The COVID Vaccine Lottery

It's an unusual health lottery where the cost of each ticket, paid in side effects, varies greatly between individuals, and some tickets are hundreds of times more likely to win the grand prize.

A COVID vaccine is a health investment in yourself, and it’s like buying a lottery ticket. Unlike most lotteries, some people have to pay a lot more than others to enter the COVID lottery, and even then, they might get far fewer tickets, and not even be eligible for the grand prize drawing.

According to Public Health England, the odds of dying from COVID in the U.K. during a four-week time period this summer were roughly 400 times higher for a fully vaccinated 80-year-old than for a fully vaccinated 21-year-old, and 90 times higher than for an unvaccinated 21-year-old. For a fully vaccinated 70-year-old relative to vaccinated and unvaccinated 21-year-olds, the respective ratios were 92 and 23. In other words, no matter what you hear shouted from the most prominent rooftops, the key variable for COVID susceptibility is age, not vaccination status.

Of course, while a 70-year-old can’t turn back the clock, he or she can get vaccinated. During the four-week time period, for every 300,000 people aged 70-79 who were vaccinated, 129 lives were saved, and 179 hospitalizations prevented. In contrast, for every 300,000 people aged 18-29 who were vaccinated, one life was saved, and 28 hospitalizations prevented. Those are the upside benefits of vaccination, and they are substantial.

However, there are downside risks associated with vaccination. The side effect profile tends to be worse for younger people, second vaccine doses, and people with natural immunity.

Based on CDC data, Bozkurt et al. estimate that the risk of myocarditis/pericarditis from two doses of an mRNA vaccine is 32 times higher for a 21-year-old male relative to a man over the age of 65. The risk is much higher after the second mRNA vaccine (particularly the Moderna vaccine, and several Scandinavian countries have stopped using the Moderna vaccine in young men), and using that as a proxy for natural immunity, the risk for a 21-year-old with natural immunity is perhaps 50 times higher than his elderly counterpart.

Among the more common side effects, the risk is also higher for second doses, younger people, and individuals with natural immunity. According to CDC, the risk of headaches for people aged 18-55 after the second dose of the Pfizer vaccine is just over 50%, whereas it is less than 40% for people over 55. Other vaccine side effects, including muscle pain, chills, fever, fatigue, vomiting, and diarrhea, are all more prevalent in younger people.

It’s analogous to a lottery, with the cost of playing the lottery paid for in side effects. Imagine three unvaccinated men playing the COVID vaccine lottery: a 70-year-old, a 21-year-old, and a 21-year old with natural immunity. The younger men pay a higher price to play the lottery in the form of side effects, particularly the 21-year-old with natural immunity.

While the younger men pay a higher price to enter the lottery, it turns out they don’t get nearly as many tickets to win the two big prizes, i.e., the “consolation prize” of avoiding hospitalization, or the “grand prize” of avoiding death.

When the 70-year-old man pays for tickets to the COVID vaccine lottery, he is given 179 tickets to put in the “avoiding hospitalization” pot, and 129 chances to win the grand prize of avoiding death (numbers based on the England Public Health data referred to above). When the unvaccinated 21-year-old man steps up to play the lottery, he is given 28 tickets to enter into the “avoiding hospitalization” pot, and only a single ticket to enter into the grand prize drawing.

What about the 21-year-old with natural immunity, the person who pays the heaviest side effect price to enter the lottery? We don’t have the exact numbers from the England Public Health data, but we can extrapolate based on a few published studies that show a roughly 2x reduction in COVID symptomatic infections when people with natural immunity are vaccinated, as well as numerous studies that suggest that natural immunity provides as good or better protection than vaccine-derived immunity. Even using very conservative estimates, the 21-year-old with natural immunity will be given only two tickets to put in the “avoiding hospitalization” pot, and no entries for the grand prize (out of 300,000 21-year-olds with natural immunity, the death rate from COVID would be far closer to zero than one, irrespective of whether the person was subsequently vaccinated).

Individual	Cost of Entry	# of Tickets for Consolation Prize (Avoiding Hospitalization)	# of Tickets for Grand Prize (Avoiding Death)
70 year-old	Low	179	129
21 y.o.	Higher	28	1
21 y.o. with natural immunity	Highest	2	0

From a purely economic viewpoint, if an arbitrary value of one unit was placed on each lottery ticket in the consolation prize drawing, and a value of ten units on each ticket for the grand prize of avoiding death, then the combined value of the lottery tickets for the 70-year-old would be 1469 units. For the 21-year-old with no previous exposure to COVID, the value would be 38 units, a little over 2.5% of the value of the old-timer’s tickets. For the 21-year-old with natural immunity, the combined value would be a paltry 2 units, roughly 0.1% of the value of the old-timer’s tickets, all while being forced to pay the highest purchase price in side effects.

Obviously, you might put different relative values on those numbers, and an economist might place unequal values on the life of a 70-year-old and a 21-year-old. Moreover, the numbers of tickets can change over time based on COVID prevalence and the type of variants. So these numbers should be taken with a grain of salt.

Nevertheless, these numbers might be worth keeping in mind the next time you hear someone say that “we are all in this together”, and that irrespective of the unpleasant side effects, or violation of bodily autonomy, or psychological stress, everyone should get vaccinated or forfeit their job and/or ability to participate fully in American life.

While I agree that we are all in this together, even if there were no moral or physical costs, some groups of people clearly derive very little relative benefit from COVID vaccines. For others, the vaccines are, quite literally, a life-saver. In places where COVID vaccines are a scarce resource, much of the world remains unvaccinated. Yet we mandate COVID vaccines for people in the United States who neither want nor are likely to benefit from vaccination, while vulnerable people around the planet desperately want and would benefit from those vaccines but can’t yet get them. Shouldn’t we prioritize giving vaccines to the people who would benefit the most, rather than forcing them upon groups of people who might, on average, derive only a tiny fraction of the value? It is analogous to force-feeding steaks to overweight vegetarians when there is a starving, malnourished family next door. We should do better.