The benefits of a COVID vaccine far outweigh the small risk of treatable heart inflammation

Posted on July 24, 2021 by particularkev

Jonathan Noonan, Baker Heart and Diabetes Institute and Karlheinz Peter, Baker Heart and Diabetes InstituteRepeated COVID-19 outbreaks in Australia have once again highlighted the need for rapid and widespread vaccination. We are extremely fortunate the global scientific community has been able to develop a handful of highly effective vaccines in such a short time.

As with any vaccine or medicine, the COVID vaccines do carry small risks. The rare blood clotting disorder caused by the AstraZeneca vaccine — thrombosis with thrombocytopenia syndrome, or TTS — has largely dominated the headlines.

But we’re also seeing reports of a potentially increased risk of myocarditis and pericarditis (heart inflammation) following the mRNA COVID-19 vaccines, developed by Pfizer/BioNTech and Moderna.

Here’s why this shouldn’t be cause for concern.

First, what are myocarditis and pericarditis?

There are three main types of heart inflammation: endocarditis, myocarditis, and pericarditis. These involve inflammation of the inner lining of the heart, the heart muscle, and the outer lining of the heart respectively.

Viruses, including the SARS-CoV-2 virus that causes COVID-19, are the most common cause of myocarditis and pericarditis. Essentially, the inflammation the immune system generates to combat infections can inadvertently lead to inflammation of the heart.

In the very rare cases of myocarditis and pericarditis observed after vaccination with a COVID mRNA shot, it’s possible a similar thing might be happening. That is, the vaccine causes the immune system to generate some level of inflammation so it’s prepared to mount a response against SARS-CoV-2, and this inflammation is partially misdirected to the heart.

But the risk is very small, and the conditions are treatable.

A heart diagram with an inflamed pericardium (pericarditis) next to a heart with inflammation showing myocarditis. — Shutterstock

What’s the risk?

The exact incidence of myocarditis and pericarditis following vaccination is still being defined, and it remains to be proven that mRNA vaccines are truly the cause of these conditions — although it seems likely.

In Australia, of roughly 3.7 million doses of the Pfizer vaccine administered up to July 11, the Therapeutic Goods Administration (TGA) reports there have been 50 cases of suspected myocarditis or pericarditis. This suggests a risk of one per 74,000 vaccines. The TGA notes most people who developed these conditions have recovered or are recovering.

However, given the relatively small number of vaccinations administered in Australia, it’s important to consider more complete data from countries with higher vaccination rates.

The United States’ Centres for Disease Control and Prevention (CDC) had received 1,226 reports of myocarditis following 296 million doses of mRNA vaccines administered up to June 11. This equates to a risk of roughly one in 240,000 doses. These cases were mostly in young men and predominantly occurred after the second dose.

Independently from vaccines, myocarditis occurs in roughly 23 per 100,000 people worldwide per year (we don’t have reliable figures for pericarditis). This shows us there’s a much lower risk from vaccination than exists in the population generally.

Symptoms to look out for

Normal side effects of COVID-19 vaccines include headache, fever, chills, muscle or joint pain, fatigue and nausea.

In contrast, chest pain, irregular heartbeat, heart palpitations, shortness of breath and light-headedness could indicate myocarditis or pericarditis. Symptoms of these conditions have generally occurred within seven days of vaccination. Anyone who experiences these symptoms should seek medical attention.

In most cases, myocarditis and pericarditis can be successfully treated with anti-inflammatory drugs, such as aspirin and corticosteroids.

In Israel, 95% of cases recently investigated were classified as mild. Similarly, the CDC has reported most patients in the US have recovered quickly.

While this very small risk of heart inflammation following vaccination may be alarming, it’s crucial to understand the risk of heart damage following severe COVID-19 is far greater.

COVID-19 and heart damage

Damage of the heart muscle is a common consequence of coronavirus. Research shows it occurs in up to 28% of patients hospitalised with COVID-19.

Importantly, the risk of death is markedly higher in COVID-19 patients who sustain heart muscle damage. While we need further research to understand precisely how COVID-19 damages the heart, myocarditis and pericarditis are major causes of the heart damage found in COVID-19 patients.

The benefit outweighs the risk

The recent limits applied to the use of the AstraZeneca vaccine in younger age groups suggests the relatively low risk of COVID-19 in Australia justifies being highly selective over vaccine use.

But while Australia has done incredibly well at containing COVID-19, the risk of transmission here remains high given the global COVID-19 situation. We’re seeing this daily as we contend with outbreaks and lockdowns around the country.

Myocarditis and pericarditis are potentially associated with the mRNA vaccines, but these complications are extremely rare, most often mild, and seem to be treatable.

As has been the consistent message from the medical and scientific communities throughout this pandemic, the benefit of COVID-19 vaccines significantly outweighs the risk of rare side effects. This is particularly true for the highly effective mRNA-based vaccines as COVID-19 continues to spread around the world.

Jonathan Noonan, Research Officer, Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute and Karlheinz Peter, Interventional Cardiologist, Alfred Hospital; Professor of Medicine and Immunology, Monash University; Professor and Head, Department of Cardiometabolic Health, University of Melbourne; Lab Head, Atherothrombosis and Vascular Biology and Deputy Director, Baker Heart and Diabetes Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Under-40s can ask their GP for an AstraZeneca shot. What’s changed? What are the risks? Are there benefits?

Posted on July 1, 2021 by particularkev

Nicholas Wood, University of SydneyPfizer remains the “preferred” vaccine for Australians aged under 40, due to a small but real increased risk of a rare clotting disorder.

But last night Prime Minister Scott Morrison said younger Australians who didn’t want to wait could ask their GP for an AstraZeneca vaccine instead.

So far 29% of Australians have received a first dose of a COVID-19 vaccine, and 7% have had their second.

While Australia has low numbers of COVID-19 cases overall, outbreaks and lockdowns are causing significant disruption in our lives, prompting some younger people to seek out a vaccine.

In most states, people under 40 may have not yet been vaccinated if they’re not in a priority or high-risk group, as the national rollout is yet to offer Pfizer to under-40s.

But this statement from the prime minister opens up access to an AstraZeneca vaccine for anyone under 40 years.

The prime minister also announced an indemnity scheme to cover GPs who give the AstraZeneca vaccine to someone who has a severe adverse reaction. But the finer details of this new scheme, and what it covers, are not yet available.

Astra wasn’t ‘banned’ for young people, just not ‘preferred’

The Australian Technical Advisory Group on Immunisation (ATAGI), a group of vaccine experts which advises the government, recommended on April 8 that Pfizer be the “preferred” vaccine for adults aged under 50.

This recommendation was based on a risk-benefit assessment at the time. The increased risk of the rare but serious clotting event following AstraZeneca vaccine in those under 50 years outweighed the potential benefit, given how much COVID-19 was circulating at the time.

However ATAGI said AstraZeneca could still be used in adults aged under 50 years where:

the benefits are likely to outweigh the risks for that individual and the person has made an informed decision based on an understanding of the risks and benefits.

ATAGI then updated its advice on June 17 to say Pfizer was the preferred vaccine for those under 60 years.

This increase in age recommendation was because new data identified a higher risk of clotting after AstraZeneca among 50- to 59-year-old Australians than had been reported internationally and initially estimated in Australia.

ATAGI reiterated on June 17 that AstraZeneca could be used in adults under 60 for whom Pfizer wasn’t available, where the benefits outweighed the risks for the person, and they made an informed decision.

What about now?

Last night the Prime Minister said:

if you wish to get the AstraZeneca vaccine, then we would encourage you to go and have that discussion with your GP.

Professor Paul Kelly, Australia’s Chief Health officer later clarified:

there’s a preference for Pfizer up to the age of 60. But that preference is a preference. It’s a discussion for doctors to have with their own patients and work through their own risk and benefit in relation to that.

What should you weigh up?

Resources such as this decision guide can help you weigh up the potential benefits and harms for your circumstances, to make an informed decision about the AstraZeneca vaccine.

So, what are the side effects and more serious adverse effects?

The common side effects of AstraZeneca vaccination include fatigue, headache, body aches and fever and, rarely, anaphylaxis. These are most often after dose one and happen in the first two to three days after vaccination.

We know this because Australia’s active safety surveillance system, AusVaxSafety, has captured vaccine reactions in over one million surveys, including more than 350,000 people who have had a first dose of AstraZeneca.

Health worker putting a bandaid on a person's arm after vaccination. — We have a good idea of the side effects and adverse effects from the AstraZeneca vaccine.
CDC/Unsplash

The clotting condition which causes most concern is called thrombosis with thrombocytopenia syndrome, or TTS. This involves blood clots (thrombosis), often in places we don’t usually see clots, such as the brain and abdomen.

It also causes low levels of blood clotting cells called platelets (thrombocytopenia).

We still don’t know the exact mechanism of TTS, but it appears to be caused by an overactive immune response, which is very different from other clotting disorders.

The estimates of clotting risk associated with first doses of the AstraZeneca vaccine are listed in the chart below. New cases detected are updated weekly on the Therapeutic Goods Administration (TGA) website.

(Keep in mind, the risk estimates in the under-50s are based on a much smaller number of people who received the AstraZeneca vaccine compared to those over 50.)

The severity of illness due to TTS ranges from fatal cases and severe disease, which is more likely to occur in younger people, to relatively milder cases. In Australia, the overall chance of dying from TTS is 3-4%.

It’s not currently possible to predict who will develop TTS. The only risk factor for TTS identified right now is age – it’s much less likely to occur in older adults than younger people.

TTS appears to be far more rare following second doses, with data from the United Kingdom indicating a rate of 1.5 per million second doses.

In a nutshell

So, if you are under 40 years old and want to get a COVID-19 vaccine the options are:

wait until Pfizer becomes available for your specific situation (you can use the vaccine eligibility checker to see when you’re eligible)
think about getting an AstraZeneca vaccine.

The best advice is to discuss with your GP your own unique story, and the risks and benefits as they relate to you.

Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A balancing act between benefits and risks: making sense of the latest vaccine news

Posted on April 12, 2021 by particularkev

Hassan Vally, La Trobe UniversityLast night, the federal government announced substantially revised plans for the use of the AstraZeneca vaccine in Australia.

Due to concerns about the vaccine’s possible links to a rare blood-clotting disorder, and following advice from the Australian Technical Advisory Group on Immunisation (ATAGI), the Pfizer vaccine is now preferred for people under 50.

These developments raise questions about how authorities and individuals assess risk, and respond. Let’s try to make some sense of it.

What’s happened?

Reports about rare blood clots possibly associated with the AstraZeneca vaccine have been floating around for a few weeks now.

So why has it taken so long for the government to clarify this relationship and make the recommendations? Authorities haven’t been keeping us in the dark.

When you have a new condition like this, and experts are examining data in real time, it takes a while to understand exactly what’s going on: to develop a clear case definition, to be confident what you’re seeing is a real phenomenon, and importantly, whether it’s likely to be caused by something in particular (in this case, the vaccine). It’s made more difficult when the event is very rare.

After reviewing a wide range of data relating to cases of this rare blood-clotting syndrome predominantly in the United Kingdom and Europe, Australian experts have now reached the threshold of evidence they needed to be satisfied there may well be a causal link between the AstraZeneca vaccine and this condition.

An arm with a bandaid on the upper arm. — The Australian government now recommends the Pfizer vaccine for adults under 50, rather than the AstraZeneca one.
Shutterstock

Understanding risk

It’s important to note every therapeutic agent (a drug or a vaccine, for example) carries the risk of unintended consequences. For most of us, most of the time, this will be minimal. This is a biological reality reflecting the interconnectedness and complexity of the human body.

So like for any other therapeutic agents, there are risks as well as benefits we have to accept in taking COVID vaccines. What we need to do is to weigh up these risks against the benefits.

We make these sorts of calculations every day in all aspects of our lives. When we decide to get in the car, we know there’s a risk associated with driving. But we assess the risks are worth taking as the benefits of getting where we want to go quickly are worth it.

Mostly, we make these calculations without being consciously aware we’re doing it. Sometimes the parameters underlying these calculations are easy to grapple with — but sometimes they’re more nebulous.

Weighing up the risks and benefits of the AstraZeneca vaccine

We know the vaccine offers near-complete protection against severe disease and death from COVID-19.

We also know severe side effects from the vaccine, in particular vaccine induced prothrombotic immune thrombocytopenia (VIPIT, the blood-clotting disorder in question), are extremely rare. But the condition is serious and around 25% of people have died after developing VIPIT.

There are a range of estimates of how often this syndrome occurs. But it’s generally accepted its incidence is about 4-6 cases per million doses of vaccine.

To put it in perspective, this puts the risk in the same order of magnitude to the average risk of dying if you complete a marathon, go scuba diving, or rock climbing.

It’s also important to note that we’ve started to see a pattern in that those who are at higher risk of this syndrome tend to be younger and tend to be women. We don’t have a clear understanding of why this is, but recognising this is really helpful in terms of making decisions about how to mitigate this risk.

Why the balancing act isn’t so easy

Although we have a pretty good understanding of the rate of severe outcomes from COVID-19, since we have over 12 months’ experience now of this illness, context is important. There are different levels of risk depending on where you live and what the rate of transmission in the community is.

While it’s all well and good in some countries to say you’re more likely to get very sick with or die from COVID than experience a complication from the vaccine, in Australia we have next to no COVID, so the risk of adverse outcomes from COVID is much lower. This needs to be factored into the equation.

We also have different strains of the virus, which can vary in how infectious they are and how sick they might make you. This also needs to be added to the mix.

In acknowledging the difficulty in completing these risk-benefit analyses, it’s really helpful to use a visualisation the University of Cambridge has put together based on UK data, which we’ve adapted here, comparing the risks and benefits of the AstraZeneca vaccine.

It depicts the risk of adverse effects from COVID (being in ICU) against adverse outcomes from the vaccine, based on an assumed incidence of COVID in the community of two in 10,000 people. Although the incidence rate in Australia is lower than this, this visual is extremely useful in conveying the nature of the relationship between the risks and benefits of the AstraZeneca vaccine in Australia.

What this visual shows clearly is that the benefits of the vaccine increase the older you are, because the risk of severe disease is higher the older you get.

It also shows that although the risks of side effects from the vaccine are relatively small regardless of age, the gap between risks and benefits narrows the younger you are. This is in part due to the reduced benefit of the vaccine for younger people who are less likely to have severe symptoms from COVID, and in part due to the increased risk of serious side effects, such as blood clots, for younger adults.

This visual clearly communicates the rationale for the changes announced yesterday. Where the risk-benefit becomes marginal, it makes sense to use other vaccines for younger adults — the Pfizer vaccine and possibly the Novavax vaccine down the track. The recommendations are both cautious and sensible.

Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How Australia can reap the benefits and dodge the dangers of the Internet of Things

Posted on November 8, 2020 by particularkev

Kayleen Manwaring, UNSW and Peter Leonard, UNSW

The Internet of Things (IoT) is already all around us. Online devices have become essential in industries from manufacturing and healthcare to agriculture and environmental management, not to mention our own homes. Digital consulting firm Ovum estimates that by 2022 Australian homes will host more than 47 million IoT devices, and the value of the global market will exceed US$1 trillion.

The IoT presents great opportunities, but it brings many risks too. Problems include excessive surveillance, loss of privacy, transparency and control, and reliance on unsafe or unsuitable services or devices.

In some places, such as the European Union, Germany, South Korea and the United Kingdom, governments have been quick to develop policies and some limited regulation to take advantage of the technology and mitigate its harmful impacts.

Australia has been late to react. Even recent moves by the federal government to make IoT devices more secure have been far behind international developments.

A report launched today by the Australian Council of Learned Academies (ACOLA) may help get Australia up to speed. It supplies a wide-ranging, peer-reviewed base of evidence about opportunities, benefits and challenges the IoT presents Australia over the next decade.

Benefits of the Internet of Things

The report examines how we can improve our lives with IoT-related technologies. It explores a range of applications across Australian cities and rural, regional and remote areas.

Some IoT services are already available, such as the Smart Cities and Suburbs program run by local and federal governments. This program funds projects in areas such as traffic congestion, waste management and urban safety.

Health applications are also on the rise. The University of New England has piloted the remote monitoring of COVID-19 patients with mild symptoms using IoT-enabled pulse oximeters.

Augmented and virtual reality applications too are becoming more common. IoT devices can track carbon emissions in supply chains and energy use in homes. IoT services can also help governments make public transport infrastructure more efficient.

The benefits of the IoT won’t only be felt in cities. There may be even more to be gained in rural, regional and remote areas. IoT can aid agriculture in many ways, as well as working to prevent and manage bushfires and other environmental disasters. Sophisticated remote learning and health care will also benefit people outside urban areas.

While some benefits of the IoT will be felt everywhere, some will have more impact in cities and others in rural, remote and regional areas.
ACOLA, CC BY-NC

Opportunities for the Australian economy

The IoT presents critical opportunities for economic growth. In 2016-17, IoT activity was already worth A$74.3 billion to the Australian economy.

The IoT can facilitate more data-informed processes and automation (also known as Industry 4.0). This has immediate potential for substantial benefits.

One opportunity for Australia is niche manufacturing. Making bespoke products would be more efficient with IoT capability, which would let Australian businesses reach a consumer market with wide product ranges but low domestic volumes due to our small population.

Agricultural innovation enabled by the IoT, using Australia’s existing capabilities and expertise, is another promising area for investment.

Risks of the Internet of Things

IoT devices can collect huge amounts of sensitive data, and controlling that data and keeping it secure presents significant risks. However, the Australian community is not well informed about these issues and some IoT providers are slow to explain appropriate and safe use of IoT devices and services.

These issues make it difficult for consumers to tell good practice from bad, and do not inspire trust in IoT. Lack of consistent international IoT standards can also make it difficult for different devices to work together, and creates a risk that users will be “locked in” to products from a single supplier.

In IoT systems it can also be very complex to determine who is responsible for any particular fault or issue, because of the many possible combinations of product, hardware, software and services. There will also be many contracts and user agreements, creating contractual complexity that adds to already difficult legal questions.

The increased surveillance made possible by the IoT can lead to breaches of human rights. Partially or fully automated decision-making can also to discrimination and other socially unacceptable outcomes.

And while the IoT can assist environmental sustainability, it can also increase environmental costs and impacts. The ACOLA report estimates that by 2050 the IoT could consume between 1 and 5% of the world’s electricity.

Other risks of harmful social consequences include an increased potential for domestic violence, the targeting of children by malicious actors and corporate interests, increased social withdrawal and the exacerbation of existing inequalities for vulnerable populations. The recent death of a woman in rural New South Wales being treated via telehealth provides just one example of these risks.

Maximising the benefits of the IoT

The ACOLA report makes several recommendations for Australia to take advantage of the IoT while minimising its downsides.

ACOLA advocates a national approach, focusing on areas of strength. It recommends continuing investment in smart cities and regions, and more collaboration between industry, government and education.

ACOLA also recommends increased community engagement, better ethical and regulatory frameworks for data and baseline security standards.

The ACOLA report is only a beginning. More specific work needs to be done to make the IoT work for Australia and its citizens.

The report does outline key areas for future research. These include the actual experiences of people in smart cities and homes, the value of data, environmental impacts and the use of connected and autonomous vehicles.

Kayleen Manwaring, Senior Lecturer, School of Taxation ＆ Business Law, UNSW and Peter Leonard, Professor of Practice (IT Systems and Management and Business and Taxation Law), UNSW Business School, Sydney, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Don’t abandon plans for high-speed rail in Australia – just look at all the benefits

Posted on July 19, 2020 by particularkev

Marcus Luigi Spiller, University of Melbourne

The Grattan Institute’s call to “abandon” plans for any high-speed rail network in Australia fails to look at the wider benefits such a project can bring by way of more productive economies and more sustainable towns and cities.

The study authors argue the development of any bullet train network linking Brisbane to Melbourne via Sydney and Canberra is “unsuitable for Australia”.

But what their argument neglects is that a project like high-speed rail has a unique capacity to reshape cities and population settlement patterns in positive ways.

A question of cost

The institute’s study says the idea of high-speed rail is an unwanted distraction in policy-making for the nation’s transport future. Its case relies on a review of the high-speed rail experience in Europe, Japan and China.

All of these nations, it says, have vastly different distributions of towns and major cities to that in Australia, which has extremely long distances between a few large cities.

The study also critiques a 2013 Commonwealth analysis that found a A$130 billion high-speed rail project linking Brisbane, Sydney and Melbourne would generate a benefit-cost ratio of 2.3 to 1.
So every A$1 invested in a high-speed rail network would generate A$2.30 in benefits such as travel time savings, avoided vehicle operating costs and reduced road congestion.

But the Grattan study authors say that figure is based on a “cherry-picked” discount rate of 4%. This is economics jargon for the minimum return that the community would expect from the investment of its collective resources in any project.

The Grattan study also says the 2013 cost-benefit analysis did not allow for cost over-runs. Nor did it consider the greenhouse gas emissions associated with the enormous quantities of concrete and steel needed to build the infrastructure.

So why are some people, including the federal Labor Party, still so enamoured with the idea of high-speed rail when others would have it binned?

Some projects reshape cities

Not all transport infrastructure projects are equal when it comes to cost-benefit analysis. Some investments have a transformative effect on population settlement patterns – they shape cities and regions.

The Sydney Harbour Bridge and the Melbourne Underground Rail Loop are classic examples of city-shaping projects. Each altered travel times between different parts of the metropolis, which then shifted the location preferences of households and businesses. This led to a substantially different city structure compared to what might otherwise have developed.

Other projects, the vast majority of government transport outlays, merely follow or service the pattern of settlement established by the city-shaping investments. These “follower” projects include the local arterial roads and tramways that circulate people and goods within cities.

The Commonwealth’s official guidelines for major project evaluation recognise this distinction.

New ways of living, learning, working and playing become possible with city-shaping projects. By comparison, the procession of follower projects simply perpetuates settlement patterns and economic structures.

This is the claim and appeal of high-speed rail. Advocates argue such an investment would divert a significant proportion of urban growth from the far-flung suburbs of metropolitan areas to new regional locations. That’s because these regions will then have similar travel times into core city labour markets.

In these regional locations, households would enjoy greater housing choice and affordability, more walkability and better access to open space. They could even have better access to a range of community facilities than their metro suburban counterparts.

Advocates also argue businesses in the big cities and intervening regional areas will be able to connect with each other at lower cost and source the skills they need more efficiently. This would boost productivity.

Consider all the benefits

The 2013 analysis took into account issues such as congestion, emissions (from travel) and transport accidents. But it did not attempt to quantify and monetise the effects of high-speed rail shaping cities and regions.

Arguably, the most important set of benefits from this investment were left out of the economic evaluation, simply because they are difficult to measure.

Modelling how the supply chains of businesses might change under the influence of city-shaping projects, or how the housing preferences of people might shift, is undoubtedly challenging. But being difficult to measure makes these impacts no less real.

Despite this limitation on the scope of benefits, the 2013 study said the high-speed rail project would return a benefit-cost ratio of 1.1 at a 7% discount rate, which the Grattan study says is the usual test applied to transport projects.

Grattan says the project barely scrapes in at this higher discount rate and implies many other projects would offer ratios greater than 1:1 and should be preferred. These would typically be smaller, follower projects that address local congestion problems.

But a project achieving a 1.1 benefit-cost ratio means Australia would still be better off undertaking the project compared to a business-as-usual case.

If the transformative effects of high-speed rail include more compact and walkable cities with less car dependency and greater productivity, then such a network has good reason to keep its grip on the Australian imagination.

Marcus Luigi Spiller, Associate Professor of Urban Planning (honorary), University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The costs of the shutdown are overestimated — they’re outweighed by its $1 trillion benefi

Posted on May 16, 2020 by particularkev

Richard Holden, UNSW and Bruce Preston, University of Melbourne

As Australia begins to relax its COVID-19 restrictions there is understandable debate about how quickly that should proceed, and whether lockdowns even made sense in Australia in the first place.

The sceptics arguing for more rapid relaxation of containment measures point to the economic costs of lockdowns and appeal to the cold calculus of cost-benefit analysis to conclude that the lives saved by lockdowns don’t justify the economic costs incurred to do so.

Their numbers don’t stack up.

To be able to weigh the value of a life against the economic costs of forgone output from lost jobs and business closures, requires placing a dollar value on one person’s life. This number is called the value of a statistical life.

In Australia, the Government generally uses a value of A$4.9 million. The United States uses a value of US$10 million.

What are the benefits of the shutdown? This is the value of lives saved plus any indirect economic or health benefits. Lives saved are those excess lives that would be lost if government relied on a strategy that allowed enough people to get infected to result in so-called herd immunity.

How many extra lives would be lost under this second strategy?

To answer this, we need assumptions about the virus.

The lives lost if we let it rip

The initial reproduction rate of the virus, R0, was thought to be about 2.5. This means that every 2 people infected were likely to infect another 5; producing an average infection rate per person of 2.5.

Herd immunity for COVID-19 is estimated to require roughly 60% of the population be infected before the curve begins to flatten and the peak infections fall.

This happens when the reproduction rate, R0, falls below one. Because of subsequent new infections, the total number infected over the course of the pandemic is closer to 90%.

Given a population of 25 million people and assuming a fatality rate of 1%, this would produce 225,000 deaths.

An assumption of a 1% fatality rate is low from the perspective of those making decisions at the onset of the pandemic, at a time when crucial and reliable data were missing.

Those lives are valued at $1.1 trillion

Converting those fatalities to dollars using the Australian value of a statistical life of A$4.9 million per life yields a cost of A$1.1 trillion.

In rough terms, that’s the amount we have gained by shutting down the economy, provided deaths do not skyrocket when lockdown measures are relaxed and borders re-open.

It is about three fifths of one year’s gross domestic product, which is about A$1.9 trillion.

What are the costs of the shutdown?

These are the direct economic costs from reduced economic activity plus the indirect social, medical, and economic costs, all measured in terms of national income.

A starting point is to take the lost income that occurs from the recession that has probably already begun.

What will the shutdown cost?

Let’s assume that the downturn results in a 10% drop in gross domestic product over 2020 and 2021 – about $180 billion – consistent with IMF forecasts of a fall in GDP of 6.7% in 2020 and a sharp rebound of 6.1% growth in 2021, and comparable to the Reserve Bank of Australia’s forecasts in the latest Statement on Monetary Policy.

Comparing this cost from shutting down – about $180 billion – to the benefit of $1,103 billion – makes the case for shutdown clear.

But this calculation grossly overestimates the costs of the shutdown.

The recession is a consequence of both the shutdown and the pandemic.

We need to attribute costs to each.

Most of the economic costs of the recession are likely to be due to the pandemic itself rather the shutdown.

Many costs would have been borne anyway

Even before the shutdown, economic activity was in decline.

Both in Australia and internationally air travel, restaurant bookings and a range of other activities had fallen sharply.

They were the result of a “private shutdown” that commenced before the mandated government shutdown.

Even in a country such as Sweden, where a shutdown has not been mandatory, there has been a more than 75% reduction in movement in central Stockholm and a more than 90% reduction in travel to some domestic holiday destinations.

To be generous, let’s assume the costs attributable to the government-mandated part of the shutdown are half of the total costs, making their cost A$90 billion.

In reality, they are likely to be less, one important study suggests much less.

It is hard to imagine a much bigger private shutdown not taking place had the government decided to simply let the disease rip until its spread was slowed by herd immunity.

Support is not a cost

It is also important to note that the government’s spending of A$214 billion to support the economy during the shutdown is a transfer of resources from one part of society to another rather than a cost.

It creates neither direct costs nor benefits for society as a whole, other than the economic distortions coming from raising the revenue to service the spending.

With long-term government bond rates near 1% (less than inflation), the total cost of distortions is likely to be tiny.

Of course, this discussion simplifies what are incredibly complex social, health and economic questions. There are clearly further costs, from both relaxing restrictions and keeping them in place.

Other costs are not that big

These costs are worthy of serious study and should rightly be part of a comprehensive public policy discussion. But looked at through the lens of a cost-benefit analysis these combined effects are likely to be small relative to the value of preventing mass death.

Among them are the incidence of mental health problems and domestic violence under lockdowns. They are important concerns that should be addressed by targeted and well-designed programs.

Weighing against that is evidence that economic crises are associated with declines in overall mortality rates.

While suicides rise, total mortality, including deaths from heart attacks and workplace and traffic accidents, falls.

In the specific case of this pandemic there is survey evidence based on respondents from 58 countries suggesting that strong government responses to the pandemic have been reducing worry and depression.

Also, we have to acknowledge that recessions and educational disruption have health and economic costs that are unequally spread.

The shutdown disproportionately impacts more-disadvantaged people including short-term casual workers, migrant workers, those with disabilities and the homeless.

The most-disadvantaged suffer, either way

This skewing will also be present in the herd immunity option. As New York City makes clear, a rapid spread of the disease also disproportionately impacts disadvantaged communities. One can only speculate about the disease burden should some of our remote indigenous communities get exposed.

To this we should add further achievements of the shutdown:

elimination of mental trauma and grief from losing our loved ones
avoiding the costs of possible longer-term implications of the disease, which we still know little about
avoiding a collapse in the capacity of the health system to deal with other emergencies through the sheer numbers of COVID-19 infected combined with staff shortages due to illness

Those advocating cost-benefit analysis of this kind have to apply the principle systematically. It is difficult to see how the total of these sorts of considerations on each side of the ledger could compare to the benefit of lives saved. They will be an order of magnitude, if not two, smaller.

$90 billion, versus $1.1 trillion

In the cold calculus of cost-benefit analysis, a highly pessimistic view of the economic costs of Australia’s shutdown comes to around $90 billion.

It is a small price to pay compared to the statistical value of lives the shutdown should save, around A$1.1 trillion.

It produces a simple message. The shutdown wins.

The question we now face is how quickly to relax restrictions. Here, too, there are costs and benefits, and we need to be mindful of the economic cost of a second-wave outbreak, plus mortality costs of disease spread before effective treatments or vaccine become available.

And in all of this bean counting, we should remember that putting a price tag on human life is sometimes unavoidable – such as when a doctor with access to only one ventilator has to choose between two patients.

But we shouldn’t mistake necessity for desirability. We should seek to avoid needing to make such wrenching choices whenever possible.

Dr Jen Schaefer of the Royal Children’s Hospital Melbourne assisted with the preparation of this piece.

Richard Holden, Professor of Economics, UNSW and Bruce Preston, Professor of Economics, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Should we re-open pubs next week? The benefits seem to exceed the costs

Posted on May 13, 2020 by particularkev

Kuranda pub, Far North Queensland.
Shutterstock

Jonathan Karnon, Flinders University and Ben W. Mol, Monash University

Nothing our leaders can do now will return the economy to where it was before COVID-19. For one thing, international travel is likely to remain closed for a long time.

But there are things they can do, and on Friday the prime minister outlined a roadmap.

Of interest to us is whether it makes sense to reopen bars and restaurants.

Commonwealth government, Friday May 8, 2020

The Australian Government committed A$320 billion over six months to support businesses and workers whose incomes has been hit by the COVID-19 pandemic.

That amounts to $12 billion per week.

Reported job losses suggest around 29% is being paid out to support the accommodation and food services industry.

That’s about $3.4 billion per week. Bars and restaurants are likely to account for half of it, $1.7 billion per week.

That can be thought of as one of the costs of keeping bars and restaurants closed.

What about the benefits? What costs do we avoid by keeping bars and restaurants closed?

It helps to illustrate our thinking as a decision tree.

The Conversation/Figures author provided, CC BY-ND

The upper branches of the tree represent the decision about whether or not to lift restrictions.

If restrictions are lifted, there may, or may not, be a new outbreak that requires the reintroduction of restrictions.

While we don’t know the likelihood of a new outbreak, we can test different assumptions.

Given the very low number of new cases of COVID-19, the assumption we have tested is that there would be a one in ten chance of a new outbreak requiring the reintroduction of restrictions.

We also assume that if there was a new outbreak, there would be a 95% chance it could be controlled by re-imposing restrictions on bars and restaurants and only a 5% chance it could not.

It’s a matter of probabilities

If the outbreak was controlled by reimposing restrictions (the 95% probability) we assume an extra 40 COVID-19 deaths and an extra four weeks of restrictions at a financial cost to the government of $6.8 billion.

If the outbreak was more severe and a broader set of restrictions are required (the 5% case) we assume an additional 200 deaths and extra cost to the government of $17 billion.

(We also assume that 25% of the government spending to support the hospitality industry would remain because a decision to reopen bars and restaurants would not result in the industry returning to it’s pre-COVID-19 state – many people would remain cautious about the risks of contracting COVID-19 or have become conditioned to less frequent socialising.)

When we weigh these costs by their probabilities we get expected costs to the government from reopening of $1.1 billion, compared to costs from keeping bars and restaurants closed for another week of $1.7 billion.

Is the $600 million per week value for money?

It suggests the government would be $600 million per week better off it it reopens bars and restaurants.

We would expect a number of extra COVID-19 deaths. Multiplying the probabilities of the extra deaths under each scenario by the likelihood of each scenario suggests there would be an extra 4.8 deaths if bars and restaurants are reopened this week.

Because the average age of people dying due to COVID-19 is around 80 years, and each might have around ten more years to live, the number of life years per week that would be lost as a result of the $600 million per week the government saved would be 48.

It suggests each life year saved as a result of keeping bars and restaurants closed costs around $12.5 million.

Decisions on whether government should fund health interventions are commonly based on an assessment of whether the health gains justify the additional costs.

As a ballpark figure, new measures are funded if they are shown to gain an additional life year at a cost of around $50,000.

This suggests that by keeping bars and restaurants closed the government is paying 250 times more than it would usually pay to gain a life year.

It is funding that doesn’t pass the usual test

A separate guideline used by Australian governments to assess regulations and infrastructure projects puts the value of a statistical life year at $200,389 in today’s dollars.

This suggests that by keeping bars and restaurants closed the government is paying 60 times more than it would usually pay to save a life.

It’s why we think governments should reopen them, next week.

Like all such analyses, ours depends on the assumptions used.

We have put a spreadsheet of our decision tree online to allow readers to experiment with different ones.

Our analysis leaves much out. It includes neither the negative impact of COVID-19 on people’s quality of life, nor the negative impact of shutting bars and restaurants on people’s health and quality of life.

It gives us an indication of how many life years the government is saving for the $600 million per week it is costing it to keep bars and restaurants closed.

It suggests the government could save many more life years by spending the money in a different way.

Jonathan Karnon, Professor of Health Economics, Flinders University and Ben W. Mol, Professor of Obstetrics and Gynaecology, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Myth busted: China’s status as a developing country gives it few benefits in the World Trade Organisation

Posted on October 7, 2019 by particularkev

President Trump and Australia’s Prime Minister Scott Morrison insist it matters whether China is classified as “developed” or “developing” in the World Trade Organisation matters. It may not.
Shutterstock

Henry Gao, Singapore Management University and Weihuan Zhou, UNSW

Whether China is a “developing” or a “developed” country for the purposes of the World Trade Organisation matters a lot to the US president.

President Donald Trump ignited a new front in the US-China trade war in July by tweeting that the world’s richest nations were masquerading as developing countries to get special treatment.

They were “cheating”, according to Trump.

He directed the US Trade Representative to “use all available means to secure changes” at the WTO.

Then Australia joined in. While in the United States, Prime Minister Scott Morrison referred to China as a “newly developed economy”, and backed Trump, saying that “obviously, as nations progress and develop then the obligations and how the rules apply to them also shift”.

China is digging in. It hasn’t resiled from a statement by its commerce ministry spokesman Gao Feng in April:

China’s position on WTO reform has been very clear. China is the largest developing country in the world.

But what’s at stake? In practical terms, almost nothing. Trump and Morrison are demanding something that would give them little.

What does “developing” even mean?

In the WTO, developing countries are entitled to “special and differential treatment” set out in 155 rules.

However, none of those rules define what a “developing country” is.

Instead, each member is able to “self-designate”, subject to challenges from other members.

Being recognised as a developing country was one of the three key principles China insisted on when negotiating to join the WTO in 2001.

It faced resistance. Several members cited “the significant size, rapid growth and transitional nature of the Chinese economy”.

In response the WTO took what it called a “pragmatic approach,” meaning that China got hardly any of the special treatment that would normally be accorded to a developing country.

For example, under the Uruguay Round of tariff reductions that applied to developing countries already in the WTO, China would have only needed to cut its average industrial tariff from 42.7% to 31.4%. Instead, it agreed to cut it to 9.5%.

Similarly, it agreed to cut its agricultural tariff from 54% to 15.1%, instead of the 37.9% that would have been required had it already been in the WTO. These put its commitments on par with those of developed rather than developing countries.

On some issues, China’s commitments far exceeded those of even developed countries. For example, it agreed to eliminate all export subsidies on agricultural products, an obligation that developed countries were only able to accept 14 years later.

It also undertook to eliminate all export taxes, which are still allowed under WTO rules and still widely used by many governments.

Many of China’s WTO commitments were imposed only on it or modified the general rules to either impose heavier obligations on it or confer less rights on it.

Contrary to popular belief, China has received hardly any of the benefits that accrue to developing countries when it became a WTO Member, other than the ability to use the title “developing country”.

It’s more about identity than benefits

After its accession, China acted as a member of the developing country group and pushed hard for its interests. In 2003 it joined India and Brazil in pushing developed countries to reform their agricultural trade policies while retaining flexibility for developing countries, a push that has yet to achieve success.

In the meantime, it enjoys little preferential treatment for itself, partly because it has eschewed special benefits, partly because most of the transition benefits that were available to it have expired, partly because some of the provisions available to it are essentially voluntary on the part of the country offering them, and partly because many of the benefits available to developing countries are not available to developing countries with large export shares.

At times it has actively forgone important benefits, such as by not invoking its right to receive technical assistance under WTO’s Trade Facilitation Agreement.

However, on some other issues, the sheer size of China has made it difficult to accommodate China’s claim for developing country treatment. One example is the negotiation on fisheries subsides, which would not be able to move without substantial commitments from China, which operates one of the largest subsidies in the world.

Identity matters to China

In its position paper on WTO Reform, China says it “will never agree to be deprived of its entitlement to special and differential treatment as a developing member”.

At the same time, it says it “is willing to take up commitments commensurate with its level of development and economic capability”.

It remains far less developed than traditionally developed countries. In purchasing power terms, its standard of living is about one-third of that in the United States.

Although not practically important in terms of its obligations under the WTO, its developing country status is useful to it in other ways, giving it the opportunity to gain meaningful advantages in other international organisations such as the Universal Postal Union.

It costs the rest of the world little to accommodate China’s wish to be described as a developing country. If Trump and Morrison got what they wanted, they would find little had changed.

Henry Gao, Associate Professor of Law, Singapore Management University and Weihuan Zhou, Senior Lecturer and member of Herbert Smith Freehills CIBEL Centre, Faculty of Law, UNSW Sydney, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Indians promised benefits of 100 smart cities, but the poor are sidelined again

Posted on January 7, 2019 by particularkev

File 20181216 185261 14z8ner.jpg?ixlib=rb 1.1 — Residents of slums like Kamla Nehru Nagar, a kilometre away from Patna Junction, have yet to share in the promised benefits of smart cities.
Sujeet Kumar, Author provided

Sujeet Kumar, Jawaharlal Nehru University

India’s urban population is growing. More than 50% of the country’s population is forecast to be living in cities by 2030. This is a major challenge for government because the country’s cities lack the infrastructure (affordable housing, roads) and basic services (sanitation, water, health care) for existing inhabitants, let alone the influx of people over the next decade.

Globally, one in eight people live in slums where they face issues of durable housing, access to safe drinking water and toilets, and insecure tenure. In India, one in every six city residents lives in a slum.

Many Indian children are growing up in very disadvantaged circumstances. These two live in Mahmudi Chak slum next to Rajendra Nagar Railway Junction in Patna.
Sujeet Kumar, Author provided

However, estimates of slum populations differ widely in many Indian cities due to differences in the counting criteria. For example, in cities like Mumbai and Delhi, it’s estimated more than 50% of the population live in slums, but the 2011 Indian Census put the figures at 41.3% and 14.6% respectively.

Launching the national Smart Cities Mission in 2016, Indian Prime Minister Narendra Modi said: “… if anything has the potential to mitigate poverty it is our cities”. He said the mission, which has a target of 100 smart cities, aims to ensure access to basic services for the people. This includes houses for the urban poor.

The program aims to fulfil the aspirations and needs of the citizens through comprehensive development of institutional, physical, social and economic infrastructure. This comprehensive development would also ensure increased public participation, Modi said.

Villagers migrated to the Danapur Block slum after the Ganga river flooded.
Sujeet Kumar, Author provided

Smart city plan has a dark side

In one of the 100 cities selected for the Smart City Mission, Patna (Bihar), I witnessed the flip side of the smart city. Patna, the state capital of Bihar, has a rich history, but 63% of its population lives in slums. And 93% of them are from the historically oppressed “scheduled castes” and “other backward castes” (based on data collected in 42 slums).

Demolished homes at Meena Bazar.
Sujeet Kumar, Author provided

The city administration often demolishes slums without following due process of law in order to seize the land in the name of beautification and development of Patna.

In slums like Meena Bazar (near the famous Nalanda Medical College Hospital) and Amu Kuda Basti (near Patna Airport) people have been living there for generations in houses often partially funded by government housing projects. These have been bulldozed.

Riot police are on hand when slum dwellers’ homes are demolished at Amu Kuda Basti.
Sujeet Kumar, Author provided

The city administration usually makes ad-hoc loudspeaker announcements before bulldozing these settlements. A massive police presence and riot vehicles are on hand in case residents protest the demolitions. They use derogatory language and forcefully enter houses and thrash male members, say women in Amu Kuda Basti.

The government could have given them more time or relocated them elsewhere in the city, rather than just bulldozing their houses, which they had built with hard-earned money, the slum dwellers said.

Residents of slums like Amu Kuda Basti say houses they built with their own hard-earned money are being demolished with little notice.
Sujeet Kumar, Author provided

There is apparently reason to smash these homes. There always is. The usual arguments for demolition include: beautification of the city, construction of a government building or enterprise, extension of the airport, crime locations, governance, illegality, encroachment etc. The state says demolitions of such slums are necessary for the development of the city.

In 2011, the state proposed a slum policy to relocate slum dwellers who had lived in the city for generations to the outskirts in a plan to develop Patna and make it a smart city, says Kishori Das, an advocate for the rights of slum dwellers for years. Faced with widespread protests, the state deferred the policy, but it is silently applying it on the ground, he said.

Who speaks for the marginalised poor?

These two leaders from Meena Bazar are among 84 community representatives, elected and non-elected, interviewed by the author.
Sujeet Kumar, Author provided

Local and mainstream media are not reporting these demolitions and forced evictions, especially when it happens in non-metro cities like Patna. Civil society and advocacy NGOs also take little notice of these frequent demolitions, probably due to threats to life and, if not, then to co-option by the state. The roles of the ruling party and opposition are also dubious.

Bihar has been ruled by leaders who attracted votes by campaigning on issues of poverty, caste and social justice for the past three decades. In the early 1990s, the prominent leader Lalu Prasad Yadav mobilised the poor and the oppressed caste groups under the umbrella of “Vikas nahin, samman chahiye” (we want dignity, not development). The present chief minister, Nitish Kumar, also known as Sushaasan Babu (good governance man), adopted the slogan “Nyay ke saath vikas” (development with justice).

However, the frequent injustices suffered by the urban poor negate the political commitment. These actions are also in conflict with the motto of the Indian Constitution, which frames justice as a balancing wheel between the haves and have-nots.

Promises of social justice ring hollow for residents of bulldozed communities like Amu Kuda Basti.
Sujeet Kumar, Author provided

These challenges are not limited to one city. In the name of smart and developed cities, the government is not only taking over urban land where millions of the poor have lived for decades but is also acquiring fertile land and violating the constitutional rights of farmers, tribes and other indigenous groups in various cities.

These reports of struggle and forced evictions contradict the statements by Modi when he said smart cities development would strictly follow large-scale public participation in preparing these plans.

Such demolitions reveal a dark side to making Indian cities smart and cast serious doubt on claimed government commitment to the urban poor. These actions hardly live up to the idea of the rights of the poor. It became more challenging when the head of the biggest democracy in the world denounces those who speak up for the poor, oppressed and voiceless as “urban Naxals”.

In the words of Abraham Lincoln, democracy is “government of the people, by the people, for the people”. For India, this means the urban poor need help both from political parties and civil society so that their voice finds expression and their demands and concerns are heard and considered in public policy.

Children sleep out in the open in a slum area in Harding Park, Patna.
Sujeet Kumar, Author provided

Sujeet Kumar, Senior Research Fellow, Centre for the Study of Law and Governance, Jawaharlal Nehru University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Most of the benefits from the budget tax cuts will help the rich get richer

Posted on May 14, 2018 by particularkev

File 20180509 34015 7hqble.jpg?ixlib=rb 1.1 — Chris Samuel/Flickr, CC BY-SA

Robert Tanton, University of Canberra and Jinjing Li, University of Canberra

In the federal budget, Treasurer Scott Morrison promised tax cuts to all working Australians in the form of an offset and changes to tax income thresholds. But our analysis of Treasury data shows that while the government advertised these as payments to low and middle income Australians, most of the benefits would flow through to high income earners in future years.

If all of the stages of the tax plan passed parliament, there would be a sharp increase in benefits for people earning above A$180,000, due to the reduction of their marginal tax rate from 45% to 32.5%.

https://datawrapper.dwcdn.net/QA4kF/3/

Taxes in most countries are progressive. This means that the more you earn, the higher your marginal rate (the additional amount you pay for each dollar earned).

There are good reasons for this – progressive tax systems mean those on a lower income pay a lower average tax rate, while those on higher incomes pay a higher average tax rate. This reduces income inequality – as you earn more, for each dollar you earn, you will pay more in tax than someone on a lower income.

With the 2018-19 budget, the proposal is for a “simpler” tax system from 2024-25. This means a reduced number of tax brackets, and a lower rate of 32.5% to those earning between A$87,001 and A$200,000.

Treasurer Scott Morrison said following the budget:

Well, you’ve still got a progressive tax system. That hasn’t changed. In fact, the percentage of people at the end of this plan, who are on the top marginal tax rate is actually slightly higher than what it is today.

However this new tax system from 2024-25 is less progressive than the current system. It means higher income inequality – the rich get more of the tax cuts than the poor.

As part of the new proposal, low and middle income earners get a tax offset in 2018-19, with high income earners getting very little. This part of the plan is progressive – more money goes to lower income earners.

However, by 2024-25, the tax cuts means high income earners gain A$7,225 per year, while those earning A$50,000 to A$90,000 gain A$540 per year, and those earning A$30,000 gain A$200 per year.

https://datawrapper.dwcdn.net/iTzyr/3/

Of course, another factor of tax cuts is that they only benefit those who are employed. Tax cuts don’t benefit people like the unemployed, pensioners, students (usually young people) and those on disability support pensions.

The conversation Australians need to have is how we should be spending the revenue boost we are seeing over the next few years. We can either spend this windfall gain on benefits to high income earners, in the hope that this will flow through spending to everyone else; or maybe we should encourage young people into housing through an increase to the first home owners grant, or increased funding for our schools, universities and health system.

We’ve developed a budget calculator so you can see how your family is affected by the 2018 budget.

Robert Tanton, Professor, University of Canberra and Jinjing Li, Associate Professor, NATSEM, University of Canberra

This article was originally published on The Conversation. Read the original article.

Sharing my thoughts with the world from a Particular Baptist perspective

First, what are myocarditis and pericarditis?

What’s the risk?

Symptoms to look out for

COVID-19 and heart damage

The benefit outweighs the risk

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Astra wasn’t ‘banned’ for young people, just not ‘preferred’

What about now?

What should you weigh up?

In a nutshell

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What’s happened?

Understanding risk

Weighing up the risks and benefits of the AstraZeneca vaccine

Why the balancing act isn’t so easy

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Benefits of the Internet of Things

Opportunities for the Australian economy

Risks of the Internet of Things

Maximising the benefits of the IoT

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A question of cost

Some projects reshape cities

Consider all the benefits

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The lives lost if we let it rip

Those lives are valued at $1.1 trillion

What will the shutdown cost?

Many costs would have been borne anyway

Support is not a cost

Other costs are not that big

The most-disadvantaged suffer, either way

$90 billion, versus $1.1 trillion

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It’s a matter of probabilities

Is the $600 million per week value for money?

It is funding that doesn’t pass the usual test

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What does “developing” even mean?

It’s more about identity than benefits

Identity matters to China

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Smart city plan has a dark side

Who speaks for the marginalised poor?

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