What we talk about when we talk about variolation

So here's a preview of a conversation I expect we're going to start having in the mainstream shortly: should the American government start offering healthy people incentives to get exposed to COVID-19 in order to hasten immune response?

Here's how I think it's going to happen. Three different discussions will get underway at once in a pretty big way:

1. Can some kind of certificate program be established to certify that people who have recovered from the disease have a sufficient quantity of antibodies to return to society.

2. Probably starting with healthcare workers, we'll see a program appear to test for antibodies (called serology assays, I've learned) in order to establish which are best prepared to do high risk work. As these antibody tests ramp up people will start demanding them in other essential sectors (such as law enforcement, food preparation and logistics) and before long the public will start demanding generalized testing for the disease but also testing for antibodies. After all, many healthcare providers believe the blood plasma of recovered people can be used in treatment. (In fact I wouldn't be surprised if a product came along that did both, since we are relatively certain that there have been many many more asymptomatic carriers than those who got sick)

3. People are going to start asking why it takes 12 to 18 months to get a vaccine out into the market and if maybe that timeline isn't a little ridiculous in a pandemic context. Don't be surprised if China gets one out much, much faster and Americans don't start asking why we can't just use theirs. If anyone gives a straight answer they will probably find that money is not, in this case, the problem.

All of these things are going to lead ineluctably to a set of ideas that's bubbling around on the internet now and I expect will start popping up on cable news and news websites: voluntary exposure to the disease.

What I'm interested in here is what happens next when that happens.

This is one of those topics that's bouncing around the internet's back alleys. Only today it appeared on the prominent blog, Marginal Revolution, operated by two of thinky media's favorite economists, Tyler Cowen and Alex Tabarrok. It was the latter who wrote the blog post that specifically mentions the concept, called variolation, but Cowen (the more famous of the two) mentioned a more inflammatory post by a extraordinarily inflammatory writer, in a link post slightly before.

It doesn't cite the idea, but Cowen points people to a blog post that will get them there.

So this is an idea that I've been following for a few weeks now and it has really fired up every corner of my brain. Mostly the plebiscite inside my head is against it. It feels like a dangerous road. But it might also be the only realistic course to avoid 12 to 18 months of inactivity and rising global body counts.

The idea really seems to have started with Robin Hanson, the writer of the blog Overcoming Bias, though I can't be sure of that. He's been pounding on this drumbeat for a while, and early this week wrote his unifying essay that he's pitched as the sort of overall intro, the sales pitch, for the idea.

To quickly sum up how it would work, imagine COVID hotels in every major American city (probably in actual hotels as they are all empty). People would go in, get exposed, hang out with each other, get sick, get treated, get better, get a certificate and (probably) get paid. If we're smart we'd make them agree to come back a couple times each week and harvest plasma off them, but your mileage may vary.

We'd do this with thousands at a time, hopefully vastly more than are in any given city's hospitals, and eventually slow transmission a lot by offering the virus a plethora of dead ends.

When I first read about this concept on Hanson's blog, I was struck by the sheer daftness of it. It's not daft in the sense that it's idiotic. It's daft in the sense that it's presented and argued with no sense for what convinces people about radical solutions. In particular, he doesn't seem to have any appreciation at all for why the notion might make people feel oppose it not intellectually, but viscerally.

And why shouldn't they?

First, assume that the broad majority of people basically assume that this pandemic is going to be something like a 60 to 90 day interruption of their normal affairs after which everything will go back to something much like normal. I really think that this is what most people think.

Second, assume that on some deep level people may not be able to articulate this, but intuit that variolation leads to ideas like eugenics or human genetic engineering. If the point is that a medical procedure that will kill some and permanently injure more will ultimately save far more lives than it costs, then why stop at hastening inoculation of just this one bug?

And third — and this is every bit as important as the other two — it just feels bad to think we'd live in a society that would do that.

To people with minds like Hanson, it's just a math problem, but to the mass of men it's not a math problem. Very little is a math problem. There's mores running much deeper than math that make intentional exposure of paid humans to a deadly virus a very tough sell.

Hanson actually links to a post on the Federalist that actually does at least acknowledge the polity:

Does a society like ours allow people the freedom to participate in CVI programs? How do we deal with potential liability issues? Will we allow parents to make these sorts of infection decisions for both themselves and their children? Are there people who should not be allowed to participate because of age or pre-existing conditions?

That said maybe it is the right move.

Here's what I worry about: if some rich country does end up pursuing this course it will be hopelessly delayed by whatever its political origin story is. That seems to be the only way ideas get looked at these days.

Who proposed it? What do they represent? Whichever writers are against whatever that person represents find a reason to attack it.

Right now, it seems to be coming from the libertarian and intellectual dark web aligned corners of the web, which means almost certainly that the progressive mainstream media crowd will hop right on the attack. And they do kind of have the initial advantage in almost any conversation among elites.

It probably won't help that elements of the idea echo in an essay that Curtis Yarvin posted to Medium this weekend. I know more about what people say about Yarvin than I actually know directly about him, but I very much know that the more social justice types hate him. I further know that in this post he takes the opportunity of the coronavirus to argue that America should at least sample a temporary dictatorship. Just to see if it works sometimes.

Regardless his essay is getting read and parts of it are being parroted in certain corners that have people's attention.

And maybe the core idea, to open a risky approach to hasten population level inoculation, actually is the only reasonable way to avoid a death count that we feel collectively for decades. Something much like the Spanish Flu's.

If that's where we end up, it's just going to be frustrating to look back and see that we wasted months pretending to talk about values when we were really talking about: whose side are you on, son, whose side are you on?

On that note, I'm going to close with a thought that will probably feel tangential here, but I don't really think it is: 2020 is somehow also an election year and here on April 5 the three candidates remaining are Bernie Sanders, Donald Trump and Joe Biden. But looking at anything through that framework, when I think about the enormity of this crisis, feels myopic right now. That election feels very small.

—Brady Dale
April 5, 2020