The One Thing that Dr. Michael Mina Has Wrong
The scientist leading the charge for rapid at-home testing makes one big mistake.
Michael Mina is an epidemiologist, immunologist, and physician at Harvard. Along with Paul Romer, he has been the leading voice in the case for at-home rapid testing as the central piece of the strategy to control COVID-19. The tests that Dr. Mina is a proponent of are essentially a paper strip that tests one’s saliva or nasal swab. While not as sensitive or specific as the lab-based PCR test, these tests immediately identify about 94% of those who are contagious. More importantly, these paper-strip tests could be produced at a relatively low price point and could be performed a few times per week by everyone. The frequency of testing and immediate results are far more important than perfect sensitivity and would allow people to self-isolate before they infect others. Widespread use of these tests would dramatically slow the spread of the virus, saving lives and allowing economic activity to resume.
Dr. Mina’s analysis of the science is convincing, and he is hero of mine for his efforts. He has been right about a lot of things, and it’s tragic how many lives could have been saved if the FDA would authorize these tests in response to his constant tweets at them. I can’t even imagine the frustration this guy is feeling. However, as at-home rapid tests finally begin to trickle through the FDA with dozens more in the pipeline, he is very, very wrong about one thing.
Last week, a couple of rapid antigen tests were FINALLY authorized by the FDA. On Tuesday, in a twitter thread of hopeful excitement that Ellume’s FDA authorization would lead to more tests to be approved, Mina said:
“We must have public health distribution [of rapid tests] - else I fear will all be bought up by rich and powerful. By keeping these purely in the free market is a potential disaster given overall lack of public health agency to have a coordinated response. I do not want to see the wealthy have access but the poor have none. That is one of the saddest endpoints of all of this.”
Dr. Mina could not be more wrong about this. “Keeping this purely in the free market” would be the most efficient way to test the most people and stop the spread of the virus. Between vaccines and testing, the default for many people seems to be that everything would be a disaster if it is not planned and paid for by the government. I think it’s clear that this would not be the case. If the dozens of companies that are currently producing tests were allowed to compete to sell tests directly over the counter to consumers, tests would become more effective and even cheaper than the current price of $5 per test. The profit incentive in a free market is what drives constant innovation to deliver goods to consumers at lower prices and more efficiently than ever. If I’m not mistaken, it’s Amazon and Walmart who are known for process and shipping innovation and low prices, not the USPS and DMV.
The most obvious flaw with Dr. Mina’s argument is that after months of tweeting at the government bureaucracy that is the FDA to hurry up and authorize these tests, he calls on the same type of government bureaucracy to be responsible for purchasing and distributing tests. Why would he expect government intervention to be the answer to our prayers this time, when the FDA is responsible for so much unnecessary loss of life?
Thomas Sowell once said, “It is hard to imagine a more stupid or more dangerous way of making decisions than by putting those decisions in the hands of people who pay no price for being wrong.” If a company producing tests were to make a mistake that hurts the quality or increases the price of the product in relation to the competition, such as being late delivering product to stores or designing packaging/instructions that are confusing, that company pays an immediate price in their bottom line and market share. That feedback loop is what drives private companies to make their customers as happy as possible. Private companies are constantly driven to compete on quality and cost, government officials are not.
Of course, the market solution would not perfect. A key feature of a dynamic market economy is trial and error. Not all lives would be saved and not all tests will be great, but the overall response would be far better because the entrepreneurs producing the tests have a direct incentive to sell safe, high-quality tests as efficiently as possible. I’m also not claiming that public health coordinated distribution would be a complete disaster, but it would likely cost lives.
Like Dr. Mina, I want these tests to be available to as many people as possible, no matter what their level of income. Competition is what will cause these tests to be cheap enough for most Americans to buy. If philanthropic organizations or local public health departments have funds and want to buy tests at market prices to provide testing for those who have trouble paying for it, that’s great! I would gladly donate. However, that is very different from the idea that public health officials should coordinate who can get tested and how often for the entire population. Lastly, the overarching goal is to bring the effective reproductive number (Re) below 1. If some individuals cannot afford to purchase tests or choose not to test themselves, that’s not ideal, but those individuals are still far safer as long as enough other people are testing so that Re stays below 1. And again, a free market solution would get tests in the hands of the most people in the least time.
Sadly, it’s no surprise that a public health academic believes in the power of government intervention and distrusts the free market, but what Michael Mina doesn’t realize, is that if this were left to the free market from the beginning, his dream solution would have been realized months ago. If there was no interference by the FDA, we likely would have had a dozen effective rapid tests in May, and this entire pandemic would have been stopped in its tracks.
I recently read that these tests can identify a specific antigen on the coronavirus’ surface and detect infection in as little as 15 minutes!! Fifteen minutes to possibly help save a life? I totally agree with you, let’s get it out there and saturate the free market ASAP. No long wait for results involved. No lab techs involved, no expensive equipment involved, and no government health officials involved.
Must there be only one approach? Let’s not toss the Federal baby out with the bureaucratic bath water.
First, let’s agree that, yes, widespread availability at corner stores would be an excellent option.
Meanwhile, why not _also_ encourage the Biden administration to infuse the market with cash somehow (antigen test vouchers distributed by social workers?), and/or provide incentives to hospitals and insurance companies to focus their efforts on distributing home-test kits, and/or help fund ramped-up production by placing a massive order of tests to be distributed in every prison, military base, and amongst the housing insecure?
These ideas are off the top of my head, and I’m not an expert in any of this, but if Dr. Mina’s ideas are as sound as they, well, sound, I’d rather see us put a little too much effort into putting them into action than a little too little. ¯\_(ツ)_/¯