COVID-19 Vaccines and the Ratchet Effect: Lessons from Crisis and Leviathan

Fall brings us pumpkin spice, college football, and seasonal illness. Although RSV and flu cases are increasing regionally, the Centers for Disease Control and Prevention and others believe the worst of “flu season” is behind us. 

Covid-19 is another story. Many expect the now endemic illness will eventually become seasonal like other respiratory viruses. This depends on when and how it continues to mutate. Fortunately, while positive cases are (slightly) increasing, severe cases (resulting in hospitalization and death) are decreasing, according to CDC data. However, water virus data collected by the same agency suggests COVID-19 infections may soon increase in some regions. 

Regardless, the CDC still recommends almost everyone get an updated COVID-19 vaccine—and includes it as part of a normal infant vaccine schedule. With new recommendations urging anyone older than six months get the jab and new COVID-19 vaccines released in August, the agency has been especially diligent in trying to get Americans vaccinated against COVID-19.

It is a losing battle—and it has been for a while. A 2023 peer-reviewed survey in Vaccines found that less than 33 percent of Americans were current on their COVID-19 boosters. The same survey found that less than 15 percent of those 18 years old and younger received a booster despite tremendous efforts to get the vaccines authorized for younger ages. 

Recommending vaccinating six-month-olds against COVID-19 is also strange. We’ve long since known it is extremely rare for children to become very ill with COVID-19. It’s also highly unlikely that children or infants transmit COVID-19. Most of the negative impacts of COVID-19 on infants are associated with pre-natal development if the mother becomes infected. However, pregnant women can pass COVID-19 antibodies to their infants through breastmilk or umbilical cord blood if they become vaccinated or have previously been infected. 

It is also unclear how effective the newest COVID-19 vaccines are against the most recent variants—even the most recent research tests for immunity against now older mutations. 

So, what is the rationale for more COVID-19 vaccines and pushing for infants to get them? In a forthcoming paper in The Independent Review, my co-author and I argue that the answer boils down to the ratchet effect. As argued in Robert Higgs’s masterful book Crisis and Leviathan, governments frequently gain control of resources and receive new powers during a crisis period. However, much of this newfound control and authority remains after the crisis ends. This important—and concerning—insight can explain continued government involvement with COVID-19 vaccines. 

On May 15th, 2020, the federal government formally announced the formation of Operation Warp Speed—a partnership between private vaccine developers and government regulatory agencies to quickly develop a COVID-19 vaccine. With ample financial support from the federal government, the first COVID-19 vaccine received emergency use authorization in November 2020. 

Operation Warp Speed’s partnership disbanded less than a year after it formed. The COVID-19 pandemic ended in May 2023. Government spending on COVID-19 vaccines did not.

Private vaccine developers spent $10 billion to develop a vaccine. That total reached $30 billion by October 2022—over a year after the partnership ended. A year after the pandemic ended, the federal government still spent billions on purchasing COVID-19 vaccines even as manufacturers increased their prices and patients elected to receive fewer boosters. 

Today, COVID-19 vaccines are covered under Medicare and Medicaid and are available at no charge for individuals without health insurance (at the taxpayer’s expense). Most private health insurance plans are also legally required to provide COVID-19 vaccines without charging a co-pay or co-insurance. 

COVID-19 will continue to mutate and cause illness for the foreseeable future. It seems government efforts to fund and force markets to provide COVID-19 vaccines will continue as well and there is little reason for it. Unfortunately, as we have learned over the past four years, the government’s answers to difficult problems are universally political and scarcely scientific. This is even the case for vaccines.