As an increasing body of evidence suggests America’s new anti-Covid vaccines are both efficacious and safe, the question of how to distribute those vaccines assumes greater importance. One poll suggests that Americans think health-care workers, the elderly and people with compromised immune systems should receive vaccines very early. But what to do after that?
There is an uncomfortable truth here: Most of the best distribution methods are blatantly unfair. In this context, however, fairness is overrated. Priority should be given to methods that will save more lives and bring back the economy more rapidly.
A central yet neglected point is that vaccines should not be sent to each and every part of the US. Instead, it would be better to concentrate distribution in a small number of places where the vaccines can have a greater impact.
Say, for the purposes of argument, that you had 20,000 vaccine doses to distribute. There are about 20,000 cities and towns in America. Would you send one dose to each location? That might sound fair, but such a distribution would limit the overall effect. Many of those 20,000 recipients would be safer, but your plan would not meaningfully reduce community transmission in any of those places, nor would it allow any public events to restart or schools to reopen.
Alternatively, say you chose one town or well-defined area and distributed all 20,000 doses there. Not only would you protect 20,000 people with the vaccine, but the surrounding area would be much safer, too. Children could go to school, for instance, knowing that most of the other people in the building had been vaccinated. Shopping and dining would boom as well.
Over time, mobility, migration and mixing would undo some of the initial benefits of the geographically concentrated dose of vaccines. That’s why the second round of vaccine distribution should go exactly to those people who are most likely to mix with the first targeted area. This plan reaps two benefits: protecting the people in the newly chosen second area, and limiting the ability of those people to disrupt the benefits already gained in the first area.
In other words, if the first doses went (to choose a random example) to Wilmington, Delaware, the next batch of doses should go to the suburbs of Wilmington. In economics language, one can say that Covid-19 infections (and protections) have externalities, and there are increasing returns to those externalities. That implies a geographically concentrated approach to vaccine distribution, whether at the federal or state level.
Of course, that is not how US politics usually works. On the national level, there is a tendency in such things as infrastructure or defense bills to give something to each state. At the state level, it is hard to imagine New Jersey, for instance, concentrating on Hudson and Essex counties for its vaccines and neglecting the Shore. Party politics, if nothing else, mitigate against it.
Yet distributing the vaccines in geographically concentrated fashion would create some natural experiments and generate information of national value. For instance, if almost everyone in an area is vaccinated, the nation will have a better sense of how demand for flu shots, dental visits, home schooling and many other services will change in post-Covid America. If it turns out that there are unexpected side effects to the vaccine, they will become obvious more quickly, as local doctors would be inundated with a particular kind of complaint.
At the same time, there will be practical limits on a fully concentrated geographic distribution of vaccines. Too many vaccines sent to too few places will result in long waits and trouble with storage. Nonetheless, at the margin the US should still consider a more geographically concentrated distribution than what it is likely to do.
Speaking of unfairness: Who else should get vaccine doses very early on? NBA players, for one. Their vaccinations could be televised, and their nightly displays of scoring and rebounding would show the American people that vaccines are quite safe. And how about early doses for leaders of the anti-mask movements? If they will take them, that is. Aren’t they relatively likely to be superspreaders?
The fairest solution to vaccine distribution, of course, would be to run a lottery. I humbly suggest a lottery where you have to live in Fairfax County, Virginia. If you’re thinking, “Hey, that’s not fair!” — well, that is exactly the point.
Bloomberg
