# Covid 4/1: Vaccine Passports

post by Zvi · 2021-04-01T12:10:01.814Z · LW · GW · 52 comments

## Contents

  The Numbers
Predictions
Deaths
Cases
Vaccinations
Vaccine Passport Hype
Privacy Concerns
Equity Concerns
Coercion Concerns and Approval Concerns
Fraud Concerns and Practical Concerns
Fear and Norm Concerns
Vibe and Anti-Elite and Vague Concerns
Culture War and Motive Concerns
Summary on Vaccination Passport Arguments
Vaccines Still Work
Participants are Heroes, Go Team Yeah
In Other News
None


Writer’s Note: This is being posted on April 1, which is April Fools Day. To avoid all ‘is this the fake out?’ issues, this post does not contain any April Fools material. The fools contained herein are the usual, regularly scheduled fools we talk about every week. The official April Fool this year is whoever accidentally ruined 15 million doses of the Johnson & Johnson vaccine by mixing in the wrong ingredients.

This week started a big debate over vaccine passports. States including New York are deploying systems that let people prove they have been vaccinated, or document recent negative tests. Naturally, lots of people are outraged by this attempt to create a public record and provide information that helps people make better decisions. Thus, the long middle section where I go over all the objections I can come up with against this proposal. Some of them are legitimate.

Meanwhile, the overall arc remains the same. Things are getting worse again, and it’s a race to see how long it will take vaccinations to catch up to the problem and get us headed in the right direction again.

Let’s run the numbers.

## Predictions

Last week’s prediction: Positivity rate of 4.9% (up 0.3%) and deaths fall by 7%.

Result:

Deaths only falling 0.4% is rather scary, and seems like strong evidence that the new strains are deadlier if it isn’t a data artifact. The data from Wikipedia suggests that it is indeed a data artifact, and deaths dropped at roughly the rate predicted, but there’s reason to suspect that result is a data artifact given what’s happening in the West. It’s all rather worrisome, and strong evidence that the new strains are sufficiently deadlier to make up for an increasingly youthful set of people being infected.

We also need to mention that the positivity rate went from 4.6% to 4.9%, while the same data source is claiming 11.8% fewer tests but 12.1% more cases, which really, really does not compute. Those three facts can’t all be true at once.

Johns Hopkins has a 4.8% positivity rate at the moment, so I’m going to assume that the positivity rate is accurate and the number of cases or tests has some error or data artifact in it that’s being corrected for the positivity rate calculation. In particular, I’m going to assume tests didn’t actually fall another 11.8% last week.

Prediction for next week: Positivity rate of 5.3% (up 0.4%) and deaths are unchanged.

Also, I really miss the Covid Tracking Project, and I’m sad that no one found a way to step up and keep it from ending. The next time something this important is about to go away, I’ll make a more explicit call to see if it can be saved.

## Deaths

I don’t see a big glaring ‘this is a timeshifted number’ sign anywhere in the data in the West, but going up this much then right back down again isn’t a thing that actually happens, so at least some of that isn’t real, and the Midwest and Northeast see no declines in cases. Those are also the currently hardest hit areas, where cases are rising, so it does make sense to believe some amount of progress in the West and South, for an overall small improvement in deaths for now.

## Cases

Sharp increases in the Northeast and Midwest, and small increases in the West and South. The fourth wave is here, the question is whether it will be small or it will be large. These are big weekly increases and there’s zero sign of any new restrictions happening, so the strategy seems to be waiting on vaccinations to get us out of this. That will work, but the tide won’t turn that way alone for at least a few weeks.

European Union comparison graph:

Again, for readability reasons I encourage you to go to Our World In Data to check out other countries of interest to you. The fourth wave might not be that bad in the United States, but in Europe where vaccine efforts are lagging far behind ours things do not look good.

## Vaccinations

Occasional dips and spikes aside, this continues to look almost exactly like a linear increase in doses available per day over the course of several months. Hopefully we get a big boost to that soon from Pfizer and Moderna, but losing 15 million J&J doses to a manufacturing error is a rather large setback on the J&J front.

Almost all gaps have been filled in, and there are far fewer remaining delays. A lot of the country has full eligibility already, and by a week from now it will be a lot more. By April 15, most restrictions will be lifted.

Availability for those who make an effort seems remarkably good based on anecdotal evidence. Most of my Magic friends have been able to find slots quickly now that they are eligible, often finding next day availability. There is certainly a traffic jam right after eligibility restrictions loosen in a given state, but that does seem to clear up before too long. If you’re not finding anything, I encourage you to keep trying.

## Vaccine Passport Hype

It seems the next big battle is going to be about vaccine passports.

For an entire year, we’ve failed to provide immunity passports, due primarily to our determination to refuse to in any way acknowledge that people who got Covid-19 were then immune to reinfection, or that someone’s actual physical risk of getting Covid-19 should be considered when deciding what actions to take. There were also a whole array of other arbitrary nonsense concerns that are used as part of the war against anyone ever doing anything potentially helpful, such as ‘equity’ and ‘privacy’ and ‘if we tell them the true situation they might change their behavior’ concerns.

With a large and increasing portion of the population getting vaccinated, widespread eagerness to let life return to some semblance of normal, and messaging leading to a widespread belief that vaccines don’t actually let one change one’s behavior leading to lots of unnecessary vaccine hesitancy, there is a strong obvious need to be able to tell who is and is not vaccinated.

Thus, the concept of a vaccine passport. You download a QR code on your phone, anyone can scan it and see that you’re vaccinated, or notice you can’t produce one and exclude you from risky activities.

This allows life for those who are vaccinated to return to normal, by ensuring that gatherings that would otherwise be risky exclude the unvaccinated until we’ve suppressed the virus, and it provides strong incentive to the unvaccinated to get vaccinated.

One thing to watch for is the distinction between those who support passports because it allows for valuable activity to take place safely, and those who support it because it allows people to ‘follow the CDC guidelines.’ That’s the distinction between caring about the physical world and caring about fulfilling symbolic requirements, and it’s important to retain that distinction.

Sounds great, and also obviously the right thing to do. Yet there are objections. It’s worth dealing with them. The first job is to list all the distinct objections I’ve seen or that I can think of, and I managed to get to 12 (with some overlap):

1. Privacy concerns – from ‘this will create a new database’ to yelling ‘mark of the beast’
2. Equity concerns – some people aren’t vaccinated, some don’t have phones, etc
3. Coercion concerns – this is effectively a vaccine mandate at pain of exile from life
4. Fraud concerns – I haven’t heard this objection yet, but won’t it be easy to fake?
5. Fear concerns – If we give the impression vaccinated people are safe, they’ll take risks!
6. Culture war concerns – Some people won’t take kindly to this, and that’s terrible.
7. Practical concerns – This will be a government program so they’ll mess it up a lot.
8. Norm concerns – If people see the vaccinated living life, the unvaccinated will too.
9. Motive concerns – If I support this helpful thing, my loyalties will be in doubt.
10. Vague concerns – Fear, uncertainty and doubt around anything new, ever.
11. Vibe concerns – This feels like a thing we should hate so we hate it.
12. Anti Elite concerns – Elite people like this, so we hate it on principle.
13. Approval concerns – This is only in Emergency Use Authorization, you can’t punish people for waiting until full approval.

Some of these seem purely hostile and/or stupid. Others are legitimate concerns.

## Privacy Concerns

Privacy is a legitimate concern, and the most common and forceful objection that I have observed. Hence this poll represents a common framing

There are multiple different privacy concerns, regarding different actors getting access to different information. Some are unavoidable, others are a choice. It’s important to track them separately.

The big distinction I would draw is between the information on who has been vaccinated and the information of who has been where and done what other things.

If the privacy concern is ‘people will know my vaccination status’ then I notice I am confused as to why this is a problem. To me this seems like the exact opposite of a problem. The whole point is to make sure people can know your vaccination status, so everyone can take appropriate action in response to this information!

If there is physical information about the world that would change the consequences of actions in ways that would change your behavior, that’s information you need to know. I’ve been asked about my vaccination status often, and I’ve asked many others about theirs, and at no point did anyone involved think privacy concerns were an issue here.

Yet there are people calling this the ‘mark of the beast’ or even invoking Godwin’s Law directly off the bat by comparing it to the Nazis forcing Jews to wear a yellow star, which fall into some combination of ‘anything scary sounding is good when signaling that everyone should be scared and making no sense is actively helpful in clarifying what you’re up to’ and ‘pattern matching systems in the brain aren’t using much logic and this feels like it might sound good so go with it.’

In short, I think the concern ‘people will respond to me based on how likely I am to have Covid-19’ is a stupid objection, to the extent it isn’t one of the other objections in disguise (e.g. it could actually be objecting that this is helpful, or that this is coercive, or about equity, etc.)

The other privacy concern is that this risks tracking us more generally, or opening the door to such tracking, and that’s a completely legitimate objection.

I was listening to the Brian Lehrer show and they were interviewing someone advocating for the New York State vaccine passport app. When asked about privacy concerns, he responded that the current version did allow people to be tracked, as each QR scan would identify who they were and that they were at a particular place and time, but that future versions would fix that real soon now and privacy would be dealt with.

I am skeptical. Government programs that collect information about private citizens tend not to view that as a bug to be fixed, but rather a feature to be preserved. Corporations that get to gather similar information aren’t going to be lining up to object to this either. It’s entirely possible this will get fixed, but unless sufficient pressure is brought to the issue, chances are that it won’t be fixed.

It would be quite bad, in my view, if the government had records of who was where at what time for many everyday activities. It is very reasonable to not want any part of such a system. It is also very reasonable to worry that once such a system is in place, the powers that be would find a way to make the system permanent, in order to keep collecting the data, or use the program as precedent to then collect the data in other ways.

Can anyone think of an example of where such information was created, and the government was respectful of our rights and didn’t check it whenever they felt like it? Anyone?

The good news is that this is avoidable. There are plenty of privacy experts out there that can design a version of the system where you can’t be tracked. The system can see if you’re vaccinated, but it can’t tell who ‘you’ are while doing so, except to verify that the claim is legitimate. I’m sure plenty of crypto people can help us out on this one and would be happy to do so free of charge.

## Equity Concerns

There are two potential inequalities.

There is the concern that some people don’t have smartphone access, and thus wouldn’t be able to provide the QR code, and would be shut out of the system.

That’s an important concern to point out, for the purpose of fixing it. The good news is that there’s no reason for this to be an issue. A QR code can be placed upon a piece of paper, and those without a phone can carry the piece of paper, the same way we can carry the vaccination card now except with a less trivial duplication/fraud problem. It’s not a meaningful objection.

The real concern is that this is punishing people for not getting the vaccine, combined with the concern that some groups and communities aren’t getting equal access to the vaccine, and those same people are already worse off in general and worse off for the lack of vaccine access. Aren’t we punishing those communities and people even more?

One could argue that those are activities people shouldn’t be doing unvaccinated under those circumstances, and one would be right, but such arguments rarely sway equity advocates. You can’t answer an equity concern with an efficiency argument, equity advocates don’t consider that a valid response.

We can separate this concern into the period where vaccines have limited availability and it’s hard to get an appointment, which for now is still everywhere, and the period in the future where vaccines are freely available at your local pharmacy to anyone who walks in or at most signs up a day in advance.

During the period where vaccines have been widely available for long enough for everyone to get them, I consider equity concerns solved. The stab is quick, the stab is free, and there are real consequences to not getting the stab. If anything, there’s an equity concern not using vaccine passports, because that would lead to the undervaccinated communities having more Covid and people getting sick or dying more often, by letting people engage in risky activities without being vaccinated, taking risk and also not having the additional incentive to get vaccinated.

Before vaccines are easy to acquire, the argument is stronger. In particular, a reasonable concern would be if major life activities ended up gated by passports before those passports could reasonably be acquired, and activities that would be reasonable to do unvaccinated and are important for people to access become impossible to do without a passport. If it’s all ballparks and concerts, I’m not sympathetic at all, and if it’s about indoor dining I’m still not sympathetic because life goes on and it’ll all be over soon enough anyway, but if it stops people from grocery shopping or getting a job, yeah there’s a concern there.

The obvious solution there is to not allow vaccine passports to be used as gateways to essential life activities until such time as vaccine availability is complete, except insofar as there’s sufficient risks involved in the activity that it makes sense to require the passport anyway.

I don’t think this needs to be a government requirement. There would be both direct loss of business (and/or good employees) and a lot of blowback for requiring vaccine passports in places like grocery stores, or firing people who aren’t vaccinated before they have the opportunity to get a shot.

Looking for new employment or new housing, or seeking travel on mass transit including airplanes, seem like the places most likely to create a real issue. These are already places where there are especially strong anti-discrimination provisions, where people making decisions are told they are not allowed to consider information (that they’d often consider quite useful) when making those decisions. For frontline jobs, I’m willing to bite the bullet and say, yes, absolutely we should allow a vaccination requirement, the physical need here is too important, and I’d prefer requiring it by law to using law to prevent there being an employer-mandated requirement.

For travel, there’s big real costs imposed by not being vaccinated. If you can’t check who is vaccinated, you’d need to impose those costs for all passengers – everyone would have to distance like no one (else) was vaccinated, often cutting capacity in half or worse. Reserving at least some capacity for vaccinated people only makes everyone’s trip cheaper and easier and safer. It’s important to make sure the unvaccinated can travel at all, and in some reasonable fashion, but ignoring the issue seems super expensive. Despite this, I don’t expect those involved to get their acts together fast enough on these matters to cause issues before vaccination access is widespread.

For those worried this is effectively class discriminiation, this will soon become the easiest class marker there is to fake. All you have to do is get vaccinated. If this becomes a central method of those who are attempting to discriminate by class, that’s great news in the medium-term.

In short: I’d sympathize with this worry (to the extent that equity concerns ever deserve any response other than ‘transfer payments’)  if we were looking at an extended period of widespread passport use for essential life activities without vaccine access, but that seems highly implausible. Anyone who wants an appointment by the end of August (to be super conservative) will be able to get one without being savvy, and it’s already April and these things take time to get adopted.

## Coercion Concerns and Approval Concerns

Is this us forcing people to get the vaccine?

Mu. It’s not us forcing you to get vaccinated, but it’s not not forcing it, either. It’s a rather strong nudge, a punishment for being unvaccinated slash a reward for being vaccinated.

The extent to which this is coercion versus bribery, and the extent to which that effect is central versus incidental, depends on one’s point of view.

One can look at ‘require passport for activity’ as coercion by punishing the unvaccinated. One can also look at it as coercion by bribing the vaccinated. In this context, the two are basically the same, even if they are clearly meaningfully different in the ‘free glazed Krispy Kreme donut’ scenario. The power to tax is the power to destroy, and the power to bribe is the power to tax.

If you don’t have a deep suspicion of anyone who wants to force or coerce others into their preferred patterns of behavior, you need to get more deeply suspicious.

The sirens can be overcome. They don’t mean we should never force anyone to do anything. It certainly doesn’t mean we should never prevent anyone from doing anything, and it most definitely doesn’t mean we should never provide an incentive to do one thing over another thing.

For example, it definitely doesn’t mean we shouldn’t coerce people into vaccinations. We should and do require people to get vaccinations! You can’t go to school, or get many jobs, without proof of vaccinations. The externality argument, and the ‘this is an overwhelmingly worthwhile thing to do’ argument, are both extremely strong. A vaccine is exactly the place where we should be least suspicious of coercion.

The approval concern is that it’s not reasonable to apply this coercion if the FDA isn’t even willing to fully approve the vaccine. There are several responses to this, but the main one is that if the FDA is playing bureaucratic games with its labeling and timing in ways that have killed hundreds of thousands of Americans, that’s on the FDA, and we should not take such labels either seriously or literally. The vaccines are safe, and even if the FDA hasn’t officially fully approved them yet, most of our most important people are vaccinated, we now have given hundreds of millions of shots and we damn well know they’re safe, so I do not want to hear it.

To the extent that this is a messaging issue, it sounds like the worry is that we’re providing a nudge against getting the vaccine and this should make us not want to push people in the other direction to fix it, which I find confusing.

To the extent that these effects are contained to vaccinations, the coercion effect is a bug rather than a feature. We want to provide strong incentives to get vaccinated. There is a real worry that this helps establish a pattern and/or method of coercion in general, that is used on other things. In this context I am not too worried about that, but I am open to that lack of worry being a mistake.

I don’t consider ‘vaccination required’ that different, in a world where vaccinations are free and widely available and the passport software protects your privacy, from ‘mask required’ or from ‘no shirt, no shoes, no service.’ We want people to wear masks and shirts and shoes, and also get vaccinated, and the lack thereof has practical real costs for all of them.

## Fraud Concerns and Practical Concerns

Can’t people who want one simply fake a QR code that will represent that they are vaccinated? Especially if the system is meant to protect their privacy?

There’s a clear trade-off involved. The easiest ways to preserve privacy involve making the signal easy to fake. Verifying that it isn’t fake requires verifying identity, which is a threat to privacy.

As I noted earlier, I expect crypto people to have good answers to these problems, as they have been hard at work dealing with similar issues for a while with large amounts of money at stake.

If not, then how are we to feel about a system where it’s not that hard to fake being vaccinated?

Presumably we should feel a similar way to how we feel about people showing ID to buy alcohol.

We have a thing people want to do (buy and consume alcohol) that we have decided some people mostly shouldn’t do until they meet the requirement to do it at lower risk (be older). Thus, we ask them for proof that they are older, in the form of ID. In response to this and other ID requirements, a huge portion of young people historically get fake IDs.

This clearly does have a big impact on the amount of alcohol consumed by minors, who spend considerable effort acquiring booze and often fail to do so, or get lower-quality booze at higher prices or in less enjoyable ways.

In exchange, we initiate our young into a culture of fraud and lying, where in order to participate in ordinary human activity (again, buying and consuming alcohol) they have to lie and commit fraud, and those who facilitate such frauds and lying, in various forms, become heroes with high status, look cool and get laid, and often also make money.

On top of that, what alcohol is still consumed is often in secret, and hidden from those who could help deal with problems when they arise, and thus is often consumed in relatively dangerous ways. The harm mainly falls on those consuming alcohol, but also on others, and also they often harm each other.

The parallel here seems obvious. If we require vaccine passports that are not that difficult to fake, then a bunch of people will respect that, but a bunch of other people will fake them and then act even less responsibly, since acting like they were unvaccinated would be suspicious, and also they’ll cultivate the anti-virtues of lying and fraud.

Given how easy it is to commit fraud and lie in order to get vaccinated earlier, my assumption is it also probably won’t be that difficult to fake the passport, so that’s the deal we’re facing here. The same way I think it would be better if the laws against minors consuming alcohol were less strict but were more strictly enforced, it would be best if we used the passports only when necessary, but ensured that it was difficult and/or risky to fake them.

Thus, the practical concerns involve privacy and fraud. They also involve error. Multiple people who called into the radio show I listened to complained or asked about issues getting the passport. One lady got her first shot in Florida, and the system didn’t know how to handle that. The response was a hand wave. Another had the concern about not having a smartphone, which again shouldn’t be an issue in theory but in practice the solution wasn’t obvious or forthcoming. And Cuomo shows us exactly how stupid a government program like this can be...

What happens when a substantial number of vaccinated people are more than 90 days out from their second dose, which will be true soon? What happens when people see this and think vaccination only works for 90 days, and thus don’t bother getting vaccinated, or start going back to pre-vaccination behaviors, or request a third dose as a booster shot?

My wife signed up for Excelsior, and she doesn’t even get to keep it until 90 days after the second dose, because it seems it has to at least be renewed every 30 days for some reason.

So, yeah. Government running the system is a real concern here.

## Fear and Norm Concerns

Whenever anyone suggests letting people who are vaccinated do things that are now safe, others respond that this would be terrible because unvaccinated people would then respond to those actions by treating the pandemic as over slash adjusting their norms and taking more risk, and also that the vaccinated people are still at some risk and any additional risk anyone takes is terrible, or something like that.

At least one person I follow on Twitter (who I won’t link to or quote here) blamed the recent uptick on cases on the CDC issuing guidance that unvaccinated people could meet together, on the theory that of course this inevitably had been misinterpreted as giving permission to others to not wear masks or not distance, and of course that was the direct cause of the uptick. Which is obvious nonsense, since the uptick was already predicted and baked in, and also I see no evidence of people making that kind of adjustment to the CDC guidelines.

## Vibe and Anti-Elite and Vague Concerns

When I talk about anti-elite concerns or vibe concerns, I mean arguments kind of like this:

One could interpret this as saying that bad people are supporting vaccine passports for bad reasons, thus we should oppose them. One could call that an uncharitable interpretation, but it’s not, because that’s both the real argument here and also not a crazy argument. If there are bad reasons people are supporting policy X, then policy X is likely to get enacted in worlds where it’s net harmful due to that support, and if we collectively push back against X a similar amount, we can correct this imbalance. That’s especially true when the motives are selfish, and some special interest wants to take from the public treasury, or otherwise get private benefit at public cost (e.g. make us all continuously show passports in order to let them feel superior).

It is a useful exercise to total up all the bad reasons people are for or against something, where bad in context means considerations you don’t value rather than a moral judgement, and then pushing back to correct this imbalance. It’s important to correct both bias and incentive on every level at all times, even if that doesn’t look like the locally ‘rational’ thing to do. Someday I hope to explore such issues in more detail.

Here, these arguments very much run both ways. There are people who are opposing this for zero-sum reasons, and people supporting it for zero-sum reasons, and it’s not obvious which effect is going to dominate. One could even say we’ll know which one dominated when we see which side won.

When I talk about vague concerns on the concern list, I’m pointing to a general Suspicion of Authority that is pervasive in America, and with good reason, and a general suspicion of anything new like this, again with good reason, but not to any particular good reason. I do think that a vague uncomfortableness is appropriate for various reasons (again, there are 13 concerns listed) and this represents a threshold effect that needs to be overcome.

## Culture War and Motive Concerns

Masks became a culture war issue, despite there being no privacy issue with masks, despite a Republican president, and with no real concerns of any kind other than ‘how dare you tell me what to wear’ and ‘this mask is mildly annoying.’ Vaccines are also already an issue. Vaccine passports dial this up even further, and raise the specter of ‘red tribe members are being systematically censored and excluded already, and now we’re going to accelerate this process and lock them out of major life activities’ with the new administration leading the way. I can totally see this perspective. I don’t think it’s right or that we should let it stop us or anything, but I do get it.

There’s thus both the concern that this is part of a broader culture war push from the left, whether or not it’s being sold or even explicitly contemplated that way, and the instinctive and automatic ‘the other side wants thing so we oppose that thing’ dynamic going on as well.

That leads into an argument from some lawmakers that goes something like this: You want to do this useful thing. However, there are lots of people that have been convinced to oppose this thing, and if you tried to do this thing anyway, they’d be mad and this would cause trouble for you, and this would be ‘combative’ and ‘divisive’ and we’d be forced to make your life miserable and job harder, so Mr. President, please don’t do this or we can’t be held responsible for the consequences. That’s not a completely illegitimate concern, even if it’s largely disingenuous and those same people saying this isn’t going over well are mostly working hard to ensure that it doesn’t go over well. Resistance is a real issue here, as is upping the general distrust factor and level of conflict and paranoia. It’s a concern.

Finally there’s the Motive Ambiguity concern. If you’re for the passports, you’re presumably for them so that people can get back to living their lives and stay safe. Those sound suspiciously like better things that you prefer to worse things. Can’t have that. Whereas if you oppose it, you can signal your loyalty to almost any group via your choice of symbolic concern, and even plausibly claim loyalty to all of them at once. Neat trick.

One could argue that there are also some plausible bad reasons to support the passports, and this could be used as a defense here. You might be supporting good things over bad things, but maybe you like inequality and discrimination, or you like punishing the outgroup for defying your preferred shibboleths, or you hate privacy. There are several good choices here that lend plausible deniability to supporters. I don’t think that fully works, because when it’s this obvious which side has the physical benefits on its side there will always be suspicion that those concerns mattered, but it does help.

## Summary on Vaccination Passport Arguments

I still find the case for vaccine passports overwhelming, as there’s no realistic path to doing things safely without them other than waiting for full suppression, and giving people incentive to get vaccinated once we have unlimited supply is super important. Yet the concerns here are real, and worth worrying about.

I am especially concerned about privacy, and it is important to find and push for a technological solution that doesn’t allow the tracking of who had their QR code scanned where and when. I would also be concerned if we were to start screening off essential aspects of life within the next few months, while access to the vaccine remained an issue, and we do need to protect housing, transportation and jobs against actions that shut people out too broadly and quickly, even if there are some efficiency losses involved.

What is especially troubling are those who seem determined to ban, boycott or punish those who attempt to run a private business in a safe fashion. The exact worst thing one could do right now would be to ban people from asking about others’ vaccination status when trying to figure out what would be safe or unsafe actions, and that’s exactly what a number of states including Florida seem to be doing in order to score political points.

Nate Silver gets major points for asking what is arguably the best question about Covid that is rarely asked, and asking it correctly, and to which I’m not super confident in the answer:

I think I’ve talked about this a few times, where there are two possible worlds. In world one, each exposure if 95% less likely to infect you, so any given action isn’t too risky but if you take lots of risky actions continuously you will eventually get Covid-19. In the other world, degree of effectiveness varies from person to person, so 95% of people can do whatever and never be infected, while 5% are at the same risk they would have been without vaccination.

You could also have a hybrid world between the two, which seems highly plausible; it gives varying degrees of additional protection to different people, that combine for 95% protection.

My prior has been that it’s mostly the second world. Most people are immune, and no realistic exposure is going to change that, and if they did get exposed a bunch it would act like a booster shot long before anything bad happened. A few people’s shots get botched or contaminated, or they have compromised immune systems, or something randomly goes wrong, and they’re still varying degrees of vulnerable, but often with substantial partial protection.

Here’s a more complete take:

I’m willing to go with that explanation.

What that means in practice is that once you’re vaccinated, there’s an effective cap on how much risk you can take. It still makes sense to defend against the bigger risks when the cost of doing so is reasonable. It could also be reasonable, if circumstances broke correctly, to actually not care at all and accept the full ‘if the vaccine didn’t work I’m going to catch this’ failure rate, since it caps out around 5% for infection and the death rate per case is much lower on top of that. Doing this likely only shortens life expectancy no more than a few days.

I still plan on taking the easy precautions, but part of that is I don’t have a way to usefully take a lot of risk. There isn’t that much to do in this town.

## Vaccines Still Work

The latest reproduction of this result is a new study of health care workers.

The headline numbers are drops in infection of 80% and 90% after the first and second doses respectively, starting fourteen days after the first dose for the date of the test, and they reflect actual behaviors of people who know they’ve been vaccinated.

There isn’t much more to the study than that. Once again, it’s clear that protection against all infection is somewhat weaker than the 95% protection against symptomatic infection, and that the first dose gets you far more than halfway to being protected.

On a related note, I did go back and look at the data about the timing of protection from the first dose, and I’ve concluded that it’s potentially slower than we thought, based on the timing of the real world data. You still have a lot of protection by day 10, but I wouldn’t get excited on day 7, and waiting until day 14 isn’t crazy. After that, we’re still talking 80%+ protection from one dose from infection alone, higher than that for symptomatic infection, higher still than that for hospitalization and death.

There is no clean way to do a study on the exact infectiousness level of the vaccinated, but I continue to view the probability that they aren’t at least roughly as much less infectious as they are less likely to test positive on a PCR test to be quite small. A bigger decline would surprise me less than a smaller decline, since those who get worse cases tend to be more infectious.

This study is commonly referred to as ‘good news.’ On reflection I agree with that assessment, but almost entirely in the sense that we now have stronger evidence to overcome vaccine hesitancy, rather than this being a positive update on effectiveness. For this to be good news on effectiveness it has to move our estimates substantially upwards, which this doesn’t. That’s a sign of good calibration.

This study also makes it very clear that first doses first would have been the correct approach, but that horse is quite dead and I see no reason to beat it further.

Also, in case there was any doubt, yes the vaccines work in children.

Hopefully this isn’t used as a ‘wait until the kids are vaccinated’ excuse.

Vaccines don’t work, unfortunately, if you ruin them during the manufacturing process. Which seems to have happened to 15 million doses (!) of Johnson & Johnson.

The argument that ‘money’ is not effectively the limiting factor on vaccine production now has to explain why people for whom ‘it was no secret that [they] did not have a deep bench of pharmaceutical manufacturing experts’ were put in charge of one of the major vaccine production sites. Either there was a supply limit that was binding, in which case perhaps that supply should have gone somewhere that had a deep bench of manufacturing experts, who would be less likely to do things like mix ingredients for two different vaccines together and thereby ruin 15 million doses. Due to a single ‘human error.’ Or, alternatively, if there wasn’t a supply limit, why aren’t there more factories?

## Participants are Heroes, Go Team Yeah

Not Covid related, but it looks like I made it onto someone’s fantasy intellectual team, going 106th in the draft. It’s quite the honor to be taken at all in such a thing, especially considering some of the giants that went only slightly before I did. Of course, the scoring system is super generous to me, with bets (B) being one of three categories, and a second (S) being steelmanning. In theory I even have some meme (M) game, especially with Eliezer Yudkowsky, Julia Galef, Robin Hanson, Robert Wiblin and Scott Alexander all counting as one of the three uses necessary for a term to count. One big advantage my team will have is that I am aware of the competition, and as always, it’s good to have fantasy players who care even a tiny bit about their fantasy scores. My understanding is there are 9 teams, and the only team member I know about is Robert Wiblin, so it’s hard to judge whether the team is well-rounded or generally seems strong. But if I keep writing at this pace, I should be a monster in the (B) category, and I do expect to keep writing for a while, so before seeing the rest of the team I’d give my team a 30% chance of winning that category outright (if you think I’m wrong please say so, but I really don’t recommend betting against me on this for an amount I’d care about, in either direction, for obvious reasons), and maybe a 20% chance to win overall out of 9 teams because I think picking me also reflects well on their likely other picks by showing they’re more likely to be thinking carefully about the points system. I wouldn’t underestimate how much the pick order was determined by whose content you wanted to monitor the whole time! You take Joe Rogan first and you’re committing to a lot of hours of listening, and I mean a lot. That’s the only way to get that kind of value. A lot of this competition will be an effort play – who will be willing to tally all the probabilistic predictions and check lots of writing everywhere against a list of potential memes? Steelmanning is easier, since it’s much harder to miss so long as you read your team’s stuff at all.

After I wrote that, the teams were posted. I’m on the Null Hypothesis, which is an excellent team name, plus you get to be on the Kling-approved Null Hypothesis Watch while looking for points. We got the number one pick at #4 (Scott Alexander), which I suspected was reasonably likely given he fell to 4th (it’s possible we had Tyler Cowen, but even that seemed highly unlikely, and several later in the round also seemed implausible), and also is great. This definitely feels like someone took people they knew and were happy to follow closely, which makes sense as a strategy. Hence both Weinsteins, and the package of myself, Alexander and Yudkowsky both make sense, and also play into finding M point triggers within the team. I’m guessing I’ll end up providing the first point for a lot of Ms from both of them. Tabarrok is similarly a free action and was a steal at #42, and Taleb is basically a giant M-point hunt – he’s never scored an S point in his life, and when asked for a probability he’ll either have a formula or tell you it’s impossible to know the probability and also there’s a 100% probability that you’re an idiot, but you’re sure to pick up Black Swan, Antifragile, Skin in the Game and so on. Collison and Thompson also feel like people such a reader would be happy to keep tabs on. Overall, there’s a lot to like, and good reason to think the team will be well-monitored, but I do think there are some potential blank spots. I definitely like our chances to win (B), which I’d bump to 35%, and I’d keep our winning chances around 20%. Tim the Enchanter’s team looks strong too. Clan Graham seems strong in very memes but not well-rounded elsewhere. I’m not sure what to make of the teams that are mostly people I don’t recognize – presumably it’s right to be skeptical there.

## In Other News

Very Serious People are back in charge of policy, so we can neither move at nor call any operation Warp Speed.

FDA approves three rapid tests for home use, two without a prescription. Better late and crippled than never.

The Biden Administration has noticed that the massive government vaccination sites tend not to be as useful as the existing infrastructure of pharmacies. So far so good, but then the implied intervention is to do less rather than do more. I will never understand why ‘costly’ gets to be an adjective in such descriptions given the benefits at stake.

There’s a take on the whole AstraZeneca announcement mess last week that it was about AZ not properly respecting the authority of the DSMB, and thereby doing things ‘the wrong way,’ rather than any substantive disagreement (e.g. 76% vs. 79% is a small disagreement anyway), and they got called out because the people calling them out were disrespected. I don’t buy it, and while it would be somewhat mitigating it doesn’t make AZ’s actions not supremely stupid, because it’s playing with fire where you can’t accomplish anything with it:

It still seemed necessary to share the alternate hypothesis.

Washington Post notices that sometimes people lie to get life-saving medicine earlier, especially when there’s zero probability they would ever be caught, and frames this as something that is ‘damaging friendships.’

Quarantine procedures to countries that aren’t doing suppression are not about preventing Covid-19 (official link). Two week quarantine for fully vaccinated people.

Zeynep piece in The Atlantic laying out our situation, solid presentation, nothing especially new, the race between vaccinations and the fourth wave coming from a new deadlier and more infectious strain, and all that. I do think this leans a little hard into the ‘if we move fast we win if we move slow we lose’ thing, especially given the late hour and how little variance is actually in play at this point, but mostly that seems fine.

She also links to one of several calls for a ‘vaccine surge.’ The logical idea is that if there are some places with high infection rates, especially when dominated by newer and deadlier strains, we should direct our vaccine supply to those areas first, because it will have a higher impact there. As a first best policy this would obviously be correct, but opening up the floodgates of which states are ‘most deserving’ would be such a disaster I don’t even want to consider it. Allocation by population rather than politics and power, even if there are real needs not being met, as the lesser of two disasters.

I too strongly endorse the strategy of yelling “Fix It.” Rather than issue rules and attempt micromanagement, if there’s something that needs to get done and isn’t getting done, because there are a bunch of veto points stopping it for reasons that obviously aren’t any good, it makes sense to try activating everyone’s blame-avoidance programming, and trigger them into physical-world mode, by yelling “FIX IT!” as loudly as possible. Pick an outcome, pick a date:

While I’m linking to that post, I’ll give my reaction to its first section as well, where he points out that there’s no correlation between the minimum age requirement and what percentage of the elderly are vaccinated, and respond that the places doing better or expecting to do better with vaccinating the elderly were then in a better position to expand eligibility. So I agree that singling out states and obvious problems isn’t useful, I don’t think this particular non-finding says what he thinks it says.

The one week delay for the 16-29 year olds is quite smart. Every time you make a lot of people eligible at once, you reliably cause a system overload and make it super hard to get an appointment that’s at all reasonable. By giving the 30-49 year olds a week’s head start, Cuomo gives them the chance to book as far out as they want, then the kids can get in line behind them. I heartily approve, and I think not doing this in other states was a missed opportunity. If anything, I would suggest going to 40 before (or instead of) 30, but this still does most of the work that needs doing.

This is not a coincidence because nothing is ever a coincidence, even though it’s definitely a coincidence, or is it:

You think your attitude on social media can’t save lives? Behold:

Reverse the associations of potential minor social awkwardness and vague blameworthiness, and those five doses get used. The source article from Guardian is mainly about the ‘controversy’ around providers turning to whoever is around to ensure doses aren’t wasted.

It then ends by pointing out that the UK is at a point where it needs to loosen eligibility requirements, as proven by inability to fill appointments, yet the requirements aren’t changing:

Finally, I got to go back to New York City this week to get my second shot of Pfizer. I have a small amount of soreness in my arm and spent a day not feeling quite 100%, but it definitely wasn’t the whammy that I’ve heard others experienced, and I’ve been able to work and write this column in its aftermath with little trouble. I decided not to try and see people because waiting two weeks allows me to not worry about conditions at all, and I’ve found that such worries distract from my ability to enjoy seeing people, so better to use the trip as a more solitary one this time, and connect with people mid-April. If you’re in New York City and would like to see me next time I’m there, please do drop me a line.

comment by tkpwaeub (gabriel-holmes) · 2021-04-02T15:40:21.047Z · LW(p) · GW(p)

Thanks for bringing up the topic of vaccine passports and doing it in a thoughtful way. Before getting started on the stuff I can actually claim to have some insight into, just a few quick points of order about the Excelsior Pass:

1. It's not really a vaccine passport, or even an immunity passport, it's a broad "good to go" credential based on whether you've been vaccinated or you've had a recent negative test.
2. As best I can tell the 30 day limit is just an artifact of when you download it. You can reset the clock by downloading it again the next day, and there's no limit on how many times you download it.

Also an important point about the extent to which there might be something rolled out at the federal level: the Biden administration has already indicated that except possibly for international travel, they don't intend to mandate anything of the sort for domestic use. Exact language matters  a lot here. The feds are using the term "digital vaccine certificate", rather than "vaccine passport", and I think the connotation is important. The former suggests something more agnostic as far as use-case. The latter suggests something much more rigid, and something that's only really appropriate for travel (as opposed to something you'd have to carry around with you anywhere you go). According to Jeffrey Zients, “any solutions in this area should be simple, free, open source, accessible to people both digitally and on paper, and designed from the start to protect people’s privacy.” I boldfaced "open source" because I really think that's key here. People, and by extension governments composed of people, make mistakes. An idea can be good-ish, and people can put in work developing an app, but as long as we keep this open source we can salvage any work that's been done without throwing the baby out with the bathwater. Not surprisingly, this is a position shared by the American Civil Liberties Union

Now to the aspect that I can actually claim insight into - "fraud concerns". They're valid. Before delving into why they're valid, I want to pose the question: what's the "end goal" of vaccine passports? Is it to

a) Ensure with 100% accuracy who is or isn't vaccinated? or

b) Maximize the percentage of vaccinated people at a given public venue?

What I want to argue for is that (a) is a fool's errand and that there are better, more cost-effective ways of getting (b). In the process I'm also going to show why "open source" is a key characteristic of any digital vaccine certificate.

About me: I've been a civil servant working in state government for almost a decade. In that time I've been exposed to a lot of different things that state government does to enforce a lot of different things that could be viewed as rough analogs to what's being suggested with vaccine passports. The recurring theme is that fraud and forgery are common, and become more so when people have a high incentive to commit fraud and forgery for personal financial gain (or avoiding personal financial losses). Indeed, in a managerial accounting class one might learn about the "fraud triangle":

It's not hard to see that all three of the above elements exist for "vaccine passports", were we to focus on that as our main tool for accomplishing the basic goal of (b) above. Here are some of the examples where fraud is surprisingly common (warning: a lot of the links below are to New York Times articles, and you may vary well blow through your monthly quota if you don't have a subscription - high quality information isn't cheap).

1. Fish About 40% of all fish is mislabeled. The problem periodically resurfaces when it's examined by investigative journalists or law enforcement, and there's very little evidence that it's going away, despite our best efforts to enforce it. One of the more disturbing forms of this is when escolar is passed off as tuna. Escolar is considered somewhat of a delicacy, but when consumed in the same quantities as tuna, it causes explosive diarrhea

2. Taxi meters - unscrupulous taxi drivers can and do tamper with their meters. A noteworthy instance of widespread fraud occurred in 2010. Cyrus Vance uncovered it in a massive sting operation that presumably involved a lot of overtime.

3. Gasoline: This doesn't happen as much as the above forms of fraud, but only because we have a government agency devoted to its prevention. But suffice to say that without a large number of government agents acting as secret shoppers, this kind of thing would happen:

4. Supermarket scales: another thing that state governments need to keep an eye on. Because people cheat.

5. Firewood: Moving firewood is a pretty big no-no everywhere in the country, and for good reason - it helps move pests from point A to point B, potentially leading to devastating blights on local flora. All levels of government are involved in enforcing this, both with secret shoppers and with periodic checkpoints.

6. Fraudulent motor vehicle inspections:  motor vehicle inspection shops have a fairly high motivation to pass paying customers on their inspections. Occasionally this is unearthed by undercover operations

7. Underage sale of alcohol and tobacco: One of the exceptions to child labor laws is the use of minors to pose as underage customers trying to buy tobacco and alcohol.

There are loads more examples - the key takeaway is that people can and do cheat. Maybe not a lot of people, but enough people do it enough that enforcing it is (pardon my language) hard as fuck. It's a game of whack-a-mole with a limited number of resources, and it involves sting operations and secret shoppers. And it's difficult to see how simply putting something on a smartphone changes the fundamental dynamic of one human checking another human's credentials. Even when merchants do catch attempts at forgery and act in good faith, things can go sideways, as is abundantly clear from the unfolding, increasingly agonizing story about George Floyd.  The fact that the fake was easy to spot wasn't the issue; the escalation was the problem. Anyone tasked with enforcing this needs to be carefully trained on de-escalation tactics, and in a country as awash in guns as ours, that's a pretty big ask.

So that's where I'm coming from with my skepticism about the feasibility about any large-scale deployment of "vaccine passports". It seems to me that the game isn't worth the candle, for this particular method of obtaining the goal of (b).

So before I get into two alternatives that I thought of - I think we can all agree that we should be hoping that we're able to convince everyone to get vaccinated quickly and efficiently enough for their own sake that the need for all of this is obviated. It's good to see that the Biden administration is making a concerted effort to do exactly that

It should be noted that both of the alternatives I'm suggesting could easily incorporate some sort of digital vaccine certificate, just not used in the way that some people have suggested for vaccine passports.

1. Batch verification of vaccination status: Here's how this could work. Say someone (the "organizer") wants to facilitate a group of people ("attendees") in one place. Instead of verifying the vaccination status of each individual at the door, the organizer turns to a third party to check the vaccination status of the attendees, but with a catch. The third party only reports back the number of vaccinated attendees. There's no reason that a "digital vaccine certificate" couldn't be used to make this easier for the third party (which is why I emphasized the importance of this software being open source). What kind of third party? Either a local health department or a licensed ticket reseller might do the trick. In the latter case, the event organizer could sell the tickets to the licensed ticket reseller, who would check the percentage of vaccinated prospective attendees. If the numbers don't work, the event is canceled and  the reseller absorbs the loss, which is easier for ticket resellers, since that's sort of what they're for anyway. The important point is that there's very little motivation either for fraud or violent escalation with this approach. Moreover, it acts as a better safeguard for personal information. Finally, I suspect this would also be better from a contact tracing perspective. A contact tracer would only have to deal with the ticket reseller.  To reiterate, digital vaccine certificates could very much have a role to play in a system like this; "vaccine passports" not so much.
2. Incentives: By now everyone has heard about the free doughnuts at Krispy Kreme, and I'd love to know if it supports the math that I'm about to outline below. As far as I can tell, reputable sources confirm that incentives work. Even the studies that claim they don't work still end up demonstrating that they increase the number of people who get vaccinated, even when they don't meet their targets, which suggests that if the financial incentives were larger, even more people would get vaccinated. And they don't all have to be monetary. A baseball stadium could offer discounted season passes to people who get vaccinated - heck, they could send them directly to whoever's doing the vaccinating (quick, CVS/Walgreen's/NYU Langone/whoever is reading this - get a ticket resale license!). What happens next? Well, vaccinated people will be more likely to step out.  And here's where Bayes' Theorem comes into play. Specifically consider the following probabilities:

probability of someone attending an event
probability that someone happens to be vaccinated
probability that someone is attending an event and is vaccinated
probability that someone is at an event given that they're vaccinated
probability that someone is vaccinated given that they're at an event

Replies from: gabriel-holmes, Zvi, lsusr
comment by tkpwaeub (gabriel-holmes) · 2021-04-02T15:52:25.959Z · LW(p) · GW(p)

Sorry, I seem to have reached my character limit, so I'm continuing this in a reply to myself - I think this is important.

There's no reason to think that incentives wouldn't serve to maximize . Bayes' Theorem relates  and  as follows:

The beauty of an incentive system is it would maximize both factors in the numerator while the denominator can stay more or less fixed (e.g. by the capacity of the venue). Same reduction in risk for people attending, at minimal cost.

Again, I want to emphasize that I can imagine a role for digital vaccine certificates in such a system, but the idea of vaccine passports presented at the door, just seems untenable.

Replies from: gabriel-holmes
comment by tkpwaeub (gabriel-holmes) · 2021-04-02T18:31:26.618Z · LW(p) · GW(p)

It turns out that non-profits in New York State don't need to obtain licenses to resell tickets. So it would be pretty easy for an event organizer in New York City to, say, sell a bunch of tickets in bulk to a large hospital system that uses MyChart. The hospital system can then resell the tickets to its own patients, as a promotion - possibly with a corporate sponsorship.

comment by Zvi · 2021-04-03T14:37:25.077Z · LW(p) · GW(p)

I would encourage you to make this a top-level post, I think there's a lot of very useful content here and I'd like to be able to comment / refer back to it. I'm especially interested in exploring why these particular areas have so much fraud relative to other areas slash whether this is true - one question is whether these are areas where we call people who lie or misrepresent out as committing fraud, whereas in other places maybe we don't as much do so.

The solutions on the other hand don't seem viable to me. E.g. having a system where it will tell you how many out of X or more people are vaccinated, but won't tell you if 1 particular person is vaccinated, sounds like something you do in math team practice or when nerd sniping at a party to figure out how to figure out exactly who is vaccinated, and/or a way to start a lot of fights and have a lot of really bad free rider problems and game theory experiments that mostly don't end so well. Fascinating stuff, though. I'm curious how you think this functions in practice if there's a bar on directly checking individuals, under your proposals.

Incentives are great and would certainly help with the 'fuzzy math' of having groups contain more vaccinated people, slash getting more people vaccinated, but I don't think there's any political/social ability to notice that going from 30% to 70% vaccinated in groups is 'good enough' in some sense and we should be OK with it, I think it needs to be effectively 100% or things won't actually happen. And yes, you can say 'but fraud!' but in some sense that serves the function of letting everyone pretend it's 100% slash not feel responsible for the fact that it's not 100% or for the people still vulnerable.

Replies from: gabriel-holmes, gabriel-holmes
comment by tkpwaeub (gabriel-holmes) · 2021-04-03T21:50:57.905Z · LW(p) · GW(p)

So I guess another approach that would make vaccine passports palatable to everyone would be if we just went ahead and gave everybody something similar to the Excelsior pass (either on their phone or printed), where we'd attempt to implement that underlying logic of "x% vaccinated or y% capacity" in real time. The venue would stop allowing new people in when neither of those conditions are met, and nobody would see anybody's personal information. And it would take away any motive for the prospective attendee to cheat. This could also be leveraged for contact tracing, and perhaps the expectation would be that you get a test if you don't feel well, or if a contact tracer tracks you down.

I don't think it would be too difficult to deploy something like this (all-in-one contact tracing/vaccination tracking/compliance app)

comment by tkpwaeub (gabriel-holmes) · 2021-04-03T15:47:13.677Z · LW(p) · GW(p)

Yeah, so I guess my point is that in the spirit of "less wrong", making a beeline for aggregate statistics appears to me to be the "least wrong".

There's also somewhat promising evidence that there's going to be enough self selection that Bayes' Theorem will have our backs even without incentives. Kinda like how there are a lot of uh, people like me in movie theaters on December 25th.

comment by lsusr · 2021-04-03T06:01:09.374Z · LW(p) · GW(p)

This is fascinating. I expect many readers of Less Wrong would be interested in top-level posts about what the world looks like from the perspective of a state government civil servant.

Replies from: gabriel-holmes
comment by tkpwaeub (gabriel-holmes) · 2021-04-03T08:01:00.202Z · LW(p) · GW(p)

Thanks. That means a lot to me. I feel like a lot of things depend on "who's in the room" when decisions are made, and all too often it's the people who are stuck with implementing things that are left out.

comment by AnthonyC · 2021-04-02T13:08:08.512Z · LW(p) · GW(p)

Given the generalized lack of competency, understanding of reality, interest in any sort of nuance whatsoever, and so on, since the pandemic began... do you really believe any of the relevant institutions could or would choose to (and would successfully) implement any of the solutions you propose to those objections you believe are reasonable? I, for one, very much do not. And I don't just mean government institutions either. The failure of infectious disease experts at major universities to speak out in favor of saner policies, the shortsightedness of business and other groups pushing for premature (and selective) re-openings, those all play a role too, and I'm skeptical of them implementing their own policies requiring vaccination by employees or customers.

Granted, overcoming that objection of mine would be very easy. All it would take is for the CDC, FDA, and whichever governor or state legislature is proposing a vaccine passport rule to come forward with a (even partial) self-assessment listing what they got right, and what they got wrong, based on the information they had at the time, since last January, and a commitment to a timeline to produce a detailed plan for how they will do better in the future. I won't hold my breath. For example:

"We should have admitted from the beginning, that yes, obviously in any given situation masks don't increase your risk of getting sick and could reduce it, so people should wear one for anything they would do in public indoors anyway, but making it a policy requirement without any plan in place based on when and why it makes sense, like requiring masks outdoors in any place less crowded than a city center, is not likely going to be helpful."

"We should have discussed, from the beginning, the importance of ventilation indoors, and encouraged more open windows, HVAC system improvements, and spending as much time outdoors as feasible."

"We should have stated clearly, from the beginning, that we were going to make the best recommendations we could at any given moment, and that some of that will definitely change as we get more data, but until we get that data we won't know which ones."

"We should have initially recommended people disinfect things coming into their house or business as a possible transmission vector, and then updated when we found out that fomites weren't a major component of the pandemic beyond very high touch surfaces."

"We should have actually bothered to do even basic cost-benefit analyses when making decisions."

"We should have recommended everyone who can do so to take vitamin D, since the potential risks are so much lower than the potential rewards. Actually, we should have been doing that for a lot more people, for a long time, in most of the US."

'We should have approved OTC/at-home/prescriptionless tests, including new types like maybe that MIT over-the-phone AI tool, with way lower thresholds for accuracy and specificity, as soon as possible. False positives just lead to more caution/less risk-taking, and false negatives are no worse than no test. We can require stricter test modalities for more critical use cases, which can help in making sure capacity is more available for those."

"We should have committed 10x more funding to vaccine development right away, and done human trials as soon as possible."

"As soon as we had any indication what handful of vaccine initiatives were likely to succeed, we should have asked Congress to approve funding to pay companies to ramp up the necessary production capacity well in advance of their expected timeline for FDA approval, since it would cost dramatically less than we were spending on relief bills or losing from the restrictions in place."

Also: at this point we have a pretty good idea how long it'll take for everyone who wants a vaccine to have had ample opportunity to get one. Those people who do, will not die of covid once a few more weeks have passed. At that point it's not unreasonable to let others take their chances if they want to, if they judge their personal risk to be low enough, because they're no longer endangering anyone who didn't choose to be so endangered. So, a vaccine passport policy may make sense for... what, until late May at most? Is it really worth it to fight this battle on passports instead of focusing on campaigns to encourage people by touting all the positive benefits of these vaccines (and vaccines in general)?

I, for one, would like to come out of this pandemic into a world where people are generally impressed with how incredible the impact and potential of mRNA vaccines will be in the future. Not one where they're mostly associated in the public consciousness with polarizing political battles.

Replies from: Dagon, cistran
comment by Dagon · 2021-04-02T14:28:46.301Z · LW(p) · GW(p)

"Government incompetence" is a fully-general objection to almost anything.  I wish it weren't so often a CORRECT objection.

And vaccine passports are exactly the sort of topic which we should expect such incompetence.  It's unclear what problems are being solved by them, what measurements can be used to adjust or kill the program if it's not working, or what the incentives are of any players involved.

I don't have a good inside-view model of the large numbers of people going maskless in crowds without the vaccine, but my outside-view model of them makes it seem VERY likely that they'll just ignore it for most things, and forge or otherwise bypass it if actively enforced.

Really, the blend of arguments adds up to "why bother?"

Replies from: AnthonyC, gabriel-holmes
comment by AnthonyC · 2021-04-02T15:54:01.443Z · LW(p) · GW(p)

Fully agreed on all counts. And the thing is, there are many things that government does competently (enough for the purposes I care about). Sometimes, when it isn't, I look at what happens and say, oh yeah, that's a train wreck, but I see how the decisions that lead to it made sense to the people involved even if they were competent and had the best of intentions. Other times, not so much.

comment by tkpwaeub (gabriel-holmes) · 2021-04-03T08:07:07.143Z · LW(p) · GW(p)

Even if we made fakes easy to spot, and the gatekeepers were able to spot them and report them every time - it's worth considering that the first link in the chain of events leading to the death of George Floyd involved somebody spotting and reporting a forgery. Is this REALLY the path we want to go down?

Replies from: Rana Dexsin
comment by Rana Dexsin · 2021-04-03T18:01:00.878Z · LW(p) · GW(p)

Mostly meta, mostly with the motivation of explaining a vote in case it would otherwise seem like an attack:

I believe you that you're pointing this out because you want to avoid very unjust and harmful outcomes that might not be easily anticipated just by looking at the first step. And that's good!

But you're also leaning hard on a highly-publicized, highly-emotionally-charged single incident in a discussion about broad public policy. And that's bad. Not only can it raise others' emotions in ways that impede truthseeking, but it's easy to make serious errors extrapolating that way in the first place.

I have downvoted this comment for that reason—but I want to contrast that your other comments have been quite good. In particular, you brought up the same issue in a more nuanced and explained way in another comment; that comment also included a lot of other useful perspective, and got an upvote from me.

I also think it's very possible that you have further information we don't (possibly intuitive, experiential information that is hard to unpack or transmit; and in fact you have already pointed at much of this in the other comment!) that does point in the direction of, say, “‘vaccine passports’ deployed in certain ways would cause people to forge them, and then cause enforcers to detect this and escalate the situation in such a way as to cause violent disasters” (or something similar—don't anchor on that if you have a better idea!). If so, I would encourage you to keep trying to reify that connection if you can (though certainly don't think you have to keep sinking energy into it regardless of anything), but also to try not to be too impulsive if people start picking it apart or depicting worlds in which not all the links hold up.

[Some edits and corrections shortly after posting.]

Replies from: gabriel-holmes
comment by tkpwaeub (gabriel-holmes) · 2021-04-04T00:51:40.458Z · LW(p) · GW(p)

I appreciate the explanation of the downvote (no harm no foul) and I'll try to tweak it if I get a chance. I probably do have experiential information that's hard to unpack (without starting to break confidentiality, based on my line of work - which is annoying, because I absolutely never wanted to play the "I could tell you, but then I'd have to wipe your memory tomorrow" card, but here we are).

I do think the potential for escalation of conflict is a real concern; and that's another reason for keeping the implementation as discreet as possible. For a restaurant, I could imagine a combined vaccine status/capacity logging/contact tracing app that has the same look and feel to everyone involved as a handy way of making reservations in 30 minute increments once the capacity reaches a certain level. This would involve giving everyone a QR code, and I believe this would probably be easier to enforce because it's a lot easier to catch "two people being in the same place at the same time"

My main "meta-points" in all of this are:

a) Keeping the code open source, like Jeffrey Zients suggests, is incredibly important.
b) We should try to come up with a set of guidelines of what it would mean for vaccine passports to be a failure (e.g., no measurable effect on case rates, evidence of rampant forgery, etc)

comment by cistran · 2021-04-03T15:45:54.270Z · LW(p) · GW(p)

False negative is worse than no test at all. It gives a person additional incentive to ignore mask rules.

Replies from: AnthonyC
comment by AnthonyC · 2021-04-04T13:33:23.339Z · LW(p) · GW(p)

I realize this is going to be different for different people and in different places, but if you're in a place where mask compliance is high already, and rules are actually enforced, this isn't likely to be a thing. I mean, obviously it is to some degree, people get a negative test result (sometimes, too soon after exposure for it to even mean anything) and then see friends and family unmasked. But I don't think it's anywhere near significant enough to change my conclusion.

If that were likely to be a major problem, I'd think we should already be seeing large numbers of people who've recovered from covid refusing to wear masks in public. After all, that's much stronger evidence of not having covid, and not being able to catch it, than a negative test result is. Also, better messaging could help mitigate that, "Sometimes tests are wrong, so you can't treat a negative test as a guarantee, but even if you could, a mask helps protect both you and others, so you should wear one to help you stay negative."

Still: I don't mean for my list to be definitive. I was making examples based on my own assessments of the kind of reflection I'd need to see from major public health figures and institutions before I start trusting them to implement any policy that requires delicacy, nuance, precision, and care, to avoid causing significant harmful side effects.

Replies from: gabriel-holmes
comment by tkpwaeub (gabriel-holmes) · 2021-04-08T20:35:52.257Z · LW(p) · GW(p)

If you're not concerned about enforcement why bother with the security theater? Might as well just trust people when they say they're vaccinated. The marginal benefits of the apps is negligible, compared to the cards. Anyone with the chutzpah and resources to forge a CDC card isn't going to have a hard time forging a QR code and a driver's license.

Replies from: AnthonyC
comment by AnthonyC · 2021-04-08T22:53:39.340Z · LW(p) · GW(p)

I agree. I'm not sure if I said otherwise anywhere, but if I did, it was a mistake. I do not support enforcing any kind of vaccine passport. I might, if the vaccine rollout were much slower than it currently is and there were an institution I trusted enough to roll out and enforce one thoughtfully enough. But as things are in the US, we're approaching the point where anyone who wants a vaccine is allowed to get one. To me that means that within a month or two, it mostly stops being a valid argument that the unvaccinated-by-choice are putting anyone but themselves at risk, unless they're working directly with vulnerable and un-vaccinatable populations.

comment by DanArmak · 2021-04-01T14:20:59.754Z · LW(p) · GW(p)

There are plenty of privacy experts out there that can design a version of the system where you can’t be tracked. The system can see if you’re vaccinated, but it can’t tell who ‘you’ are while doing so, except to verify that the claim is legitimate.

I'm not a privacy expert. It's not obvious to me how to design such a system. Can someone explain or link to a proposal? The 'obvious' way would be to give people tokens when vaccinating them, but it's too late for that.

Also, do you mean "can't be tracked by the system itself, including the app you've installed on your phone which provides QR codes", or "can't be tracked by everyone you show the QR codes to, even if they cooperate" (because they all get QR-verifying software from the same vendor, which phones home)?

ETA: you write both "I expect crypto people to have good answers to these problems" and "my assumption is it also probably won’t be that difficult to fake the passport". This is contradictory. My comment responds to the first claim.

(Rewrote to better present the same argument, and removed some weaker arguments)

I don't see how to accomplish the first (stronger) version. Since people weren't given un-forgeable tokens when they were vaccinated, you need them to install an app and tell it who they are. Which lets the app track them; you'd need to trust the government, the software sub-contractor who actually wrote it, their software supply chain, and the server it talks to.

Suppose you do trust the app, or you only want to achieve the weaker kind of security, where the verifiers (who see your QR tokens) can't identify or track you. That still leaves some issues:

1. How does the app know you're vaccinated? Does the government already have a database / list of vaccinated people? Did people get magical pieces of paper [LW · GW] when they were vaccinated? Based on your past posts about the distribution process, I would expect this info to be incomplete, inaccurate, and probably not yet centralized. And if it did exist, privacy advocates would probably be concerned about that.

If vetting people who install the app is taken seriously, there will probably be a lot of false negatives, which will justly upset people and get media attention. And any attempt to redress this will make it easier for un-vaccinated people to register.

2. How do you prove to the passport app that you're you? If the system knows "John Doe" is vaccinated, what stops people from telling their phone they are John Doe? Maybe they need details like when and where John was vaccinated, but this is likely to leak for a bunch of people. On a smaller scale, vaccinated people can register on their unvaccinated friends' and loved ones' phones, to let them go places. Or just loan them their phones for a bit.

The system could show the verifier a photo of the real John Doe (but does the government have everyone's photos?) That would mostly solve the problem, although using a single / 'reference' photo for each person would let verifiers link data and look that person up without resorting to image recognition or image search. (I'm assuming here verifiers can surreptitiously take a photo of you, but that it would be less convenient / useful than a 'reference' one.)

The system could enforce a reasonable limit of phones (installations) per person. That might enable griefing, if I can register in your name and prevent you from registering yourself. This might be an acceptable tradeoff. It would still let people register for 1-2 'extras'.

Replies from: Zvi, gabriel-holmes, gabriel-holmes
comment by Zvi · 2021-04-02T10:14:12.662Z · LW(p) · GW(p)

I think this assumes that the system needs to be more robust than the current system, by a lot, plus also gain privacy. What I'm saying is that (1) yes we could do both if we cared enough, in theory, because we have proof by example but also (2) we don't need that level of robustness. We need something harder to fake than a Fake ID, where the QR code doesn't reveal who you are, so you can't be tracked beyond the existing ability to track cell phones.

There's a trade-off of security vs. privacy for sure, but right now the existing systems are lousy at best on both.

Replies from: DanArmak
comment by DanArmak · 2021-04-02T16:37:05.897Z · LW(p) · GW(p)

we have proof by example

What's the example you're thinking of? I'm sorry if you mentioned it before and I missed it.

We need something harder to fake than a Fake ID, where the QR code doesn't reveal who you are, so you can't be tracked beyond the existing ability to track cell phones.

If I understand correctly, you don't want the QR code to prove that "John Doe, ID #123456789, is vaccinated" and then have the verifier ask to see a separate, pre-existing ID that shows you're John Doe. Which is how the actual and proposed vaccination passports in Israel and some of the EU work. (Hence I don't know what example you're thinking of.)

Instead you want the QR code to prove that "the bearer of this code is vaccinated". That implies the code must be secret and not trivially shareable between many different people. But copying images and taking screenshots is trivial. So the code must not be a single permanent QR per person, but generated by the application: either frequently replaced (like OTP) or on-demand (challenge-response protocol).

This could work if installing or activating the app required approval from a central database / service. This approach has difficulties I noted before, including proving to the app you're you, and multiple activations. And it still lets the app owner track you, since the app stays active.

What approach are you thinking of?

comment by tkpwaeub (gabriel-holmes) · 2021-04-06T17:01:04.120Z · LW(p) · GW(p)

Interestingly in New York State it appears aren't allowed to store anything about the verification per GBL 899-aa and 899-bb. That's about as close to a "no warranty" statement as it gets.

comment by tkpwaeub (gabriel-holmes) · 2021-04-03T08:14:40.037Z · LW(p) · GW(p)

I feel like there's some sort of yet-to-be-articulated "impossibility theorem" here. Some sort of mash-up of the project management trilemma and Shannon's theorem

comment by DanArmak · 2021-04-01T14:43:33.114Z · LW(p) · GW(p)

A QR code can be placed upon a piece of paper, and those without a phone can carry the piece of paper, the same way we can carry the vaccination card now except with a less trivial duplication/fraud problem. It’s not a meaningful objection.

You seem to assume a user would print out a QR code from e.g. a website at home and then carry it around. It would need to be valid for at least a day, and to be re-usable for multiple verifications. This could make it harder to build a secure system with the same guarantees as you might get from very short lived tokens (OTP style). I don't think you should dismiss this out of hand.

It also rules out a challenge/response system between the verifier and the app, which might be useful for some designs.

Replies from: uncomputable
comment by uncomputable · 2021-04-01T22:02:41.735Z · LW(p) · GW(p)

the QR code can just have a cryptographically signed attestation from a government agency that the person has been vaccinated. that can be verified by an app which does not need to communicate with a central authority. if the authority released the corresponding public keys, open source apps could do the job. and the vaccination doesn't expire, so the code doesn't need to. (but perhaps you could include some vaccine lot number info if you're super excited about such things, so apps could know about bad batches? that's probably not worth the effort to discuss.)

the hard part is figuring out who to attest has been vaccinated, and what information you can cram into the attestation which will satisfy people viewing the QR code. (an entire photo wouldn't fit.)

Replies from: DanArmak, Cesare
comment by DanArmak · 2021-04-02T07:17:16.290Z · LW(p) · GW(p)

the vaccination doesn't expire, so the code doesn't need to

If a person receives a static, permanent QR code, then some QRs will leak (or be deliberately leaked) and will be used en masse. And some QRs will be given out to friends and family.

With permanent codes, the application presenting the QR can't prove it's the genuine application, so people could just as easily show an image.

That also lets everyone share QR codes easily (i.e. without being tech savvy or investing effort) - just use your phone's screenshot function while the real app is open. And whoever verifies the QR code can also reproduce it.

This is the lowest possible level of security. Saying that such an un-trustworthy system creates net positive value for society requires some serious proof, which I haven't seen.

Including photos in the QR is possible; a B&W photo would fit. If you want to include more data, you can put a copy of the photo online (so that the verifier can pull the exact file) and sign its hash and URL as part of the QR token. Or use NFC to transmit the (signed) photo. Or use several QRs displayed in succession. QR bandwidth is surprisingly high. However, using photos raises other questions, such as what about all the people the government doesn't have official or up-to-date photos of (and see also my other top level reply).

Replies from: uncomputable
comment by uncomputable · 2021-04-02T15:43:35.108Z · LW(p) · GW(p)

If a person receives a static, permanent QR code, then some QRs will leak (or be deliberately leaked) and will be used en masse. And some QRs will be given out to friends and family.

...who cares? The QR code contains a cryptographically signed attestion that "DanArmak" is vaccinated. Not "whoever displays this code is vaccinated". You only need a program for decoding it, and verifying the signature against the signing keys from states.

Photocopying them would be only slightly more useful than photocopying somebody else's drivers license. Sure, if they've got the same name or look just like you, they can use it, but if I photocopy my drivers license and put it online, there's not a lot of people who could reasonably pass as me.

With permanent codes, the application presenting the QR can't prove it's the genuine application, so people could just as easily show an image.

You absolutely do not need anything to display it, you could print it out on paper. The genuine-ness comes from the cryptographic signature.

Saying that such an un-trustworthy system

It's extremely trustworthy, but unfortunately the mechanism of trust isn't clear until you understand public key cryptography.

Including photos in the QR is possible; a B&W photo would fit. If you want to include more data, you can put a copy of the photo online

The whole point of the suggestion was a scheme which was not traceable. That means not fetching people's pictures.

QR bandwidth is surprisingly high.

I understand how QR codes work just fine, but being on a piece of paper in somebody's wallet, we've got to turn the ECC up to max, and I've also got an estimate for the size of the rest of the data that needs to go in there in order to make it useful.

The mechanism doesn't need to be perfect, it'll just mostly work, and this one also perfectly preserves privacy. (It can also be tweaked and tuned in a variety of ways which I'm not going to take the effort to explain to a non-software engineer.)

Replies from: DanArmak
comment by DanArmak · 2021-04-02T16:46:39.271Z · LW(p) · GW(p)

We're talking past one another, trying to solve different problems. I'm a software engineer by profession and I understand how public-key cryptography works. I also assumed you were not a software engineer because your comment didn't make sense for the problem as I understand it.

The QR code contains a cryptographically signed attestion that "DanArmak" is vaccinated. Not "whoever displays this code is vaccinated".

That works fine, and is the system used in Israel and proposed in some EU countries. But it's not what I understand Zvi to be arguing for. Zvi wants a system which doesn't let verifiers identify the person in front of them, only learn that they're vaccinated. He clarifies this in this comment [LW(p) · GW(p)].

If the QR proves "DanArmak is vaccinated", then I also need to prove I'm DanArmak. E.g. by displaying a state ID. This lets verifiers track me, simply because they learn who I am and businesses regularly sell or share data on customers / visitors. The application verifying the QR codes can make this even easier - most businesses install the same verifier application, and it uploads info about the people whose IDs it verifies. IIUC, the US doesn't have any privacy laws that would forbid private entities from such collading, tracking, and selling such data, even without disclosure.

Replies from: gabriel-holmes, gabriel-holmes
comment by tkpwaeub (gabriel-holmes) · 2021-04-08T11:20:48.053Z · LW(p) · GW(p)

To clarify - the most humane, least risky use case that would satisfy these desiderata would be have a modular system where we

1. Verify off-site that DanArmak is vaccinated (or has allergies, or a heart condition, or is immunocompromised)

2. Verify on-site that you're DanArmak

3. Give the user the option of sharing information with the state or local health department so they can contact you or your physician about virus exposure (not just covid), food poisoning, whatever.

This could be widely adapted to a variety of situations, depending on how rigorous one wants to be about verifying someone's ID.

If we DO stick with apps, the best approach might be to give everyone a QR code (including those who haven't gotten vaccinated or tested). Separately, provide multiple options for verifying the codes (strict verification of ID, census of how many people are vaccinated once capacity is exceeded, etc)

Looks like some people may already be moving in this direction.

https://github.com/joelbcastillo/CS6903-Vaccine-Passport-Checker/tree/main/src/CS6903-Vaccine-Passport-Checker

Again, easier to implement if the software is open source.

comment by tkpwaeub (gabriel-holmes) · 2021-04-02T18:28:22.735Z · LW(p) · GW(p)

Right, so whatever direction we go with this, it's really important that the application be open source, as Jeffrey Zients has suggested, so that businesses can add on security features that identify the person.

comment by Cesare · 2021-04-01T23:04:22.945Z · LW(p) · GW(p)

My thoughts exactly. What a QR Code could do is to store names, and perhaps the dates they got the vaccine. If people have time to check photos, then they might as well do so on any photographic ID, whose name matches the one on the QR Code, and which is shown together with the QR code wherever that's relevant.

comment by Ryan Landay (ryan-landay) · 2021-04-03T11:06:30.499Z · LW(p) · GW(p)

Washington Post notices that sometimes people lie to get life-saving medicine earlier, especially when there’s zero probability they would ever be caught, and frames this as something that is ‘damaging friendships.’

I don’t understand why you’re downplaying this issue. I have a friend whose parents are both doctors (I also have one parent who’s a doctor) who signed up to do IT work at one of his parents’ medical practices and then got a vaccine as a “healthcare worker.” His girlfriend did the same thing. Now I have to listen to my friend brag about how great the US is handling COVID (>550k dead, including ~900 additional deaths per day, etc.) since everyone’s able to get a COVID vaccine. He thinks all states should remove all restrictions now that “most high risk people” (i.e. himself) have personally been vacccinated (despite the aforementioned ongoing ~900 deaths per day).

I just saw today that the CDC says you can safely go on vacation if you’ve gotten a COVID vaccine. So if you’ve been working and paying taxes for the last year in the US, but don’t meet any of the high-risk criteria for getting COVID (age, obesity, smoking, etc.), and haven’t been willing to lie to the government, you’re stuck in your basement (or engaging in very limited social outings, or socially-distanced vacations wearing an N95 mask, etc.) while friends/enemies/total strangers who either cheated the system and lied to the government, or don’t give a crap about anyone they might give COVID to, get to go out and party.,

What do you think is going to happen to a society that teaches people that hard work is for idiots and suckers and the only ways to get ahead are either to lie and cheat and steal, or to intentionally harm your own health?

I personally gave up and moved to Taiwan, which was willing to grant me a visa without me having to lie, become obese, or smoke 100 cigarettes, and has a fair system that protects the whole country from getting COVID and allows everyone to live a normal life, instead of merely people who are politically well-connected, engage in self-destructive behavior like smoking cigarettes, or are essentially giant assholes potentially killing people by taking vaccines that were supposed to go to them (I’m not making a judgment about how correct or optimal the US’s allocation rules are, merely that, under the rules we decided, they were supposed to go to someone else first).

comment by benjaminikuta · 2021-04-01T13:26:46.889Z · LW(p) · GW(p)
1. "Can anyone think of an example of where such information was created, and the government was respectful of our rights and didn’t check it whenever they felt like it? Anyone?"

I'm not sure if this is exactly the sort of example you're looking for, but if I recall, the Census Bureau refused to divulge personal information to the President, even when federal agents showed up at their office and threatened to arrest them. I may be misremembering though, because now I can't find the story with a quick search. Perhaps someone else knows what I'm talking about.
Replies from: benjaminikuta, cistran
comment by benjaminikuta · 2021-04-01T14:10:40.810Z · LW(p) · GW(p)

Found it.

https://www.census.gov/dmd/www/pdf/afs38.txt

"1980: Armed with a search warrant authorizing them to seize census documents, four FBI agents enter the Census Bureau's Colorado Springs office.  No confidential information is ever released because a census worker holds off the agents until her superiors resolve the issue with the FBI."

Replies from: Zvi
comment by Zvi · 2021-04-02T10:16:43.425Z · LW(p) · GW(p)

Very cool! This is an interesting example because it shows the system protecting the information in at least one case, but also shows that yes the government damn well tried to get the information, despite it being an information source that was deeply important to protect - if census info leaked and it got out our ability to do a census would be crippled.

comment by cistran · 2021-04-03T16:33:45.494Z · LW(p) · GW(p)

Census is explicitly prescribed in the Constitution. It is a very protected service which cannot be cancelled without a Constitution amendment.

comment by CraigMichael · 2021-04-04T07:04:18.423Z · LW(p) · GW(p)

There’s an announcement on covidly.com that it’s shutting down at the end of April. Like rt.live it was/is also very useful to me throughout the pandemic.

Reached out to the admin to see how much money they’re talking about.

Update (April 2, 2021): Operating Covidly for the past year has been an incredible experience but unfortunately I can no longer afford to self-fund this project. If anyone can help out with the costs, please reach out to me. If all else fails, I'll be shutting down Covidly at the end of April. Regardless of the outcome, it's been a great experience working on the project and I'm grateful for all the people I've met as a result of this project 🥰 Alexey

comment by brp · 2021-04-02T03:17:37.787Z · LW(p) · GW(p)

Re: quarantines for fully vaccinated travellers

The problem a national government has in setting quarantine standards for vaccinated people is that there are so many inconsistencies to vaccines, and the topic is wrapped in geopolitics.

• Do you exempt (from quarantine) those who claim to have gotten vaccines in countries where vaccine documentation is easy to fake? What about countries where vaccine documentation is nonstandard between regions?
• How do you (cheaply) verify vaccine documentation from each foreign country / region?
• Does refusing to exempt people from poorly-documented countries cause a diplomatic incident with those countries?
• Do you exempt those who have documented vaccines which are not authorized in your country? If so, what are your criteria for accepting vaccines?
• If not, then the home countries of inelligible vaccines will lodge a diplomatic protest, and maybe accuse you of racism.
• Or do you only exempt those who got vaccines which are produced in your country? (Chinese-style vaccine nationalism.)
• Do you exempt those who got vaccines which are authorized in your country, but are coming from countries where immunity-escaping strains are common?
• Do you exempt those who got the vaccine, but are in a demographic likely to have poor immune response?
• If you exempt people with vaccine immunity, do you exempt people with positive COVID antibody tests?
• If you exempt people with antibody tests, which tests do you exempt? See all the previous questions about reliability of documentation again...

The cost to administration of such an exemption program is high, the social, political, and medical perils are many, and there is the chance of quarantine escape in >5% of cases. Vaccine exemption from national quarantine is unlikely.

Replies from: gabriel-holmes
comment by tkpwaeub (gabriel-holmes) · 2021-04-03T09:44:29.849Z · LW(p) · GW(p)

Especially when there's a case to be made for quarantines as a way to stop the next pandemic.

comment by Cesare · 2021-04-01T21:39:34.568Z · LW(p) · GW(p)

Zvi, I live in the UK and back in February I had asked my GP to please call me if they had any spare doses.

Well, my GP called me on the evening of the 7th of March, telling me that they had an open vial of Astrazeneca, and to come down if I could. I asked if I could also bring my partner, he said "sure, there's more than one dose in there and we close in 20 minutes".
So I did get vaccinated before 60 years old were even eligible, and so did my partner. For the record, I am 29 and in perfect health, and she is 23 and not even a patient of that GP.
This happened to many other people I know, and I have seen even more of that on social media. My understanding is that, while the policy is clear, GPs do have a lot of freedom in trying to avoid wasting vaccines.

My guess about the thing you reported... is that some GPs misunderstood guidelines. I wasn't able to find the official ones, though (I suspect those might not be publicly available).

One more point: given how doses work each GP could theoretically "risk to waste" (and hence give to any passerby) at most 9 doses of Astrazeneca, and 5 doses of Pfizer per day (the number of doses you get from a vial minus one). That doesn't seem like a huge number to me. Any bigger "abuse" of the system (i.e. give doses to people before it's their turn) would still be detected quite easily.

comment by Rana Dexsin · 2021-04-01T15:34:44.725Z · LW(p) · GW(p)

Regarding the mandatory quarantine thing, the first hypothesis to my mind in that situation is “if vaccine/testing proof from abroad is too easy to fake, it's much easier to have everyone go through locally-verified quarantine than try to figure out who's faking and risk political blowback and/or catastrophic outbreaks depending on which mistakes you make”, or more weakly “that was the evaluation of some part of the Canadian government independently of whether it is actually true”.

This is doubly true for any kind of “I have recovered from” attestation, and (especially if not from a medical system) that has the extra dice-roll of “was the disease properly identified”. In both of these, the risk will come substantially from the worse end of the distribution, so even if median people are reliable-and-trustworthy enough, too much variance could be a huge deal.

Edited to add: also, the Twitter link in that paragraph points to a tweet about FDA authorizing tests without a prescription, which seems like it might've been mixed up with a different link?

Replies from: lsusr
comment by lsusr · 2021-04-03T05:56:09.735Z · LW(p) · GW(p)

In the specific case of Taiwan, the only sane strategy (which they are doing) is to require all newcomers to undergo a two-week quarantine.

Incoming visitors have a strong incentive to avoid quarantine. It is difficult for the Taiwanese government to confirm whether someone from the United States or another country has been vaccinated. Allowing visitors who claim to have been vaccinated enter the country without quarantine guarantees a COVID outbreak. Taiwan has COVID under control. Taiwan has few citizens vaccinated. A COVID outbreak in Taiwan would be a national disaster.

A mandatory quarantine may not make sense for Canada on consequentialist grounds since COVID has long since [LW · GW] gotten out-of-control there. But the general principle of a mandatory quarantine is sound.

comment by Jiro · 2021-04-06T16:12:18.083Z · LW(p) · GW(p)

Not allowing unused doses to go to ineligible people is legitimate. It's one of those cases where something is a Pareto improvement in the immediate situation, but creates bad incentives.

If you allow unused doses to go to other people, you'll end up with corruption where doses are deliberately held back from eligible people because someone paid under the table to have doses set aside as "leftover doses".

It's similar to why some organizations have a policy of making sure their discarded equipment goes into a landfill rather than letting employees take it. Because that way it's not possible to bribe someone to throw out good equipment for you to take. That sucks if you could have used the discarded equipment, but it's good if you're someone affected by fraud and it eliminated the incentive for fraud.

comment by Jiro · 2021-04-06T15:52:42.657Z · LW(p) · GW(p)

You left out one: the possibility that people will be deliberately denied COVID vaccination passports for other reasons than not having a COVID vaccination. It's like when Facebook denied the "verified" status to people who were verified, but who said politically inconvenient things.

This is going to be a risk when the passport is "private" but becomes ubiquitous, especially when encouraged by the government.

comment by PatrickDFarley · 2021-04-02T15:54:25.726Z · LW(p) · GW(p)

Coercion concern:

Shouldn't we think about the counterfactual where the vaccine is not completely safe and healthy? What happens next time, when the thing is even more tribal-affiliated, such that the tribe in power won't be upfront about the downsides of it? I don't want a world where politics & power incentivize what medical procedures I should/shouldn't get. I'd love to keep those spheres as separate as possible.

And that's where I'm confused - because it's conveniently very possible to keep them separate in this case: the vaccine works on individuals. You don't need sweeping mandates for the whole community in order to get it to work. Everyone can just make a medical decision in their own best interests.

If you think not getting the vaccine is healthier, you should be able to live that experiment, as long as its effect on others is negligible. And likewise, in the possible future where I actually think it's healthier to not do X medical procedure, I hope I can run that experiment without incurring the wrath of politics and power.

Replies from: gabriel-holmes
comment by tkpwaeub (gabriel-holmes) · 2021-04-02T18:17:19.715Z · LW(p) · GW(p)

expected net personal benefit of getting vaccinated
expected net collective benefit of getting vaccinated.

It's possible to imagine a scenario where the former is negative and the latter is positive. That would leave us with a genuine "free rider" problem, and a rather high-stakes one at that. The most prosaic solution to such problems is to pay people to do the thing that they wouldn't otherwise do rationally.

I don't think there's anything terribly objectionable about the government incentivizing people to take on personal risks they wouldn't otherwise take. After all, there are lots of government jobs which are inherently dangerous - and the government "incentivizes" them by paying people decent sums of money.

comment by Charlie Steiner · 2021-04-05T19:05:15.968Z · LW(p) · GW(p)

Just listened to a great podcast with Sean Carroll and Zeynep Tufekci. Anyone have thoughts about putting Ms. Tufekci in charge of large organizations?

comment by cistran · 2021-04-03T16:50:34.286Z · LW(p) · GW(p)

Vaccination passports must come with an expiration date and we do not know what date is best yet (obviously not 90 days.) This is because we don't yet know for how long the vaccines provide protection and because  new strains with higher vaccine escapes may emerge which will eventually necessitate boosters designed specifically against these new strains.

comment by Rune · 2021-04-02T22:39:28.319Z · LW(p) · GW(p)

Have you already written about the recent concerns with the Oxford vaccine causing Cerebral Sinovenous Thrombosis (CSVT)? I don't mean just any old blood clots, but these specific blood clots that happen in the brain that are super rare and often lethal?

Much of the earlier blood clot discussion was unfortunately confused with regular blood clots, like deep vein thrombosis (DVT), which is not as big a deal, and neither is there good evidence that the Oxford Vaccine increases its occurrence. But CVST seems both serious and potentially a bigger side effect of one particular vaccine over the other options. So I would still take the Oxford vaccine over getting COVID, but now it's unclear whether Oxford's vaccine is just as good as the others, or somewhat inferior due to this side effect.

comment by Primer (primer) · 2021-04-05T16:12:57.292Z · LW(p) · GW(p)

Prediction: Countries with high approval ratings of vaccinations will have high approval ratings of some equivalent of a vaccination passport, leading to a high adoption rate of vaccination passports and causing vaccination rates to climb. And vice versa.

I'd like to add to the analysis on vaccination passports: about 1/4 of the population - those below the age of 18 - will not be offered a vaccine in the next months, probably not even in 2021 (at least in Europe). So the argument that once everyone who wants her shot could easily get it we quickly need vaccination passports for all the reasons mentioned in the post has to either somehow exclude children or it won't work for another year. No vaccination passport for children also means way less benefit from vaccination passports for parents.

comment by Borasko · 2021-04-02T14:39:19.202Z · LW(p) · GW(p)

As far as QR code privacy goes, anybody that has their location checked on in their phone is getting tracked much more than that code could ever do. Although I'm sure they wouldn't mind having the 'vaccinated/non-vacinated' categories. If being vaccinated wasn't already inferable by reading the persons emails / listening to their phone calls.

I really like the idea of privacy. But I just assume after Snowden's leaks everybody is being maximally tracked 24/7. I'm not saying its right, but I have no power to stop it. So when I hear of people's privacy concern issues about being tracked the best I can do is be sympathetically supportive, but I believe it's a lost cause and thus usually pre-factor it in to government proposals.

Replies from: gabriel-holmes
comment by tkpwaeub (gabriel-holmes) · 2021-04-04T13:41:57.758Z · LW(p) · GW(p)

Privacy concerns could be addressed by periodically deleting data more than ten days old.