Ari Armstrong, Coronavirus, Exclusives, Featured, Uncategorized

Armstrong: Distribute vaccines to save the most lives

Should criminals go first? You may have read about the fight over how best to distribute vaccines in Colorado. No one disputes that, at least for the most part, vaccines should go first to doctors and other health-care workers and to people most likely to spread or succumb to the virus. I’m a healthy person under 50 who works from home, so everyone sensibly agrees I should be at the back of the line. The main debate is over prisoners’ place in line.

First I want to step back and make some broader observations. The faster the line moves, the less important is line placement. If we could get everyone vaccinated within a week (for the first dose), it would barely matter who went first. But the process will take several months (assuming everything goes well), and making someone wait may expose the person to additional risks, maybe even death. So placement does matter. But this is a great problem to have, because it means researchers have developed effective vaccines in record time. Anyone getting the vaccine is better than no one getting it.

It seems obvious to me that a very simple principle should guide vaccine distribution: Do it in a way that most reduces COVID-caused deaths. This makes a few things obvious. Doctors and nurses should be near the front of the line, as should residents and staff at elderly care facilities, while young, healthy people who work at home should go last.

The one minor exception I’d make is for people who volunteered for the vaccine trials. They played a key role in bringing the vaccines to fruition, so I think they should be rewarded for that with a better place in line.

I don’t like the idea of government favoring one sector or activity over another, apart from a death-prevention standpoint. For example, government could get the vaccines first to teachers to keep schools open, but government favoring some people’s health over others based on profession seems tricky.

Which brings us to prisons. It’s obvious why the coronavirus has spread easily in a prison environment, where many people live in close proximity. Moe Clark has reported some of the numbers. I think prisoners should get their place in line by the same standard as everyone else—whatever placement most reduces COVID deaths. I assume that means at least older people in prison would move close to the front of the line. I don’t have a good sense of whether that also means other people in prison should be near the front just by virtue of living in dangerous conditions, but that should be a question of science, not politics.

Government agents don’t have any proper business deciding that a prisoner’s life is worth more or less than anyone else’s life. Indeed, I think a good case can be made that subjecting a prisoner to greater risk constitutes a form of extrajudicial punishment that runs afoul of the Eighth Amendment. For those who don’t have their pocket Constitutions handy, that’s the one that forbids “cruel and unusual punishments.”

For obvious reasons, Governor Jared Polis has had a rough time with the politics of this. On one side, District Attorney (and leading Republican) George Brauchler has beat him up for seeming to initially prioritize prisoners over some nonprisoners. On the other side, the Criminal Justice Reform Coalition, the ACLU, and others have beat him up for seeming to jeopardize the health and safety of prisoners. This should not be fodder for partisan politics. It should be about maximum death reduction.

In a December 9 announcement, Polis seemed to indicate that only prisoners age 65 or over and those with preexisting conditions would get priority during the middle, Springtime phase of release. The ACLU’s Rebecca Wallace fears the move to exclude most prisoners puts “political control over what is supposed to be a science-driven public health decision.” I have no way to independently evaluate whether the announced rollout is optimal in terms of saving the most lives, but I do worry the matter has become politicized.

I’m not saying it’s easy to calculate which line ordering is most likely to reduce overall deaths; I’m saying that is the proper aim. Ultimately, it should be up to health officials to make the best call they can. As long as they make a good-faith effort to save the most lives based on their best reading of the data, that should be good enough. There’s a time for partisan politics, and this ain’t it.

Let’s broaden the discussion. My libertarian-leaning readers might have noticed a presumption built into the discussion: It’s government’s proper job to distribute the vaccine. I’m not convinced that’s the case.

Of course government would have to provide vaccinations to prisoners, and perhaps also to some or all government employees, no matter what. But why do most people assume government should provide vaccines to everyone?

Alex Tabarrok, an economist at the generally free-market George Mason University, is among those who have argued vociferously for federal funding of vaccines. The basic argument is that vaccines are so important to general health—and to our financial health—that the government captures enormous value by spurring vaccine development. The general premise here is that government rightly addresses public-goods problems, which is what almost everyone believes these days.

John Cochrane, another economist, makes the case that vaccines should be sold to the highest bidder, or that at least people should be able to sell their spot in line. He also reminds us that Moderna has had its vaccine since January 13 but was forbidden to sell it to anyone. Granting the vaccine wasn’t tested in January, I think Moderna should have been able to do some quick testing and sell a riskier vaccine to anyone willing to accept the risks. If that had happened, we might have avoided many of the deaths and costs of the pandemic. Those losses have been enormous.

At least the FDA should have worked double-time to approve the vaccine once tested. It didn’t even do that, as Tabarrok notes.

But that broader debate is not directly relevant to the matter at hand. Government will in fact distribute the COVID vaccines now coming online. It should do so in a way that aims to reduce overall deaths and doesn’t try to play God by deciding whose life is more important.

Ari Armstrong writes regularly for Complete Colorado and is the author of books about Ayn Rand, Harry Potter, and classical liberalism.  He can be reached at ari at ariarmstrong dot com.


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