Tag: health emergency

Does COVID vaccination or infection generate more social benefit?

The US (and many other) governments currently deploy considerable resources and effort to increase COVID-19 vaccination rates above whatever rate might occur if left to spontaneous provider and individual decisions. Compared to support for other health interventions, the magnitude of government support for C-19 vaccination is unprecedented. 

The rationale for this support is the societal benefit produced by the vaccinations. Plainly speaking, in addition to whatever personal health benefit I get from a C-19 vaccination, it also reduces my likelihood of spreading the virus for some period of time. The latter is the societal benefit, or in economics-speak, the positive externality that constitutes a rational for government action to increase the vaccination rate.*

Current COVID vaccination policy presumes this societal benefit from individuals getting vaccinated is sizable. The societal benefit production process can be understood thus: a virus-naïve person is vaccinated and thereby acquires some immunity, rendering him a non-spreader**. He thereby contributes to the proportion of immune or non-spreading people in the community, and renders interpersonal interaction in the community “safer” for other people. In particular, high risk people who are self-isolating gain because at some higher level of safety – they are able to return to normal social interaction.

If this mechanism of producing a societal benefit is indeed the positive externality justifying unprecedented state support to induce individuals to get vaccinated, then, here is what perplexes me.

Let’s assume the naïve person does not get vaccinated, but instead gets infected.  Then, he either dies and is gone from the community; or, he recovers and has acquired natural immunity. Compared to the person getting vaccinated, this transformation puts him in the nonspreader category for a longer period of time, and also keeps him in that category more reliably in the face of virus mutation. For the high risk person, the community’s “safeness” depends on the proportion of nonspreaders in the population on a continuous, sustained basis. Thus, they obtain more societal benefit when someone gets infected compared to getting vaccinated – because the recovered person maintains their nonspreader status longer (& more reliably) than a vaccinated person.***

I realize additional potential externality issues may arise here. See this awesome paper Leeson, P. T. and L. Rouanet (2021). “Externality and COVID-19.” Southern Economic Journal 87(4): 1107-1118 for a more refined elaboration. However, the production of the “community safeness level augmentation” positive externality that I outline here does seem to be the one that dominates COVID vaccination policy discourse. That is, government support (subsidies to vax development, subsidies to vax delivery, marketing and other communications to persuade members of the public to get vaccinated; coercive tools such as mandates & passport regimes to establish burdens and barriers in daily life that incentivize unvaccinated people to get vaccinated) appears to be predicated on this type of positive externality being significant.

Yet, if my logic is correct, people highly concerned with reducing their probability of getting infected – gain more benefit from people getting infected compared to getting vaccinated. If this is correct, then the unprecedented government support to increase vaccination rates is, to put it politely, unmerited.

I welcome comments elaborating what I am missing or what is wrong with my logic on this.

* Note that for an intervention with significant positive externalities to merit public support also requires that the intervention be cost effective and spontaneous private demand be inadequate. See Musgrove (1999) Public spending on health care: how are different criteria related? Health Policy.  

**I realize that it would be more accurate to refer to the person’s status as “relatively unlikely spreader”.

*** The calculus is different for vaccinations leading to eradication or elimination.  For viruses that are susceptible to eradication or elimination, achieving a high proportion of nonspreaders at a single point in time could conceivably end transmission and exposure risk for a very long period of time or even permanently. In that case, the positive externality of transforming a large proportion of the community into nonspreaders via vaccination would be dramatically higher than is the case here.