We Could Be Vaccinating Twice as Fast. The Government Won't Allow It.

"Let's do the thing, which saves the most lives," says economist Alex Tabarrok: Instead of holding back second doses, use them all right away.


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The COVID-19 vaccines made by Moderna and Pfizer/BioNTech were developed and brought to market at a blistering pace, but their distribution has been hobbled by poor planning and rigid eligibility rules. The rollout was centrally planned in a way that didn't give local officials and health care workers enough flexibility to adjust to the realities on the ground—and to make tradeoffs between treating as many people as possible and strictly adhering to the rules.

The most recent data from the Centers for Disease Control and Prevention (CDC) show that of the more than 30 million doses shipped, only about 11 million have been used. And those are mostly first doses: The Pfizer/BioNTech and Moderna vaccines are both given as two identical shots, three and four weeks apart respectively. To ensure everyone who received the first dose is guaranteed a second one at the prescribed time, the government stockpiled one dose for every one shipped.

Alex Tabarrok, an economist at George Mason University who blogs at Marginal Revolution, has been promoting an idea called "first dose first," which the United Kingdom recently adopted. This approach would allocate all available vaccines to be used as first doses, while pushing off second doses for weeks (or even months) until production can catch up.

"That means you can give twice as many first doses," says Tabarrok, who consulted with the Trump administration, the World Bank, and foreign governments on optimal ways to incentivize rapid development of a COVID-19 vaccine. "You can have two people who are protected at an 80 percent efficacy rate, as opposed to one person who's protected at a 95 percent efficacy rate."

This week, the Trump administration reversed course on stockpiling doses, announcing that all doses held in reserve would be shipped. But there are no plans to follow the U.K.'s approach of vaccinating more widely by pushing off the second dose.

Tabarrok attributes this to a failure to think in terms of tradeoffs.

"What economists are good at," he tells Reason, "is making decisions under uncertainty and scarcity. And, it's being hard-nosed in…thinking about probabilities, thinking about risk, expected value."

"Economists are very good at saying, 'let's do the thing, which saves the most lives.'"

Produced by Isaac Reese, with production help from Paul Detrick, Ian Keyser, and Regan Taylor

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