U.S. Regulators Are Failing the (Rapid) Test
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pDear Capitolisters, /p
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pTwo Saturdays ago, right after my daughter’s school year began, we learned that one of her classmates tested positive for COVID-19. (Fortunately, the student was not seriously ill.) The initial informal notice was followed by anbsp;more formal one Sunday afternoon about the school’s COVID-19 protocols for this situation, in particular whether our daughter was—per the CDC guidelines and internal school procedures—in sufficiently close contact with the infected student to require testing or quarantine. Turns out, we were in the clear, and nothing more was required at that time. However, being anbsp;diligent (read: Type‐A) parent—and not feeling super‐hot myself after anbsp;lot of August travel—I started looking online Sunday morning for how to get tested quickly. The search results weren’t exactly reassuring: appointments for either anbsp;polymerase chain reaction (PCR) test or antigen test within anbsp;10‐mile radius of home were extremely limited. So Inbsp;next started Googling for an at‐home “rapid” test; luckily, Inbsp;found some in stock at anbsp;nearby CVS and rushed out to grab them. Since there were only anbsp;handful on the mostly bare shelves, Inbsp;grabbed anbsp;couple two‐packs, paid almost $60, and went home to run the tests./p
pThe good news is that both my daughter and Inbsp;tested negative and have remained asymptomatic. She went to school all last week, and life at the homestead has been pretty normal. Crisis averted./p
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pWhat it says about our testing regime and the systemic regulatory problems that hinder it. /p
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pThenbsp;embad/emnbsp;news, however, is just how difficult this all was at this stage of the pandemic—more than 18 months after it began in earnest here. And it says anbsp;lot about not only our still‐weak testing regimenbsp;embut also/emnbsp;the systemic regulatory problems that all but ensure it./p
pstrongAmerica’s Dearth of At‐Home COVID-19 Tests/strong/p
pSince mid‐2020, several companies have produced rapid self‐tests to detect anbsp;COVID-19 infection, but the FDA refused to approve them last year because—as my colleague Ryan Bourne explained in his recent book,nbsp;ema href=https://www.cato.org/books/economics-one-virus target=_blankEconomics in One Virus/a/em—the agency’s “regulations … demanded similarly high accuracy for these tests to standard [PCR] tests,” which were highly accurate but took several days (and anbsp;lab) to complete. At that time, the antigen tests’ sensitivity and accuracy was relatively low compared to the PCR tests, so the FDA wouldn’t approve them out of concern for “false negatives” (people with COVID-19 getting anbsp;negative test result and then going out and potentially infecting others). None of this ever made any sense from anbsp;statistical and theoretical level, as George Mason’s Alex Tabarroknbsp;a href=https://marginalrevolution.com/marginalrevolution/2020/07/frequent-fast-and-cheap-is-better-than-sensitive.html target=_blankexplained/anbsp;last year:/p
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pThe PCR tests can discover virus at significantly lower concentration levels than the cheap tests but that extra sensitivity doesn’t matter much in practice. Why not? First, at the lowest levels that the PCR test can detect, the person tested probably isn’t infectious. The cheap test is better at telling whether you are infectious than whether you are infected but the former is what we need to know to open schools and workplaces. Second, the virus grows so quickly that the time period in which the PCR tests outperforms the cheap test is as little as anbsp;day or two. Third, the PCR tests are taking days or even anbsp;week or more to report which means the results are significantly outdated and less actionable by the time they are reported./p
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pTabarrok went on to explain that the proper comparison wasn’t anbsp;single antigen versus anbsp;single PCR test but comparing “test regimes” (e.g., seven strip tests at $5 each taken over anbsp;week versus one $35 PCR test). In this framework, subsequently provided in chart form below, “it’s hard to come up with anbsp;scenario in which infrequent, slow, and expensive but very sensitive is better than frequent, fast, and cheap but less sensitive.”/p
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pTabarrok and Bourne surely weren’t alone in championing rapid tests back then: They were joined by numerous other economists (such as Nobel laureatenbsp;a href=https://paulromer.net/covid-sim-part3/ target=_blankPaul Romer/anbsp;in March 2020!) and public health experts (such as Harvard’snbsp;a href=https://ccdd.hsph.harvard.edu/people/michael-mina/ target=_blankMichael Mina/a), all of whom understood—and wrote constantly!—that quick home testing was anbsp;critical way to control COVID-19 and let people get back to relative normalcy./p
pAnd they’ve all been proven right. We nownbsp;a href=https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00268-1/fulltext target=_blankhave/anbsp;a href=https://www.umassmed.edu/news/news-archives/2021/07/serial-rapid-antigen-testing-on-par-with-pcr-covid-19-tests-radx-team-reports/ target=_blankplenty/anbsp;ofnbsp;a href=https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783550 target=_blankresearch/anbsp;and real‐world examples showing rapid antigen testing, if performed regularly, is just as effective as the theorists claimed more than anbsp;year ago—and, importantly—just as effective as the PCR tests approved early on by the FDA. The tests have also evolved to be more sensitive and accurate: Mina’s teamnbsp;a href=https://twitter.com/michaelmina_lab/status/1362890283625676805?s=20 target=_blankestimates/a, for example, that the new tests’ specificity—confirmed in multiple tests of thousands of cases—is more than 99 percent.nbsp;/p
pYet, despite all of this, the FDA didn’t first issue an emergency approval for an over‐the‐counter, at‐home rapid test until mid‐December 2020—and that Australian‐made Ellume test was available only in extremely limited quantities (and required anbsp;smartphone app to use!). Since then, the FDA hasnbsp;a href=https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/in-vitro-diagnostics-euas-antigen-diagnostic-tests-sars-cov-2#iaft1 target=_blankapproved/anbsp;only five more, bringing the grand total of approved at‐home antigen tests in the United States to anbsp;whoppingnbsp;emsix/em: Ellume; Abbott Labs’ BinaxNOW; Quidel’s QuickVue; OraSure’s Intelliswab; Access Bio’s CareStart; and Becton Dickinson’s BD Veritor. Really, though, we have justnbsp;emthree at‐home antigen tests/emnbsp;right now because, as thenbsp;emWall Street Journal/em a href=https://www.wsj.com/articles/delta-variant-home-covid-tests-11629918580 target=_blankreported/a, the last three listed above were approved only recently and thus aren’t yet on the market here. (The final two were approved last week!)/p
pThis dearth of home tests is not for lack of companies trying: Public health expertnbsp;a href=https://twitter.com/EricTopol/status/1362883049466122240 target=_blankDr. Eric Topol/anbsp;stated innbsp;emFebruary of this year/emnbsp;that there were more than 30 different rapid home tests sitting at the FDA awaiting approval—some since April 2020! Furthermore, other jurisdictions have approved dozens of tests: Germany, for example, has authorizednbsp;a href=https://twitter.com/tompaja/status/1430211739925323778 target=_blankmore than 60/anbsp;self‐tests from producers all over the world—emincluding several made in the United States and approved for export only/em.nbsp;/p
pThe FDA’s restrictions on the domestic supply of at‐home rapid tests has had unsurprising (albeit still depressing) results—home test kits are not ubiquitous; prices are relatively high (at least $20 for anbsp;two‐pack); and, given the first and second issues, they’re not very widely used. Back in Germany, by contrast, they’renbsp;a href=https://marginalrevolution.com/marginalrevolution/2021/08/testing-abundance.html target=_blankavailable basically everywhere/anbsp;and cost less than anbsp;buck per test:/p
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pTalk to people innbsp;a href=https://twitter.com/NateSilver538/status/1431990756978343936?s=20 target=_blankIsrael,/anbsp;the U.K. or elsewhere in Europe, and you’ll find many places practically giving away strip tests—often subsidized by the government as part of its broader public health efforts. (As Bourne calculates in his book, the budgetary cost is low compared to the economic benefit.)/p
pHere,nbsp;emnot so much/em. And the United States’ clear lack of “a href=https://marginalrevolution.com/marginalrevolution/2021/08/testing-abundance.html target=_blanktesting abundance/a” may now be moving from regulatory embarrassment to real problem. In particular, the combination of the Delta variant’s heightened transmissibility, the start of the school year, and many workplaces ending full‐time remote work has spiked interest in and demand for rapid tests that people—vaccinated or not—can use to check themselves and their kids to meet private or public protocols like the ones at my daughter’s school:/p
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pAnd that demand may be outstripping the supply of approved rapid tests. Last week, for example,nbsp;a href=https://t.co/PbuzBNvQGF?amp=1 target=_blankCVS/anbsp;began to limit in‐store purchases, and thenbsp;emJournal/emnbsp;reported that approved suppliers andnbsp;a href=https://www.wsj.com/articles/delta-variant-home-covid-tests-11629918580 target=_blankare struggling/anbsp;to keep up:/p
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pAbbott Laboratories said it expects supplies of its at‐home test to be limited in the next few weeks as it hires workers and reboots factory lines that were slowed or idled earlier this summer. Availability on Amazon.com of Abbott’s BinaxNOW test and anbsp;similar test made by Quidel Corp. has been spotty, and an at‐home test made by Ellume USA LLC was out of stock as of Wednesday. …/p
pAn at‐home molecular test made by Lucira Health Inc. LHDX -2.82% is out of stock on the company’s website. Anbsp;company spokesman said Lucira is boosting production./p
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pShortly thereafter, bothnbsp;a href=https://www.amazon.com/s?k=covid+home+testamp;ref=nb_sb_noss_1 target=_blankAmazon/anbsp;andnbsp;a href=https://www.walmart.com/ip/BinaxNOW-COVID-19-Antigen-Self-Test-2-Tests/142089281?amp;adid=22222222254418684945amp;wmlspartner=wmtlabsamp;wl0=bamp;wl1=gamp;wl2=camp;wl3=525629553523amp;wl4=dsa-504748227745amp;wl5=9009734amp;wl6=amp;wl7=amp;wl8=amp;veh=semamp;gclid=Cj0KCQjwg7KJBhDyARIsAHrAXaGs6FpxbBlrtkKVv8xFIEIhS_fQI6dqM0ZDZixyLAnpLXBlNAFJXeYaAqrEEALw_wcBamp;gclsrc=aw.ds target=_blankWalmart/anbsp;(online) went from low inventory to out of stock entirely, though they have since replenished their supplies and offer delivery in anbsp;few days. (Not exactly a “rapid” test, but better than nothing.) Many other online retailers are in anbsp;similar boat. And there variousnbsp;a href=https://twitter.com/search?q=covid%20tests%20out%20of%20stockamp;src=typed_queryamp;f=live target=_blankanecdotal reports/anbsp;of local drugstore shelves being bare:/p
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blockquote class=twitter-tweetp lang=en dir=ltrWanted to get some at‐home rapid tests before school starts on Monday, but everyone is out (including Amazon) while my understanding is that in Europe they have multiple approved vendors and they sell for less than $1 anbsp;pop./p— Matthew Yglesias (@mattyglesias) a href=https://twitter.com/mattyglesias/status/1431586074883760136?ref_src=twsrc%5EtfwAugust 28, 2021/a/blockquote
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blockquote class=twitter-tweetp lang=en dir=ltrUpdate: local Walgreens in Arkansas is out of tests toobrbr(No personal need for us, just reporting from the field) a href=https://t.co/aFJnYq3KGzhttps://t.co/aFJnYq3KGz/a a href=https://t.co/klTLHUAfFtpic.twitter.com/klTLHUAfFt/a/p— Jeremy Horpedahl ???????? (@jmhorp) a href=https://twitter.com/jmhorp/status/1426990157916422144?ref_src=twsrc%5EtfwAugust 15, 2021/a/blockquote
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pThe good news is that, as of this writing, itnbsp;a href=https://www.globalpointofcare.abbott/en/product-details/binaxnow-covid-19-antigen-self-test-us.html target=_blankappears/anbsp;that most people can still get anbsp;rapid self‐test if they really need it, but doing so will probably come at some expense (time, money, travel, etc.)—precisely what younbsp;emdon’tnbsp;/emwant when the need arises.nbsp;/p
pAnd schools and workplaces are just now reopening./p
pHopefully, we’ll avoid anbsp;serious crunch here because production is increasing or Delta is starting to wane. But it’s ridiculous that we should’ve ever been put in this situation—one that testing advocates were warning about earlier this year, even as vaccines became abundant and the virus looked to be behind us. Mina, for example,nbsp;a href=https://time.com/6050846/covid-19-rapid-testing/ target=_blankwrote/anbsp;in late May that “we still need widespread rapid testing even with vaccines” because of the potential for new, more potent variants, waning vaccine immunity, and potential outbreaks as fall arrives and people resume their normal lives (traveling more, masking less, going back to work or school, etc.). Tabarroknbsp;a href=https://marginalrevolution.com/marginalrevolution/2021/06/update-on-rapid-testing-for-covid.html target=_blanksaid pretty much the same thing/anbsp;anbsp;week later—long before Delta was raging here and in plenty of time for the FDA to get moving./p
pYet here we are (and may be again in anbsp;few months)./p
pstrongIt’s Not Just Rapid Tests/strong/p
pIf the FDA’s longstanding (at this point) resistance to COVID-19 rapid tests were its only significant mistake during the pandemic, then perhaps we could cut them and the rest of the United States’ public health bureaucracy some slack. Unfortunately, that’s not the case—far from it. Instead, the last 18 months are littered with examples of how the bureaucracy has thwarted reasonable efforts to put the pandemic behind us. This includes:/p
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pThe FDA’s and CDC’snbsp;a href=https://www.washingtonpost.com/investigations/2020/04/03/coronavirus-cdc-test-kits-public-health-labs/ target=_blankinitial bungling/anbsp;of laboratory testing protocols, which, as Bourne details at length in his book, actually inhibited the proliferation of widespread testing based on anbsp;bizarre FDA demand for anbsp;emhigher/emnbsp;level of efficacy than in non‐emergency times. (“Unbelievably, working diagnostic tests developed in the United States were being used in Sierra Leone before the FDA allowed them to be used here.”)/p
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pThe FDA’s slow‐walking the vaccines’nbsp;a href=https://www.scientificamerican.com/article/how-human-challenge-trials-can-accelerate-vaccine-development/ target=_blankearly trials/a,nbsp;a href=https://marginalrevolution.com/marginalrevolution/2021/01/the-new-strain-and-the-need-for-speed.html target=_blankemergency use authorizations/anbsp;(for adultsnbsp;emandnbsp;/ema href=https://twitter.com/scottlincicome/status/1432451518360432647 target=_blankchildren/a), and eventualnbsp;a href=https://www.cato.org/commentary/fda-serious-about-vaccine-hesitancy-it-should-fully-approve-vaccines-now target=_blank“full” approvals/a, with the first two substantially delaying the U.S. vaccine rollouts and the latter fuelingnbsp;a href=https://www.cnn.com/2021/04/29/health/fda-approval-covid-19-vaccines-explainer/index.html target=_blankvaccine skepticism/anbsp;and delayingnbsp;a href=https://www.cbsnews.com/news/vaccine-mandates-pfizer-covid-19-vaccine-fda-approval/ target=_blankprivate mandates/anbsp;(in the face of the most robust real‐world dataset ever assembled and the delta variant gaining steam)./p
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pThe many issues with the initial, overly bureaucratic vaccine rollout last December, which Inbsp;a href=https://capitolism.thedispatch.com/p/vaccine-rollout-operation-warp-speed target=_blankdetailed/anbsp;at length in an earlier post./p
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pThe CDC’snbsp;a href=https://reason.com/2021/04/14/johnson-and-johnson-pause-experts-fauci-vaccine-science-nate-silver/ target=_blankkneejerk pause/anbsp;of the Johnson amp;nbsp;Johnson vaccine because of anbsp;very remote health risk (onenbsp;a href=https://www.yalemedicine.org/news/coronavirus-vaccine-blood-clots target=_blankfar less risky/anbsp;than actually getting COVID-19!), which—based on the charts below andnbsp;a href=https://www.wsj.com/articles/j-j-vaccine-pause-stoked-hesitancy-that-threatens-covid-19-vaccination-drive-11620561601 target=_blanknumerous/anbsp;a href=https://www.nytimes.com/2021/08/12/nyregion/covid-vaccine-black-young-new-yorkers.html target=_blankanecdotes/a—may have stifled vaccine uptake in the United States (though survey data are admittedly mixed)./p
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blockquote class=twitter-tweetp lang=en dir=ltrMaybe instead of trying to heroically interpret ambiguous survey data, we should look directly at the variable of interest: how many people are getting vaccinated. It underwent anbsp;huge nonlinear plunge timed *exactly* to the Jamp;J pause and has never recovered (see below). a href=https://t.co/1udbR60z21https://t.co/1udbR60z21/a a href=https://t.co/pC7OhdVq1hpic.twitter.com/pC7OhdVq1h/a/p— Nate Silver (@NateSilver538) a href=https://twitter.com/NateSilver538/status/1390789014517604352?ref_src=twsrc%5EtfwMay 7, 2021/a/blockquote
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pAnd these are just thenbsp;embiggest/emnbsp;(in my opinion) mistakes; as the Progressive Policy Institute’s Alec Stapp and othersnbsp;a href=https://twitter.com/AlecStapp/status/1430941390062637064 target=_blanknoted/anbsp;on Twitter last week, there are plenty of others across essentially the entire range of U.S. pandemic response./p
pWhile these problems vary, however, most of them stem from the same systemic failures within the American public health bureaucracy. Doctor and writer Scott Alexandernbsp;a href=https://astralcodexten.substack.com/p/adumbrations-of-aducanumab target=_blankdug deep/anbsp;into these issues in anbsp;recent (and well worth your time) piece, focused primarily on the FDA and chock‐full of depressing anecdotal support. His diagnosis (ha), likenbsp;a href=https://www.theatlantic.com/health/archive/2012/05/medicines-missing-measure/257901/ target=_blankso/anbsp;a href=https://technologyprofits.com/posts/the-cost-of-not-acting target=_blankmany/anbsp;a href=https://www.jstor.org/stable/26659541?seq=1#metadata_info_tab_contents target=_blankothers/a, really boils down to one thing: The agencies are—by their very mandates—far too unwilling to take anbsp;risky action even though the risks ofnbsp;eminaction/emnbsp;are clearly far higher. (Alexander describes the FDA’s mandate as “approve drugs that definitely work, reject ones that are unsafe/ineffective, expect people to freak out and demand your head if any unsafe/ineffective drug gets through, nobody will care no matter how many lifesaving treatments you delay or stifle outright.”)nbsp;/p
pThis is anbsp;classic “a href=https://review.chicagobooth.edu/economics/2021/article/covid-19-trolley-problem target=_blanktrolley problem/a” scenario, in which an individual faces the tough choice of letting anbsp;trolley stay its current course and run over many peoplenbsp;emor/emnbsp;pulling anbsp;switch and saving those folks but definitely running over (and thus being directly responsible for harming) one other person. Except in the case of the American bureaucracy, the switch is basically hardwired to stay unpulled in the absence of anbsp;ton of time, money, and paperwork (and evennbsp;emthen,/emnbsp;maybe not)./p
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pThus, we have anbsp;public health system full of insanely technocratic rules, mainly developed for non‐pandemic times, that demand near‐perfection in times of crisis instead of maximizing overall benefits based on real‐world needs, constraints, and tradeoffs. Throw somenbsp;a href=https://technologyprofits.com/posts/the-cost-of-not-acting target=_blankJohn Nestors/anbsp;into the mix, and it’s anbsp;system effectively designed to generate the problems above (and many others)./p
pstrongSo What Can Be Done?/strong/p
pAs Alexander then notes, the U.S. public health bureaucracy’s systemic problems arenbsp;emreally/emnbsp;problems with the United States more broadly:/p
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pAnd it’s hard to even blame the people who set the FDA’s mandate. They’re also doing the best they can given what kind of country/what kind of people we are. If some politician ever stopped fighting the Global War On Terror, then eventually some Saudi with anbsp;fertilizer bomb would slip through and kill ~5 people. And then everyone would tar and feather the politician who dared relax our vigilance, and we would all restart the Global War On Terror twice as hard, and drone strike twice as many weddings. This is true even if the War on Terror itself has an arbitrary cost in people killed / money spent / freedoms lost. The FDA mandate is set the same way — we’re open to paying limitless costs, as long as it lets us avoid anbsp;very specific kind of scandal which the media will turn into 24–7 humiliation of whoever let it happen. If Inbsp;were anbsp;politician operating under these constraints, I’m not sure Inbsp;could do any better./p
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pThis is precisely what Inbsp;meantnbsp;a href=https://capitolism.thedispatch.com/p/vaccine-rollout-operation-warp-speed target=_blankback in January/anbsp;when Inbsp;lamented that American citizens, politicians, and media would likely have freaked out at a “market‐based approach that simply auctioned off doses to the highest bidders and let anyone get an untested jab,” even though that system may have been “theoretically more effective in encouraging production and distribution (and thus in eliminating the virus).” As my Cato colleague Dr. Jeff Singer convincinglynbsp;a href=https://www.cato.org/commentary/johnson-johnson-vaccine-fiasco-business-usual-fda target=_blankargued/anbsp;back in April, there are plenty of good reasons for root‐and‐branch reform of the current system, but Inbsp;do doubt whether most of the polity would go along—at least not quickly./p
pGiven these practical considerations, Alexander—and then economist John Cochranenbsp;a href=https://johnhcochrane.blogspot.com/2021/08/adumbrations-of-fda.html#more target=_blankresponding/anbsp;to him—suggests anbsp;few “small” fixes to the current system to produce better outcomes while acknowledging our current societal limitations, including: (1) rewiring (“unbundling”) the FDA approval process to distinguish between doctors’ being allowed to prescribe anbsp;drug and insurance (public or private) being required to cover it; (2) the FDA only providing information about safety and efficacy instead of making a “yes/no” ruling on those issues (and trying to divine and manage public psychology in the process); and (3) changing the FDA’s incentive structure by linking its budget to drug approvals. All interesting and worth considering./p
pFor my money, however, the easiest fix to the current system is one they didn’t mention:nbsp;a href=https://marginalrevolution.com/?s=reciprocity+pharmaceutical target=_blankreciprocity/a. In particular, the United States government should immediately approve (and allow the importation of) any medical good—drugs, tests, medical devices, PPE, etc.—that has been approved by the regulatory body of another major, developed country like Germany. Doing so wouldn’t require anbsp;major rewiring of the bureaucracy (via complex and lengthy rulemaking) but would achieve at least three benefits over the current system. Most obviously, it would accelerate Americans’ ability to access critical, often life‐saving drugs and other goods that, for whatever reason, our public health bureaucracy won’t timely approve. Second, it would letnbsp;a href=https://capitolism.thedispatch.com/p/a-reality-check-on-the-pandemic-supply target=_blankglobalization do its thing/a: encouraging more production of essential medical goods to meet latent U.S. demand and easing domestic production bottlenecks during national emergencies. It’d sure be nice, for example, if we could import anbsp;bunch of those deeply discounted strip tests from Germany while U.S. factories crank up again. Finally, reciprocity might accelerate U.S. regulatory action, either by giving risk‐averse bureaucrats political cover or just embarrassing them into moving more quickly. For these and other reasons, anbsp;wide range of economists and health expertsnbsp;a href=https://marginalrevolution.com/?s=reciprocity+pharmaceutical target=_blanksupport/anbsp;medical reciprocity, and, as Singer noted back in April, there’s even legislation in Congress—a href=https://www.ntu.org/publications/detail/ntu-thanks-senator-cruz-for-introducing-the-result-act target=_blankthe Reciprocity Ensures Streamlined Use of Lifesaving Treatments (RESULT) Act/a—to get the ball rolling.nbsp;/p
pIn the meantime, however, you might want to stock up on anbsp;few rapid tests.nbsp;/p
pstrongPostscript/strong/p
pAmazingly enough, just as Inbsp;was finishing off this column, we learned that two top FDA officials will leave their positions this fall because they were upset that the White House was moving too fast on announcing vaccine booster shots. As onenbsp;a href=https://www.axios.com/biden-coronavirus-vaccine-boosters-fda-cdc-4189df4c-e794-4e4f-af16-cce32f63b3d9.html?utm_source=twitteramp;utm_medium=socialamp;utm_campaign=editorialamp;utm_content=health-vaccineboosters target=_blankreport/anbsp;put it, “[t]he Biden administration has made clear that its priority, when it comes to boosters, is to stay ahead of the virus. But in doing so, it’s also getting ahead of the process by which such decisions are usually made.”/p
pThat “process” is very much the problem./p
pstrongChart(s) of the Week/strong/p
p(a href=https://twitter.com/Brian_Riedl/status/1432508767699152908?s=20 target=_blankSource/a)/p
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img width=660 height=450 alt=reg-19-7.jpg class=lozad image-style-pubs-2x component-image loading=lazy data-src=/sites/cato.org/files/styles/pubs_2x/public/2021-09/reg-19-7.jpg?itok=IcqoaorC typeof=Image /
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pa href=https://www.aei.org/poverty-studies/the-days-of-subsidizing-non-work-are-back/?mkt_tok=NDc1LVBCUS05NzEAAAF_EWzs0Ty6kbjJvYLltmMHd5GtDm9wyu_ZJhzFxi0anavcHNwyfpehgwFfAVaPCIZsuXJ-jvdpjWZdIwxSbJly4s1I7gcb_Jww4oRchnOGhMA target=_blankDoes this affect labor supply/a?/p
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img width=700 height=444 alt=reg-19-8.jpg class=lozad image-style-pubs-2x component-image loading=lazy data-src=/sites/cato.org/files/styles/pubs_2x/public/2021-09/reg-19-8.jpg?itok=W3w5MFyj typeof=Image /
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pstrongThe Links/strong/p
pa href=https://www.cato.org/blog/new-us-tariffs-are-contributing-shipping-crisis-theres-little-we-can-do-about-it target=_blankAlfredo Obregon and Inbsp;talk about tariffs and the “shipping crisis”/a/p
pa href=https://reason.com/2021/08/24/alabamas-dumb-health-care-regulations-helped-create-a-shortage-of-icu-beds/ target=_blankHow state regulations (“certificate of need”) laws limit ICU beds and worsen the pandemic/a/p
pa href=https://t.co/qE2WqUsBnb?amp=1 target=_blankCan libertarians support vaccine mandates?/a/p
pa href=https://nbcnews.com/business/consumer/dollar-general-came-your-grocery-dollars-now-it-wants-slice-n1277794 target=_blankDollar General getting into rural health care/a/p
pa href=https://t.co/9y3e7L7TAM?amp=1 target=_blankColorado Gov. (D) Jared Polis: the state’s income tax “should be zero”/a/p
pa href=https://t.co/dGjq6Gmuer?amp=1 target=_blankThe legacy of 9/11 for U.S. immigration policy/a/p
pa href=https://www.latimes.com/environment/newsletter/2021-08-05/a-federal-agency-is-blocking-americas-largest-wind-farm-boiling-point target=_blank“How anbsp;federal agency is blocking America’s largest wind farm”/a/p
p“a href=https://t.co/7XXyt6UDmp?amp=1 target=_blankLack of anbsp;Vaccine Mandate Becomes Competitive Advantage in Hospital Staffing Wars/a”/p
pa href=https://t.co/Vqtq3qgf2a?amp=1 target=_blankChina limiting kids’ screentime/a/p
pa href=https://t.co/FWENLaMs5I?amp=1 target=_blank“There’s just not enough metal inside of North America”/a/p
pa href=https://t.co/MSyTFIkoTX?amp=1 target=_blankSwedish rent control still not working/a/p
pa href=https://t.co/R3UUOaIxmW?amp=1 target=_blankFrench wine authorities versus “renegade winemakers”/a/p
pa href=https://t.co/1lxmN5Ogb4?amp=1 target=_blankWhy we love hot peppers/a/p
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