15 ms·
A drug for smallpox has been approved, even though the disease no longer exists
- spraak 8y agoCheckmate, vaxxers. /s
- sctb 8y agoPlease don't do this here. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- goda90 8y agoWhy do we discontinue vaccines for "eradicated" diseases? Is it just to save money? Did the vaccine have side effects that stop being worth it? On the other hand, besides protection from bioterrorism, can a vaccine provide some benefit in protecting against related diseases?
- deleted 8y ago[deleted]
- mikeash 8y agoLet’s say it cost $5 per person to vaccinate against smallpox. That’s well over $1 billion to vaccinate all Americans against a disease that no longer exists. Surely we could do something more useful with that money. Maybe vaccinate against a disease people can still catch.
- ComputerGuru 8y ago1 billion isn’t even worthy of a line item in the defense budget. Stick it there as part of national security in the event of biological warfare. QED.
- nojvek 8y agoYes but that 1 billion could go to the defense contractors, lobbyists and “donations” to politicians. Why would any rational politician do that?
- throwaway76543 8y agoAll vaccines have side effects -- the side effects are quite rare but are sometimes severe. Several thousand people have life-threatening reactions to vaccination each year. The standard vaccination schedule is comprised of vaccinations with benefits which outweigh the medical risk and cost. If you travel to less developed areas you may receive a wider array of vaccinations. For an eradicated disease there is no benefit and therefore no reason to assume the risk, or cost.
- jefftk 8y ago> Based on past experience, it is estimated that between 1 and 2 people out of every 1 million people vaccinated may die as a result of life-threatening reactions to the vaccine. -- http://www.who.int/vaccine_safety/committee/topics/smallpox/questions/en/ http://www.who.int/vaccine_safety/committee/topics/smallpox/...
- NeedMoreTea 8y agoLet's be clear here. There are TWO eradicated diseases. Smallpox and a cattle disease that doesn't affect humans. Otherwise our track record isn't stellar. The efforts with other diseases that could be eradicated have struggled. Polio is closest with just a few remaining countries. Future eradication attempts may be much harder due to the rise of anti-vaxxers.
- joecool1029 8y ago> Polio is closest with just a few remaining countries. Actually Guinea worm disease is closest to eradication: closer than polio. https://en.wikipedia.org/wiki/Eradication_of_dracunculiasis https://en.wikipedia.org/wiki/Eradication_of_dracunculiasis
- Spooky23 8y agoBecause they are not gone. Weaponized smallpox almost certainly exists. It escaped a Soviet lab in the 70s and other countries including the US worked on it. Smallpox is uniquely deadly... it wiped out something like 75% of the indigenous population of the americas.
- UncleEntity 8y ago> Weaponized smallpox almost certainly exists. Yep, when they shipped us off to the Middle East in '03 they gave us the smallpox vaccination even if you had it as a kid because, well, WMDs. Don't think I had it as a kid since I was born in '71 and that's around the time they were phasing it out -- or at least didn't have the vaccination scar before '03.
- opo 8y ago>...Smallpox is uniquely deadly... The indigenous people were exposed to many diseases, not just smallpox: >...Numerous diseases were brought to North America, including bubonic plague, chickenpox, cholera, the common cold, diphtheria, influenza, malaria, measles, scarlet fever, sexually transmitted diseases, typhoid, typhus, tuberculosis, and pertussis (whooping cough).[2][3][4] Each of these brought destruction through sweeping epidemics, involving disability, illness, and extensive deaths https://en.wikipedia.org/wiki/Native_American_disease_and_epidemics https://en.wikipedia.org/wiki/Native_American_disease_and_ep... >...it wiped out something like 75% of the indigenous population of the americas. It's hard to give a precise estimate of how many deaths occurred. Some say it was much higher than 75%. For example: >...Between 1492 and 1650 the Native American population may have declined by as much as 90% as the result of virgin-soil epidemics (outbreaks among populations that have not previously encountered the disease), compound epidemics, crop failures and food shortages. https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/impact-european-diseases-native-americans https://www.encyclopedia.com/science/encyclopedias-almanacs-...
- jogjayr 8y agoAccording to Wikipedia, for smallpox the reason was: > Based on past experience, it is estimated that 1 or 2 people in 1 million (0.000198 percent) who receive the vaccine may die as a result, most often the result of postvaccinial encephalitis or severe necrosis in the area of vaccination (called progressive vaccinia). Given these risks, as smallpox became effectively eradicated and the number of naturally occurring cases fell below the number of vaccine-induced illnesses and deaths, routine childhood vaccination was discontinued in the United States in 1972, and was abandoned in most European countries in the early 1970s.
- bzbarsky 8y agoThe smallpox vaccine used at the time of eradication had two main issues: 1) In some (fairly small) fraction of recipients it lead to severe side-effects, including death. 2) It was a live-virus vaccine, which meant a vaccine recipient could actually infect those around them (with the vaccine, effectively). This was a serious problem if anyone near the recipient was immune-compromised; the risk of deleterious side-effects in immune-compromised individuals, who would not be vaccinated normally) was much higher. There is a modern (a few years old!) smallpox vaccine that is a dead-virus vaccine and would have a very different cost-benefit tradeoff in medical terms. I don't know what the economic tradeoff looks like (i.e. how expensive it is).
- Puer 8y agoIt would be unfortunate if otherwise eradicated diseases make a reoccurrence because of the ill-informed anti-vaccination movement. I hope this drug and others never has to see use in the future.
- rhino369 8y agoPeople aren't generally vacinated against small pox becuase it has been eradicated. If it comes back, it's because of biowarefare or research mistake.
- trentmb 8y agoOr climate change. https://www.scientificamerican.com/article/as-earth-warms-the-diseases-that-may-lie-within-permafrost-become-a-bigger-worry/ https://www.scientificamerican.com/article/as-earth-warms-th...
- occamrazor 8y agoHow do they know that the treatment is effective? I would assume it has been tested only in vitro, unless they infected and cured volunteers.
- projektfu 8y agohttps://www.ncbi.nlm.nih.gov/pubmed/29972742 https://www.ncbi.nlm.nih.gov/pubmed/29972742 They received special dispensation to declare it effective if it treated monkeypox in monkeys and rabbitpox in rabbits.
- jessriedel 8y agoAre the in vivo animal tests considered significantly more convincing than in vitro tests on human cell cultures?
- civilitty 8y agoThey had to have used both in their premarketing application. There are a lot of basic tests that can be done in vitro that can flag early indications of toxicity in humans but in the end you need some sort of in vivo testing. Infecting someone with what is essentially a bioweapon for a clinical trial is a an ethical nonstarter but together, the in vitro and in vivo tests are enough to tacitly approve this drug. I think this is essentially unprecedented and I doubt any pharmacies would be allowed to stock it let alone dispense it without calling the FDA/manufacturer directly and getting case by case approval to apply it under clinical supervision. The approval does clear the bureaucratic hurdles to transporting across state lines and getting it into the hands of a doctor quickly in the emergency event that smallpox returns. Edit: Their Phase 3 trial [1] appears to be the equivalent to a regular Phase 1 trial where the dosage of the drug is increased under clinical supervision until side effects become intolerable for 50% of the patients to find a safe maximum dose. This means that they tested safety in vivo on humans already and instead of showing efficacy (whether it actually does what it is supposed to do vs a placebo) on humans, they were allowed to do it with animals. They used 449 18 to 80 year old patients which is quite a bit more than usual for a safety phase so they can be reasonably certain it won't make the situation worse in the event of smallpox. [1] https://clinicaltrials.gov/ct2/show/NCT02474589 https://clinicaltrials.gov/ct2/show/NCT02474589
- hamilyon2 8y agoCan we fund development and stockpile reserves of new, effective antibiotic, all while not selling it to anyone else? As an insurance against bioterrorism, if nothing else.
- dev_dull 8y agoIf you’re a company that can develop a new, effective antibiotic, you’d sell it to everybody and make out like a bandit.
- garmaine 8y agoAt the cost of killing those infected by antibiotic resistant strains now.
- Retric 8y agoFew people die just due to antibiotic resistant bacteria. Generally someone’s immune system is compromised from something like cancer before they are at risk of death. And at that point it’t a race to find what’s going to finish the job.
- jakobegger 8y agoAre there actually pathogens that are resistant against all antibiotics? I assumed that the problem with multi-resistant pathogens was that the patient may not live long enough to try all antibiotics.
- charleslmunger 8y agohttps://en.m.wikipedia.org/wiki/Totally_drug-resistant_tuberculosis https://en.m.wikipedia.org/wiki/Totally_drug-resistant_tuber... But over time it's going to get worse and worse.
- ju-st 8y agoThey exist: https://en.wikipedia.org/wiki/Drug_of_last_resort https://en.wikipedia.org/wiki/Drug_of_last_resort
- 1996 8y agoFor profit! You know what's better than selling an expansive drug for a deadly diseases? Selling an expansive drug for a deadly disease that no longer exists! This way, you get profits without the potential lawsuits from patients, of having to bother with stupid things like efficiency or unexpected side effects. Even better: your customer is the US government - the same customers that buy F-35 flying turkeys. I thought fearmongering during the various influenza fears until the governements stockpiled oseltamivir (tamiflu) was brilliant. But this is pure genius!!
- DenisM 8y agoI am awed every time I think that we have eradicated a disease. It’s just such a “the future is now” thing. I mean, it was 1980, but still.
- duxup 8y agoRockets landing themselves all backwards is pretty amazing no matter how often I see it. Rockets don't do that.....
- pishpash 8y agoRetrorockets and landing backwards have been around (e.g. the Apollo lunar module). The rockets landing backwards thing is hard for a different reason among many other things, namely the inverted pendulum problem.
- duxup 8y agoI get what you're saying but... the first part is obviously not what I was saying ;)
- welly 8y agoYep. That was the bit when aliens should have landed and made their selves known saying "alright guys, you've passed." as they then go on to share the wisdom of the rest of the universe. Was disappointed they didn't. I guess we have to show them a few more tricks.
- ddebernardy 8y agoIt's still the only one we've eradicated insofar as I can recollect... (Polio will, hopefully, follow in the coming decades.) Aside - Good video series by Yale for anyone interested in the history of diseases in western society: https://www.youtube.com/watch?v=UoWxdlGBVTI&list=PL7C32775F0529BFEF https://www.youtube.com/watch?v=UoWxdlGBVTI&list=PL7C32775F0...
- tialaramex 8y ago
- jccalhoun 8y agoI love that the subtitle gives the answer.
- lanius 8y agoI shudder to think what modern warfare would be like without biological weapons being banned.
- duxup 8y agoIt's hard to imagine a nation choosing to release something like smallpox considering the risk of it coming back at you and infecting your own population is pretty high. It's not like anyone has a fully resistant population where they could be sure it wouldn't spread to their own nation, or allies or generally cause political / military response by other nations. I mean if two nations were at war, my nation / I didn't care, but fucking small pox showed up spreading around I'd be all for some serious interventionist stuff.... I imagine most nations would be all for it. Granted, chemical warfare could still be a thing :(
- scarface74 8y agoNation states usually act somewhat rationally because they want to continue their existence. What you have to worry about are the zealots who don’t care about dying as long as they can take their enemies out with them because they think they will have a better life on the other side.
- duxup 8y agoYeah fringe groups / terrorist organizations who are all about causing as much chaos and flourishing in that would be the folk's I'd be worried about that.
- PhasmaFelis 8y agoTerrorists are still acting for a cause, and usually it involves the (perceived) well-being of their culture. Which doesn't mean that terrorists actually have the good judgment to recognize potential consequences, but e.g. your typical Islamic extremist would consider wiping out the Middle East to be undesirable.
- dragonwriter 8y ago
- preinheimer 8y agoThe article makes it sound like the only remaining samples are tightly controlled. Remember just a few years back the NIH found some samples lying around in a closet: https://www.cnn.com/2014/07/11/health/smallpox-found-nih-alive/index.html https://www.cnn.com/2014/07/11/health/smallpox-found-nih-ali... I doubt that it was the only sample in the world to escape eradication.
- dfsegoat 8y agoIt was pretty well documented that Russian stockpiles of their India strain went missing by the metric ton, post-USSR. https://www.wsj.com/articles/SB1039129770495563833 https://www.wsj.com/articles/SB1039129770495563833 https://www.nytimes.com/1999/06/13/world/government-report-says-3-nations-hide-stocks-of-smallpox.html https://www.nytimes.com/1999/06/13/world/government-report-s...
- andy_ppp 8y agoHow is it that we haven’t seen more disasters caused by missing suitcase nukes or smallpox? My guess is the security services are better at keeping things stable than we think but it also probably means you’re under perpetual surveillance.
- ganzuul 8y agoA very optimistic perspective. Seems more likely to me that we are simply lucky than that the intelligence community is competent in their charter.
- flingo 8y agoIf potential disasters were actively getting stopped, they'd be documented. I think it's just that nobody has both the ability and desire to destroy the world at the same time. Do we even know if smallpox would kill a modern human?
- hn_throwaway_99 8y ago
- fallingfrog 8y agoSomebody needs to come up with a military application of Lyme disease so we can get a vaccine for it finally.
- mmt 8y agoWe already had a vaccine, LYMErix. https://en.wikipedia.org/wiki/Lyme_disease#Vaccination https://en.wikipedia.org/wiki/Lyme_disease#Vaccination No military involvement necessary, only emotional restraint and emphasis on rationality.
- strictfp 8y agoWhy do you say this?
- fallingfrog 8y agoBecause in the current political climate you can only get money for something if it can be weaponized somehow.
- strictfp 8y agoAh. Went over my head, thanks.
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- Mr_Miner 8y agoI think some labs keep the same virus for ethical and unethical reasons.