Wednesday, 10 March 2021

Vaccination priorities

Chris Hipkins announced some of the government's prioritisation for the coming vaccination campaign. 

I don't quite get it, given the situation here differs considerably from the situation abroad.

Here and abroad, there's been priority on those at most risk.

But who's at most risk differs.

Here, it's people working in the border system, and the government has been entirely correct to prioritise those workers and their families. That absolutely makes sense. 

They're also prioritising South Auckland, where we have had outbreaks because that's where leakages from the border system turns up.

But the rest of it is sounding way too much like prioritisation for MIQ.

They're looking at having a national significance category which will let them vaccinate anyone who the government wants to be able to travel abroad, like for representing NZ in sport. And then they're having another category on compassionate grounds, for people who have to travel abroad for one reason or another. 

It is just so easy to predict how this plays out. The cricket team and whatnot will get vaccinated if they need to tour. Businesses who need to send workers overseas will have to beg and plead, and decisions will be arbitrary because they cannot be other than arbitrary. 

Late last year, John Cochrane made the case for just selling vaccines to the highest bidders.

People can argue about that in places where there really are lives on the line because there's uncontrolled community transmission. I think John's right: the US wound up wasting doses and prosecuting doctors who tried to avoid wasting doses, because they insisted on the government's priority list being the only way to do things. But at least it's there debatable.

If you're looking at a place like New Zealand, where there is no community transmission, and where vaccination of border workers makes community transmission less likely, that has to be different right?

Here's an alternative.

First call absolutely has to be the border system and health workers and their families. That keeps everybody else safer. 

After that, differences in risk faced by an 80 year old here and a 20 year old here are trivial because there is no covid here. We'll all wind up getting the vaccine, and the government says the border can open again once everyone's gotten it. For those who have no plans to go abroad, and who aren't anywhere near the border system, it really doesn't matter much whether you're early or late in the queue. 

But for those who need to head abroad, it's really very different. And the government has no good way of sorting who needs to travel in a hurry and who doesn't. The government has proven that in the way it has allocated scarce MIQ positions. Minister Hipkins right now is talking about designing strict criteria around compassionate grounds, and trying to avoid people pushing themselves up the queue. He's also very clearly suggesting that sport will wind up being national interest. It all sounds like MIQ. 

Another rather feasible option: open up bidding for a decent fraction of the earlier vaccination slots AFTER all of the border and health system are vaccinated. Most people are in no hurry at all. Some have pressing needs or risk of pressing needs. Instead of setting up definitions of national interest and compassionate need that will wind up making a mess, let the cricket team pay a bit to get earlier vaccination slots - along with anyone else needing to be vaccinated faster so they might travel. 

What do you do with the money raised? Subsidise vaccination at the later stages. Take the money paid to get early slots, and spread it across all the later days as payment to the later-vaccinated. It won't take long before you have very few people willing to pay for a priority slot, 

Advantages:

  1. No need to set national interest criteria that will wind up giving 50 vaccinations to anybody with a horse or a boat or some kind of horseboat and none to people with critical business needs to travel and none to people who fall between the cracks in compassionate grounds definitions;
  2. Lots of people see that lots of other people are willing to pay a lot to be vaccinated: vaccination is safe and desired! Look at how much those crazy people are willing to pay to get it first! I won't be a mug like them, I'll get paid to be vaccinated later!
  3. Encouraging efficient sorting by time;
  4. Encouraging people to slot in in those last periods when it's the vaccine-hesitant who are the ones left and when encouraging herd immunity gets important. 
You could still run the compassionate category alongside all this if you wanted to - this mechanism would let people who need to travel but don't fit the government's criteria to do so. 

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