The Devil is in the Details

by wj

We’re starting to see what some of the implementation challenges will be when we start to roll out the covid-19 vaccines. Some are pretty obvious. Others far less so, but no less important.

First up: priorities – who gets the vaccine first? ICU doctors and nurses, obviously. But do other doctors and nurses in a hospital go before, for example, ICU orderlies? And even after you get thru medical personnel, ambulance staff, and police and firemen, you still are going to be making priority decisions all the way thru the population. Do retail workers, who interact with lots of different people, come before office workers? Count on facing lots of people who will be unhappy at the state making decisions which, at least implicitly, say that they are less important than some other people.

Second, infrastructure. Two of the three vaccines require refrigeration. California is already working on getting enough refrigeration capacity together. Poorer states may not be able to acquire it. But that’s not all. You also have to have people to administer the vaccines. Considering how long the lines currently are to get tested, this may not be trivial. Especially in poor, rural counties where there may not be any medical infrastructure at all. (There’s a tendency to deal with these things at the county, rather than state, level. Which is fine if there is a country level. But in some places you can have a county with several thousand people, and just one doctor, and one ambulance driver. Period.)

And in addition, there is the detail that two of the three vaccines require a second vaccination. You have to track who is due for a second shot. And have some way to notify/remind them to come in. Email? Text messages? And for those who don't have that technology? Phone calls? Regular mail? And do you do personal follow-ups if they still don’t show? With what personnel?

AND you have to track who got which vaccine, so you don’t end up giving the second Pfizer vaccination to someone whose first vaccination was the Moderna vaccine, or vis versa. Plus, you need to track everybody who has been vaccinated, just so you can work out who still needs to be. Which means you need to figure out who "everybody" is. This may make the Census look like a walk in the park. And you need the software to do the tracking. (California has a state-wide Immunization Registry which we can use as a basis. Do other states? And how do you deal with people who move across state lines while all this is going on?)

Third, resistance. We’ve talked about the anti-vaxxers. Are they, or at least their children, going to be forced to be vaccinated? (Could be lots of fun, and lengthy, court cases on that. Not least because some of them may figure out that, with the current Supreme Court, claiming a religious justification might help their cause.)

But there is also a lot of resistance in minority communities, even though they are apparently hit harder than others by the virus. The Tuskegee Study casts a long shadow. A major sales effort may be required to overcome that history.

In short, even once we have a competent administration, which actually cares about getting the job done, it's going to be a mess.

Comments

[wj]

A couple links on the topic:
https://www.eastbaytimes.com/2020/11/29/path-forward-massive-coronavirus-vaccine-effort-faces-enormous-challenges-in-california/
https://www.washingtonpost.com/health/vaccine-distribution-alabama/2020/11/28/bc66459a-2dab-11eb-96c2-aac3f162215d_story.html

[liberal japonicus]

Great timely post. Here in Japan, there are orders for the low temp freezers needed, but haven't heard anything about similar prep in Korea.

A lot will depend on the state infrastructure, and I think that the CDC has been crippled dealing with Trump. I know that Hawaii'i has a state epidemiologist, though there have been some questions about how she has done
https://www.civilbeat.org/2020/04/shes-running-hawaiis-virus-response-but-should-we-trust-her/

Hawai'i is probably a special case, given the thought it must give to inbound international tourists, I wonder what the infrastructure is in other states.

[JanieM]

I wonder what the infrastructure is in other states

Maybe I'm misunderstanding the question, but even a small state like Maine has quite a large state CDC. I could ask my friend in state goverment just how big it is, if you're interested. There's also an epidemiologist per se in the hierarchy AFAIK. But again, I could get details if you care.

The Maine CDC Director, Dr. Nirav Shah (MD/JD from Chicago), has been the indefatigable public face of our CDC since March. He originally did daily weekday briefings for the press and the public, which I watched online pretty often for the first month or so. They were cut back to two a week at some point; I think he may be doing more again now but I'm not sure. He's impressive beyond belief in his honesty, his straightforwardness, and his utter unflappability.

Early on he sometimes appeared with the governor and the head of the Maine DHHS, who is also pretty impressive.

I can't imagine there are many, if any, states without some such structure, but the only one I've paid any direct attention to is Ohio, because of my relatives there. They too had an impressive director of public health, Dr. Amy Acton, who was driven out of the job...sort of parallel with Gov. DeWine (R) going from being one of the early quite sensible governors to backsliding under enormous political pressure. But I'm not going to get into a political rant about that.

*****

Quick thoughts on your post, wj:

Very timely indeed, and helpful to have the challenges broken down that way. Since I read it I've had an image in my mind of standing in line sometime in the fifties in little North Park, a square of greenery on the edge of downtown in Ashtabula, Ohio, outside a temporary structure that was set up there as the headquarters for administering polio vaccine to pretty much everyone. I remember sugar cubes, which I think was the Sabin vaccine, though I feel like I was younger than when that came out; my memory is pretty fuzzy on the details. The adults -- most of whom knew someone whose life had been changed forever by polio -- were about as far from being anti-vaxxers as it's possible to be. What a crazy idea, to refuse to be protected from polio!

Right? . . . Right?

Point being: I think the biggest problem is going to be resistance, not logistics. We can do logistics (I wouldn't be saying this if the election had come out the other way, quite the opposite, I think Clickbait would have sabotaged the effort as much as he could). Not that it will be easy, but just that it's a much more solvable problem than people's mindsets.

As for keeping track of e.g. who's been vaccinated, who needs which second dose -- I could go on a monthlong diatribe about our healthcare system, including information flow screw-ups (as during my mother's final illness last spring, when the hospital and the nursing home weren't great at keeping each other properly informed). But overall, I feel like my immunizations have been recorded faithfully both in my doctor's portal and in my pharmacy's records. Mistakes will be made, no doubt, but overall, I'm hopeful that we can pull this off, at least effectively enough to end the slaughter that's going on right now.

[JanieM]

PS 1. wj -- I wasn't addressing the resistance in minority communities, which, as you imply, is a different phenomenon, arising from different sources than the don't tread on me anti-vaxxer idiots.

PS2. lj -- I assume you know it, but the state CDCs or departments of public health are not subsidiaries of the federal CDC. They obviously work in concert in many ways, and depend on each other for planning, information flow, etc., but I don't have the impression that the sidelining of the federal CDC has had any direct counterpart in relation to the state versions.

Certainly Maine's CDC has been a visible and by most people appreciated factor in our handling of the coronavirus for the past nine months -- I assume somewhat hampered by the general viciousness and lunacy of the Clickbait administration, but not crippled by any means.

[wj]

... even a small state like Maine has quite a large state CDC.

Maine may be small. But it isn't poor the way Alabama or West Virginia are. They are where things will get bad. Probably take major Federal assistance for them to cope. Which they will vigorously resist.

The adults -- most of whom knew someone whose life had been changed forever by polio -- were about as far from being anti-vaxxers as it's possible to be. What a crazy idea, to refuse to be protected from polio!

Right? . . . Right?

It's been my observation that most anti-vaxxers are simply too young to remember when lives were upended by polio. Or ended by one of the other "childhood diseases." Vaccines mostly eliminated the diseases, so those born later have the luxury of dismissing them. Or claiming that they were disappearing already, and vaccines were just a coincidence. (Yes, I actually heard someone say that. He was too young to remember, of course. I'm not, so I know it's total bull.)

[wj]

I think the biggest problem is going to be resistance, not logistics. We can do logistics.

We can do logistics. But a) will we all be willing to? (That's resistance, of course.)

And b) how fast will we manage to? Just-in-time manufacturing, with supply chains spread across multiple continents, has combined with local needs in the manufacturing countries leading to commandeering stuff. The result being long delays (call it "not-in-time" manufacturing?) in supplies here.

I see reports of people waiting 6-8 months for a new home refrigerator. I expect something similar for the industrial-size reefers the vaccine storage will need. Although drafting space from failing restaurants might be a work-around....

[JakeB]

I believe we live in the same neck of the woods, wj. Today, on SB 680 in Walnut Creek, I saw a group of concerned citizens had put up a sign saying "COVID-19 VACCINE MANUFACTURERS HAVE LIABILITY IMMUNITY!" on the Oak Park Blvd. overpass.

I started typing multiple comments about anti-vaxxers, and then took our beloved hilzoy's advice that the delete key is my friend.

[liberal japonicus]

I did know that that the state and national CDC are not related, but I assumed that the red states didn't have such an office or those offices were run by part time people, which is why their governors could ignore public health proscriptions. But googling shows that Mississippi has a Office (not a department) of Epidemiology
https://msdh.ms.gov/msdhsite/_static/14,0,73.html

However, how involved he has been in the Covid measures, I don't really know.

Of course, Bobby Jindal thought the volcano monitoring was a waste of money, so I can't imagine what he thought about worrying about things you can't even see.

I've not dove into the stories about the CDC, though it sounds like there was increased interference from the admin and I assume for things to work well, there has to be good cooperation between the state and national. Here's a couple of stories a quick google finds, though I don't think they will surprise anyone here, though where the last two links come from should give anyone with two brain cells to rub together pause.

https://www.politico.com/news/2020/11/23/biden-cdc-officials-spotlight-trump-438843

https://www.bloomberg.com/opinion/articles/2020-09-28/donald-trump-is-destroying-the-cdc

https://www.nature.com/articles/d41586-020-03035-4

https://www.sciencemag.org/news/2020/10/inside-story-how-trumps-covid-19-coordinator-undermined-cdc

From that last one.
rum Zaidi, a top aide to White House Coronavirus Task Force Coordinator Deborah Birx, chaired the meeting. Zaidi lifted her mask slightly to be heard and delivered a fait accompli: Birx, who was not present, had pulled the plug on the Centers for Disease Control and Prevention’s (CDC’s) system for collecting hospital data and turned much of the responsibility over to a private contractor, Pittsburgh-based TeleTracking Technologies Inc., a hospital data management company. The reason: CDC had not met Birx’s demand that hospitals report 100% of their COVID-19 data every day.

According to two officials in the meeting, one CDC staffer left and immediately began to sob, saying, “I refuse to do this. I cannot work with people like this. It is so toxic.” That person soon resigned from the pandemic data team, sources say.

[nous]

It's been my observation that most anti-vaxxers are simply too young to remember when lives were upended by polio.

My brother's family, anti-vaxxers all, have a close family friend who had polio as a child and has limited mobility as a result. That doesn't seem to keep them from deciding that vaccines are bad science propping up profit margins and that they understand the science better than the medical professionals.

[Hartmut]

I usually get on my doctor's nerves by asking at every visit whether I am up-to-date with my vaccinations but this time around I am a bit sceptical. The development of Covid-19 vaccines has been a rather rushed affair and there are reasonable doubts that testing has met the usual standards in all cases. Given that immune system overreactions play a major role in corona fatalities, I'd be a wee bit reluctant to be among the first to get vaccinated this time. If it turns out to be safe, I will join in.

[CharlesWT]

The vaccines are new technology. Which means they could be safer than traditional vaccines. Or not.

[Hartmut]

The problem would be here, if the vaccine worked TOO well. Worst case: the immune system follows the US Vietnam doctrine (destroying in order to save). RIP in the knowledge that it was not the virus that killed you but the collateral damage of your defences' successful counterattack.

[wj]

Given that immune system overreactions play a major role in corona fatalities, I'd be a wee bit reluctant to be among the first to get vaccinated this time.

You are fortunate, then, that unless you are in a handful of job categories you won't be able to get it first. Indeed, unless you are in one of the high risk categories, you probably won't be able to get it second either. (Assuming Germany prioritizes similarly to what the US seems to intend.)

[Nigel]

Such adverse reactions to vaccines almost always happen fairly quickly.
The three closest to approval have been administered to tens of thousands of volunteers without obvious problems, so I'd have no hesitation receiving any of them once approved.

Far less risk than that associated with actually getting the virus.

[Nigel]

The Moderna results look very good indeed, and they are applying for emergency authorisation.

https://www.statnews.com/2020/11/30/moderna-covid-19-vaccine-full-results/

[Nigel]

The other point, of course, is that the mRNA vaccines, though a new technology, have been in clinical trials for other indications for a few years now, so there is a substantial body of evidence that the platform is safe.

[Nigel]

The kind of catastrophic over-reaction which is specifically to a vaccine for a particular disease occurs very quickly.
Though it's not the immune system going into overdrive, but rather the vaccine actually assisting viral entry into cells:
https://en.wikipedia.org/wiki/Antibody-dependent_enhancement

We would have seen it early on in the PII/III trials if it was going to occur.

[Nigel]

One last point, pretty well all the vaccines in development prompt the immune system to target a particular piece of the virus (the spike protein).
So they are far more narrowly targeted than the body's natural response to the virus itself, which causes severe problems in some individuals.

There's absolutely no sign from any of the trials that the vaccine causes the kind of massive and damaging immune response seem in seriously ill Covid patients.
The mRNA vaccines in particular do provoke quite a string general immune repose in some people, with substantial numbers experiencing a 24 hour fever, but that (AFAIK) seems to be about as bad as it gets.

(Disclaimer - I am not a medic, but have been following news of the trials fairly closely.)

[nooneithinkisinmytree]

Our dear Dr. Birx:

The Senors in the Republican Trump Death Cult require their Senorita Muertes to serve their murderous masters and sabotage decent governance as well:

http://www.lazerhorse.org/2014/09/25/laurie-lipton-dark-art/laurie-lipton-senorita-muerte/

As the local authorities of El Paso, Texas should ....in order to fend off by all means the faux-Christian Republican murderers running what is loosely called the Texas State government, and this applies as well in many of the bloody-red states in which the Biden campaign should be bringing Court challenges in perpetuity to cheating, lying, thieving, racist Republican vote counts ... the CDC should contract with the Chinese Communist Party, who themselves are certified murderous conservatives as well, but seem in some cases to overcome their detestable impulses to operate competently vis a vis Covid-19 detection and tracing, to run the shit show.

[Hartmut]

No, the vaccine itself will not cause that itself (and that would indeed have come up in the trials) but there is a disctinct possibility that once the real foe shows up (a vaccinated person gets infected), the immune system will get overaggressive. And that will not necessarily show in the initial trials.
If this was not an emergency situation, the pharmaceutical companies would rather test a bit longer (unless they get shielded from any liability). At least one company is currently under scrutiny for potentially not 100% truthful statements about their field tests.
This does not mean that I would encourage anyone not to get vaccinated!

As a schoolteacher-in-training I'd probably be medium-high on the priority list around here.

[Michael Cain]

1) No mention of the elderly, where there's a much higher risk of death? One of the key things the Phase III trials have been looking at is whether the vaccines are effective in the elderly.

2) We get our care (and insurance) through Kaiser Permanente. I already know that if they're using a two-dose vaccine with a specified spacing, that when the second dose is coming due I will get texts, e-mails, robocalls, and eventually calls from live people reminding me, asking if I have transportation issues, etc. I got the pneumococcal shot because the Kaiser system had decided I was an at-risk patient (over 65, never had one), and getting the shot was the only way to get their computers to stop nagging. When I mentioned it to the nurse who gave me the shot, she smiled and said, "No one does nagging better than Kaiser's computers."

[Girl from the North Country]

ICU doctors and nurses, obviously. But do other doctors and nurses in a hospital go before, for example, ICU orderlies?

I was having various blood tests etc today, and the specialist nurse doing it all said in response to my comment about how healthcare workers should be first on the list: "What about the cleaners? They go everywhere we go - and plenty of places we don't."

[hairshirthedonist]

A nurse friend of mine suggested that EMTs and other first responders should be vaccinated first because their interactions with the public are far less controlled than those of hospital staff. I don't know if that's how it will or should go, but it was an interesting point that hadn't occurred to me.

[wj]

[With] Kaiser Permanente. I already know that if they're using a two-dose vaccine with a specified spacing, that when the second dose is coming due I will get texts, e-mails, robocalls, and eventually calls from live people reminding me, asking if I have transportation issues, etc.

The challenge will be those with less aggressive health care providers. Or no health care at all. Especially if their level of communications connection is low.

[bluefoot]

@Nigel We also would have seen antibody-dependent enhancement in the Regeneron (and other) and other COVID antibody therapy trials. So far there hasn't been any. I looked into this fairly deeply for a friend who had the option of enrolling in the Regeneron trial. (I work in biopharma.)
Also, with the essentially uncontrolled spread here in the US, we will be seeing whether or not someone vaccinated (clinical trial participants) has an abnormal immune response when exposed to the virus.

[Ned]

If you are talking with an anti-vaxxer who is against *all* vaccines, suggest that they google "iron lung". They are one of the things that the polio vaccine saved us from.

[Girl from the North Country]

It really does make you wonder whether anti-vaxxers as a group should be nominated for a Darwin Award...

[Girl from the North Country]

Nominated prospectively I suppose I should have said...

[wj]

I incline more towards indicted for child abuse. But then, I can remember what it was like....

[Girl from the North Country]

That too. And although I cannot remember, I have heard all the stories. E.g. my mother, on discovering there was an outbreak of polio in Johannesburg, packed all her kids and assorted others into a station wagon and drove non-stop through the night for 12 hours through the Karoo to Cape Town to escape it. And of course, there are still plenty of people around, from other countries, who are crippled from outbreaks. One of them, Ade Adepitan, is a fairly prominent UK sports reporter (in a wheelchair) originally from Nigeria. And of course eradication attempts in that country were scuppered by lack of trust in the WHO, and the connivance of certain mullahs, not that long ago. It does seem that polio has largely been eradicated there now, however.

[Snarki, child of Loki]

Humanity has always been at war with microbe pathogens.

Anti-vaxxers are species-traitors.

[Pro Bono]

I can remember what it was like

Because of vaccination, my generation knows polio only as something our parents talked about. What we remember is measles, which everyone caught as a child - it's highly contagious. And what we remember about it is that is was no big deal.

Of course there's a selection bias here - the people who died of measles encaphalitis aren't around to tell us about it.

But I suggest that one of the reasons why measles vaccine in particular has attracted so much anti-science is precisely that there are so many people who can remember what, for them, the disease was like.

[nous]

This thread seems to have slid towards different topics and may be winding down, but this NPR piece really gets at the way that all of these different racial structures and institutional approaches interact to create a carceral system that is badly out of balance.

https://www.npr.org/2020/11/28/933436082/bobby-shmurda-authenticity-conspiracy-flatbush-dream-deferred

Wish I had more time to give to it, but it's closing down on finals week more rapidly than I might wish.

[nous]

Oops...wrong thread.

[doretta]

“ Count on facing lots of people who will be unhappy at the state making decisions which, at least implicitly, say that they are less important than some other people.”

No doubt we can count on lots of people being unhappy. For one thing, the Trump cult exults in going beyond unhappy straight to enraged.

The decisions are based on minimizing serious illness and death across the population. How high is a given group’s risk and how valuable is that group in saving other’s lives. The latter is their importance as a commodity, which in this case is, for the most part, not a benefit but a detriment to the individuals in question.

[Nigel]

Thanks, bluefoot. You likely know rather more than I do.

Interesting Nature article discussing the vaccine.

Toward superhuman SARS-CoV-2 immunity?
https://www.nature.com/articles/s41591-020-01180-x

At a guess, I’d say the Moderna vaccine is the best bet for the elderly.

[liberal japonicus]

From this side of the lake

https://asia.nikkei.com/Spotlight/Coronavirus/Japan-aims-to-secure-COVID-19-vaccine-for-whole-population-by-June

They will push in order to hold the Olympics

[wj]

My impression is that folks here expect that we'll have most people vaccinated, and life will be back to normal, by June. Good luck with that.

My guess is, we'll do well to be there by the time school starts in the fall. With some time close to a year from now being more likely.

[wj]

It will be useless for some, of course. But here's an idea that might make a big difference in resistance to vaccination in some populations.
https://www.washingtonpost.com/opinions/2020/12/02/fight-covid-19-biden-harris-should-get-vaccinated-do-it-live-tv/

[Michael Cain]

My impression is that folks here expect that we'll have most people vaccinated, and life will be back to normal, by June. Good luck with that.

Absolutely. To get to "herd immunity" levels of vaccination by the end of June requires that everything go exactly right. No hitches in manufacturing (despite never having done the kind of stuff Pfizer and Moderna need at that scale before). No shortages because Pfizer and Moderna have committed a bunch of their production to other countries. No problems in the logistics chain. No unexpected unpleasant surprises like 0.5% of the population has a problem three months after they get vaccinated.

[sapient]

There's not going to be herd immunity, but if I'm able to be vaccinated, I'm going to behave normally. It's not "herd immunity" but it's me hanging out with my people.

[sapient]

In other words, we need right now to be alarmist and careful (I just declined an extremely tempting and fun post-New-Year beach trip with friends who are extremely careful and vigilant, so I think it would probably be safe, but can't do it anyway).

But if I'm vaccinated? Not waiting for herd immunity to take fun trips, and hang out with much needed friends. If I'm not going to give or receive, I'm going to celebrate!

[sapient]

Not waiting for herd immunity to take fun trips, and hang out with much needed friends.

And other people who are themselves vaccinated and celebrating their immunity will bring back elements of the economy perhaps.

[Michael Cain]

But if I'm vaccinated? Not waiting for herd immunity...

Just curious, but where do you fall on the proposed guidelines for vaccination order? My wife and I, aged 65+ but with no other risk factors, are in the next-to-last category. I figure we'll be lucky if we are eligible before May.

[nooneithinkisinmytree]

Be aware that the conservative movement, following Trump's malignant modus operandi, and through the usual propaganda networks, Murdoch's FOX, Brietbart, Limbaugh, QAnon, One America, Tea Party House members, faux Christian grifters, and deep state conservative saboteurs now burrowing into our government, and the rest of the evil edifice, is about to embark on an all points battle of lying disinformation regarding the various vaccines to convince as many as possible that they are ineffective, defective, and dangerous to Americans' precious bodily fluids, in order to maintain the genocidal spread of the virus and the havoc it is wreaking on the economy to discredit all Biden federal efforts to run a competent show.

They'll vomit up the same crap they have all of this terrible 2020 on masks and social distancing, and claim immunity from prosecution for their monstrous fraud via their fucking sacred First Amendment.

Parallel to that bullshit, natch, conservatives and republicans across the land will be shoving and pushing to the head of the line to receive the vaccine themselves, and the wealthy among them will be extending payola to get the vaccines first, and extolling trump for discovering the vaccines, why, he's a regula Jonas Salk, and even one death or tragic side effect associated with the vaccines will be blamed on socialist liberal Biden gummint and the Chinks, Mexicans, Jews, and blacks too.

You watch.

Not hating these filth with every fiber of our beings is abject surrender to armed evil.

[nooneithinkisinmytree]

And the Devil and His details shows up on that cue. Ta Da!

https://www.mediamatters.org/laura-ingraham/fox-guest-says-covid-vaccine-downright-dangerous-and-will-send-you-your-doom

Back to blogging quarantine.

[wj]

Well, Count, it appears that they are determined to achieve your desired end for you. Killing off the gullible who won't get vaccinated. And you won't have to lift a finger.

[nooneithinkisinmytree]

Trump and the Republican Party will bleed them dry first and then assist their suicides.

https://digbysblog.net/2020/12/the-election-grift/

Abolish Citizens United. Execute David Bossie and company. Require he and his politician clients and to return every single cent they have stolen from the American public via their payola grifts. Take their homes and every asset they own to repay the theft. Go after their children.

If the Supreme Court rules against abolishing Citizens United, defund the Court.

If not that, then take it to the inevitable max.

America is grifting, grasping disgrace among nations.

[CharlesWT]

Abolish Citizens United.

Keep in mind that this would not only adversely affect corporations, but labor unions and other institutions that wish to influence government policy.

[wj]

Abolish Citizens United.

Keep in mind that this would not only adversely affect corporations, but labor unions and other institutions that wish to influence government policy.

Which does not, however, make it a bad idea. They are still free to argue for their preferred policies. They would just be limited in the money they could give to candidates.

[russell]

Keep in mind that this would not only adversely affect corporations, but labor unions and other institutions that wish to influence government policy.

First, it's not clear that it would adversely affect corporations. See also wj's comment just above.

But in any case, that is a trade I would be happy to make.

[nous]

After Janus the playing field is already tilted so far in management's favor that I have no problem taking away both their and my own union's media sticks. We're already a spit and baling wire operation. We'll adapt.

[russell]

completely OT - because it's Friday and we all need to have some fun.

A cover of Parliament's "We Want The Funk" featuring 13-count'em'-13 Boston area bassists. Because you can never, ever, ever have too much low end. And we all need the funk.

[russell]

and yeah, for a good cause, too.

[Nigel]

As we're OTing, I thought this article interesting.

It's something of a special case, obviously, but it touches on the urban/rural divide we've been talking about, and means of bridging it.

It the spirit, as much as the particular policies which interested me.
https://www.politico.com/news/magazine/2020/12/04/rancher-colorado-river-climate-west-water-crisis-341705

[Michael Cain]

The Politico article has several typical biases. Let's go through some of them.

A very large majority of surface water diversions in Colorado are for agricultural purposes. Cities take a small share. Senior water calls from other ag users are far more likely to limit what a rancher near Kremmerling can divert than city usage.

Agriculture in general is a very inefficient use: more than 85% of water diversions go to ag, which produces about 2% of state GDP. In Colorado's climate, using diverted water to grow cattle fodder is quite possibly the least valuable use for it.

Denver Water is a piker when it comes to diversions from the Colorado River, with rights to about 140,000 acre-feet annually and consistently taking about 100,000 acre-feet. Up at the northern end of the Front Range (around Fort Collins) is a 250,000 acre-feet diversion used primarily for agriculture. At the southern end of the Front Range (around Colorado Springs) is another 250,000 acre-feet diversion, again used primarily for agriculture.

Denver Water uses most of their diversion across the Continental Divide twice, and some of it three times. Colorado water law, written when the legislature was controlled by agricultural interests on the eastern plains, forbids using in-basin water more than once.

[wj]

California water use and water law is quite similar. Except that Los Angeles gets a big chunk of water from the north center of the state (specifically the Sacramento River). But it got taken from water flowing into San Francisco Bay and supporting fish populations from trout to salmon, rather than from agricultural users.

Agriculture uses essentially all of the San Joaquin River before it gets close to the Bay, else LA would likely have tried for that. And further pumping from the aquifers are causing the land to sink.

Not just any agriculture either. Big users include big almond orchards created in the last 30 years. Which is one of the most water-inefficient crops going.

[Michael Cain]

Not just any agriculture either. Big users include big almond orchards created in the last 30 years. Which is one of the most water-inefficient crops going.

The largest single crop for total water use in California is alfalfa. A significant portion of that is exported to China for animal fodder. Or at least it was until Trump started a tariff war.

Number two is rice. This strikes me as insane given how cheap it is to ship bulk dried grain from almost anywhere.

[CharlesWT]

If water users had to pay what the market would bear for the water they use...

[nooneithinkisinmytree]

..... many would go thirsty, but the federal government would reinstate strict waterflow restrictions for toilets and showers.

Golf courses would go kaputnik, unless they figured how to use much less water, unless we want only the rich to play golf, which come to think of it, we already do.

[CharlesWT]

Currently, some water users pay far above market value for water while others pay almost nothing.

[russell]

If water users had to pay what the market would bear for the water they use

I'd say we should think twice before we start treating water like a commodity or private good.

No water, you die.

If people want to discuss things in terms of markets, they really need to consider what conditions are required for an efficient market, and they really need to consider the consequences of applying market dynamics to the thing in question.

The perception that markets equal freedom is, IMO, a pernicious falsehood.

No water, you die. You die, the issue of "your freedoms" are moot. At that point, you are free to feed worms.

[nooneithinkisinmytree]

The price of a subscription to Reason Magazine would rise, and the sponge baths for the ill and dying in those rural hospitals recently freed from onerous state regulations would rise in price or be eliminated.

Water cooled nuclear reactors?

They'd have to switch to gin.

The Chinese reportedly are working on air-cooled reactors, but we're not permitted to do that because it's bureaucratic state socialism, like the Covid-19 vaccines.

[Pro Bono]

I'd say we should think twice before we start treating water like a commodity or private good.

Let everyone have enough water to drink for free. It's a trivial amount.

But if you want to ration water between competing demands - agriculture, manufacturing, golf courses, swimming pools...put a price on it that's the same for all of them.

[bobbyp]

Is the Colorado River a public good or a private one? Who gets to decide on 'bidding rights' for that resource? These are old questions in the west...which is, by the way, mostly desert.

Between water compacts and dams, western agriculture is highly subsidized....for just about everything. You name it: Water, power, roads, schools, etc.

But sure enough it seems many folks in the "rurals" will berate you with spittle flecked intensity about how they, unlike the loafers in cities, are oh so hard working and 'self relaiant', and that city folks telling the 'rurals' what to do is some kind of communist oppression.

I remain aghast that the many cletus safaris into the rurals has not made this point clear to the American people.

[bobbyp]

The perception that markets equal freedom is, IMO, a pernicious falsehood.

Indeed. I'd put this one not too far behind racial superiority.

[nous]

This discussion of water treaties and usage patterns and politics reminds me of one of the short stories that I teach in my science fiction themed writing class - Paolo Bacigalupi's "The Tamarisk Hunter:"

https://www.hcn.org/issues/325/tamarisk-hunter-Bacigalupi

I get some great projects based on student interaction with the worldbuilding of the story. It's one of the least SF feeling SF stories I teach, yet it is probably the most on-genre in terms of extrapolating a believable future.

[Michael Cain]

Between water compacts and dams, western agriculture is highly subsidized....for just about everything. You name it: Water, power, roads, schools, etc.

Little known fact... the prices charged for electricity by the BPA and WPA from the big western dams includes the cost of construction amortized over 50 years at market interest rates. The BPA and WPA have always been responsible for ongoing maintenance and capital expenses. They both remit a "profit" to the US Treasury every year.

Granted that the dams and transmission systems couldn't have been built without the feds to guarantee it and to donate the necessary land. But the notion that they were built gratis and the costs weren't eventually borne by western users is just wrong.

[wj]

Is the Colorado River a public good or a private one? Who gets to decide on 'bidding rights' for that resource? These are old questions in the west...which is, by the way, mostly desert.

A question which is not unique to us, however. For example, consider the water that (left to nature) flows in the Nile River thru Egypt. Which, quite literally, dies without it. Does Egypt have some kind of rights to it?

Or does it belong, at least until it leaves their territory, to the nations upstream? If Ethiopia wants to use 100% of the Blue Nile for irrigation, can they do that? (Ignoring, for the moment, what the Egyptian military may have to say on the subject in sheer self-preservation.)

You could have similar issues with a river like the Danube, too. But fortunately, it doesn't run thru deserts.

Next to those international issues, our interstate and intrastate conflicts look far less fraught.

[russell]

But if you want to ration water between competing demands - agriculture, manufacturing, golf courses, swimming pools...put a price on it that's the same for all of them.

I think it makes perfectly good sense to use pricing as a mechanism for rationing. Where 'rationing' in this case means allocating a finite but essential resource between competing demands.

My objection to the libertarian 'what the market will bear' idea when applied to water is that some folks have way more resources to bring to the equation than others. Which leads to things like Nestle Water pumping potable water from places that end up having insufficient water to drink, so they can bottle it and sell it to snotty coastal elites like me who have enough money that they are willing to pay a dollar a pint or whatever the hell bottled water goes for these days for the convenience of not having to fill their damned thermos from the tap.

I'm not hating on people who purchase bottled water here (although they need to recycle the bottles, dammit). I'm saying that you can make more money selling bottled water to people who have enough money to spend than you can providing it to communities via some public means. So in a world where markets rule, some communities will not have water to drink.

Which sucks.

There are a lot of things that shouldn't be left to the vagaries of the market. Water is one of them, not least because very very few people - basically anyone who doesn't access and rights to their personal source of water - have the option of declining to buy.

Markets are a great way of setting prices. Sometimes they are a great way of making goods and services available in an efficient way. They are not a good way of making goods and services available in contexts where the conditions for an efficient market do not exist. They are a horrible and, frankly, criminally inhumane way of making goods and services that are essential to life and basic well-being available when the conditions for an efficient market for those things do not exist.

[Michael Cain]

A question which is not unique to us, however. For example, consider the water that (left to nature) flows in the Nile River thru Egypt. Which, quite literally, dies without it. Does Egypt have some kind of rights to it?

My favorite example these days is Alabama, Florida, and Georgia fighting over the Apalachicola (and tributaries). Georgia needs water to keep Atlanta growing; Alabama needs water for power plant cooling; and Florida needs enough fresh water flowing into one of their bays to maintain the fishery. The first lawsuit was filed in 1990 and they're still bickering.

I think Georgia understands that Atlanta is probably screwed. They're back to trying to get an 1817 surveying error corrected which would give them access to the Tennessee River and the legal authority to make a substantial diversion that could be piped to Atlanta.

[Priest]

Also, lots of agricultural diversion from the Chattahoochee downstream from metro Atlanta before it gets to Lake Seminole, which was created by the Jim Woodruff dam just below what was the confluence of Spring Creek and the Chattahoochee and Flint rivers.

[wj]

I don't know about Michael. But I confess that I have (had) blind spot here. It simply didn't occur to me that there would be major water allocation issues in the eastern 1/3 of the country which, compared to the west, has abundant, year around, rainfall. With all that rain, how can they not have plenty of water for everything?

Live and learn.

[Michael Cain]

But I confess that I have (had) blind spot here. It simply didn't occur to me that there would be major water allocation issues in the eastern 1/3 of the country which, compared to the west, has abundant, year around, rainfall.

Yes. I have a friend who moved from Denver to Washington, DC and sent back e-mail saying, "They have this interesting concept here. Every week or ten days, free water simply falls out of the sky."

I have the advantage to have lived in NJ and hiked and canoed in enough places there to understand how New York and Pennsylvania (more accurately, NYC and Philadelphia) partitioned the upper Delaware River watershed. Also to have lived through a (by western standards mild) drought year where a number of NJ municipalities that thought their reservoirs were comfortably full were required to dump large amounts of water back into the Delaware to keep the salt line well downstream from Philadelphia's water intakes.

There is a mistaken belief that because the Ohio, Lower Missouri, and Mississippi Rivers flood often that there are no water imbalances Back East.

[hairshirthedonist]

They don’t put beer in plastic bottles. Just sayin’.

(Spare me the link to something about any rare exception.)

[bobbyp]

But the notion that they were built gratis and the costs weren't eventually borne by western users is just wrong.

I would counter with this: It depends on which users you are referring to (this is from my reactionary hometown newspaper). Dams are just the beginning.

[bobbyp]

Logrolling, meat grinding, pork, unbridled self-interest, pure politics, and water in the west. A small sampler.

[bobbyp]

They don’t put beer in plastic bottles. Just sayin’.

I had to look that one up. The ramifications are horrifying.

[Hartmut]

Over here beer in plastic bottles is quite common, although not dominating. And some brands leave the choice to the user (i.e. shops carry both glass and PET bottles for the same brands of beer). The true heresy is to put beer in bottles larger than 0,5 l. If you want more, take more bottles or go for a barrel/keg.

[Priest]

You can't play Edward 40-hands if you don't have bottles larger than 0.5l.

[CharlesWT]

"Water is joining gold, oil, and other commodities traded on Wall Street, highlighting worries that the life-sustaining natural resource may become scarce across more of the world.

Farmers, hedge funds, and municipalities alike will be able to hedge against -- or bet on -- potential water scarcity starting this week when CME Group Inc. launches contracts linked to the $1.1 billion California spot water market. According to Chicago-based CME, the futures will help water users manage risk and better align supply and demand.

The contracts, a first of their kind in the U.S., were announced in September as heat and wildfires ravaged the U.S. West Coast. They are meant to serve both as a hedge for California’s biggest water consumers against skyrocketing prices and a scarcity gauge for investors worldwide."
Water Futures to Start Trading Amid Growing Fears of Scarcity

[wj]

As so often, xkcd nails it:
https://xkcd.com/2398/