President Biden’s signature in early April (4/11) ended the Covid-19 national emergency, signaling that the moment had officially arrived to move on from one of the most devastating pandemics the U.S. has ever faced.
But it should also be a time to reflect and reform. The lessons of Covid-19 are especially painful in California, where politics interfered with good policy.
For example, look at what happened in February of 2021, when vaccines were arriving in the state for everyone, but not for everyone at the same time. Gov. Gavin Newsom turned to Blue Shield of California, operator of the biggest health database in the state, to coordinate deliveries. The plan quickly blew up when county executives realized they were being cut out of the decision chain. The result was a free-for-all as counties placed their own orders, leaving some very vulnerable populations at the bottom of the line while others got shots right away.
The chaos ended only when supply finally met demand several months later. In the meantime, lives were at stake and the cost of prolonged economic impacts mounted.
Another example occurred in the early days of the pandemic, when the state moved swiftly to shut down economic activity in an effort to contain the virus. The policy initially had widespread public support, but it was not driven by reliable health or economic data. In retrospect, more targeted shutdowns might have made more sense.
A key lesson from the pandemic is that the state needs to get a better handle on economic trade-offs as it implements preventive measures, especially vaccines. Empirical science can help policy makers make informed choices. Right now, that capability is lacking.
Among the many vaccine-related challenges the state had to handle ad hoc during the pandemic were the need for multiple shots to achieve full immunity, the need for cold storage, kinks in the supply chain, school participation, and the economic ramifications of quarantines prior to the arrival of vaccines. The goal for a population to achieve immunity against a highly infectious disease is more than just the acquisition of the vaccine itself – the cost-efficiency of all elements of the vaccine program matter and need to be accounted for.
To reduce the impact of political decisions in the health arena and increase the impact of impartial scientific and economic analysis, the state should establish a new office of Health Economics and Outcomes Research reporting directly to the Governor.
This office would be charged with calculating the vast resources needed to budget for vaccine programs. It would be able to assess the capability of the vaccines and measure the long term value of the drugs and their distribution. By understanding the cost-effectiveness of a vaccine using economic methods, it would be possible to calculate savings and budget for many different assets that health systems would need to deploy all at once to counter a pandemic.
It would not have regulatory authority, but should have the expertise to guide the governor, legislature and public-private partnerships on devising programs for both health crises and for chronic diseases. It would not interfere with the new Office of Healthcare Affordability, which is focused on the rising cost of healthcare to patients.
Properly installed and staffed, a California office of Health Economics and Outcomes Research would be an example to the nation on how to drive health policy with data. The science is there. The question is whether the political will is also there to establish the office, combined with a commitment to reduce political influence in emergent public health decisions.
William V. Padula, Ph.D., is a fellow at the Schaeffer Center for Health Policy & Economics and assistant professor of pharmaceutical and health economics at the Mann School of Pharmacy at the University of Southern California.
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