Why do we have a vaccine shortage?–

Kevin Drum has a thoughtful post on the vaccine shortage, plausibly speculating that the restrictive FDA process is the likeliest culprit (tip Reynolds). Drum reviews seven possible explanations, noting:

[W]ith two exceptions, all of these explanations apply to every country in the world — but the United States is the only one with a problem. So most of them don’t actually explain anything.

That leaves the two exceptions, and only one of them seems to hold water. Explanation #7, liability costs, is certainly something that could be unique to the United States, but liability costs wouldn’t drive companies out of the flu vaccine market unless liability insurance were unavailable, and this must not be the case since both Chiron and Aventis presumably have liability insurance. It might be expensive, and therefore drive prices up, but it wouldn’t force companies out of the market. (It would — potentially — be a big problem if the price of the vaccine were capped, but while that’s the case for some vaccines, flu vaccine is not price capped.)

That leaves explanation #5, [the FDA,] and at first glance it seems the most likely to be the real deal. The FDA has a famously tight regulatory regime, made even tighter in the late 90s, and as a result the United States has only two approved manufacturers of flu vaccine while Britain has half a dozen. (Although, ironically, it’s worth noting that a breakdown of the regulatory regime seems to be a more likely explanation for Chiron’s immediate problem.) The bottom line is that there are other flu vaccine manufacturers besides Chiron and Aventis, but they don’t sell into the U.S. market because the cost of complying with FDA regulations is higher than the narrow profits they could expect to make from selling flu vaccine.

UPDATE:
Russell Roberts also points his finger at regulation.

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