Should the Trump administration really have bought more Pfizer vaccine doses?

Much faster than most thought possible, Covid-19 vaccines are here. The UK delivered its first shots today, administering the first dose of the Pfizer vaccine to a few elderly patients.

Other countries will follow soon, including the US, which reserved 100 million doses of the Pfizer vaccine in July, as part of a deal in which the US agreed to invest $1.95 billion for large-scale production and distribution of the vaccine.

The 100 million doses cover just about a sixth of the US’s need. The European Union, by comparison, has already purchased 200 million doses of the Pfizer vaccine and has an option to purchase 100 million more. So, the US government is scrambling to get more vaccine doses, and president Donald Trump signed an executive order to force US companies to make distribution to Americans a priority.

However, the order wouldn’t help to increase the number of doses available—something that the administration could have reportedly done months ago, in July. According to the New York Times, Trump’s officials didn’t lock in a deal to secure between 100 million and 500 million additional doses of the Pfizer vaccine beyond the ones included in the original agreement.

In hindsight, of course, it looks like a foolish move. The US could have secured enough doses to vaccinate its entire population.

But was it really that clear a calculation? As of July, many vaccines from other companies were in a similar development stage as Pfizer’s, which had already received the largest investment by the government for vaccine distribution and development. Other vaccines could have become available before then, and some—such as AstraZeneca’s—were projected to be much cheaper, and easier to distribute, said Moncef Slaoui, the official leading the White House’s Operation Warp Speed initiative, in justifying the decision. Did it really make sense to buy hundreds of millions more doses of a vaccine that might not prove effective?

Well, yes.

In fact, says Christopher Snyder, a professor of economics at Dartmouth College, the US should have bought sufficient dosage of all vaccines available—and certainly of the ones in more advanced development stages, such as those from Pfizer, Moderna, and AstraZeneca.

As a member of Accelerating Health Technologies, a group focused on the financial and economic cases for vaccine development, Snyder has supported the argument for bold government investment in vaccines with economic data.

Of couse, notes Snyder, we don’t know the circumstances in which the deal fell through, but if it was purely based on economic concerns, then the calculations were faulty.

According to its cost-benefit analysis, the group had concluded that the government had a good case to make investments up to $70 billion—many times the $18 billion Warp Speed investment—even if that involved making investments in vaccines that might not have been effective. The risk, of course, would have been wasting billions—which pales compared to the trillions that can be saved with the economic restart only a vaccine could guarantee.

“Even at an earlier stage you’d want to invest at risk in 26 candidates, fully vaccinating your population with 26 candidates. So if you had three candidates, it’s just a no-brainer,” Snyder says.

There is, however, one silver lining. If indeed, by declining the deal the US has ceded its place in line to countries with lower purchasing power, as has been reported, then the Trump administration has made an uncharacteristically generous gesture toward the rest of the world.

Many vaccine experts have advocated the importance of deploying the vaccine globally, covering all at-risk populations around the world first, rather than all the population of a specific country. And while the US has been a prime culprit of so-called vaccine nationalism, it seems that with the Pfizer decision, people in other countries, including the EU, could get their vaccine sooner.

“That could have a cooperative outcome, which may not have been intended,” says Snyder.