reportedly discussing the “medical tourism” jet scheme with bosses at Moscow’s Domodedovo airport.
The German airline is also in talks with the Russian foreign ministry about a regular service to the airport, it was reported.
Passengers would fly in and out without necessarily needing a visa or entering the country to see the sights such as Red Square and St Basil’s Cathedral.
They would then make a second trip three weeks later to be fully protected by the Russian vaccine.
Two return flights from Frankfurt are estimated to cost around £1,750.
This hasn’t happened yet but it’s something to watch closely, especially if you’re in the EU or other countries that have barely begun to vaccinate. Russia’s vaccine is highly effective, per a study published in The Lancet:
Vaccine efficacy, based on the numbers of confirmed COVID-19 cases from 21 days after the first dose of vaccine, is reported as 91·6% (95% CI 85·6–95·2)
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The US is actually not far behind the UK in vaccinations per person anymore, although we were significantly behind until recently. And we are actually putting out more doses per capita than the UK at the moment. So, this gives us an idea of what we have to look forward to. If anything, our results should be even better because a more contagious variant is more widespread in the UK than here.
Indeed, we’ve seen cases fall by 2/3rds over the same period:
To me, this seems like an incredibly powerful endorsement of Brexit and the Johnson government, neither of which I ever thought I’d favor! But the rollout in the EU has been pathetic. Meanwhile, as an American, I’ve been looking upon the UK with envy.
Bottom line: the vaccines really are working, and we have an amazing summer to look forward to!
For more on COVID and vaccines, check out these posts:
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A huge untold story of the world today is how far Europe has fallen behind the US economically in recent decades:
Here are the 2019 numbers (in 2019 dollars, again World Bank) US: $65,297. UK $42,330. That’s 35% less than the US. Or, the US is 54% better off than the UK.. France: $40,494. Italy: $33,228 That’s 50% less than US. Or the US is 96% better off than Italy. China: $20,261.
And it’s been getting steadily worse. France got almost to the US level in 1980. And then slowly slipped behind. The UK seems to be doing ok, but in fact has lost 5 percentage points since the early 2000s peak. And Italy… Once noticeably better off than the UK, and contending with France, Italy’s GDP per capita is now lower than it was in 2000.
I definitely noticed this difference when I went to Paris for the first time in the fall of 2019. I was expecting a gleaming city, but I was surprised at the poverty I saw. There were panhandlers at the airport, which I’ve never seen in the US, and a lot of crumbling buildings and down-and-out people. It was rather sad. However, I enjoyed my time there a great deal, and would recommend their delicious food and superb art highly.
With the vaccine rollout in Europe going far more slowly than in the US, I think they will fall much further behind, and quickly. Other parts of the world will be wide open while they’re still locked down.
On the bright side, this could provide a great opportunity for the UK to catch up, since it has outpaced the US, China and almost every other country worldwide on vaccines. Their speed and innovative policies, like delaying second doses of vaccines, have impressed me a great deal.
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The particles that the Pfizer and Moderna vaccines rely on are 1/1000th the width of a human hair. They’re called lipid nanoparticles, and they’re revolutionizing medicine as we speak.
The Pfizer and Moderna COVID vaccines work by sending mRNA to your cells. The mRNA tells the cells how to make proteins that block the virus. But you can’t send the mRNA on its own, because it would be repelled and flushed out through the kidneys.
The mRNA needs a wrapper, and that’s where the lipid nanoparticle comes in. The mRNA molecules are negatively charged and so are our cells. These two negatives push each other away. But, the nanoparticle can make it inside the cell.
Once inside the cell, the particle faces another barrier. The cell wraps it in a container called an endosome, because the cell doesn’t want to be contaminated. So, the lipid nanoparticle has to be specially designed to escape that endosomal prison.
Decades of research has gone into these particles, and they can now escape and spread the necessary information into the watery substance inside the cell (called the cytoplasm). Our commitment to funding basic science decades ago is paying off today in ways we could never have anticipated.
I learned a great deal about these incredible particles today at an online seminar hosted by the journal Nature with Kathryn Whitehead of Carnegie Mellon University and Yizhou Dong of Ohio State University. They gave some great perspective on the development of this amazing technology.
One thing Professor Whitehead mentioned was that despite concerns that the mRNA vaccines are too new and unproven to be safe, the lipid nanoparticles they use have existed for decades. In fact, she said she’s had research rejected for publication because these particles are considered too old hat!
I also finally learned why the vaccines have to be stored at such cold temperatures: molecules will start moving around too much once the temperature rises, so the lipid nanoparticles could come apart. Perhaps one reason Moderna’s vaccine doesn’t need quite as cold of storage is that they’ve been researching these particles for much longer than Pfizer/BioNTech, so their particles may be a bit more stable.
Beyond COVID, lipid nanoparticles and the mRNA therapies they’re a part of could be used for other viruses like the flu, Zika and Ebola. They may also be used as cancer immunotherapies. (This echoes what the co-founders of BioNTech said recently.)
These particles seem likely to underlie an entire new generation of medicines. I’ll be keeping a close eye on them, microscopic as they are!
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This all started when I had to renew my library card.
I got an e-mail requesting a picture of a photo ID with my current address on it. I got my driver’s license and passport before I moved here two years ago, so I asked how else I could renew my card and continue to experience the joys of reading. The friendly folks at the library demanded a photo ID and two (!) proofs of residence.
This got me thinking about how a lot of things in this country are working. In short: not well.
We are carefully following rules and accomplishing nothing. We put in place an arcane system of regulations and lose sight of our overall goal. And it goes way beyond your little local library.
The Problem is Everywhere
Early in the pandemic, getting a COVID test was next to impossible. I volunteered to schedule them at a nearby hospital in March, and the desperation in the voices of the callers struck me.
Why was it so hard to get a test? The CDC first required all labs to use their test, which did not work, rather than letting labs develop their own.
The University of Washington sought to make a COVID test on its own in February. Widespread testing at that time might have stopped the pandemic in its tracks. They made a test, filled out the mountain of documents the government required, and sent them off.
One problem: regulations required they also mail a USB drive or CD-ROM containing the documents. Here’s the lab’s director, Keith Jerome:
We’ve got a lot of scientists and doctors and laboratory personnel who are incredibly good at making assays. What we’re not so good at is figuring out all the forms and working with the bureaucracy of the federal government.” Jerome said that Greninger had to call and e-mail the F.D.A. multiple times to figure out what they needed to secure an E.U.A. “At one point, he was very frustrated because he’d e-mailed them what we were doing so they could review it,” Jerome said. “But legally you also had to mail a physical copy. Here we are in this SARS-CoV-2 crisis, and you have to send them something through the United States Postal Service. It’s just shocking.” (The F.D.A. has since dropped the requirement to send a CD-ROM or USB drive with a copy of the application.)
Frankly, as much as I try to stay calm, reading this sort of thing makes my blood boil. Still not convinced? Well, let’s mosey over from the CDC to the Pentagon.
The Department of Defense took a year to get cloth masks for our soldiers. A year! But at least they got a great deal. Each one comes at the bargain price of $45:
It took a full year for the service to design, approve and distribute a face mask — called a Combat Cloth Face Covering, or CCFC — for its soldiers, an effort that required an additional $43.5 million in contracts to provide temporary solutions. That comes out to about $45 per mask, if you assume every active-duty, National Guard and Reserve soldier received one. A pack of 20 N95 masks at Home Depot costs about $20.
And yet, the Army congratulated itself on the “expedited” timeline, compared to the 18- to 24-month procurement cycle such an effort would normally take.
“The system worked as designed,” tweeted a former Marine.
If you’re still unconvinced we have a problem here, I’ll give you one last example. Here are some of the ways you can get a COVID vaccine in Hudson County, NJ where I live. Each one has a separate website, and some have no website at all! I haven’t been able to find an appointment on any of them yet:
An AirBnB engineer in New York, Huge Ma, made his own website for $50 that aggregates the similar patchwork of vaccination sites in New York into one slick system. Government had most of 2020 and millions of dollars to do something similar, but never saw fit to do it.
How We Can Fix It
Huge Ma shows us what one capable person can do, freed of constraints. What government needs to do is to get some capable people together, give them an overall goal, and let them do the work.
What might that look like? Get together a few of the best IT people in the New Jersey state government, call in a couple outside experts (perhaps Mr. Ma!), and tell them “We need to get people vaccines. Make it happen.”
Getting together a group of capable people, giving them an endpoint, and letting them figure out how to get there is how the best organizations work. The superb book Good to Great details how that process has succeeded at one organization after another.
In addition, we need all the Huge Ma’s we can get. Let’s have private citizens make things without permission, and also agitate to get government to work better.
With that in mind, I will now politely submit all the required documents for my new library card, but also enquire how we might make this process easier for others in the future. 🙂
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Tremendous 