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PaperclipPerfector  11d ago (text post)   33775 thread views

Culture War Roundup for the week of November 11, 2024

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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.

Infectious disease mortality declined during the first 8 decades of the 20th century from 797 deaths per 100000 in 1900 to 36 deaths per 100000 in 1980.

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

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.

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?

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?

Yes. Fix torts and we can unlock a lot of benefits. But let's not put the cart before the horse.

but the American legal system often assigns huge legal damages that are not warranted.

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.

Agreed. There are problems with how we calculate compensatory damages. That could be fixed resulting in the better cost benefit regulation of not just vaccines but al products.

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.

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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