17 ms·

So no, we did not “have the vaccine” in February. We did have it, we just didn't know which one it was. And we refused to risk any individual life in order to

by GavinB 6y ago

So no, we did not “have the vaccine” in February. We did have it, we just didn't know which one it was. And we refused to risk any individual life in order to potentially save hundreds of thousands or more. We also could have invested single digit billions early on to build capacity for all of these different potential vaccines, but we decided to play if "safe" and will now be spending over a trillion again to try to save the economy. I don't blame the pharma companies for this. Our government and medical establishment was not intellectually prepared to make the hard decisions required to save us. And we need to be building momentum to learn how to do better.

jimbokun 6y ago
> We also could have invested single digit billions early on to build capacity for all of these different potential vaccines Are we sure "we" didn't? I don't know the actual numbers behind what was spent ahead of time for the various vaccines, but I believe the manufacturing process was ramped up before the trials completed.
- GavinB 6y ago
  There was discussion of it early on, but there's no evidence that it was done on any significant scale outside of the efforts of individual pharma companies working on their own supply chains. It's possible that I'm wrong! Maybe we invested everything possible and couldn't have done significantly more. But it's striking that this article doesn't even address that question. Basically, I haven't seen any evidence that this take is wrong: https://thezvi.wordpress.com/2021/01/28/covid-bill-gates-and-vaccine-production/ https://thezvi.wordpress.com/2021/01/28/covid-bill-gates-and...
  - natechols 6y ago
    Oh thanks I was looking for followup on the Gates thing, that blog post is superb. And depressing.
  - _carbyau_ 6y ago
    I am not entirely sure I agree with the thinking though. While initial production ramp up would get the richer countries vaccinated quickly it seems like Gates has a more holistic picture and wants to see the whole world vaccinated faster. I agree with this thinking. It won't matter if rich countries are vaccinated if other countries are coming up with new variations all the time. We want to eradicate this by having everyone in the world on the same page, not have it hanging around like the flu.
- maxerickson 6y ago
  The economists that put together this working paper estimated that we left a lot on the table. Several months and hundreds of billions of dollars in the US (that invested a relatively large amount) and nearly a year and over a trillion dollars for the globe. Table 1 on page 6 summarizes it. https://bfi.uchicago.edu/wp-content/uploads/2021/01/BFI_WP_202108.pdf https://bfi.uchicago.edu/wp-content/uploads/2021/01/BFI_WP_2...
tass 6y ago
Doesn’t this raise the same problem with the current manufacturing process? There was limited capacity to manufacture back then, probably less so than there is today. Which vaccine candidate would Pfizer have manufactured? All of them?
- GavinB 6y ago
  Yes, all of them. Or possibly expanding capacity for each of the major vaccine types, to be ready when we know which one is the winner. And then, yes, a lot of those factories would have ended up sold for scrap (or mothballed for future pandemics or mutations). But the few that worked then save trillions of dollars of value and hundreds of thousands of lives. It's a simple matter of calculating expected values and investing accordingly. But thats not how our civilization works.
  - natechols 6y ago
    Last year Bill Gates talked about doing exactly that (I don't know if this actually happened): https://www.businessinsider.com/bill-gates-factories-7-different-vaccines-to-fight-coronavirus-2020-4 https://www.businessinsider.com/bill-gates-factories-7-diffe... The fact that someone like Gates is throwing the idea around suggests that it's not really incompatible or inconsistent with our civilization. (EDIT: saw your other comment with the follow-up, sigh.)
    - deleted 6y ago
      [deleted]
  - tass 6y ago
    I'm going off the assumption that the capacity has been expanding as much as possible, so scrap factories wouldn't be a problem. The Pfizer vaccine seems to have a shelf life of 6 months, so realistically the earliest they could have begun mass manufacture and have an effect today would have been June. That's right around the time they narrowed down to a single vaccine candidate. I'm surprised that mass manufacturing didn't begin back then with the only possible candidate, especially since the US government also put their order in around that time. I can't find a whole lot of info on when they did ramp up (something I saw said October), and what reasons they had for not starting earlier.
chuckcode 6y ago
Agree that relative to the cost in lives and global GDP leaders have drastically under invested in production and distribution of vaccines. Arguments about what ethical and incentive policies should be will continue forever. Certainly though we shouldn't be blocked at this point by availability of a few machines, shipping and inventory tracking, etc. Especially in the US we have really wasted 9-10 months to work on public health in general and vaccine delivery in particular. History will not be kind
azangru 6y ago
> And we refused to risk any individual life in order to potentially save hundreds of thousands or more But we are risking individual lives now. Vaccines have side effects. It's never about an individual life, always a calculus of number of lives risked vs number of lives saved, I would think.
- mortehu 6y ago
  I think the point is that we chose and are still choosing to wait for a hundred people to get infected at random in each efficacy trial, instead of just deliberately infecting a hundred people immediately. The cost of our approach is that roughly the same proportion of the country's population must bet infected as in the trials.
  - Digit-Al 6y ago
    So, would you volunteer to be deliberately infected with a disease that might or might not kill you in order to save many other lives?
    - nickpp 6y ago
      For a nice sum, a whole bunch of people would probably volunteer.
      - pgodzin 6y ago
        An ethical consideration is whether it is ethical to disproportionately place the poorest (those most in need of a nice sum) at this unknown risk
        umeshunni 6y ago
        Given that we have seen that the poorest are the most at risk of dying from the disease, I'm not sure that argument even holds any more. Sadly, it's this obsession with straw man arguments about ethics and equity that's cost the West a million lives in the last year.
sna1l 6y ago
+1 It was clear the US government made the wrong decision when they backtracked and tried to buy more doses from Pfizer + Moderna[1]. Given how much the US has spent on stimulus, you would think even like 10-15 extra billion would be nothing. [1]: https://www.nytimes.com/2020/12/07/us/trump-covid-vaccine-pfizer.html https://www.nytimes.com/2020/12/07/us/trump-covid-vaccine-pf...
gus_massa 6y ago
> And we refused to risk any individual life in order to potentially save hundreds of thousands or more. Are you volunteering? Will you sign all the paperwork? If you die in the trial or get a severe reaction, would your family be happy with the paperwork, or they will claim that they fooled you? If you die and the vaccine candidate fails, will the TV claim that they should have used a good old method like a modified adenovirus instead of playing god and creating a frankenvirus in the lab?
- d7ryerh 6y ago
  You make it sound as though no one would volunteer. I think you're severely underestimating the altruism of some people.
- Symmetry 6y ago
  I and a ton of other people signed up for challenge trials through 1 Day Sooner (https://www.1daysooner.org/ https://www.1daysooner.org/). Sure, there was some risk to me but it was small compared to the potential to save the lives of older friends and family even before considering strangers.
- ClumsyPilot 6y ago
  People have voluntered for fucking one way trip to Mars. Maybe you think they are mad, but thats a different problem.
  - visarga 6y ago
    Instead of paying the volunteers they could give them free health care for the next 25 years or life. I bet many would take that chance.
standardUser 6y ago
To be fair, part of the reason we establish rules of ethics is so that when an emergency happens, we don't just wing it and start making up the rules. Situations like this pandemic are a very good reason to revisit established rules of ethics, but using it as justification to overrule existing rules negates the entire idea of establishing rules of ethics in the first place.
- GavinB 6y ago
  I agree in principle. On the other hand, global crises have always called for extraordinary measures. Even in this pandemic, we've (correctly, I would say) basically thrown out important principles like freedom of movement and freedom of association during lockdowns. I think that allowing volunteers to put themselves at a relatively low risk to speed up vaccine trials would have been a relatively small transgression, compared to the lockdowns and travel bans (which, again, I think were justified). But I do take your point.
  - cameldrv 6y ago
    This is a very good point. The lockdown measures, while very arguably necessary, are an extremely severe measure. They were perhaps the only measure that would have been effective at the beginning when there was no preparation. Yet, things like enforced mask wearing, or enforced out of home quarantine/isolation somehow were off the table. It is a weird path-dependent quirk of the fact that we had no testing at the beginning, that instead of quarantining and isolated the exposed and infected, we are effectively quarantining everyone.
  - raphaelj 6y ago
    Isn't it exactly what happened? Some vaccines started large scale tests around March/April. It's just that you have to wait a few months to know if the vaccine you're testing is effective. You can't make this delay shorter with more volunteers. And when you're fighting a decease that "only" kills 0.5% of the people inflected, your risk margin is pretty low (what if your vaccine creates deadly consequences to 0.6% of the people vaccinated?).
milliondollar 6y ago
EXACTLY my question. How much would it have cost to make some bets against the various types of vaccines that could come out. Make a "generic" manufacturing facility that could then help scale up. So what if we "wasted" $10B on facilities that didn't pan out?
deleted 6y ago
[deleted]
Gatsky 6y ago
The virus can be controlled with appropriate measures to limit the death rate - see Taiwan, SK, Australia, New Zealand etc. If you want to argue that we could have saved hundreds of thousands of lives I would probably start there instead of experimenting on billions of people.
- _carbyau_ 6y ago
  While this is true (I live in Melbourne Australia) it did affect a lot of people - financially, mentally etc. Depending on where in society you sit probably shapes whether you think it was worth it. (Full disclosure, I do but I was also not inconvenienced much.) As it stands currently, I note that interventions in Australia are much faster now. Our stand down position was we had to wear masks to the supermarket and on public transport. Everywhere else was pretty close to normal. But one case detected yesterday in our 4 million population city, means we all wearing masks whenever we're indoors today. That one case has flicked that switch overnight. So it seems that the main thing is to test well and react quickly.
  - peytn 6y ago
    It likely helps to be a bit remote. That’s why Australia is free of other viruses like rabies.
- eloff 6y ago
  An island at the edge of the world with more sheep than people is not at all comparable with the US or Europe. If they'd acted early and decisively like the countries you mentioned, the outcome would likely have been better. But it would still look very different from those countries.
  - Clewza313 6y ago
    China has it under control (yes, seriously, it's not just CCP propaganda) and they have over a billion people. So do many other countries like Vietnam.
Florin_Andrei 6y ago
> We did have it, we just didn't know which one it was. What we had was the ending of Indiana Jones and the Last Crusade. A table full of cups. Some of those have the Water of Life. Some just water. Some will outright kill you. Pick one. It's only when you go through the trial process that you can separate the life-giving stuff from the rest.
jbullock35 6y ago
> We also could have invested single digit billions early on to build capacity for all of these different potential vaccines As of the end of October, the U.S. had invested $18 billion to "build capacity," mainly by making advance purchases of vaccines that had yet to be produced (and had yet to pass clinical trials). See [1]. But maybe you're thinking of building capacity in a different way. > We refused to risk any individual life in order to potentially save hundreds of thousands or more. This is such an important point. In particular, human challenge trials, in which healthy, low-risk volunteers are infected with a low dose of the virus, could have saved tens of thousands of lives -- at a minimum -- in the U.S. alone. The case for HCTs, including the ethical case, is taken up in [2]. In a comment below, someone likens HCTs to the infamous Tuskegee syphilis study. The comparison isn't apt. In the Tuskegee study, people infected with syphilis were promised medical care that they were later denied. When they were diagnosed with syphilis, they weren't even told of the diagnosis. Those conditions are a world apart from the HCTs that Eyal et al. propose in [2]. - - - - - [1] https://www.bloomberg.com/news/features/2020-10-29/inside-operation-warp-speed-s-18-billion-sprint-for-a-vaccine https://www.bloomberg.com/news/features/2020-10-29/inside-op... [2] https://academic.oup.com/jid/article/221/11/1752/5814216 https://academic.oup.com/jid/article/221/11/1752/5814216
- WalterBright 6y ago
  Even worse, the rate of vaccine development and production seems to be falling behind the rate of covid mutation. I.e. the way we do things means we cannot stop covid.
  - maxerickson 6y ago
    That's not evident at all. The vaccines appear to be effective enough against the existing 'notable' mutations, and we don't really have much information about what rate of concerning mutations to expect. And then on the other side of it, Moderna has a vaccine against the South African mutation in a trial. And production capacity on the mRNA vaccines is pretty clearly not maxed out in any long term sense (and then the other vaccines apparently have a better path to volume; J&J still sounds like they will make 1 billion vaccines this year. The viral vector vaccines aren't as immediately adjustable as the mRNA vaccines, but they are similarly targeted, choosing a protein to be expressed).
wahern 6y ago
> we refused to risk any individual life in order to potentially save hundreds of thousands or more. The concern wasn't Trolley problem[1] paralysis, where authorities are afraid to deliberately shift harm to a minority to protect a majority. The concern was vaccine-associated disease enhancement (VADE), which could possibly cause more overall harm and deaths than simply doing nothing at all. It's a significant and legitimate concern because not only has it happened before with released vaccines, it has been a particular problem in SARS vaccine research and trials for 20 years. See "Learning from the past: development of safe and effective COVID-19 vaccines", https://www.nature.com/articles/s41579-020-00462-y https://www.nature.com/articles/s41579-020-00462-y We had complete candidate vaccines mere days into the outbreak, but nobody was sure they were safe because they were just the latest iterations in long lines of similar candidate vaccines, all eventually failing. They couldn't rush trials too quickly because VADE situations might not become apparent without a large pool tracked over an extended period of time so that you can see what happens with reinfections, etc. We got lucky. It seems to be the case that we had just recently turned the corner in resolving many of these barriers. If were were facing COVID-10 (i.e. a SARS pandemic in 2010), we'd be screwed because in 2010 we were much further away from figuring out how to avoid VADE-like failures in SARS vaccines. [1] https://en.wikipedia.org/wiki/Trolley_problem https://en.wikipedia.org/wiki/Trolley_problem
- Robotbeat 6y ago
  Actual it was trolley problem paralysis. We could've gotten a much larger sample size much earlier (and with challenge trials, in addition to other methods) to screen out the very thing you're mentioning here (VADE).
  - wahern 6y ago
    Trials were accelerated. Anyhow, the whole premise that excessively cautious American and European regulations delayed testing is flawed. This is a global problem, and there are plenty of countries with far less onerous regulatory requirements, or with less apprehensive populations more willing to volunteer. It's no coincidence that many of these trials have occurred in other countries like Brazil.
JoeAltmaier 6y ago
That's refuted in the article. We were not finished developing them in February. It took all the time it took, to find vaccines that actually worked. With science. Not throwing darts. Several companies have still not worked out their vaccines. It's like saying "We had steel mills; we had cars back in February!" All it takes is designing and building them.

by GavinB 6y ago

jimbokun 6y ago

> We also could have invested single digit billions early on to build capacity for all of these different potential vaccines Are we sure "we" didn't? I don't know the actual numbers behind what was spent ahead of time for the various vaccines, but I believe the manufacturing process was ramped up before the trials completed.

GavinB 6y ago
There was discussion of it early on, but there's no evidence that it was done on any significant scale outside of the efforts of individual pharma companies working on their own supply chains. It's possible that I'm wrong! Maybe we invested everything possible and couldn't have done significantly more. But it's striking that this article doesn't even address that question. Basically, I haven't seen any evidence that this take is wrong: https://thezvi.wordpress.com/2021/01/28/covid-bill-gates-and-vaccine-production/ https://thezvi.wordpress.com/2021/01/28/covid-bill-gates-and...
- natechols 6y ago
  Oh thanks I was looking for followup on the Gates thing, that blog post is superb. And depressing.
- _carbyau_ 6y ago
  I am not entirely sure I agree with the thinking though. While initial production ramp up would get the richer countries vaccinated quickly it seems like Gates has a more holistic picture and wants to see the whole world vaccinated faster. I agree with this thinking. It won't matter if rich countries are vaccinated if other countries are coming up with new variations all the time. We want to eradicate this by having everyone in the world on the same page, not have it hanging around like the flu.
maxerickson 6y ago
The economists that put together this working paper estimated that we left a lot on the table. Several months and hundreds of billions of dollars in the US (that invested a relatively large amount) and nearly a year and over a trillion dollars for the globe. Table 1 on page 6 summarizes it. https://bfi.uchicago.edu/wp-content/uploads/2021/01/BFI_WP_202108.pdf https://bfi.uchicago.edu/wp-content/uploads/2021/01/BFI_WP_2...

tass 6y ago

Doesn’t this raise the same problem with the current manufacturing process? There was limited capacity to manufacture back then, probably less so than there is today. Which vaccine candidate would Pfizer have manufactured? All of them?

GavinB 6y ago
Yes, all of them. Or possibly expanding capacity for each of the major vaccine types, to be ready when we know which one is the winner. And then, yes, a lot of those factories would have ended up sold for scrap (or mothballed for future pandemics or mutations). But the few that worked then save trillions of dollars of value and hundreds of thousands of lives. It's a simple matter of calculating expected values and investing accordingly. But thats not how our civilization works.
- natechols 6y ago
  Last year Bill Gates talked about doing exactly that (I don't know if this actually happened): https://www.businessinsider.com/bill-gates-factories-7-different-vaccines-to-fight-coronavirus-2020-4 https://www.businessinsider.com/bill-gates-factories-7-diffe... The fact that someone like Gates is throwing the idea around suggests that it's not really incompatible or inconsistent with our civilization. (EDIT: saw your other comment with the follow-up, sigh.)
  - deleted 6y ago
    [deleted]
- tass 6y ago
  I'm going off the assumption that the capacity has been expanding as much as possible, so scrap factories wouldn't be a problem. The Pfizer vaccine seems to have a shelf life of 6 months, so realistically the earliest they could have begun mass manufacture and have an effect today would have been June. That's right around the time they narrowed down to a single vaccine candidate. I'm surprised that mass manufacturing didn't begin back then with the only possible candidate, especially since the US government also put their order in around that time. I can't find a whole lot of info on when they did ramp up (something I saw said October), and what reasons they had for not starting earlier.

chuckcode 6y ago

Agree that relative to the cost in lives and global GDP leaders have drastically under invested in production and distribution of vaccines. Arguments about what ethical and incentive policies should be will continue forever. Certainly though we shouldn't be blocked at this point by availability of a few machines, shipping and inventory tracking, etc. Especially in the US we have really wasted 9-10 months to work on public health in general and vaccine delivery in particular. History will not be kind

azangru 6y ago

> And we refused to risk any individual life in order to potentially save hundreds of thousands or more But we are risking individual lives now. Vaccines have side effects. It's never about an individual life, always a calculus of number of lives risked vs number of lives saved, I would think.

mortehu 6y ago
I think the point is that we chose and are still choosing to wait for a hundred people to get infected at random in each efficacy trial, instead of just deliberately infecting a hundred people immediately. The cost of our approach is that roughly the same proportion of the country's population must bet infected as in the trials.
- Digit-Al 6y ago
  So, would you volunteer to be deliberately infected with a disease that might or might not kill you in order to save many other lives?
  - nickpp 6y ago
    For a nice sum, a whole bunch of people would probably volunteer.
    - pgodzin 6y ago
      An ethical consideration is whether it is ethical to disproportionately place the poorest (those most in need of a nice sum) at this unknown risk
      - umeshunni 6y ago
        Given that we have seen that the poorest are the most at risk of dying from the disease, I'm not sure that argument even holds any more. Sadly, it's this obsession with straw man arguments about ethics and equity that's cost the West a million lives in the last year.

sna1l 6y ago

+1 It was clear the US government made the wrong decision when they backtracked and tried to buy more doses from Pfizer + Moderna[1]. Given how much the US has spent on stimulus, you would think even like 10-15 extra billion would be nothing. [1]: https://www.nytimes.com/2020/12/07/us/trump-covid-vaccine-pfizer.html https://www.nytimes.com/2020/12/07/us/trump-covid-vaccine-pf...

gus_massa 6y ago

> And we refused to risk any individual life in order to potentially save hundreds of thousands or more. Are you volunteering? Will you sign all the paperwork? If you die in the trial or get a severe reaction, would your family be happy with the paperwork, or they will claim that they fooled you? If you die and the vaccine candidate fails, will the TV claim that they should have used a good old method like a modified adenovirus instead of playing god and creating a frankenvirus in the lab?

d7ryerh 6y ago
You make it sound as though no one would volunteer. I think you're severely underestimating the altruism of some people.
Symmetry 6y ago
I and a ton of other people signed up for challenge trials through 1 Day Sooner (https://www.1daysooner.org/ https://www.1daysooner.org/). Sure, there was some risk to me but it was small compared to the potential to save the lives of older friends and family even before considering strangers.
ClumsyPilot 6y ago
People have voluntered for fucking one way trip to Mars. Maybe you think they are mad, but thats a different problem.
- visarga 6y ago
  Instead of paying the volunteers they could give them free health care for the next 25 years or life. I bet many would take that chance.

standardUser 6y ago

To be fair, part of the reason we establish rules of ethics is so that when an emergency happens, we don't just wing it and start making up the rules. Situations like this pandemic are a very good reason to revisit established rules of ethics, but using it as justification to overrule existing rules negates the entire idea of establishing rules of ethics in the first place.

GavinB 6y ago
I agree in principle. On the other hand, global crises have always called for extraordinary measures. Even in this pandemic, we've (correctly, I would say) basically thrown out important principles like freedom of movement and freedom of association during lockdowns. I think that allowing volunteers to put themselves at a relatively low risk to speed up vaccine trials would have been a relatively small transgression, compared to the lockdowns and travel bans (which, again, I think were justified). But I do take your point.
- cameldrv 6y ago
  This is a very good point. The lockdown measures, while very arguably necessary, are an extremely severe measure. They were perhaps the only measure that would have been effective at the beginning when there was no preparation. Yet, things like enforced mask wearing, or enforced out of home quarantine/isolation somehow were off the table. It is a weird path-dependent quirk of the fact that we had no testing at the beginning, that instead of quarantining and isolated the exposed and infected, we are effectively quarantining everyone.
- raphaelj 6y ago
  Isn't it exactly what happened? Some vaccines started large scale tests around March/April. It's just that you have to wait a few months to know if the vaccine you're testing is effective. You can't make this delay shorter with more volunteers. And when you're fighting a decease that "only" kills 0.5% of the people inflected, your risk margin is pretty low (what if your vaccine creates deadly consequences to 0.6% of the people vaccinated?).

milliondollar 6y ago

EXACTLY my question. How much would it have cost to make some bets against the various types of vaccines that could come out. Make a "generic" manufacturing facility that could then help scale up. So what if we "wasted" $10B on facilities that didn't pan out?

deleted 6y ago

[deleted]

Gatsky 6y ago

The virus can be controlled with appropriate measures to limit the death rate - see Taiwan, SK, Australia, New Zealand etc. If you want to argue that we could have saved hundreds of thousands of lives I would probably start there instead of experimenting on billions of people.

_carbyau_ 6y ago
While this is true (I live in Melbourne Australia) it did affect a lot of people - financially, mentally etc. Depending on where in society you sit probably shapes whether you think it was worth it. (Full disclosure, I do but I was also not inconvenienced much.) As it stands currently, I note that interventions in Australia are much faster now. Our stand down position was we had to wear masks to the supermarket and on public transport. Everywhere else was pretty close to normal. But one case detected yesterday in our 4 million population city, means we all wearing masks whenever we're indoors today. That one case has flicked that switch overnight. So it seems that the main thing is to test well and react quickly.
- peytn 6y ago
  It likely helps to be a bit remote. That’s why Australia is free of other viruses like rabies.
eloff 6y ago
An island at the edge of the world with more sheep than people is not at all comparable with the US or Europe. If they'd acted early and decisively like the countries you mentioned, the outcome would likely have been better. But it would still look very different from those countries.
- Clewza313 6y ago
  China has it under control (yes, seriously, it's not just CCP propaganda) and they have over a billion people. So do many other countries like Vietnam.

Florin_Andrei 6y ago

> We did have it, we just didn't know which one it was. What we had was the ending of Indiana Jones and the Last Crusade. A table full of cups. Some of those have the Water of Life. Some just water. Some will outright kill you. Pick one. It's only when you go through the trial process that you can separate the life-giving stuff from the rest.

jbullock35 6y ago

> We also could have invested single digit billions early on to build capacity for all of these different potential vaccines As of the end of October, the U.S. had invested $18 billion to "build capacity," mainly by making advance purchases of vaccines that had yet to be produced (and had yet to pass clinical trials). See [1]. But maybe you're thinking of building capacity in a different way. > We refused to risk any individual life in order to potentially save hundreds of thousands or more. This is such an important point. In particular, human challenge trials, in which healthy, low-risk volunteers are infected with a low dose of the virus, could have saved tens of thousands of lives -- at a minimum -- in the U.S. alone. The case for HCTs, including the ethical case, is taken up in [2]. In a comment below, someone likens HCTs to the infamous Tuskegee syphilis study. The comparison isn't apt. In the Tuskegee study, people infected with syphilis were promised medical care that they were later denied. When they were diagnosed with syphilis, they weren't even told of the diagnosis. Those conditions are a world apart from the HCTs that Eyal et al. propose in [2]. - - - - - [1] https://www.bloomberg.com/news/features/2020-10-29/inside-operation-warp-speed-s-18-billion-sprint-for-a-vaccine https://www.bloomberg.com/news/features/2020-10-29/inside-op... [2] https://academic.oup.com/jid/article/221/11/1752/5814216 https://academic.oup.com/jid/article/221/11/1752/5814216

WalterBright 6y ago
Even worse, the rate of vaccine development and production seems to be falling behind the rate of covid mutation. I.e. the way we do things means we cannot stop covid.
- maxerickson 6y ago
  That's not evident at all. The vaccines appear to be effective enough against the existing 'notable' mutations, and we don't really have much information about what rate of concerning mutations to expect. And then on the other side of it, Moderna has a vaccine against the South African mutation in a trial. And production capacity on the mRNA vaccines is pretty clearly not maxed out in any long term sense (and then the other vaccines apparently have a better path to volume; J&J still sounds like they will make 1 billion vaccines this year. The viral vector vaccines aren't as immediately adjustable as the mRNA vaccines, but they are similarly targeted, choosing a protein to be expressed).

wahern 6y ago

> we refused to risk any individual life in order to potentially save hundreds of thousands or more. The concern wasn't Trolley problem[1] paralysis, where authorities are afraid to deliberately shift harm to a minority to protect a majority. The concern was vaccine-associated disease enhancement (VADE), which could possibly cause more overall harm and deaths than simply doing nothing at all. It's a significant and legitimate concern because not only has it happened before with released vaccines, it has been a particular problem in SARS vaccine research and trials for 20 years. See "Learning from the past: development of safe and effective COVID-19 vaccines", https://www.nature.com/articles/s41579-020-00462-y https://www.nature.com/articles/s41579-020-00462-y We had complete candidate vaccines mere days into the outbreak, but nobody was sure they were safe because they were just the latest iterations in long lines of similar candidate vaccines, all eventually failing. They couldn't rush trials too quickly because VADE situations might not become apparent without a large pool tracked over an extended period of time so that you can see what happens with reinfections, etc. We got lucky. It seems to be the case that we had just recently turned the corner in resolving many of these barriers. If were were facing COVID-10 (i.e. a SARS pandemic in 2010), we'd be screwed because in 2010 we were much further away from figuring out how to avoid VADE-like failures in SARS vaccines. [1] https://en.wikipedia.org/wiki/Trolley_problem https://en.wikipedia.org/wiki/Trolley_problem

Robotbeat 6y ago
Actual it was trolley problem paralysis. We could've gotten a much larger sample size much earlier (and with challenge trials, in addition to other methods) to screen out the very thing you're mentioning here (VADE).
- wahern 6y ago
  Trials were accelerated. Anyhow, the whole premise that excessively cautious American and European regulations delayed testing is flawed. This is a global problem, and there are plenty of countries with far less onerous regulatory requirements, or with less apprehensive populations more willing to volunteer. It's no coincidence that many of these trials have occurred in other countries like Brazil.

JoeAltmaier 6y ago

That's refuted in the article. We were not finished developing them in February. It took all the time it took, to find vaccines that actually worked. With science. Not throwing darts. Several companies have still not worked out their vaccines. It's like saying "We had steel mills; we had cars back in February!" All it takes is designing and building them.