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Donald Trump nominates RFK Jr. to be Secretary of Health and Human Services.
I am not naturally sympathetic to criticizing policy or personnel decisions on the grounds that they "embolden" the wrong people, but I am going to make an exception here. The sheer magnitude of human suffering prevented by vaccines and antibiotics is hard to comprehend. Due to complex structural and psychological reasons, the developers of these treatments capture a miniscule fraction of the total utility surplus created.
Enter the pharma skeptics: I do not know what RFK Jr.'s specific stance on vaccines is, besides "more skeptical than the liberal establishment will accept", but I do know how Twitter works. Twitter is real. It affects real events in actual reality, up to and including the US presidential election. Trans issues are getting dumped from the mainstream Democratic Party agenda because of how much it gets dunked on on Twitter.
In this Twitter thread, the entire concept of rewarding companies for treating disease is getting dunked on like it's a Lia Thomas podium. This is of course not the only example I could have pulled, but it shocked me both because of it's location (Alex Tabarrok's feed), and because of the sheer intensity of what can only be described as concentrated stupid.
But perhaps the most alarming implications are for democracy itself. RFK's endorsement likely won Trump the election, not least because it paved the way for the Rogan endorsement. Republicans won by increasing their share of the stupid vote. Indeed, no party can win a national election without winning large swaths of the stupid vote. There simply aren't enough smart people to win. Perhaps this explains the modern political environment. The decision between Democrat or Republican boils down to a decision on which party's concession to the stupid vote will do the least amount of damage.
RFK Jr provided a reasonable critique of vaccines. They are shielded for liability. Arguably the fox is guarding the hen house. So all things equal you’d expect vaccines to marginally fail the learned hand formula though not massively because reputation still matters.
That doesn’t mean vaccines are bad or even most vaccines or bad. It does mean bringing back liability seems like a reasonable step to encourage pharma companies to internalize the costs of vaccines.
Does RFK go too far? Almost certainly. But the core economic argument doesn’t seem fallacious.
The reason that vaccines need to be protected from liability is because the cost of a wrongful death lawsuit is orders of magnitude higher than the value the vaccine manufacturer can extract per life saved. Tort litigation is just a really terrible system for dealing with diffuse risks like this, especially when the expected net public good is overwhelmingly positive.
This suggests the costs of vaccines don’t equal the value form vaccines unless the courts are overvaluing wrongful deaths.
What is the argument that there is a very large positive externality?
Let's do a little back of the envelope calculation.
https://pubmed.ncbi.nlm.nih.gov/9892452/
The actual infectious disease mortality in 1980 was 80k people. At 1900 mortality rates, it would have been 1.8M, so let's ballpark it at 1.7M deaths averted thanks to sanitation and antibiotics. FEMA values a human life at $7.5M. 1.7M people * $7.5M/person = $13T. US GDP in 1980 was $3T.
Obviously this is highly simplified, but I think it's safe to say that vaccine companies did not capture a large part of the benefits of vaccines.
But a large part of that value was captured by the customer (ie not an externality).
The argument for eliminating liability is that the cost benefit to the individual is negative (otherwise pharma could raise the cost to account for liability while customers would still buy since positive EV) but the benefit to society is positive.
Of course there could be an elasticity issue but that implies the cost to vaccines are much higher compared to what people think.
If the vaccine manufacturer is not capturing all the benefit of the vaccine but is liable for all the downside, it's clear that the math isn't mathing even for plainly good vaccines.
Just to expand, the three theoretical cases where liability prevents a valuable good from being produced is where there is a large positive externality (ie a benefit derived by neither the seller nor buyer such that the buyer is not willing to pay more), ability to pay for buyers, or where liability isn’t properly measured (eg the Bronx jury). Before we accept that the case applies here, we ought to actually prove it out. After all, vaccines didn’t have immunity from liability until the 1980s
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That just isn’t correct. The vast majority of manufacturers are subject to strict liability and they don’t capture all of the benefit. Yet they survive because they make an EV+ product.
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