COVID Policy after a Vaccine | Opinion

Conventional wisdom holds that after the launch of a COVID vaccine, infections will disappear quickly and we will get back to a pre-COVID economy. However, a vaccine may have little effect on infections—though mortality may drop dramatically. It is important to not let the large number of new infections remaining after a vaccine's introduction drive the government's continued response, a risk that is greater under a President Biden than under a President Trump.

Demand for the vaccine will likely be higher the more it reduces infection risk and the lower the risk of side effects. A high vaccine demand is almost certain among essential workers, whose jobs put them at greater risk of infection, and among the elderly or other vulnerable populations. Past evidence suggests lower-risk populations will have less demand for a vaccine, and likely will be more sensitive to any potential side effects and therefore may wait for better safety data from large-scale vaccine adoption by higher-risk populations.

These predictable demand patterns imply that infections may not fall much, or may even rise, immediately after a vaccine is introduced. However, a vaccine will drive down mortality substantially. The high-risk population older than 65 makes up less than 12 percent of COVID infections but 85 percent of mortality from the disease. After a vaccine launches, infections will likely continue among the large low-risk population, but mortality will decline among the small high-risk population.

When vaccination rates are larger among the small number of people at high risk than they are for the massive pool of people at low risk, infection rates will drop less than mortality rates. After all, the seasonal flu is vaccine preventable and comparable in case fatality risk for low-risk COVID populations. Yet people still choose not to get the seasonal flu vaccine, and there are about 30 million estimated yearly flu infections, compared to about 8 million confirmed COVID cases since March.

There are two types of incentives that could dampen vaccine demand among low-risk populations and lead to sustained infections. First, many of the young are engaged in prevention to protect their beloved older family members. That incentive will be reduced greatly after high-risk parents or grandparents get vaccinated.

Second, and more importantly, the demand for prevention ultimately depends on disease risk. This means that when some people increase prevention, disease risk falls, leading others to reduce prevention. Disease risk driving prevention is a common phenomenon across many infectious diseases, and is behind the COVID cycles seen at home and abroad. Mitigation incentives rise with new COVID outbreaks, leading people to take steps that limit the disease, and fall with reduced caseloads, causing new spread.

The incentives that drive this cycle mean that if the high-risk population demands a COVID vaccine, then the incentives for the low-risk population to demand it decrease. An extreme example of these incentives is the anti-vaxxers who do not vaccinate against polio when the disease is not around—which of course is due to the high demand for the polio vaccine by others. This implies that public subsidies for prevention "crowds out" private prevention, as more public prevention for some leads to less private prevention for others.

NYC masks
A child wearing a mask sits on his father's shoulders while walking through Times Square on October 25, 2020 in New York City. Alexi Rosenfeld/Getty

Indeed, economists have long argued that government intervention has less of an impact on disease occurrence when infection risk drives private prevention in this manner. This would explain why similar cycles of COVID outbreaks occur across states or countries with vastly different forms of government intervention.

In the short run, public prevention often has a neutral effect because private prevention responds more quickly than governments to disease risk. Public and private prevention are typically substitutable—a government can lock you down, but so can you, so the quicker one matters more. The late response of President Reagan to HIV and President Obama to H1N1 are extreme illustrations, but evidence suggests government COVID mandates by states was also slower than private-sector response. Put simply, restaurants were already empty by the time eating out was banned.

In the long run, disease occurrence may be policy-neutral, because if a policy drives down cases temporarily, as lockdowns did, prevention is lower afterwards, making the disease reemerge.

The spread of the disease is largely driven by private-sector behavior. The reasons COVID is still with us are similar to the reasons much of the U.S. population is obese: people trade off health with other activities. So, given governments' muted ability to control an ongoing disease, what should be the focus of future policy?

The American people have made it clear that they are focused on mortality and not infections. As more was learned about the larger mortality risks to the elderly, private mitigation responded accordingly and there was a large drop in the average age of infection. The low-risk young valued participating in the economy to earn a living, while the retired and other high-risk populations took on greater protective measures.

Americans' correct focus on mortality suggests that government policy should push for treatments and vaccines. President Trump's Operation Warp Speed initiative is therefore essential. It seems unlikely that career politicians like Vice President Biden or Senator Harris would have launched a program like Operation Warp Speed that uses government funding but is driven by the private sector.

Instead of worrying about mortality, the Biden campaign and its media allies focus on infections for political reasons. Focusing on case counts—after more than seven months of living with COVID—abandons science, as does urging Americans to listen to medical experts with zero expertise in how to measure and assess the losses induced by a disease, the policy tradeoffs of mitigation or the incentives that drive pandemics.

Elected representatives trying to balance their constituents' tradeoffs are told to not let "politics" interfere with out-of-touch health bureaucrats who are focused on COVID infections. Leaders who dare advocate for policies that lower mortality for high-risk populations, but allow economic activity for others, are shamed by so-called experts without the relevant expertise. If the misguided policy focus on infections continues after a successful vaccine is launched, even more damage will be done in the name of "science."

Tomas J. Philipson is a professor of public policy at the University of Chicago. He served as a member of White House Council of Economic Advisers from 2017 to 2020, and its acting chairman from 2019 to 2020.

The views expressed in this article are the writer's own.