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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.wikipedi

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.
  - shajznnckfke 6y ago
    Maybe we should first distribute the vaccine to the elderly, then? It sounds like the trade-off benefits and risk would be different there.
    - timr 6y ago
      Maybe. You still have to be careful, though: your prior assumption is that older/sicker people are more likely to have side-effects from anything. It's also hard to find big enough groups of old/sick people to do sensitive statistical experiments. Vaccine development is hard.
      - bbarnett 6y ago
        On top of that, there are cases of many vaccines which are much less effective in the elderly. While secondary causes are likely causing much of the higher mortality in the elderly, sometimes the immune system is just... not as strong. And yes, that does mean something other than COVID-19 could come along an 'get that person', but... here's my point: https://www.cda-adc.ca/jcda/vol-66/issue-10/551.html https://www.cda-adc.ca/jcda/vol-66/issue-10/551.html Hepatitis B surface antigen (HBsAg) induces neutralizing antibodies (anti-HBs) that protect against HBV infection. ... Response to vaccine following a 3-dose series is typically greater than 95% in young, healthy people, although it decreases with age (< 90% response at age 40 and only 75% response at age 60). Other factors such as smoking, obesity and chronic disease decrease vaccine efficacy and may be used to predict risk of nonresponse.6 Adverse events are minimal, although mild injection-site reactions may occur in 20% of recipients. Quite a few vaccines are like this. Less effective on the elderly. So we could end up with an even larger horror show, with some COVID-19 vaccines. Such as, it has some bad side effects, AND, doesn't really help the most-at-risk group as much as desired! What really bugs me is, there are what? Greater than 70 vaccines in development? Some governments have pre-picked supposed winners. On top of all the other political bull going on, are they going to stick with those winners, regardless of outcome? Or have preferentiality to those specific vaccines? Because I can imagine some being highly effective and safe, and others being the reverse.
    - 6y ago
BurningFrog 6y ago
Let's quantify "a lot of people". Out of 45 million vaccinated, 450 got Guillain-Barré Syndrome. I couldn't find info on if any of them died. That would have been acceptable if it had stopped a disaster, but as it turned out the 1976 Swine Flu epidemic never really materialized as expected. With Covid killing 1000 Americans per day, I think we should happily accept those odds of side effects or worse.
- ethanbond 6y ago
  Yeah, um, the point of trials is to find out what those odds are. They can easily be much, much, much worse.
  - saalweachter 6y ago
    Also, what the reduction is risk of catching the disease in question is.
  - shajznnckfke 6y ago
    There’s no hard line where we need to test for t months, and then we will find out if the vaccine is safe. There is no magic threshold where suddenly we know the answer for sure. It’s more like: the size of the error bars on our estimate of the harm y in quality-adjusted-life-years (QALY) is constrained by some function on the time t, where there is diminishing returns as t increases. It’s always going to be possible that there’s some side-effect that doesn’t show up until t+1 months. Further, we could build an expression of our estimate z of the total harm caused by the virus (including downstream harms like “deaths of despair” from economic damage). By minimizing y-z over t, we can find out the best time to release the vaccine (maybe to the most at-risk populations first). I don’t think anyone at the FDA is doing this calculation. I think they are just trying to get y below some threshold, which is probably quite low compared to z. My goal in this conversation is to advocate for the people who will suffer and die because of that gap - and hope there is someone better qualified than me that fills that role in the government helping decide what to do. My fear is that the FDA is a highly conservative institution using processes that aren’t well-adapted to the current epidemic. To add more color, I think if the vaccine comes out with unexpected side-effects, heads will roll at the FDA. But no heads will roll at the FDA over the many thousands who could have been saved by releasing a vaccine sooner.
deleted 6y ago
[deleted]
hjnilsson 6y ago
You don’t need to go so far back. The 2009 swine flu pandemic vaccine caused Narcolepsy in about 10 / 100 000 vaccinated, all of which were children aged 12-16 (which is not a group included in trials, by the way). https://en.wikipedia.org/wiki/Pandemrix https://en.wikipedia.org/wiki/Pandemrix
andrekandre 6y ago
slight aside, but from that link, was surpised to see "jet injectors" were used in 1970s.... i just toally assumed this stuff was sci-fi... https://en.wikipedia.org/wiki/File:8365_loresOLDSCHOOL.jpg https://en.wikipedia.org/wiki/File:8365_loresOLDSCHOOL.jpg
- bXVsbGVy 6y ago
  I think this used at least at late 80's in developing world, I'm 30 and have a scar (almost impossible to notice). My parents have very deep scars.
  - mardifoufs 6y ago
    Yep, I think everyone from my parents generation in morocco have a very distinguishable, large round scar that resembles a burn scar. Not only does it look painful, but it also looks like an absolutely perfect way to spread diseases. They were lucky AIDs wasn't really around at the time!

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.
- shajznnckfke 6y ago
  Maybe we should first distribute the vaccine to the elderly, then? It sounds like the trade-off benefits and risk would be different there.
  - timr 6y ago
    Maybe. You still have to be careful, though: your prior assumption is that older/sicker people are more likely to have side-effects from anything. It's also hard to find big enough groups of old/sick people to do sensitive statistical experiments. Vaccine development is hard.
    - bbarnett 6y ago
      On top of that, there are cases of many vaccines which are much less effective in the elderly. While secondary causes are likely causing much of the higher mortality in the elderly, sometimes the immune system is just... not as strong. And yes, that does mean something other than COVID-19 could come along an 'get that person', but... here's my point: https://www.cda-adc.ca/jcda/vol-66/issue-10/551.html https://www.cda-adc.ca/jcda/vol-66/issue-10/551.html Hepatitis B surface antigen (HBsAg) induces neutralizing antibodies (anti-HBs) that protect against HBV infection. ... Response to vaccine following a 3-dose series is typically greater than 95% in young, healthy people, although it decreases with age (< 90% response at age 40 and only 75% response at age 60). Other factors such as smoking, obesity and chronic disease decrease vaccine efficacy and may be used to predict risk of nonresponse.6 Adverse events are minimal, although mild injection-site reactions may occur in 20% of recipients. Quite a few vaccines are like this. Less effective on the elderly. So we could end up with an even larger horror show, with some COVID-19 vaccines. Such as, it has some bad side effects, AND, doesn't really help the most-at-risk group as much as desired! What really bugs me is, there are what? Greater than 70 vaccines in development? Some governments have pre-picked supposed winners. On top of all the other political bull going on, are they going to stick with those winners, regardless of outcome? Or have preferentiality to those specific vaccines? Because I can imagine some being highly effective and safe, and others being the reverse.
  - 6y ago

BurningFrog 6y ago

Let's quantify "a lot of people". Out of 45 million vaccinated, 450 got Guillain-Barré Syndrome. I couldn't find info on if any of them died. That would have been acceptable if it had stopped a disaster, but as it turned out the 1976 Swine Flu epidemic never really materialized as expected. With Covid killing 1000 Americans per day, I think we should happily accept those odds of side effects or worse.

ethanbond 6y ago
Yeah, um, the point of trials is to find out what those odds are. They can easily be much, much, much worse.
- saalweachter 6y ago
  Also, what the reduction is risk of catching the disease in question is.
- shajznnckfke 6y ago
  There’s no hard line where we need to test for t months, and then we will find out if the vaccine is safe. There is no magic threshold where suddenly we know the answer for sure. It’s more like: the size of the error bars on our estimate of the harm y in quality-adjusted-life-years (QALY) is constrained by some function on the time t, where there is diminishing returns as t increases. It’s always going to be possible that there’s some side-effect that doesn’t show up until t+1 months. Further, we could build an expression of our estimate z of the total harm caused by the virus (including downstream harms like “deaths of despair” from economic damage). By minimizing y-z over t, we can find out the best time to release the vaccine (maybe to the most at-risk populations first). I don’t think anyone at the FDA is doing this calculation. I think they are just trying to get y below some threshold, which is probably quite low compared to z. My goal in this conversation is to advocate for the people who will suffer and die because of that gap - and hope there is someone better qualified than me that fills that role in the government helping decide what to do. My fear is that the FDA is a highly conservative institution using processes that aren’t well-adapted to the current epidemic. To add more color, I think if the vaccine comes out with unexpected side-effects, heads will roll at the FDA. But no heads will roll at the FDA over the many thousands who could have been saved by releasing a vaccine sooner.

deleted 6y ago

[deleted]

hjnilsson 6y ago

You don’t need to go so far back. The 2009 swine flu pandemic vaccine caused Narcolepsy in about 10 / 100 000 vaccinated, all of which were children aged 12-16 (which is not a group included in trials, by the way). https://en.wikipedia.org/wiki/Pandemrix https://en.wikipedia.org/wiki/Pandemrix

andrekandre 6y ago

slight aside, but from that link, was surpised to see "jet injectors" were used in 1970s.... i just toally assumed this stuff was sci-fi... https://en.wikipedia.org/wiki/File:8365_loresOLDSCHOOL.jpg https://en.wikipedia.org/wiki/File:8365_loresOLDSCHOOL.jpg

bXVsbGVy 6y ago
I think this used at least at late 80's in developing world, I'm 30 and have a scar (almost impossible to notice). My parents have very deep scars.
- mardifoufs 6y ago
  Yep, I think everyone from my parents generation in morocco have a very distinguishable, large round scar that resembles a burn scar. Not only does it look painful, but it also looks like an absolutely perfect way to spread diseases. They were lucky AIDs wasn't really around at the time!