# How poor is US vaccine response by comparison to other countries?

Epistemic status: unapologetically US-centric.  Noticing that I am confused, and hoping the internet will explain things.

SECTION I: OBSERVATIONS
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Many places I follow have been saying for a long time that US vaccine procurement and distribution is very poor, and that we could have many more people vaccinated if we would not drag our feet so much/not prosecute people for giving out vaccines when we decide they shouldn't have/etc.  (I won't reiterate details.  For examples, start with e.g. Zvi's post [here](https://www.lesswrong.com/posts/PQACEuWpkSyRgHC4p/covid-2-11-as-expected)).  

I'll admit that I am predisposed to this viewpoint, and began with a very negative view of e.g. the Food and Drug Administration, but even taking that into account they seem to have very strong points that the US response has been very very bad.

However, Zvi's post included an image of a graph 'daily COVID-19 vaccines doses administered per 100 people' that confused me by showing the US very near the top:

![](https://lh4.googleusercontent.com/7VQUnbXW_Fo_xYg4rKYXp0mRwZobYsor_R2zzH9pLSUm3I_sO65cn0mGM5Gcoo3wBmcmCIuf9CvFaUl756Jmk52GIK1KN7wOYnLGIg39m0u-wYt1-bIazustjSaFM4DMhvWfexfG)

This is only a 7-day average rather than a longer-term one, but still shows the US doing better than most countries.  I believe I tracked the data source down to [https://ourworldindata.org/covid-vaccinations.](https://ourworldindata.org/covid-vaccinations.)

When I sort a list of countries there by total # of vaccinations per 100 people, I get the following list of countries above the US:

| Gibraltar | 77.0 |
| --- | --- |
| Israel | 76.3 |
| Seychelles | 56.9 |
| United Arab Emirates | 51.4 |
| Cayman Islands | 23.6 |
| United Kingdom | 23.3 |
| Jersey | 20.8 |
| Turks and Caicos Islands | 16.6 |
| Isle of Man | 16.1 |
| Bermuda | 16.1 |
| United States | 15.8 |

followed by 75 more countries with lower numbers and a bunch more with no data.

Overall, there are 10 countries ahead of the US.  One is the UK (a fairly similar country which is also facing a more dangerous local strain).  One is Israel (commentary withdrawn).  And the other eight, at the risk of seeming like a stereotypical American, are tiny places I didn't even think were countries.  (Isn't the Isle of Man part of the United Kingdom? Why does it get its own row?)

I notice that I am confused.  If the US rollout of vaccines has been this botched, why are we so far ahead of, say, Germany (5.0)?  Or Singapore (4.4)?  Or Switzerland (5.6)? 

SECTION II: EXPLANATIONS
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Five explanations spring to mind:

1.  The data for the US is mistaken (too high).  Perhaps we are fraudulently inflating our numbers to look good.
2.  The data for other nations is mistaken (too low).  Perhaps they are not publicizing their vaccine efforts/are distributing through informal networks/otherwise haven't made Our World In Data aware.
3.  The things the US is doing that look like they should be slowing down vaccine deployment are not actually slowing it down.  The Very Serious People are smarter than me and a handful of mostly-libertarian bloggers I follow, and correctly took reasonable safety precautions that did not materially slow the vaccine deployment.
4.  The things the US is doing that look like they should be slowing down vaccine deployment are indeed slowing it down, but almost every other nation is doing just as many things like this (or more) that are just as bad (or worse), I simply haven't heard about e.g. all the things that are going wrong with the vaccine deployment in Italy.
5.  The things the US is doing that look like they should be slowing down vaccine deployment are indeed slowing it down, but we have enough other advantages that this hasn't hurt us that much.  As a large, rich country, and one that infamously pays a lot for medical stuff, we attract substantial investment from medical companies even when we put barriers in their way.  As a result, we can get away with making Pfizer's life very inconvenient, because we're such a big market that we're still more lucrative than e.g. Italy.

Overall I think #4 and #5 sound like the most likely ones - I'm going to be assuming below that the argument is between #4 and #5, though if people want to tell me that obviously #3 is correct I guess I'll listen.

SECTION III:  WHY DOES IT MATTER?
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I think there's a substantial difference between these.  In particular, #4 and #5, while they both admit that US policy has been bad, seem to advocate for very different reactions.  

If the FDA is terrible **but still far better than its equivalents in almost all other countries**, that seems to advocate for a more measured and positive response, and less criticism of them.  

If the FDA is terrible **but this is being papered over by our status as a wealthy country and major consumer market**, that seems like much worse news.

I don't know how to distinguish these cases from one another, though.