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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.
I think there is a distinction to be made here between proven, old vaccines for serious diseases, and everything else. I'm much more comfortable with no liability for the former. I don't know to what extent this distinction is feasible in reality, tho.
Why? If the technology is proven and established with no problems, that is exactly the sort of situation where a liability shield provides the worst incentives. If we know that a given product is reliable and problem free, then shielding the manufacturer from liability gives them a direct incentive to reduce quality control and otherwise take risks/cut corners. If we know the technology works reliably, that's exactly when people SHOULD be liable for damages if they get nasty consequences from it.
I assumed no liability applies to known and expected side effects, and that for proven vaccines you can cheaply and reliably test for any outright manufacturing trickery since it is possible to just settle on a standard.
The motivation in part is that I think diseases like polio or mumps should be a separate conversation. Clearly those vaccines had gigantic positive effects, and take attention away from questionable products and tactics used to push these products onto the public.
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Speaking of that, I've seen the vax schedule for children these days and it does seem a bit... extreme.
https://www.cdc.gov/vaccines/imz-schedules/downloads/parent-ver-sch-0-6yrs.pdf
Like, does my kid really need 3 shots for Hep B? Can I just skip all the ones added after 1990 and call it good?
It's not like kids today are healthier than they were 35 years ago. If anything, the opposite is true. Given a messy, politicized epistemic environment, maybe it's best to revert to the last "known good state". There is knowledge encoded in survivorship.
In other words, I'm sure as hell not giving my infant a Covid vaccine.
From my research, they are all pretty clearly worth it in cost/benefit terms except the Covid vaccine (cause Covid hardly affects young kids). I have a baby and the pediatrician didn't even bring up the Covid vaccine - idk if she's tired of getting yelled at or also agrees with my analysis. But I'm happy to have given my baby all the other vaccines.
The main health difference between kids today and 35 years ago is obesity, and it's hard to imagine a mechanism where vaccines cause obesity. Especially when you look at the crap people feed their kids these days. So I'm just going to try to minimize that crap and I figure that'll probably prevent me from having a fat kid. Wish me luck! If your plan is to achieve the same thing just by not vaccinating, I wish you luck too, but you might need a lot more luck than me.
Even Hep B? My kid's not going to be engaging in sex tourism in Thailand (prior to age 18 at least).
On the potential negatives of vaccines, I won't pretend to be an expert. People are who very smart and know the science way better than I do say they are safe. But there are others who are just as smart (admittedly rarer) who say they aren't safe. The problem is that I can't trust the experts because I don't have Rube Goldberg amnesia. I see how full of shit experts are on all sorts of topics. So I can't trust them fully on any topic. If high quality anti-vax research was produced, it would be politically suppressed and careers would be destroyed. In that environment, truth seeking is impossible.
I'm not anti-vax. I think vaccines are one of the best inventions of all time. But I do see the large rise in childhood mental illness, autism, and yes, obesity, and I struggle to explain it. I don't see any harm in waiting to take the post-1990 vaccines when the benefit is not there and the risks (though probably low) are a hot button political topic.
Yeah, side effects from the Hep B vaccine are so low that the very low risk of Hep B itself (I know 99% of cases come from sex tourism in Thailand, but there's still that niggling 1% remaining) makes it worth it. But that probably is the closest one to not being worth it, after Covid.
Mental illness is social contagion and increased diagnosis. Autism is increased diagnosis. Obesity is eating more food and exercising less. Obviously there are other factors, but overall they don't seem too hard to explain. But even if they were hard to explain, idk why vaccines seem more plausible than 5g or chemtrails or whatever. It's all just vague gestures at stuff with no mechanism and no evidence.
How sure are you of this? It might be worth an effort post sometimes. I've seen some stats that suggest this is not the case at all, and that the real rates of autism have skyrocketed. I'll admit low confidence, so it might be worth it to hear from someone who knows better. Maybe you?
This is certainly the normie belief. But many serious people disagree with this hypothesis. I am one of them. A properly functioning human body will regulate hunger and activity levels to ensure homeostatis. In any case, this has been discussed ad nauseum in this forum, and is perhaps the hottest flame of the culture war. Probably best to just agree to disagree.
Yes, I mostly agree. Or, rather, the science is so bad and politicized that I certainly don't trust anti-vax research. If you listen to RFK talk, he does seem to propose some pretty solid reasons for why vaccines (as they are currently administered) could be harmful. But he's a lawyer, not a scientist.
In any case, if you are looking for someone to make the anti-vax case, it's not me. I will, however, not be giving my children Covid or Hep B vaccines. I will look into the benefits on the other ones, and probably stick to the rest of the schedule.
Yeah a lot of this has been debated to death. But I'm not sure if "eating more food and exercising less" is the normie belief. A lot of normies seem to believe in other stuff - some kind of poison in our food, some kind of environmental contaminant, some metabolic issue where 1000 calories/day doesn't result in weight loss, the belief that obesity is normal, etc. There may not be a majority belief about the cause of rising obesity, idk.
I don't mean to try to disparage your belief system, sorry if it came across that way. To me, "normie" isn't a bad thing. It's usually correct!
But I do believe that most regular people haven't read Slime Mold Time Mold or Gary Taubes. "Just eat less fatty" does seem to be the default belief. Although, yeah, Midwesterners do have an odd way of thinking that fat people are normal and skinny people need to eat more.
This is real: https://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html
Obviously these are extreme cases, but to a lesser extent I think it applies to most Americans. You have a set weight. It's unclear how to lower it (other than taking Ozempic).
I'd still like to hear from you about autism! I think an effort post would be great.
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From what I’ve seen, the majority of vaccines are very low risk. The concern I have is that the combined cocktail hasn’t really been studied.
My kids got most but not all of their vaccines.
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You need the Hep B vaccine in case some of the doctors and nurses giving all those shots have been engaging in sex tourism in Thailand.
And if they aren't, you're probably doing it wrong.
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They’re protected from liability because the US legal system is this complete bullshit thing where 1% of users complaining about a thing can bankrupt a company.
I was talking to someone who develops and sells their own perfumes recently and they mentioned that when getting insurance to sell their products it costs them more to get covered for sales in the US than the entire rest of the world combined!
One day I'll write an effort post about this, but the legal environment makes producing products in the U.S. impossible.
Good luck suing the Chinese company with brand name MoonShenBubble when your baby pacifier has lead in it.
On the other hand, if an American company makes 10,000 products, and even one of them gets targeted by lawyers, the whole company can be strip mined for cash. There will never be another Johnson & Johnson or 3M. It's all going to be made in China forever.
Might not be China, specifically, but yeah. International liability basically doesn’t exist even in the face of ruinously and maliciously bad behavior, local liability is absolutely crushing even in face of well-intentioned and innocent mistake, and the old solution of importers being responsible has collapsed in the face of big names outsourcing that to tiny and judgement proof third parties in the Amazon Marketplacificiation of internet sales.
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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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No it doesn't, because people don't pay anywhere near the QALY value of vaccines to the vaccine company.
Let's pretend we have a vaccine for smallpox (40-50% fatality rate in babies). People/governments pay maybe $100 per dose (https://www.cdc.gov/vaccines-for-children/php/awardees/current-cdc-vaccine-price-list.html). The value of a wrongful death is $10M, so you would break even on a $100 vaccine for smallpox at one wrongful death in 100,000, while the vaccine would save 40,000 to 50,000 lives per 100,000.
I actually have to compliment @Quantumfreakonomics here, because until 15 minutes ago I thought liability was reasonable.
Why wouldn’t pharma just increase the cost of the vaccine to cover the increased cost of liability?
In the end that's exactly what would happen. Rich people would pay a lot for vaccines, poor people wouldn't get them at all, and grifters would get rich off the back of lawsuits.
Measles would go back to killing thousands of people a year in the U.S.
Is this the world you want to live in?
These concerns just seem internally silly. The only reason prices would rise a bunch is if there are a lot of vaccine related harms. If the harms are very small, then the cost for pharma would be small meaning costs would not increase much.
So what is it? Do vaccines cause a lot of damage meaning drug costs would need to increase a lot? Or do vaccines cause little harm meaning costs would rise only a little?
Neither.
Vaccines (at least the non-MRNA variety) cause little harm but the American legal system often assigns huge legal damages that are not warranted. For reference:
https://www.cnn.com/2024/05/01/business/j-and-j-talc-cancer-lawsuits-settlement/index.html
https://www.bloomberg.com/news/articles/2023-08-29/3m-to-pay-6-billion-to-resolve-vast-military-earplug-lawsuits
Ok. Now we are talking. So the problem isn’t torts per se but absurd compensatory damages. Isn’t the solution then not unlimited liability but a more proscribed amount of damages?
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It sounds like that's the real problem here. Maybe instead of defending a specific carve-out patch for vaccines in particular, people should be pursuing tort reform instead.
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They might, but that ignores the collective benefits of vaccines. Imagine that our smallpox vaccine from above kills one in ten. Surely, compared to four in ten deaths from smallpox, we collectively are vastly better off with one in ten deaths and immunity to smallpox, or zero deaths if we can beat smallpox and phase out the vaccine. But now the vaccine company has liability for post vaccine deaths, and so a single dose of the vaccine is going to cost... $1M just to cover the liability. No patient/government is going to pay $1M to save a 4/10 of a life when there are cheaper QALYs to save elsewhere, so we will never beat smallpox and we will see 40% fatality rates in perpetuity.
The fair mathematical solution might be to limit the vaccine manufacturer's liability to the collective damages or to damages external to the vaccine (i.e. negligence). So if you have a vaccine which saves lives (or QALYs) on net, you have no liability, but you'd better be sure your vaccine saves lives.
This is the liquidity problem I mentioned but the reality is that practically speaking there aren’t vaxx that kill 1/10 (they would never hit the market because few diseases are so ubiquitous and deadly that it would make sense to take the vaxx).
But if a human life is worth 10m then this is spending a million to save 4 million. That’s great ROI! Why wouldn’t you spend that if you were a government?
In any event not sure it is worth spending so much time on a non central example.
Surely the answer is that the life of an arbitrary stranger is not worth anywhere near 10m. If you tout for charities based on cost per lives saved, as EA does, you find that the majority of people are not willing to spend $1 to save a life, much less $10,000,000. That figure is a political fiction designed to reflect voter’s estimation of their own (or a loved one’s) life so as not to make the government unpopular.
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A number of diseases have been functionally eliminated in the USA; polio, measles, diphtheria, rubella. One person foregoing the vaccine gives them some small value with negligible cost, although who knows, maybe the value proposition is still there if you plan on traveling to the third world. Some of these things are really nasty if you get them as an adult.
The entire population foregoing vaccines would lead (eventually) to these diseases becoming endemic again. Polio alone was paralyzing 15,000 kids a year prior to the vaccine and killing a fraction of those. I suppose we could decrease the amount of vaccination to allow a little bit of endemic disease back just to improve the value proposition for individuals and please the economists. Thankfully, our forefathers knew that was Fucking Stupid as they watched kids dying of preventable diseases and made vaccines as mandatory as they could.
So, if you want to translate the above into econ-speak - where is the positive externality? And if you agree that eliminating diseases via vaccination is preferable to the alternative, how would you like to give pharma companies enough of a profit motive to make the things?
While we're on the subject, COVID notwithstanding, vaccines are horrifically underfunded for this exact reason. The USA vaccine market was 29 billion in 2024, and pre-COVID was only 17 billion. As an aside, the entire biotech ecosystem in the USA is only ~800 billion; just over half the market cap of Meta, a single tech company. The MMR vaccine costs 100$ and you get two doses over your entire life. This isn't exactly some massively profitable scheme whereby Big Pharma is fleecing hapless poors, it's just a convenient punching bag that plays well with the base.
I’m suggesting that just like pretty much every other product there is no liability shield. It is a weird argument — if Person A can be vaccinated then Person B being unvaxxed ought not impact Person A. That’s where I’m not seeing the externality.
If we allow for liability, then Pharma will increase the cost of vaccines to cover liability. The vast majority of vaccines would show a small cost increase. The ones that don’t probably aren’t that valuable in the first place.
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