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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 fro

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.
  - refurb 6y ago
    Absolutely. Prioritize those at highest risk of Covid complications (elderly, comorbidities) or those at high risk of exposure (front line healthcare workers). It will be interesting once vaccines become available. Vaccinating several billion people will have a lot of operational challenges and will likely take upwards of a year to complete.
- CydeWeys 6y ago
  > 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. They have little risk of death if they have no comorbidities, but even for a 20 year old, just getting COVID-19 is likely gonna be worse than the side effects from almost any vaccine imaginable. I've had vaccine side effects and I've had COVID and I'd take ten more vaccine side effects over one COVID, please. There's also the fact that vaccines are never 100% effective and that herd immunity is important, so the 20 year old still needs the vaccine to protect the older people they may run across. So even if the 20 year old is personally somehow guaranteed an asymptomatic, no-damage infection from COVID, they still need the vaccine. Vaccines don't just protect you, they protect everyone else, and a large part of their efficacy in reducing total population mortality is through these herd immunity effects, not just from protecting the individual people who've been vaccinated.
  - umanwizard 6y ago
    > just getting COVID-19 is likely gonna be worse than the side effects from almost any vaccine imaginable Do you have any non-anecdotal articles that quantify this?
    - CydeWeys 6y ago
      Do you just want to do more research, or are you contending that you think the harm from COVID-19 is actually less than the harm from the most severe side effects of a vaccine we've ever seen?
      - timr 6y ago
        In what age group? The 1976 vaccine actually killed people and gave Guillain Barré to many more, so that's your worst-case outcome. So far, under 20 years of age, the fatality rate for Covid is measured in low-single-digit thousandths of a percent (i.e. under a thousand in the US). https://www.medrxiv.org/content/10.1101/2020.08.24.20180851v1.full.pdf https://www.medrxiv.org/content/10.1101/2020.08.24.20180851v...

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.
- refurb 6y ago
  Absolutely. Prioritize those at highest risk of Covid complications (elderly, comorbidities) or those at high risk of exposure (front line healthcare workers). It will be interesting once vaccines become available. Vaccinating several billion people will have a lot of operational challenges and will likely take upwards of a year to complete.
CydeWeys 6y ago
> 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. They have little risk of death if they have no comorbidities, but even for a 20 year old, just getting COVID-19 is likely gonna be worse than the side effects from almost any vaccine imaginable. I've had vaccine side effects and I've had COVID and I'd take ten more vaccine side effects over one COVID, please. There's also the fact that vaccines are never 100% effective and that herd immunity is important, so the 20 year old still needs the vaccine to protect the older people they may run across. So even if the 20 year old is personally somehow guaranteed an asymptomatic, no-damage infection from COVID, they still need the vaccine. Vaccines don't just protect you, they protect everyone else, and a large part of their efficacy in reducing total population mortality is through these herd immunity effects, not just from protecting the individual people who've been vaccinated.
- umanwizard 6y ago
  > just getting COVID-19 is likely gonna be worse than the side effects from almost any vaccine imaginable Do you have any non-anecdotal articles that quantify this?
  - CydeWeys 6y ago
    Do you just want to do more research, or are you contending that you think the harm from COVID-19 is actually less than the harm from the most severe side effects of a vaccine we've ever seen?
    - timr 6y ago
      In what age group? The 1976 vaccine actually killed people and gave Guillain Barré to many more, so that's your worst-case outcome. So far, under 20 years of age, the fatality rate for Covid is measured in low-single-digit thousandths of a percent (i.e. under a thousand in the US). https://www.medrxiv.org/content/10.1101/2020.08.24.20180851v1.full.pdf https://www.medrxiv.org/content/10.1101/2020.08.24.20180851v...