10 ms·

Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says

71 points by okket 8y ago

TangoTrotFox 8y ago
Can anybody briefly describe how a 3x funding increase would change things from "may not be able to invent" to "[likely] to be able to be produced in the foreseeable future"? I'm very disappointed that news articles no longer hit on even the most fundamental questions like this. Instead articles now take a position (you should be in favor of donating money to [x,y,z]) and then go from there. This seems to challenge belief. There are almost always rapidly diminishing returns on increasing allocation of resources once you reach a certain baseline. And almost is a weasel word there -- I can't think of anything where this is not true. Just like 50 programmers won't work 50 times faster than 1 programmer on a given task, 50 times the amount of money dedicated to a task will often provide far less than 50x the return. And the article's premise is suggesting not only a linear return on investment, but a largely exponential one. Of course this all goes out the window when you're desperately understaffed or underfunded, but if $3 billion a year is anything remotely close to 'desperately underfunded' then it makes one wonder if that may be a product of waste and inefficiency than a lack of funding.
- thomasfedb 8y ago
  For some science, the baseline is very high. You can't do X-ray crystallography of organic compounds, for example, without a synchrotron.
  - TangoTrotFox 8y ago
    Absolutely, but I think we become desensitized to numbers. $3,000,0000,000 is alot of money. In trying to find the costs of a synchotron I came upon this article [1] that mentions the construction of an entire campus surronding a synchrotron, experimental facilities, and so on. The entire construction project and synchotron cost £263 million. That's at government level efficiency, which is to say significantly overpriced, and of course is also just a one-time expense. Even this one time inefficient cost however is only about 10% of our annual spend. The ongoing spend related to maintenance of the facility would of course be a small fraction of that upfront cost. I just don't understand how one can argue that a 3x increase in funding can be expected to yield massive exponential gains in output. [1] - https://www.theage.com.au/national/synchrotron-will-cost-taxpayers-20040212-gdxai5.html https://www.theage.com.au/national/synchrotron-will-cost-tax...
    - AnthonBerg 8y ago
      It’s $0.5 per person.
      - ItsMe000001 8y ago
        That's great in a single-variable universe, but in ours unfortunately there are a million other "it's (only) $0.5 per person" things. It's like letting the public choose what students have to learn - "but this is sooo important!" (and this, and this, and this,...). I don't understand that kind of argument. You have to choose the right level of scale for what you are looking at. I would not trust an architect (of buildings) who is a particle physicist, or a forest(-system) manager whose specialization is the cell. Some things need to be looked at the the higher (compound) level to get any useful results. EDIT (for the reply below, to which I cannot reply?): > I find it important / useful for myself to put it into context. Well, my point is that you don't.
        AnthonBerg 8y ago
        It’s both a lot of money and also much less. I find it important / useful for myself to put it into context. For me the takeaway is that I went and calculated how many times richer than the average and therefore what my share of $0.5 per person would be. It still wasn’t a lot. And probably more affordable to me than the person at the middle of the income scale even then. But yes! I see the “what about all the other things” element too.
  - yborg 8y ago
    DNA's structure was deduced from X-ray crystallography using a conventional X-ray tube, most laboratory protein crystallography doesn't require a synchrotron light source. Here's a typical unit: https://www.rigaku.com/en/products/protein/micromax007 https://www.rigaku.com/en/products/protein/micromax007
    - CamperBob2 8y ago
      The MicroMax™ 007 HF is the most widely used home lab X-ray source for protein crystallography and a popular source for small molecule crystallographers who need the additional flux of a rotating anode generator. Yow. I thought I had a pretty hardcore home lab with my Faxitron cabinet machine.
    - thomasfedb 8y ago
      Sorry, I meant lipid-phase organics. In any case, it is true that some science has huge initial investment cost - synchrotrons, space telescopes, etc
- wallace_f 8y ago
  Look at all the money thrown into all of wars. Not just the longest-running war in history in Afghanistan and the War on Terror. But the War on Drugs. War on Poverty. What about global warming--how much money is thrown into that? Are we really making progress. Meanwhile every day I see homeless people on the streets, and read about stories of police murdering, beating, or swat raiding innocent people over nothing. How far could giving a little bit of that money to protect people's supposed rights to life and liberty go? Isn't that what we are supposedly going after, anyways? Or do we just donate to who causes based on other factors. Such as who has the best fundraising? The best lobbying? Or the cause that people with money personally care about? Future generations are going to look back at us like we are psychopathic barbarians.
  - haihaibye 8y ago
    >> longest-running war in history https://en.m.wikipedia.org/wiki/List_of_conflicts_by_duration https://en.m.wikipedia.org/wiki/List_of_conflicts_by_duratio...
    - wallace_f 8y ago
      In US history, sorry it made sense as implied when I was typing it.
- hcs 8y ago
  A lot of money goes into taking a good idea for a vaccine to syringes ready to deploy. The actual study goes into the real detail: https://gatesopenresearch.org/articles/2-23/v2 https://gatesopenresearch.org/articles/2-23/v2
- antpls 8y ago
  > This seems to challenge belief. There are almost always rapidly diminishing returns on increasing allocation of resources once you reach a certain baseline. And almost is a weasel word there -- I can't think of anything where this is not true. Just like 50 programmers won't work 50 times faster than 1 programmer on a given task, 50 times the amount of money dedicated to a task will often provide far less than 50x the return. And the article's premise is suggesting not only a linear return on investment, but a largely exponential one. I see research, especially fundamental research, like a lottery in which we don't know what we will win. State invests X billions of dollars, and a breakthrough will likely happen, but maybe not in the expected problem (principle of serendipity). More X billions means a higher chance of breakthrough, and hopefully on the desired problem. Surely experts and thinkers looked at efficiency in research, but by definition researching is about looking at the unknown, and when there is uncertainty, a lottery model is probably a better way of thinking about it.
ars 8y ago
This article is seriously lacking. For example this: https://www.hiv.gov/federal-response/funding/budget https://www.hiv.gov/federal-response/funding/budget says: "With the generous support of the American people, the U.S. government has annually committed more than $6.6 billion to bilateral HIV/AIDS programs, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and NIH international HIV research." And yet the entire world spent 3B on all vaccine research combined, of which the US alone spent half? The numbers are not adding up, unless most of the research is not for a vaccine, and if that's the case the article should have said so.
- thomasfedb 8y ago
  > unless most of the research is not for a vaccine This. Only a small sliver of that would be for vaccine research, probably at a handful of labs.
  - ars 8y ago
    So under the assumption that the researchers involved are smart people, they believe that this is the best use of the money. So why should I believe a random article that increasing specifically vaccine spending is the right thing to do? If it's only a small sliver, them to get the massive increase the article wants, total spending must go up massively. Either that or the researchers are not directing their money in the right proportions, which seems unlikely to me. Whatever the correct situation is, the article is seriously lacking for not even mentioning any of it. And if that's the case, I am inclined to disbelieve the entire thing.
    - lostmyoldone 8y ago
      Researchers are usually bright people, but funding is often decided by entirely different people, and policy. But anyway ... Vaccines, as well as antibiotics are hard to find/make and eithee have high price sensitivity, nobody will pay a million for a dose of vaccine, or as with new antibiotics, will only be used as a last resort to combat bacterial resistance. As most medical research today is made by for profit companies, less money is spent on things that are harder to make money on. Many 'easy' vaccines are already done, and the same goes for antibiotics, so there is. need to move public funding into the entire pipeline for these kinds of substances. Almost forgot, antivenoms also suffer from this, mostly because there are many venoms, and few victims.
aussieguy1234 8y ago
There is already prep, a once a day pill that if taken consistently, is over 95% effective at stopping HIV infection, I've heard some sources say it's 100% effective. While it's not medically considered to be a vaccine, most vaccines for other conditions have a lower effectiveness rate. There is work being done to turn prep into an injectable chip in the arm, like long term contraceptives, but for HIV prevention.
- ekianjo 8y ago
  Can you point us to a source regarding this pill? Is it in clinical trials?
  - randaouser 8y ago
    You must be North American, it has been in broad use for years: https://www.cdc.gov/hiv/basics/prep.html https://www.cdc.gov/hiv/basics/prep.html
  - matthewmacleod 8y ago
    This is a medication that’s far beyond the clinical trial phase and is widely available in many countries, though still subject to some large-scale trials for this particular usage. There’s lots of information on sites like https://www.iwantprepnow.co.uk https://www.iwantprepnow.co.uk - it’s available through the healthcare system in some parts of the UK, purchasable privately in others, and from what I understand available on some insurances in the US. It’s a combination of two antiretroviral drugs also used in HIV treatment (Tenofovir and Emtricitabine) and the effectiveness of it can’t really be overstated - my understanding is that there are only two documented cases of someone correctly using this drug becoming HIV-positive, and in both cases due to rare strains with resistance to both drugs. It’s not a vaccine, but it does change the picture massively for at-risk groups.
    - craftyguy 8y ago
      > and in both cases due to rare strains with resistance to both drugs. So then it is only a matter of time before we have 'super' HIV strains that are resistant running around. Perhaps it's not such a great idea to have large numbers of people exposing these drugs to the virus regularly, else we'll end up with more resistant strains..
hannob 8y ago
Given what I learned in recent years about the scientific process I'm always a bit wary of making this a "spend XXX money to get YYY results". We have issues like that still a sizable amount of medical studies are unpublished because they don't produce the desired result the funder wants, that experts think a vast amount of studies are simply research waste due to poor methodology or that the majority of pre-clinical cancer studies can't be replicated. How much better could we be at tackling diseases if science wouldn't have these problems? Sure, more funding is one part of the equation. But I increasingly get the feeling that if modern science wants to make a significant step forward they need to clean up their methodological problems. And that will not necessarily cost more, in many situations it may even cost less. (E.g. don't pay for studies that won't get published later or that are methodologically so weak that they won't produce actionable results.)
- FabHK 8y ago
  > don't pay for studies that won't get published later or that are methodologically so weak that they won't produce actionable results. Most typically, to make studies methodologically stronger, you require a bigger sample, ie more subjects, to increase power while maintaining or even improving significance. And that would make it more expensive.
  - leoc 8y ago
    But it's uncertain whether simply pouring more money into the funding hopper would generally result in studies with larger sample sizes, or whether it would just result in a larger number of surveys with a sample size similar to the deficient ones we see today, as a larger number of scientists manage to cling by their fingertips to the gravy train. After all, there's presumably little good reason why we couldn't have fewer but better studies today, at existing funding levels.
    - Broken_Hippo 8y ago
      You could be reasonable and make larger sample sizes and so on requirements. While it isn't certain that simply pouring money into funding hoppers results in more studies, it is pretty certain that larger sample sizes (and things like this) cost more money. It is prudent to give enough for these things. If you want to have more accountability with money, build it in. You might find it costs more or less than current funding levels - I'm going to guess costs will vary with sort of funding. Use equipment funds for equipment. Give researchers and their staff actual, decent, steady wages not reliant on results. (A "negative" result isn't negative, after all, for it disproves something). And so on.
ezequiel-garzon 8y ago
The title of the article seems to suggest no vaccines are available for these diseases, but at least in the case of tuberculosis there is one [1]. The article does refer to it: “The foundation still hopes to show that booster doses of BCG, a century-old childhood tuberculosis vaccine, can protect adolescents and that a vaccine candidate it is developing with GlaxoSmithKline, the pharmaceutical company, will stop latent tuberculosis from becoming active.” [1] https://www.cdc.gov/tb/topic/basics/vaccines.htm https://www.cdc.gov/tb/topic/basics/vaccines.htm
- classichasclass 8y ago
  BCG has its own issues, though. Immunity wanes after awhile, the protection is incomplete and it seems to be more effective at preventing extrapulmonary disease than pulmonary. This by no means says it's useless. It has probably greatly diminished pediatric tuberculous meningitis in at-risk counties, which can be devastating (one of my nightmare cases was a two-year-old who lost part of his occipital lobe to contaminated dairy). In low-prevalence countries, however, where pulmonary TB is the primary concern, its utility is questionable. https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm https://www.cdc.gov/tb/publications/factsheets/prevention/bc...
sidcool 8y ago
At least for HIV/AIDS & TB, a widely available and a sure cure would be great. Of course nothing beats the efficacy of vaccination.
- classichasclass 8y ago
  TB is very curable in most cases. The problem is it takes a long time, the regimens can be difficult, and active cases become resistant if they're not monitored (why we use directly observed therapy), and latent cases with the typical treatment take just about as long. What we really need for TB are shorter high-efficiency regimens. These would be done quicker, leave less opportunity for drug resistance, and make progress on today's latent cases which are tomorrow's active cases. The newer 3HP regimen reduces latent treatment to 3 months instead of six to nine, but we really need to get it down to weeks or less.
rdl 8y ago
AIDS/HIV seems largely containable through PReP. I don’t know if long term pervasive but not universal use of PReP by those at risk would eventually lead to resistance to the medications used, though. Malaria probably can be eliminated for single digit millions of dollars through gene drive against specific species of mosquitoes which carry it. TB scares me, mainly due to high risk populations and XDR variants.
- JshWright 8y ago
  Yeah, while we may never win the war against HIV and Malaria, we will continue to make progress towards prevention and treatment, and they will become less and less of an issue with time. With TB we seem to be losing on both of those fronts, and it is indeed something to be scared of...
- shard972 8y ago
  We cannot stop AIDS/HIV research until gay sex is just as safe as hetrosexual sex. Much higher priority than malaria according to where the money is being spent....
  - close04 8y ago
    Sure, because HIV through heterosexual sexual relations, needles, mother to child, and other types of bodily fluids exchange definitely aren't a thing. Let's go back 3 decades and call AIDS "GRID" again.
  - rdl 8y ago
    Even if AIDS went away overnight, there would still be a whole range of other diseases spread particularly through male homosexual sex, IV drug use, and high-partner count or professional sex. I wonder at what point hepatitis actually becomes more of a problem in rich first world cities than HIV.
    - kadendogthing 8y ago
      >there would still be a whole range of other diseases spread particularly through male homosexual sex Like what?
m3kw9 8y ago
Is also unlikely given if everyone gets vaccinated, drug companies lose hundreds of billions, they are likely to buy out and bury such endeavours. Someone tell me I’m wrong to think that way.
- HarryHirsch 8y ago
  The recent Hep-C antivirals (Sovaldi & friends) should be a counterargument. With a course of medication you actually cure Hepatitis C. Previously you'd be looking at a liver transplant and taking immunosuppressants for the rest of your life.
DoreenMichele 8y ago
I will note that since these are "diseases of the poor," a valid approach would be to eliminate poverty instead of assuming it will always be with us. You can't ever eliminate relative poverty, which is about "keeping up with the Joneses". But you can make real progress on absolute poverty. This is a fundamental difference between developed and developing countries. We need to do this anyway to address the growing issue with antibiotic resistant infections.

71 points by okket 8y ago

Can anybody briefly describe how a 3x funding increase would change things from "may not be able to invent" to "[likely] to be able to be produced in the foreseeable future"? I'm very disappointed that news articles no longer hit on even the most fundamental questions like this. Instead articles now take a position (you should be in favor of donating money to [x,y,z]) and then go from there. This seems to challenge belief. There are almost always rapidly diminishing returns on increasing allocation of resources once you reach a certain baseline. And almost is a weasel word there -- I can't think of anything where this is not true. Just like 50 programmers won't work 50 times faster than 1 programmer on a given task, 50 times the amount of money dedicated to a task will often provide far less than 50x the return. And the article's premise is suggesting not only a linear return on investment, but a largely exponential one. Of course this all goes out the window when you're desperately understaffed or underfunded, but if $3 billion a year is anything remotely close to 'desperately underfunded' then it makes one wonder if that may be a product of waste and inefficiency than a lack of funding.

thomasfedb 8y ago
For some science, the baseline is very high. You can't do X-ray crystallography of organic compounds, for example, without a synchrotron.
- TangoTrotFox 8y ago
  Absolutely, but I think we become desensitized to numbers. $3,000,0000,000 is alot of money. In trying to find the costs of a synchotron I came upon this article [1] that mentions the construction of an entire campus surronding a synchrotron, experimental facilities, and so on. The entire construction project and synchotron cost £263 million. That's at government level efficiency, which is to say significantly overpriced, and of course is also just a one-time expense. Even this one time inefficient cost however is only about 10% of our annual spend. The ongoing spend related to maintenance of the facility would of course be a small fraction of that upfront cost. I just don't understand how one can argue that a 3x increase in funding can be expected to yield massive exponential gains in output. [1] - https://www.theage.com.au/national/synchrotron-will-cost-taxpayers-20040212-gdxai5.html https://www.theage.com.au/national/synchrotron-will-cost-tax...
  - AnthonBerg 8y ago
    It’s $0.5 per person.
    - ItsMe000001 8y ago
      That's great in a single-variable universe, but in ours unfortunately there are a million other "it's (only) $0.5 per person" things. It's like letting the public choose what students have to learn - "but this is sooo important!" (and this, and this, and this,...). I don't understand that kind of argument. You have to choose the right level of scale for what you are looking at. I would not trust an architect (of buildings) who is a particle physicist, or a forest(-system) manager whose specialization is the cell. Some things need to be looked at the the higher (compound) level to get any useful results. EDIT (for the reply below, to which I cannot reply?): > I find it important / useful for myself to put it into context. Well, my point is that you don't.
      - AnthonBerg 8y ago
        It’s both a lot of money and also much less. I find it important / useful for myself to put it into context. For me the takeaway is that I went and calculated how many times richer than the average and therefore what my share of $0.5 per person would be. It still wasn’t a lot. And probably more affordable to me than the person at the middle of the income scale even then. But yes! I see the “what about all the other things” element too.
- yborg 8y ago
  DNA's structure was deduced from X-ray crystallography using a conventional X-ray tube, most laboratory protein crystallography doesn't require a synchrotron light source. Here's a typical unit: https://www.rigaku.com/en/products/protein/micromax007 https://www.rigaku.com/en/products/protein/micromax007
  - CamperBob2 8y ago
    The MicroMax™ 007 HF is the most widely used home lab X-ray source for protein crystallography and a popular source for small molecule crystallographers who need the additional flux of a rotating anode generator. Yow. I thought I had a pretty hardcore home lab with my Faxitron cabinet machine.
  - thomasfedb 8y ago
    Sorry, I meant lipid-phase organics. In any case, it is true that some science has huge initial investment cost - synchrotrons, space telescopes, etc
wallace_f 8y ago
Look at all the money thrown into all of wars. Not just the longest-running war in history in Afghanistan and the War on Terror. But the War on Drugs. War on Poverty. What about global warming--how much money is thrown into that? Are we really making progress. Meanwhile every day I see homeless people on the streets, and read about stories of police murdering, beating, or swat raiding innocent people over nothing. How far could giving a little bit of that money to protect people's supposed rights to life and liberty go? Isn't that what we are supposedly going after, anyways? Or do we just donate to who causes based on other factors. Such as who has the best fundraising? The best lobbying? Or the cause that people with money personally care about? Future generations are going to look back at us like we are psychopathic barbarians.
- haihaibye 8y ago
  >> longest-running war in history https://en.m.wikipedia.org/wiki/List_of_conflicts_by_duration https://en.m.wikipedia.org/wiki/List_of_conflicts_by_duratio...
  - wallace_f 8y ago
    In US history, sorry it made sense as implied when I was typing it.
hcs 8y ago
A lot of money goes into taking a good idea for a vaccine to syringes ready to deploy. The actual study goes into the real detail: https://gatesopenresearch.org/articles/2-23/v2 https://gatesopenresearch.org/articles/2-23/v2
antpls 8y ago
> This seems to challenge belief. There are almost always rapidly diminishing returns on increasing allocation of resources once you reach a certain baseline. And almost is a weasel word there -- I can't think of anything where this is not true. Just like 50 programmers won't work 50 times faster than 1 programmer on a given task, 50 times the amount of money dedicated to a task will often provide far less than 50x the return. And the article's premise is suggesting not only a linear return on investment, but a largely exponential one. I see research, especially fundamental research, like a lottery in which we don't know what we will win. State invests X billions of dollars, and a breakthrough will likely happen, but maybe not in the expected problem (principle of serendipity). More X billions means a higher chance of breakthrough, and hopefully on the desired problem. Surely experts and thinkers looked at efficiency in research, but by definition researching is about looking at the unknown, and when there is uncertainty, a lottery model is probably a better way of thinking about it.

ars 8y ago

This article is seriously lacking. For example this: https://www.hiv.gov/federal-response/funding/budget https://www.hiv.gov/federal-response/funding/budget says: "With the generous support of the American people, the U.S. government has annually committed more than $6.6 billion to bilateral HIV/AIDS programs, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and NIH international HIV research." And yet the entire world spent 3B on all vaccine research combined, of which the US alone spent half? The numbers are not adding up, unless most of the research is not for a vaccine, and if that's the case the article should have said so.

thomasfedb 8y ago
> unless most of the research is not for a vaccine This. Only a small sliver of that would be for vaccine research, probably at a handful of labs.
- ars 8y ago
  So under the assumption that the researchers involved are smart people, they believe that this is the best use of the money. So why should I believe a random article that increasing specifically vaccine spending is the right thing to do? If it's only a small sliver, them to get the massive increase the article wants, total spending must go up massively. Either that or the researchers are not directing their money in the right proportions, which seems unlikely to me. Whatever the correct situation is, the article is seriously lacking for not even mentioning any of it. And if that's the case, I am inclined to disbelieve the entire thing.
  - lostmyoldone 8y ago
    Researchers are usually bright people, but funding is often decided by entirely different people, and policy. But anyway ... Vaccines, as well as antibiotics are hard to find/make and eithee have high price sensitivity, nobody will pay a million for a dose of vaccine, or as with new antibiotics, will only be used as a last resort to combat bacterial resistance. As most medical research today is made by for profit companies, less money is spent on things that are harder to make money on. Many 'easy' vaccines are already done, and the same goes for antibiotics, so there is. need to move public funding into the entire pipeline for these kinds of substances. Almost forgot, antivenoms also suffer from this, mostly because there are many venoms, and few victims.

aussieguy1234 8y ago

There is already prep, a once a day pill that if taken consistently, is over 95% effective at stopping HIV infection, I've heard some sources say it's 100% effective. While it's not medically considered to be a vaccine, most vaccines for other conditions have a lower effectiveness rate. There is work being done to turn prep into an injectable chip in the arm, like long term contraceptives, but for HIV prevention.

ekianjo 8y ago
Can you point us to a source regarding this pill? Is it in clinical trials?
- randaouser 8y ago
  You must be North American, it has been in broad use for years: https://www.cdc.gov/hiv/basics/prep.html https://www.cdc.gov/hiv/basics/prep.html
- matthewmacleod 8y ago
  This is a medication that’s far beyond the clinical trial phase and is widely available in many countries, though still subject to some large-scale trials for this particular usage. There’s lots of information on sites like https://www.iwantprepnow.co.uk https://www.iwantprepnow.co.uk - it’s available through the healthcare system in some parts of the UK, purchasable privately in others, and from what I understand available on some insurances in the US. It’s a combination of two antiretroviral drugs also used in HIV treatment (Tenofovir and Emtricitabine) and the effectiveness of it can’t really be overstated - my understanding is that there are only two documented cases of someone correctly using this drug becoming HIV-positive, and in both cases due to rare strains with resistance to both drugs. It’s not a vaccine, but it does change the picture massively for at-risk groups.
  - craftyguy 8y ago
    > and in both cases due to rare strains with resistance to both drugs. So then it is only a matter of time before we have 'super' HIV strains that are resistant running around. Perhaps it's not such a great idea to have large numbers of people exposing these drugs to the virus regularly, else we'll end up with more resistant strains..

hannob 8y ago

Given what I learned in recent years about the scientific process I'm always a bit wary of making this a "spend XXX money to get YYY results". We have issues like that still a sizable amount of medical studies are unpublished because they don't produce the desired result the funder wants, that experts think a vast amount of studies are simply research waste due to poor methodology or that the majority of pre-clinical cancer studies can't be replicated. How much better could we be at tackling diseases if science wouldn't have these problems? Sure, more funding is one part of the equation. But I increasingly get the feeling that if modern science wants to make a significant step forward they need to clean up their methodological problems. And that will not necessarily cost more, in many situations it may even cost less. (E.g. don't pay for studies that won't get published later or that are methodologically so weak that they won't produce actionable results.)

FabHK 8y ago
> don't pay for studies that won't get published later or that are methodologically so weak that they won't produce actionable results. Most typically, to make studies methodologically stronger, you require a bigger sample, ie more subjects, to increase power while maintaining or even improving significance. And that would make it more expensive.
- leoc 8y ago
  But it's uncertain whether simply pouring more money into the funding hopper would generally result in studies with larger sample sizes, or whether it would just result in a larger number of surveys with a sample size similar to the deficient ones we see today, as a larger number of scientists manage to cling by their fingertips to the gravy train. After all, there's presumably little good reason why we couldn't have fewer but better studies today, at existing funding levels.
  - Broken_Hippo 8y ago
    You could be reasonable and make larger sample sizes and so on requirements. While it isn't certain that simply pouring money into funding hoppers results in more studies, it is pretty certain that larger sample sizes (and things like this) cost more money. It is prudent to give enough for these things. If you want to have more accountability with money, build it in. You might find it costs more or less than current funding levels - I'm going to guess costs will vary with sort of funding. Use equipment funds for equipment. Give researchers and their staff actual, decent, steady wages not reliant on results. (A "negative" result isn't negative, after all, for it disproves something). And so on.

ezequiel-garzon 8y ago

The title of the article seems to suggest no vaccines are available for these diseases, but at least in the case of tuberculosis there is one [1]. The article does refer to it: “The foundation still hopes to show that booster doses of BCG, a century-old childhood tuberculosis vaccine, can protect adolescents and that a vaccine candidate it is developing with GlaxoSmithKline, the pharmaceutical company, will stop latent tuberculosis from becoming active.” [1] https://www.cdc.gov/tb/topic/basics/vaccines.htm https://www.cdc.gov/tb/topic/basics/vaccines.htm

classichasclass 8y ago
BCG has its own issues, though. Immunity wanes after awhile, the protection is incomplete and it seems to be more effective at preventing extrapulmonary disease than pulmonary. This by no means says it's useless. It has probably greatly diminished pediatric tuberculous meningitis in at-risk counties, which can be devastating (one of my nightmare cases was a two-year-old who lost part of his occipital lobe to contaminated dairy). In low-prevalence countries, however, where pulmonary TB is the primary concern, its utility is questionable. https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm https://www.cdc.gov/tb/publications/factsheets/prevention/bc...

sidcool 8y ago

At least for HIV/AIDS & TB, a widely available and a sure cure would be great. Of course nothing beats the efficacy of vaccination.

classichasclass 8y ago
TB is very curable in most cases. The problem is it takes a long time, the regimens can be difficult, and active cases become resistant if they're not monitored (why we use directly observed therapy), and latent cases with the typical treatment take just about as long. What we really need for TB are shorter high-efficiency regimens. These would be done quicker, leave less opportunity for drug resistance, and make progress on today's latent cases which are tomorrow's active cases. The newer 3HP regimen reduces latent treatment to 3 months instead of six to nine, but we really need to get it down to weeks or less.

rdl 8y ago

AIDS/HIV seems largely containable through PReP. I don’t know if long term pervasive but not universal use of PReP by those at risk would eventually lead to resistance to the medications used, though. Malaria probably can be eliminated for single digit millions of dollars through gene drive against specific species of mosquitoes which carry it. TB scares me, mainly due to high risk populations and XDR variants.

JshWright 8y ago
Yeah, while we may never win the war against HIV and Malaria, we will continue to make progress towards prevention and treatment, and they will become less and less of an issue with time. With TB we seem to be losing on both of those fronts, and it is indeed something to be scared of...
shard972 8y ago
We cannot stop AIDS/HIV research until gay sex is just as safe as hetrosexual sex. Much higher priority than malaria according to where the money is being spent....
- close04 8y ago
  Sure, because HIV through heterosexual sexual relations, needles, mother to child, and other types of bodily fluids exchange definitely aren't a thing. Let's go back 3 decades and call AIDS "GRID" again.
- rdl 8y ago
  Even if AIDS went away overnight, there would still be a whole range of other diseases spread particularly through male homosexual sex, IV drug use, and high-partner count or professional sex. I wonder at what point hepatitis actually becomes more of a problem in rich first world cities than HIV.
  - kadendogthing 8y ago
    >there would still be a whole range of other diseases spread particularly through male homosexual sex Like what?

m3kw9 8y ago

Is also unlikely given if everyone gets vaccinated, drug companies lose hundreds of billions, they are likely to buy out and bury such endeavours. Someone tell me I’m wrong to think that way.

HarryHirsch 8y ago
The recent Hep-C antivirals (Sovaldi & friends) should be a counterargument. With a course of medication you actually cure Hepatitis C. Previously you'd be looking at a liver transplant and taking immunosuppressants for the rest of your life.

DoreenMichele 8y ago

I will note that since these are "diseases of the poor," a valid approach would be to eliminate poverty instead of assuming it will always be with us. You can't ever eliminate relative poverty, which is about "keeping up with the Joneses". But you can make real progress on absolute poverty. This is a fundamental difference between developed and developing countries. We need to do this anyway to address the growing issue with antibiotic resistant infections.