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The virus is pretty bad, right? Ought we be making a cost-benefit analysis where we compare the risks of side effects from the vaccine to the risks of the sprea

The virus is pretty bad, right? Ought we be making a cost-benefit analysis where we compare the risks of side effects from the vaccine to the risks of the spread of the virus? In comparison to a vaccine like Gardisil, which surely prevents far fewer deaths than a covid-19 vaccine will, wouldn’t such an analysis actually indicate that the trials be rushed to some extent? I’m feeling anxious that the current political milieu has a few factors pushing against deployment of a vaccine: 1. Republicans have been downplaying the virus the whole time, so they don’t take the need for a vaccine seriously. 2. Democrats are justifiably afraid of Trump pushing out a vaccine to get a pre-election “win”. What I’m worried about: 1. Huge numbers of people dying every day from covid-19, with so many people out of work and struggling, with no end in sight other than a vaccine. What’s the worst-case scenario for undiscovered side-effects on a treatment that has already been tested on thousands of people for months, and how probable is that risk?

JMTQp8lwXL 6y ago
No point shipping a vaccine early if it doesn't actually work. That could do more damage, people thinking it's safe to be around others maskless, when in fact the world population instead received an ineffective vaccine.
- shajznnckfke 6y ago
  We already know that some of the vaccine candidates work (ie. immune response). I’m not arguing we should ship untested vaccines, but challenging how many months we need to wait after testing.
  - FreakyT 6y ago
    We know that they trigger an immune response, but that alone doesn't necessarily mean much. For example, an early SARS vaccine candidate triggered an immune response in tests, but that immune response in practice actually made SARS infections worse.[1] [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335060/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335060/
    - shajznnckfke 6y ago
      Yeah, certainly we ought to see how animals and people with the vaccine react when exposed to the virus, but have we not already done that in the months these vaccine candidates have been tested? The current trials did things like give the vaccine to thousands of Brazilian health-care workers, which should have uncovered any issues like that (in the article you linked, the issue was uncovered by testing in a small sample of animals).
      - pwinnski 6y ago
        We have a process with three stages of trials. No vaccine candidate has yet gone through all three stages, no.
        shajznnckfke 6y ago
        What I’m arguing is that we don’t need complete phase 3 trials to establish efficacy - we can establish that based on early data from those (and earlier) trials, while accepting larger error bars on the risk of side effects.
- SpicyLemonZest 6y ago
  I think you're misunderstanding the problem space here. We don't expect a coronavirus vaccine to prevent close to 100% of infections, so it's not a binary question of working vs. not working. The question is, how strong of an effect at what level of confidence is required to conclude that it's working well enough?
  - JMTQp8lwXL 6y ago
    The effect needs to be strong, because in ordinary times, many social circles cross paths and a much higher level of human contact occurs. The average person won't read into the nuance of 'the vaccine is X% effective, depending on risk factors Y and Z'. They'll rush to their ordinary behavior. While there isn't a vaccine, it's easier to obligate folks into social distancing. That strategy won't exist anymore once we have a vaccine, regardless of its efficacy.
    - SpicyLemonZest 6y ago
      I agree, but that's what the challenge is. We have to solve for the values of X, Y, and Z where we're comfortable with people's inevitable rush back to their ordinary behavior, and it's extraordinarily hard to figure out what those values should be.
  - gniv 6y ago
    > We don't expect a coronavirus vaccine to prevent close to 100% of infections Why not? I would have thought we do. Most vaccines do (flu notwithstanding).
    - SpicyLemonZest 6y ago
      I don't know the biological reasons behind it (I don't even know if the reasons are known, or if it's just based on early results), but Dr. Fauci's said that scientists are hoping for 75% effectiveness and 50-60% effectiveness would be acceptable. (https://www.cnbc.com/2020/08/07/coronavirus-vaccine-dr-fauci-says-chances-of-it-being-highly-effective-is-not-great.html https://www.cnbc.com/2020/08/07/coronavirus-vaccine-dr-fauci...)
- takeda 6y ago
  And not working that's actually the better outcome of a bad vaccine. It could also have side effects that are worse than COVID-19.
gizmo686 6y ago
Covid isn't that bad when compared to the potential harm that a dangerous vaccine could cause when injected into billions of people. Particularly because deploying the vaccine would not immediately stop all the covid19 damage. Further, deploying a dangerous or innefective vaccine would also cause significant long term damage to public health by fueling doubt in healthcare; particuarly since antivaccers are already a growing public health concern. If we want to rush the process safely, the way forward is a challenge trial; where we deliberatly expose vaccinated people to the virus to see if they get infected. If you cannot get that experiment passed an ethics review board, you should not be able to get widespread deployment of an untested vaccine passed.
- shajznnckfke 6y ago
  Given the way this story is going, I’m somewhat expecting a future where right-wingers refuse to wear masks but happily take the vaccine, while the left goes antivax and refuses to take it (because it was “rushed by Trump”) but continues to wear masks. Perhaps by our powers combined, we’ll defeat the virus!
  - takeda 6y ago
    That's why they want to absolutely make sure it won't cause a damage. The vaccine in 1976 was rushed for political reasons and that didn't end up well besides hurting many people it is also still used as an argument why you should not vaccinate.
    - shajznnckfke 6y ago
      I feel we are overweighting the importance of the political meta-game here and underweighting the real ongoing suffering caused by the virus (in terms of health, but also in economic deprivation). But if we’re going to talk about the meta-game, I think a swift return to normalcy after the vaccine is distributed could do a lot for the public’s opinion of the importance of vaccination. It could marginalize the antivax movement for decades to come.
spamizbad 6y ago
The 1976 swine flu outbreak is one example of what can go wrong if you rush a vaccine: https://en.wikipedia.org/wiki/1976_swine_flu_outbreak https://en.wikipedia.org/wiki/1976_swine_flu_outbreak It was rushed by the Ford administration for political reasons and got a lot of people very sick.
- shajznnckfke 6y ago
  Is this the worst-case scenario? It doesn’t sound nearly as bad as covid-19. My concern is that there’s an agency whose job is to minimize the risk of harm from a covid-19 vaccine, but not an agency whose job is to balance the risk of harm from a vaccine with the ongoing harm from not having a vaccine.
  - SpicyLemonZest 6y ago
    It's not the worst case, just the worst one that's happened in a vaccine deployed at scale. The dengue vaccine is a famous example of why careful research and approval processes are required; it's effective and not too inherently dangerous, but was found to actually make the disease worse for people who haven't been infected in the past.
  - timr 6y ago
    "Is this the worst-case scenario? It doesn’t sound nearly as bad as covid-19." This is a case where the media hysteria surrounding the risks of Covid isn't helping anyone. If polling is to be believed, the general public significantly overestimates their personal risk of mortality from the virus: https://us.beyondbullsandbears.com/2020/07/28/on-my-mind-they-blinded-us-from-science/ https://us.beyondbullsandbears.com/2020/07/28/on-my-mind-the... As noted by the link above, the vast majority of that risk is concentrated in the oldest/sickest people. If everyone in the population is given a vaccine with even a fraction of a percent mortality, it could vastly exceed the risk posed by the virus to younger people. It would be tragic, for example, to see any serious side-effects from a vaccine in people under the age of 20, who have essentially no risk from infection.
    - 6y ago
DoreenMichele 6y ago
with so many people out of work and struggling This concern can be addressed other ways. I run two subreddits aimed at helping people establish an online income (as part of the goal). In a post-covid world, I think we will do more good if we focus more on adapting to a new reality where increased germ control is a permanent expectation rather than expecting a vaccine to fix everything and allow us to return to "business as usual."
- shajznnckfke 6y ago
  I do think there will be a permanent adjustment in society to deal with the risks created by this type of virus in the future. Tell everyone to start wearing masks as soon as the outbreak starts, instead of telling them that masks are only for idiots and healthcare workers. Isolate travelers from affected areas before it has a chance to spread, and so on. But I also expect that just about every occupation from industries that are shut down will continue to exist in this new world.
  - DoreenMichele 6y ago
    Well, I didn't say anything about eliminating jobs. Just that I, personally, see no reason to tie the idea of going back to work to a vaccine. I think we would do better to look for germ control solutions that are already proven and available currently. As one example, ordering online or calling ahead and picking up is a way to support local eateries while minimizing the spread of germs. I'm a big fan of Little Caesar's pizza portal as a contactless pick-up option and I don't see any reason we can't actively promote such existing practices right here, right now, instead of seemingly hanging all hopes on "there will be a vaccine and after it comes out, we can just keep doing the same things the same way." That seems like needless suffering to me. We don't know how long that will take and, in the mean time, people need to survive right now. Not having any money/resources at all coming in for X months is not survivable for most people who don't have savings and the like to live off of.
    - shajznnckfke 6y ago
      I agree that we should try to adjust to the world we find ourselves in, but there’s only so much problem-solving effort to go around, and I think most people are already trying to do what they can. It’s tough to reshape society on a dime.
marcosdumay 6y ago
A bad vaccine is pretty bad, and can easily be much worse than the virus. That's why we test them.

JMTQp8lwXL 6y ago

No point shipping a vaccine early if it doesn't actually work. That could do more damage, people thinking it's safe to be around others maskless, when in fact the world population instead received an ineffective vaccine.

shajznnckfke 6y ago
We already know that some of the vaccine candidates work (ie. immune response). I’m not arguing we should ship untested vaccines, but challenging how many months we need to wait after testing.
- FreakyT 6y ago
  We know that they trigger an immune response, but that alone doesn't necessarily mean much. For example, an early SARS vaccine candidate triggered an immune response in tests, but that immune response in practice actually made SARS infections worse.[1] [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335060/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335060/
  - shajznnckfke 6y ago
    Yeah, certainly we ought to see how animals and people with the vaccine react when exposed to the virus, but have we not already done that in the months these vaccine candidates have been tested? The current trials did things like give the vaccine to thousands of Brazilian health-care workers, which should have uncovered any issues like that (in the article you linked, the issue was uncovered by testing in a small sample of animals).
    - pwinnski 6y ago
      We have a process with three stages of trials. No vaccine candidate has yet gone through all three stages, no.
      - shajznnckfke 6y ago
        What I’m arguing is that we don’t need complete phase 3 trials to establish efficacy - we can establish that based on early data from those (and earlier) trials, while accepting larger error bars on the risk of side effects.
SpicyLemonZest 6y ago
I think you're misunderstanding the problem space here. We don't expect a coronavirus vaccine to prevent close to 100% of infections, so it's not a binary question of working vs. not working. The question is, how strong of an effect at what level of confidence is required to conclude that it's working well enough?
- JMTQp8lwXL 6y ago
  The effect needs to be strong, because in ordinary times, many social circles cross paths and a much higher level of human contact occurs. The average person won't read into the nuance of 'the vaccine is X% effective, depending on risk factors Y and Z'. They'll rush to their ordinary behavior. While there isn't a vaccine, it's easier to obligate folks into social distancing. That strategy won't exist anymore once we have a vaccine, regardless of its efficacy.
  - SpicyLemonZest 6y ago
    I agree, but that's what the challenge is. We have to solve for the values of X, Y, and Z where we're comfortable with people's inevitable rush back to their ordinary behavior, and it's extraordinarily hard to figure out what those values should be.
- gniv 6y ago
  > We don't expect a coronavirus vaccine to prevent close to 100% of infections Why not? I would have thought we do. Most vaccines do (flu notwithstanding).
  - SpicyLemonZest 6y ago
    I don't know the biological reasons behind it (I don't even know if the reasons are known, or if it's just based on early results), but Dr. Fauci's said that scientists are hoping for 75% effectiveness and 50-60% effectiveness would be acceptable. (https://www.cnbc.com/2020/08/07/coronavirus-vaccine-dr-fauci-says-chances-of-it-being-highly-effective-is-not-great.html https://www.cnbc.com/2020/08/07/coronavirus-vaccine-dr-fauci...)
takeda 6y ago
And not working that's actually the better outcome of a bad vaccine. It could also have side effects that are worse than COVID-19.

gizmo686 6y ago

Covid isn't that bad when compared to the potential harm that a dangerous vaccine could cause when injected into billions of people. Particularly because deploying the vaccine would not immediately stop all the covid19 damage. Further, deploying a dangerous or innefective vaccine would also cause significant long term damage to public health by fueling doubt in healthcare; particuarly since antivaccers are already a growing public health concern. If we want to rush the process safely, the way forward is a challenge trial; where we deliberatly expose vaccinated people to the virus to see if they get infected. If you cannot get that experiment passed an ethics review board, you should not be able to get widespread deployment of an untested vaccine passed.

shajznnckfke 6y ago
Given the way this story is going, I’m somewhat expecting a future where right-wingers refuse to wear masks but happily take the vaccine, while the left goes antivax and refuses to take it (because it was “rushed by Trump”) but continues to wear masks. Perhaps by our powers combined, we’ll defeat the virus!
- takeda 6y ago
  That's why they want to absolutely make sure it won't cause a damage. The vaccine in 1976 was rushed for political reasons and that didn't end up well besides hurting many people it is also still used as an argument why you should not vaccinate.
  - shajznnckfke 6y ago
    I feel we are overweighting the importance of the political meta-game here and underweighting the real ongoing suffering caused by the virus (in terms of health, but also in economic deprivation). But if we’re going to talk about the meta-game, I think a swift return to normalcy after the vaccine is distributed could do a lot for the public’s opinion of the importance of vaccination. It could marginalize the antivax movement for decades to come.

spamizbad 6y ago

The 1976 swine flu outbreak is one example of what can go wrong if you rush a vaccine: https://en.wikipedia.org/wiki/1976_swine_flu_outbreak https://en.wikipedia.org/wiki/1976_swine_flu_outbreak It was rushed by the Ford administration for political reasons and got a lot of people very sick.

shajznnckfke 6y ago
Is this the worst-case scenario? It doesn’t sound nearly as bad as covid-19. My concern is that there’s an agency whose job is to minimize the risk of harm from a covid-19 vaccine, but not an agency whose job is to balance the risk of harm from a vaccine with the ongoing harm from not having a vaccine.
- SpicyLemonZest 6y ago
  It's not the worst case, just the worst one that's happened in a vaccine deployed at scale. The dengue vaccine is a famous example of why careful research and approval processes are required; it's effective and not too inherently dangerous, but was found to actually make the disease worse for people who haven't been infected in the past.
- timr 6y ago
  "Is this the worst-case scenario? It doesn’t sound nearly as bad as covid-19." This is a case where the media hysteria surrounding the risks of Covid isn't helping anyone. If polling is to be believed, the general public significantly overestimates their personal risk of mortality from the virus: https://us.beyondbullsandbears.com/2020/07/28/on-my-mind-they-blinded-us-from-science/ https://us.beyondbullsandbears.com/2020/07/28/on-my-mind-the... As noted by the link above, the vast majority of that risk is concentrated in the oldest/sickest people. If everyone in the population is given a vaccine with even a fraction of a percent mortality, it could vastly exceed the risk posed by the virus to younger people. It would be tragic, for example, to see any serious side-effects from a vaccine in people under the age of 20, who have essentially no risk from infection.
  - 6y ago

DoreenMichele 6y ago

with so many people out of work and struggling This concern can be addressed other ways. I run two subreddits aimed at helping people establish an online income (as part of the goal). In a post-covid world, I think we will do more good if we focus more on adapting to a new reality where increased germ control is a permanent expectation rather than expecting a vaccine to fix everything and allow us to return to "business as usual."

shajznnckfke 6y ago
I do think there will be a permanent adjustment in society to deal with the risks created by this type of virus in the future. Tell everyone to start wearing masks as soon as the outbreak starts, instead of telling them that masks are only for idiots and healthcare workers. Isolate travelers from affected areas before it has a chance to spread, and so on. But I also expect that just about every occupation from industries that are shut down will continue to exist in this new world.
- DoreenMichele 6y ago
  Well, I didn't say anything about eliminating jobs. Just that I, personally, see no reason to tie the idea of going back to work to a vaccine. I think we would do better to look for germ control solutions that are already proven and available currently. As one example, ordering online or calling ahead and picking up is a way to support local eateries while minimizing the spread of germs. I'm a big fan of Little Caesar's pizza portal as a contactless pick-up option and I don't see any reason we can't actively promote such existing practices right here, right now, instead of seemingly hanging all hopes on "there will be a vaccine and after it comes out, we can just keep doing the same things the same way." That seems like needless suffering to me. We don't know how long that will take and, in the mean time, people need to survive right now. Not having any money/resources at all coming in for X months is not survivable for most people who don't have savings and the like to live off of.
  - shajznnckfke 6y ago
    I agree that we should try to adjust to the world we find ourselves in, but there’s only so much problem-solving effort to go around, and I think most people are already trying to do what they can. It’s tough to reshape society on a dime.

marcosdumay 6y ago

A bad vaccine is pretty bad, and can easily be much worse than the virus. That's why we test them.