9 ms·

Single-Shot and First Doses First

40 points by drocer88 6y ago

ketamine__ 6y ago
> My view is that it would be good if the J&J vaccine was followed by a booster–perhaps of some other vaccine–but that it’s individually fine and in fact socially beneficial to get more people protected quickly by delaying the booster for at least 12 weeks to when vaccines are less scarce. I don’t currently see a reason for thinking differently about the Pfizer and Moderna vaccines. Not an expert, not a researcher, but an economist...
- notatoad 6y ago
  Regardless of his qualifications, his point is interesting: J&J seems to be about as effective as a single dose of Pfizer. There was a whole bunch of worry about what would happen if people got only one of their two Pfizer doses. Was that worry all for nothing? Was it backed up by any science? If there was legitimate reason for concern, why do we not have the same concern around the j&j vaccine? (I'm not trying to advocate any of these points. I'm even less qualified than an economist. But they seem like legitimate questions)
  - nicoburns 6y ago
    > Was that worry all for nothing? Was it backed up by any science? If there was legitimate reason for concern. I believe it was because of a lack of evidence either way. The Pfizer trials were two doses. So we didn't know for sure how well one would work. The decision to only do one was made on the basis that this works well for most (but not all) vaccines. It is now known that it indeed works for the Pfizer vaccine, and so it seems to have been a good decision. The concern was that it would not and would set the vaccination programme back by months. > Why do we not have the same concern around the j&j vaccine? I'm not sure, but I suspect the J&J vaccine was trialed as one dose from the outset.
    - notatoad 6y ago
      That makes sense to me. Thanks for explaining
  - Rapzid 6y ago
    > Regardless of his qualifications, his point is interesting: J&J seems to be about as effective as a single dose of Pfizer. The most compelling J&J number is, IMHO, the 100% efficacy at preventing hospitalizations and deaths. Is a single shot of the double-shot vaccines that effective? AFAIK that study was never run..
    - disgruntledphd2 6y ago
      The trouble with all of these 100% numbers is that very few people (in either group of trial participants) were hospitalised. We have a small sample for the estimate of this efficacy. That being said, all the vaccines have shown this in small samples, so my current working theory is that the hospitalisation rates post vaccine will be very, very low (but almost certainly not 0%).
- monkeypizza 6y ago
  Other related posts including quotes from supporting experts: https://marginalrevolution.com/?s=first+doses+first https://marginalrevolution.com/?s=first+doses+first This is more about looking at the ability of our systems to change their response in emergencies; why are obvious things so hard to do, when they both fully make sense, and are supported by an interested group of experts, against a larger but less interested group of conventional, rule-following experts?
- deleted 6y ago
  [deleted]
- monkeypizza 6y ago
  What is the relationship of his credentials to his logical argument? By arguing from credentials you implicitly take the side of the status quo in history; you'd have been arguing against every overturning of conventional wisdom. I'm not saying all rejection of convention is correct, obviously - but if you look at the specifics of the argument, not the status or credentials of the arguer, it seems more likely to come to a correct judgement.
kevinmchugh 6y ago
Note that the link takes you to the comments. Scroll up for context.
ambicapter 6y ago
Oh god that first comment rings so depressingly true. Is this just the nature of mankind forever or is there some way of setting up incentives such that this doesn't play out exactly the same way every time?
- beaconstudios 6y ago
  Yes but AFAIK we don't do it. Incentive structures can be treated as causal structures if you simplify by saying that incentives "cause" people to act a certain way. The disciplines involved in fixing or improving causal structures are systems theory and cybernetics. But these tools are extremely under utilised.
monkeypizza 6y ago
from an earlier post in the series: Michael Osterholm, Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP) and state epidemiologist for the Minnesota Department of Health: …Imagine you are setting across the table from two people both of whom are 65 or older, both with underlying health conditions. You have two doses of vaccine, one in each hand. And you say to them I can give two doses to you or to you but then the other person gets nothing. Or I can give one dose to both of you. And this is what I know. At the very least, one dose is likely to prevent serious illness, hospitalization and death. Two doses will probably even prevent clinical disease with B.1.1.7. But the other one of you; if you get infected with this virus, which I think substantial numbers of Americans will, things are not looking good for you. What do you want me to do? If that is your Mom or Dad. Your Grandpa or Grandma. What would you do? This is where the rubber meets the road. I think if the data bears it out we can save so many lives in the upcoming weeks and we are missing that opportunity. I have already made my choice. I am postponing my second dose. I want my second dose. But I am confident that I can wait. And I can only hope that my second dose, which I have just deferred, will go to someone who it will save their life. It will make a totally different world for that family. You know some could argue that this could be the end of my career. But I could not sleep with myself at night if I didn’t do this. I just know in my heart of hearts that this is something we must do if we are going to save lives. https://marginalrevolution.com/marginalrevolution/2021/02/osterholm-on-first-doses-first.html https://marginalrevolution.com/marginalrevolution/2021/02/os...
- melling 6y ago
  ... or you could give both doses to the other person because I can wait 3-4 months. In the US there are - 25 million Americans over 75 - 50 million 65 and older, including the 75 year olds We have given out 70 million doses. I think we’re around 40 million jabs a month, hopefully that increases to 60 million soon There’s no need to experiment. However, if we find >3-4 weeks between jabs is fine, let’s do it.
  - wang_li 6y ago
    We did 50 million in the last thirty days.
JohnHaugeland 6y ago
Why have we, as a nation, not yet learned to reject pseudo-intellectuals and their false medical knowledge? This is little better than anti-vaxxing
taxicabjesus 6y ago
I try to read all perspectives. I appreciate that a lot of people believe vaccination is the only way out of the pandemic, but I think it's a mistake to put 'all the eggs in one basket. I haven't noticed much in the way of efforts to help people become healthier so they can have mild cases of COVID-19, COVID-21, COVID-23, etc. Furthermore, why are the medical industry wasting vaccine supply on people who are already immune due to surviving their infection? If a person loses antibodies after 6 months from a natural infection, why would they be expected to have antibodies for longer from a vaccine? I haven't noticed many attempts to rationalize vaccinating people who've already had a case of the SARS-CoV-2. The CDC says "Yes, you should be vaccinated regardless of whether you already had COVID-19. That’s because experts do not yet know how long you are protected from getting sick again after recovering from COVID-19." [0] But that's just "trust us we're experts." [0] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.htm... This week I learned my hair stylist had a mild case in January. She diligently wears her mask, but was not protected from getting exposed to her symptomatic co-worker. She was symptomatic herself for 5 days, and recovered without getting too sick. (Her husband was not so lucky, but survived his hospitalization.) She said she's waiting patiently until she too can get vaccinated. My uncle got himself hospitalized in December 2020 or January 2021. He recovered, but just got vaccinated anyways, even though he certainly still had the antibodies. My brother said our uncle was attesting to his faith in in the vaccine - I think the technical term is "virtue signaling". I think my uncle ought to know better than to use vaccines recreationally. My brother and his wife both had SARS-CoV-2... He was rather sick for a week or two. She was asymptomatic, but tested positive for antibodies. They both got vaccinated, 7 months after their illness/exposure. My brother was presumably coerced by his workplace, she was probably virtue signaling too. SARS-CoV-1 burned out after two years. Why would this version be any different? Is not vaccinating people who've already recovered from SARS-CoV-2 the smarter approach to achieving population immunity?
- manwe150 6y ago
  I think you're being downvoted since you are rhetorically asking questions people have already beat to death. The main two answers being (a) each virus behaves differently, so extrapolation should be done carefully, and not just from your personal experience with surviving past flu's (b) there isn't a limit on how much vaccine we can produce in total, so there isn't really a good reason not to get it. That's perhaps like saying the flu vaccine is only half effective (which is true), so I'd rather get sick twice as often, rather than signal that I trust science.
carbocation 6y ago
If your "normal times" scientific standards need to change for an emergency, then they were never appropriate to begin with. But here, I do think the scientific standards are OK. What should be changed in an emergency is not scientific rigor, but the amount of resource that we are willing to spend on the problem with an expectation of waste. With that mindset, throwing money at the problem to fund trials that address a wide range of questions (e.g., 1 vs 2 doses of Pfizer/Moderna, 2 vs 4 vs 6 weeks for booster timing, etc) would have been the way to go.
Majromax 6y ago
> This is evidence of what I call magical thinking–an undue focus on the clinical trial design as having incantatory power. This isn't complicated. Once we have clinical trial evidence, the protocols tested form the standard of care. With no standards of care (i.e. no tested vaccine, here), then we can only guess about what might be better than nothing. It's fair to make that decision on a balance of probabilities -- try something if it's 51% likely to help (absent negative side-effects, anyway). But once we have such a standard, the very deliberate conservatism of our medical science means we need compelling evidence before supplanting it. I think it's very likely that a single dose of Pfizer/Moderna is adequately protective in the medium term (weeks to months), but this was not fully tested. It's not appropriate to start experimenting on the general population based on a hunch. This community is IT-centric, so think of it like experimenting on a production system. Even if you are 80% sure that something's likely to work out, the risk of failure is so catastrophically high that you don't do it when any other option is open to you.
- baggy_trough 6y ago
  The deliberate conservatism of medical science may be appropriate in "peacetime", but it is murderous in "wartime" (a pandemic).
  - ridaj 6y ago
    The "what have you got to lose" approach doesn't have a great track record either... Even wartime medics take time to disinfect their tools
    - baggy_trough 6y ago
      Certainly one could go too far in either direction, but there's little doubt we are too far in the status quo / conservative direction at the moment.
      - nojokes 6y ago
        I think that the most murderous conservative decision was to not allow early human challenge trials on the ethical grounds while hundred thousands of people were dying.
stevesimmons 6y ago
Alex Tabarrok has been arguing in Marginal Revolution for "First Doses First" since mid-December. Back then, media commentators and the medical establishment objected "But the clinical trials were for two doses". Sadly, very few people acknowledged that prudence had a very real cost in additional infections, deaths, risk of mutations, slower economic recovery. The consensus only shifted to "First Doses First" after the faster spreading UK and South African variants emerged, and the risk of inaction became more obvious. If we step back from Covid-19, this kind of one-sided thinking is all too common in daily life. We need more training (at school, university, in media debates) that the choice is never "Do A or not". It is "do A instead of B (and compare the likely costs and benefits of both)". Or "do the first bit of A, learn some more, and do A' or go back to B". Etc. Real options improve expected outcomes!
- fallingknife 6y ago
  We don't need more training in school. That's where this type of procedural, bureaucratic thinking comes from in the first place.
  - stevesimmons 6y ago
    My point, expressed more fully, is: "teach people to design projects with measurable outcomes versus the status quo; calculate an NPV to make your implicit assumptions and biases explicit; look for ways to restructure your project plan into intermediate goals where you can reassess your strategy (aka "real options"). And your projects will, on average, cost less and be more successful." My meta-point is: these are useful skills that can and should be taught more widely. Your argument is essentially "No", is it not? I'm not sure how that helps improve the situation.
    - dalbasal 6y ago
      This is basically the primary curriculum of current management training. The more people "train" in it, the more we get to a stupid "ruled by metrics" world. IRL, you can't actually be scientific outside of certain cases. Bad/fake science can be worse than no science. Fake objectivity is usually worse than subjectivity. The whole things gets bogged down into "searching under the streetlamp" problems. If you can find a problem that fits the solution you (+ most bogus management consultants of the last 10 years) are advocating, it'll work. Mostly, it gets bolted on to whatever people are doing as an additional layer of bullshit. Nonsense analytics + politics.
devinplatt 6y ago
Naive question: given that there is a sort of pareto distribution in covid vulnerability, and that the vaccine rollout prioritizes vaccinating the most vulnerable first, doesn't it also make some sense to prioritize stronger vaccinations (2 doses of Pfizer or Moderna) for the early recipients of the vaccine? Increasing the speed of the rollout with delayed second doses or skipping second doses sounds compelling for other reasons, but it does seem like a more complex calculus to me than many articles online want to admit.
- simonh 6y ago
  By delaying the second dose, more of the most vulnerable cohorts can be vaccinated more quickly. By the time you get to vaccinating significantly less vulnerable cohorts with their first dose, you will also be second dosing the most vulnerable cohorts. So it's not really a case of denying the most vulnerable a second dose in order to give significantly less vulnerable people a first dose.
throwawaysea 6y ago
As an aside, I feel like suggesting this on social media will likely get you banned or in the least, you would have your posts labeled with a warning, and have to endure attacks from others for “not trusting the experts”. First doses first, and I would argue first doses as fast as possible (not having various “equity” focused schemes slowing things down), are very logical stances to hold. In the least, they are reasonable to bring to a societal discussion. The fact that we can’t openly talk about such ideas with friends, coworkers, or broader society is sad.
kcartlidge 6y ago
Way back when, I wasn't convinced about our (UK) vaccination stance; from the start of the rollout it has been first doses - with the gap for the second set at 12 weeks. The British Medical Association said it was wrong, and there was international condemnation. Now the WHO have endorsed an 8 to 12 week gap. They've also recommended the AZ jab for all age groups over 18, despite French and German comments otherwise (I'm not anti either, I'm a remainer and respect both, but their politician's uninformed comments denigrating the AZ jab were downright dangerous, and the EU is now sitting on unused doses of it). I don't know whether we've rather unexpectedly got something right in this sorry mess, or just had a very lucky break. Edit: I'm in the first-doses camp, but not first-doses-first, as the UK is doing two doses in parallel but with an extended gap so a larger volume of first doses go out 'quickly' but people aren't just left with the one. Feels like a good compromise to me. I also have to say, despite the fact that it is absolutely nothing to do with me, it does feel quite good that the Oxford jab is by far the cheapest and also being manufactured by third parties across the world at pretty much cost. They done well.

40 points by drocer88 6y ago

> My view is that it would be good if the J&J vaccine was followed by a booster–perhaps of some other vaccine–but that it’s individually fine and in fact socially beneficial to get more people protected quickly by delaying the booster for at least 12 weeks to when vaccines are less scarce. I don’t currently see a reason for thinking differently about the Pfizer and Moderna vaccines. Not an expert, not a researcher, but an economist...

notatoad 6y ago
Regardless of his qualifications, his point is interesting: J&J seems to be about as effective as a single dose of Pfizer. There was a whole bunch of worry about what would happen if people got only one of their two Pfizer doses. Was that worry all for nothing? Was it backed up by any science? If there was legitimate reason for concern, why do we not have the same concern around the j&j vaccine? (I'm not trying to advocate any of these points. I'm even less qualified than an economist. But they seem like legitimate questions)
- nicoburns 6y ago
  > Was that worry all for nothing? Was it backed up by any science? If there was legitimate reason for concern. I believe it was because of a lack of evidence either way. The Pfizer trials were two doses. So we didn't know for sure how well one would work. The decision to only do one was made on the basis that this works well for most (but not all) vaccines. It is now known that it indeed works for the Pfizer vaccine, and so it seems to have been a good decision. The concern was that it would not and would set the vaccination programme back by months. > Why do we not have the same concern around the j&j vaccine? I'm not sure, but I suspect the J&J vaccine was trialed as one dose from the outset.
  - notatoad 6y ago
    That makes sense to me. Thanks for explaining
- Rapzid 6y ago
  > Regardless of his qualifications, his point is interesting: J&J seems to be about as effective as a single dose of Pfizer. The most compelling J&J number is, IMHO, the 100% efficacy at preventing hospitalizations and deaths. Is a single shot of the double-shot vaccines that effective? AFAIK that study was never run..
  - disgruntledphd2 6y ago
    The trouble with all of these 100% numbers is that very few people (in either group of trial participants) were hospitalised. We have a small sample for the estimate of this efficacy. That being said, all the vaccines have shown this in small samples, so my current working theory is that the hospitalisation rates post vaccine will be very, very low (but almost certainly not 0%).
monkeypizza 6y ago
Other related posts including quotes from supporting experts: https://marginalrevolution.com/?s=first+doses+first https://marginalrevolution.com/?s=first+doses+first This is more about looking at the ability of our systems to change their response in emergencies; why are obvious things so hard to do, when they both fully make sense, and are supported by an interested group of experts, against a larger but less interested group of conventional, rule-following experts?
deleted 6y ago
[deleted]
monkeypizza 6y ago
What is the relationship of his credentials to his logical argument? By arguing from credentials you implicitly take the side of the status quo in history; you'd have been arguing against every overturning of conventional wisdom. I'm not saying all rejection of convention is correct, obviously - but if you look at the specifics of the argument, not the status or credentials of the arguer, it seems more likely to come to a correct judgement.

kevinmchugh 6y ago

Note that the link takes you to the comments. Scroll up for context.

ambicapter 6y ago

Oh god that first comment rings so depressingly true. Is this just the nature of mankind forever or is there some way of setting up incentives such that this doesn't play out exactly the same way every time?

beaconstudios 6y ago
Yes but AFAIK we don't do it. Incentive structures can be treated as causal structures if you simplify by saying that incentives "cause" people to act a certain way. The disciplines involved in fixing or improving causal structures are systems theory and cybernetics. But these tools are extremely under utilised.

monkeypizza 6y ago

from an earlier post in the series: Michael Osterholm, Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP) and state epidemiologist for the Minnesota Department of Health: …Imagine you are setting across the table from two people both of whom are 65 or older, both with underlying health conditions. You have two doses of vaccine, one in each hand. And you say to them I can give two doses to you or to you but then the other person gets nothing. Or I can give one dose to both of you. And this is what I know. At the very least, one dose is likely to prevent serious illness, hospitalization and death. Two doses will probably even prevent clinical disease with B.1.1.7. But the other one of you; if you get infected with this virus, which I think substantial numbers of Americans will, things are not looking good for you. What do you want me to do? If that is your Mom or Dad. Your Grandpa or Grandma. What would you do? This is where the rubber meets the road. I think if the data bears it out we can save so many lives in the upcoming weeks and we are missing that opportunity. I have already made my choice. I am postponing my second dose. I want my second dose. But I am confident that I can wait. And I can only hope that my second dose, which I have just deferred, will go to someone who it will save their life. It will make a totally different world for that family. You know some could argue that this could be the end of my career. But I could not sleep with myself at night if I didn’t do this. I just know in my heart of hearts that this is something we must do if we are going to save lives. https://marginalrevolution.com/marginalrevolution/2021/02/osterholm-on-first-doses-first.html https://marginalrevolution.com/marginalrevolution/2021/02/os...

melling 6y ago
... or you could give both doses to the other person because I can wait 3-4 months. In the US there are - 25 million Americans over 75 - 50 million 65 and older, including the 75 year olds We have given out 70 million doses. I think we’re around 40 million jabs a month, hopefully that increases to 60 million soon There’s no need to experiment. However, if we find >3-4 weeks between jabs is fine, let’s do it.
- wang_li 6y ago
  We did 50 million in the last thirty days.

JohnHaugeland 6y ago

Why have we, as a nation, not yet learned to reject pseudo-intellectuals and their false medical knowledge? This is little better than anti-vaxxing

taxicabjesus 6y ago

I try to read all perspectives. I appreciate that a lot of people believe vaccination is the only way out of the pandemic, but I think it's a mistake to put 'all the eggs in one basket. I haven't noticed much in the way of efforts to help people become healthier so they can have mild cases of COVID-19, COVID-21, COVID-23, etc. Furthermore, why are the medical industry wasting vaccine supply on people who are already immune due to surviving their infection? If a person loses antibodies after 6 months from a natural infection, why would they be expected to have antibodies for longer from a vaccine? I haven't noticed many attempts to rationalize vaccinating people who've already had a case of the SARS-CoV-2. The CDC says "Yes, you should be vaccinated regardless of whether you already had COVID-19. That’s because experts do not yet know how long you are protected from getting sick again after recovering from COVID-19." [0] But that's just "trust us we're experts." [0] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.htm... This week I learned my hair stylist had a mild case in January. She diligently wears her mask, but was not protected from getting exposed to her symptomatic co-worker. She was symptomatic herself for 5 days, and recovered without getting too sick. (Her husband was not so lucky, but survived his hospitalization.) She said she's waiting patiently until she too can get vaccinated. My uncle got himself hospitalized in December 2020 or January 2021. He recovered, but just got vaccinated anyways, even though he certainly still had the antibodies. My brother said our uncle was attesting to his faith in in the vaccine - I think the technical term is "virtue signaling". I think my uncle ought to know better than to use vaccines recreationally. My brother and his wife both had SARS-CoV-2... He was rather sick for a week or two. She was asymptomatic, but tested positive for antibodies. They both got vaccinated, 7 months after their illness/exposure. My brother was presumably coerced by his workplace, she was probably virtue signaling too. SARS-CoV-1 burned out after two years. Why would this version be any different? Is not vaccinating people who've already recovered from SARS-CoV-2 the smarter approach to achieving population immunity?

manwe150 6y ago
I think you're being downvoted since you are rhetorically asking questions people have already beat to death. The main two answers being (a) each virus behaves differently, so extrapolation should be done carefully, and not just from your personal experience with surviving past flu's (b) there isn't a limit on how much vaccine we can produce in total, so there isn't really a good reason not to get it. That's perhaps like saying the flu vaccine is only half effective (which is true), so I'd rather get sick twice as often, rather than signal that I trust science.

carbocation 6y ago

If your "normal times" scientific standards need to change for an emergency, then they were never appropriate to begin with. But here, I do think the scientific standards are OK. What should be changed in an emergency is not scientific rigor, but the amount of resource that we are willing to spend on the problem with an expectation of waste. With that mindset, throwing money at the problem to fund trials that address a wide range of questions (e.g., 1 vs 2 doses of Pfizer/Moderna, 2 vs 4 vs 6 weeks for booster timing, etc) would have been the way to go.

Majromax 6y ago

> This is evidence of what I call magical thinking–an undue focus on the clinical trial design as having incantatory power. This isn't complicated. Once we have clinical trial evidence, the protocols tested form the standard of care. With no standards of care (i.e. no tested vaccine, here), then we can only guess about what might be better than nothing. It's fair to make that decision on a balance of probabilities -- try something if it's 51% likely to help (absent negative side-effects, anyway). But once we have such a standard, the very deliberate conservatism of our medical science means we need compelling evidence before supplanting it. I think it's very likely that a single dose of Pfizer/Moderna is adequately protective in the medium term (weeks to months), but this was not fully tested. It's not appropriate to start experimenting on the general population based on a hunch. This community is IT-centric, so think of it like experimenting on a production system. Even if you are 80% sure that something's likely to work out, the risk of failure is so catastrophically high that you don't do it when any other option is open to you.

baggy_trough 6y ago
The deliberate conservatism of medical science may be appropriate in "peacetime", but it is murderous in "wartime" (a pandemic).
- ridaj 6y ago
  The "what have you got to lose" approach doesn't have a great track record either... Even wartime medics take time to disinfect their tools
  - baggy_trough 6y ago
    Certainly one could go too far in either direction, but there's little doubt we are too far in the status quo / conservative direction at the moment.
    - nojokes 6y ago
      I think that the most murderous conservative decision was to not allow early human challenge trials on the ethical grounds while hundred thousands of people were dying.

stevesimmons 6y ago

Alex Tabarrok has been arguing in Marginal Revolution for "First Doses First" since mid-December. Back then, media commentators and the medical establishment objected "But the clinical trials were for two doses". Sadly, very few people acknowledged that prudence had a very real cost in additional infections, deaths, risk of mutations, slower economic recovery. The consensus only shifted to "First Doses First" after the faster spreading UK and South African variants emerged, and the risk of inaction became more obvious. If we step back from Covid-19, this kind of one-sided thinking is all too common in daily life. We need more training (at school, university, in media debates) that the choice is never "Do A or not". It is "do A instead of B (and compare the likely costs and benefits of both)". Or "do the first bit of A, learn some more, and do A' or go back to B". Etc. Real options improve expected outcomes!

fallingknife 6y ago
We don't need more training in school. That's where this type of procedural, bureaucratic thinking comes from in the first place.
- stevesimmons 6y ago
  My point, expressed more fully, is: "teach people to design projects with measurable outcomes versus the status quo; calculate an NPV to make your implicit assumptions and biases explicit; look for ways to restructure your project plan into intermediate goals where you can reassess your strategy (aka "real options"). And your projects will, on average, cost less and be more successful." My meta-point is: these are useful skills that can and should be taught more widely. Your argument is essentially "No", is it not? I'm not sure how that helps improve the situation.
  - dalbasal 6y ago
    This is basically the primary curriculum of current management training. The more people "train" in it, the more we get to a stupid "ruled by metrics" world. IRL, you can't actually be scientific outside of certain cases. Bad/fake science can be worse than no science. Fake objectivity is usually worse than subjectivity. The whole things gets bogged down into "searching under the streetlamp" problems. If you can find a problem that fits the solution you (+ most bogus management consultants of the last 10 years) are advocating, it'll work. Mostly, it gets bolted on to whatever people are doing as an additional layer of bullshit. Nonsense analytics + politics.

devinplatt 6y ago

Naive question: given that there is a sort of pareto distribution in covid vulnerability, and that the vaccine rollout prioritizes vaccinating the most vulnerable first, doesn't it also make some sense to prioritize stronger vaccinations (2 doses of Pfizer or Moderna) for the early recipients of the vaccine? Increasing the speed of the rollout with delayed second doses or skipping second doses sounds compelling for other reasons, but it does seem like a more complex calculus to me than many articles online want to admit.

simonh 6y ago
By delaying the second dose, more of the most vulnerable cohorts can be vaccinated more quickly. By the time you get to vaccinating significantly less vulnerable cohorts with their first dose, you will also be second dosing the most vulnerable cohorts. So it's not really a case of denying the most vulnerable a second dose in order to give significantly less vulnerable people a first dose.

throwawaysea 6y ago

As an aside, I feel like suggesting this on social media will likely get you banned or in the least, you would have your posts labeled with a warning, and have to endure attacks from others for “not trusting the experts”. First doses first, and I would argue first doses as fast as possible (not having various “equity” focused schemes slowing things down), are very logical stances to hold. In the least, they are reasonable to bring to a societal discussion. The fact that we can’t openly talk about such ideas with friends, coworkers, or broader society is sad.

kcartlidge 6y ago

Way back when, I wasn't convinced about our (UK) vaccination stance; from the start of the rollout it has been first doses - with the gap for the second set at 12 weeks. The British Medical Association said it was wrong, and there was international condemnation. Now the WHO have endorsed an 8 to 12 week gap. They've also recommended the AZ jab for all age groups over 18, despite French and German comments otherwise (I'm not anti either, I'm a remainer and respect both, but their politician's uninformed comments denigrating the AZ jab were downright dangerous, and the EU is now sitting on unused doses of it). I don't know whether we've rather unexpectedly got something right in this sorry mess, or just had a very lucky break. Edit: I'm in the first-doses camp, but not first-doses-first, as the UK is doing two doses in parallel but with an extended gap so a larger volume of first doses go out 'quickly' but people aren't just left with the one. Feels like a good compromise to me. I also have to say, despite the fact that it is absolutely nothing to do with me, it does feel quite good that the Oxford jab is by far the cheapest and also being manufactured by third parties across the world at pretty much cost. They done well.