[HN Gopher] Myths of Vaccine Manufacturing
___________________________________________________________________
Myths of Vaccine Manufacturing
Author : undefined1
Score : 126 points
Date : 2021-02-03 15:41 UTC (7 hours ago)
(HTM) web link (blogs.sciencemag.org)
(TXT) w3m dump (blogs.sciencemag.org)
| joe_the_user wrote:
| Here's a general article:
|
| https://www.statnews.com/2020/12/11/covid19-vaccine-timeline...
|
| _" "Vaccine manufacturers hold their production capacity pretty
| close to their vest because it's a point of a negotiation." he
| said. Companies want to have flexibility in their contracts so
| they can balance production of various drugs and vaccines. "These
| companies are businesses and want to maximize their revenue.
| They'll continue to make other products they can sell while
| manufacturing their vaccine.""_
|
| I know less than either Lowe or the State News author. I don't
| know where the particular bottlenecks might be. But it seems hard
| for me to believe that "ramping up is impossible" doesn't mean
| "ramping up is impossible under standard procedures, where we
| keep proprietary information proprietary, where we don't spend
| massively on capital equipment we might not need down the line
| (etc etc)"
|
| That is to say that we're far and far from a Manhattan Project
| intended to push vaccine manufacture to the logistical maximum.
| That's just how just any institutional process works.
| readams wrote:
| Derek is a smart guy but here again we see the utter lack of the
| ability to think big in the drug community. It would have been
| worth it to spend a trillion dollars and speculatively build out
| capacity and manufacturing for every vaccine candidate. We should
| have built megafactories and employed a million people.
|
| And we should have done large-scale phase 3 trials by randomizing
| distribution of large fractions of the output of these
| megafactories.
|
| It's just completely wrong to say that everything was done as
| well as it could possibly have been and there's no way it could
| have been faster. There basically no amount of money that it
| would not have been worth it to spend.
| 13415 wrote:
| This is narrow-minded thinking influenced by recent events
| instead of a realistic risk assessment. Imagine you spend
| trillions on vaccines for possibly deadly diseases, and then
| the Yellowstone supervolcano breaks out and general disaster
| control is in a bad shape because you've spent trillions
| elsewhere.
|
| You can prepare for everything but it needs to be done on the
| basis of balancing many different concerns.
| ClumsyPilot wrote:
| Why should we imagine highly contrived scenario, most risks
| are known, we underinvest in prevention and then pay 10x when
| shit hits the fan
| hef19898 wrote:
| There are problems that cannot be solved by simply throwing
| money at them. Sure, invest billions in new manufacturing
| capacity. That capacity probably wouldn't been ready _now_ ,
| ramping manufacturing is hard enough, starting from scratch
| even harder.
|
| This whole vaccine availability "scandal" is driving me nuts.
| It was clear that nobody knew which vaccine would work. It was
| prudent to buy all of the potential candidates.
|
| It was also clear that there would be a ramp up phase, in each
| country and for each vaccine. The EU pretty much delivered on
| part one, sourcing. And I don't care what the press writes, 5
| doses for each EU citizen regardless of age is enough.
|
| EU member states screwed up on managing part two. And
| communication. I think, things will tun smoother once we have a
| vaccine that can be handled and used by every doctors practice.
| That supply chain works for millions of vaccinations every
| year. Before that, it is hit and miss.
| FabHK wrote:
| > we see the utter lack of the ability to think big in the drug
| community
|
| I don't know what you are talking about. Speculatively building
| out capacity for as yet unproven vaccines was suggested and
| planned back from the beginning already.
|
| (Here for example the Gates foundation in April 2020:
| https://www.businessinsider.com/bill-gates-factories-7-diffe...
| )
|
| > There basically no amount of money that it would not have
| been worth it to spend.
|
| The Economist calculated, based on a Goldman Sachs study, that
| "an American wearing a mask for a day is helping prevent a fall
| in gdp of $56.14. Not bad for something that you can buy for
| about 50 cents apiece." - so, basically a 10000% ROI in a day!
|
| Yes, then, money could have been sensibly employed, but on
| what? Maybe it would have been better employed on PR to
| persuade people to wear masks, or maybe a DDOS shutting down
| social media. How to allocate money optimally in real time
| remains a difficult question.
|
| I don't think things could have been substantially faster,
| though things could have been much less painful if not for the
| intransigence and recklessness of many covidiots.
|
| EDIT to add the source: https://www.economist.com/finance-and-
| economics/2020/08/22/w...
|
| and outline if paywalled: https://outline.com/yCeVzn
| fabian2k wrote:
| I don't see any realistic way to expand manufacturing
| capacities at that kind of scale in such a short time. There
| are a lot of things that are potential bottlenecks because the
| stuff you need isn't produced at that scale and there aren't
| unlimited numbers of people that have the right experience. And
| with producing a vaccine it is extremely important that the
| production results in exactly what you intend to produce, to
| ensure it is safe and effective. That part is done by designing
| processes, carefully checking that they work and then strictly
| adhering to them. That is not an activity that is easy to scale
| up.
| readams wrote:
| By now the scale could be far larger than it is currently.
| Moving up vaccine timetables by just a few months would be
| enormously valuable. I never said it was easy, but the answer
| was not "let's do nothing because it's hard."
| bluGill wrote:
| You are speaking from hindsight. Just a few months ago the
| smart money was on the mRNA vaccines not completing phase-3
| before some of the more conventional vaccines that we
| already have the ability to produce in large quantities.
|
| That mRNA completed phase-3 trials first was a big shock to
| everyone. That they are significantly better than the
| conventional vaccines is also a big shock. If we knew about
| these shocks 1 year ago we would have invested a lot more
| money in mRNA (and none at all in all the other vaccines -
| some failed trails, some are in progress, and the rest are
| are not as good) and had more manufacturing as a result.
| abacadaba wrote:
| we certainly knew there was a potential for this "shock"
| bluGill wrote:
| Yeah, but it was a long shot potential. If it hadn't
| worked out you would be mad at the government for
| allocating money to this stupid bet instead of something
| else (probably J&J which wouldn't have come out any
| sooner)
| epc wrote:
| The market clearly decided that investing a trillion dollars in
| speculative capacity was not valuable. Absent Federal
| intervention (in the US at least), where would the money come
| from? Had the Trump Administration utilized the Defense
| Production Act to nationalize the necessary resources, then
| perhaps we would have had the necessary capacity by now, but it
| decided to go with "Warp Speed" instead.
| readams wrote:
| Obviously this would not happen with purely private
| investment.
| bluGill wrote:
| Even if Trump had done that, he would have invested in the
| wrong vaccines. This is NOT incompetence, nobody had any
| reason to think mRNA would be the way to go 9+ months ago
| when the money was allocated.
| robocat wrote:
| > The market clearly decided that investing a trillion
| dollars in speculative capacity was not valuable
|
| Somehow the investors need to get back their investment,
| cover their risk, and make a profit on top of that.
| Impossible?
|
| Even worldwide, the median per-capita household income is
| $2,920. 1 trillion is a lot of money.
|
| Edit: is there a name for the fallacy "something costs an
| individual $x, therefore the individual can afford to pay
| $x", or the similar fallacy "something costs people an $x
| GDP, therefore the government should pay $x to fix it".
| jbullock35 wrote:
| The blog post is mainly about the difficulty of producing
| vaccines. I don't see much in it that is objectionable. But this
| line may be misleading:
|
| _So no, we did not "have the vaccine" in February._
|
| The author is arguing that, because it's difficult to produce of
| the Moderna vaccine, we couldn't have disseminated it on a wide
| scale in February or shortly thereafter. That argument may be
| fine, but it diverts attention from the critical role that the
| U.S. regulations in general, and the U.S. FDA in particular,
| played in slowing the process of widespread vaccine
| dissemination.
|
| Specifically: the process could have been sped by months if the
| U.S. had been willing to conduct human-challenge trials [1] and
| to integrate tests of safety (Phase 2) and efficacy (Phase 3)
| [2].
|
| To my knowledge, understanding of how to integrate the safety and
| efficacy trials has only recently developed; perhaps the FDA
| shouldn't be faulted on that front. But the benefits of human-
| challenge trials have long been understood.
|
| [1] https://doi.org/10.1093/infdis/jiaa152
|
| [2] https://doi.org/10.1198/016214504000001790
| foobiekr wrote:
| We have a vaccine in February in the same way that we have 5nm
| fabs this year.
|
| After all, all the technology is there, it's just the
| investment and those pesky actual manufacturing process that's
| standing in the way.
| bluGill wrote:
| Not exactly. If you have a 5nm fab you can produce chips
| today that you know work. (the yield might be terrible, but
| you can get some functional chips every day). In February
| what we had was something that completed the process, but we
| had no idea if it worked at all.
| foobiekr wrote:
| From a manufacturing perspective, the equipment was there
| because they've been working on it 20Y; whether the vaccine
| worked is a separate question.
|
| By analogy, it's one thing to have a fab, a working fab can
| make 5nm chips as designed at some yield, however, the fab
| is not responsible for whether the chip designs work or are
| valid.
|
| My point here really was that tech people, and especially
| people in the software industry, ignore that the bulk of
| the work isn't the equipment, it's the long tale of supply
| chain, manufacturing process and QA. All of the 5nm
| equipment exists today, it's the other parts that are the
| hold up.
|
| Essentially, in our own domain we know better, and we
| should really understand this and stop making this mistake
| in other domains.
| angry_octet wrote:
| Firstly, it wasn't produced in large quantities in February.
| They have to do trials against the mass produced article, not
| lab samples.
|
| Secondly, it would be extremely unethical to overlap phase 2 &
| 3 trials, when there are effective NPIs.
|
| The lessons of unethical medical science, like Tuskegee and
| experimentation on armed forces personnel, must not be ignored.
| And yet that is precisely what your ref Eyal[1] is proposing,
| because practically none of the safeguards can be achieved.
|
| Efficacy trials require a much larger participant group, given
| the still low infection rates. I don't see how one can justify
| giving a candidate to 100k people before safety screening,
| especially when the downside risk is significant risk of death
| if they ever catch COVID.
| tptacek wrote:
| So this explains why recruiting other firms to produce Pfizer or
| Moderna mRNA vaccines is difficult (because the limiting factor
| is probably microfluidics devices built specifically for
| processes only Pfizer and Moderna had a reason to scale). But
| what's the bottleneck on scaling up J&J's adenovirus design?
| Exmoor wrote:
| I cannot speak specifically for J&J, but by the number of
| adenovirus licensing agreements I've seen for Oxford, Sputnik
| V, etc. I would guess that existing facilities can be converted
| to produce a viral-vector vaccine much easier than an mRNA
| vaccine. From there I would suspect that the scaling issues are
| mostly related to QA and repeated cycles of ensuring what
| you're producing is actually exactly what you intended to
| produce.
| timr wrote:
| The technology is pretty standard. I can't imagine that
| there's any tech-driven bottleneck to development, but
| rather, issues surrounding licensing, IP transfer, liability,
| etc (in other words: legal concerns).
|
| Once those are resolved, there's still a fixed amount of time
| that it takes to convert existing production facilities to
| some new purpose that you can't really eliminate (the old
| saying about 9 women having a baby in 1 month applies
| here...)
|
| Basically, it's the sort of thing HN readers don't like to
| hear: the complexities of the real world create obstacles
| that are difficult to surmount with technology alone. If I
| had to guess, even if you got approval to have N partners
| manufacture the vaccine _today_ , it would still take a few
| months to ramp those partners up to capacity.
| BasinAndRange wrote:
| This is exactly what's happening at Royalmount in Canada.
| andred14 wrote:
| Stay away from these untested drugs. The satan1c ped0phile
| eugenicists that made them are trying to kill you.
|
| Please learn about these dangerous new vacc1nes:
|
| https://www.bitchute.com/video/KAzUeDrgijM3/
| twoslide wrote:
| This article discusses why mRNA vaccine manufacturing cannot be
| outsourced to third parties, but there are other vaccines that
| might be be produced in this way (Oxford/AstraZeneca). Not sure
| if this is authorized in the US, but it is in many other
| locations experiencing shortage (e.g. the EU).
| smnrchrds wrote:
| Oxford/AstraZeneca vaccine is indeed being produced around the
| world:
|
| https://www.biopharma-reporter.com/Article/2020/08/06/AstraZ...
|
| https://www.reuters.com/article/health-coronavirus-canada-va...
|
| Another traditional vaccine, Novavax, is signing licensing
| deals as well:
|
| https://globalnews.ca/news/7613878/covid-made-in-canada-vacc...
| jancsika wrote:
| > My own guess as to what such a Vaccine Machine involves
|
| In a global pandemic, why are we guessing?
| _Microft wrote:
| It's a thing he does not work with.
| jancsika wrote:
| Sorry, that wasn't clear.
|
| Are the specs for the design of the "Vaccine Machine"
| machine-- as he terms it-- public knowledge?
| [deleted]
| GavinB wrote:
| _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.
| gus_massa wrote:
| > _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 wrote:
| You make it sound as though no one would volunteer. I think
| you're severely underestimating the altruism of some people.
| ClumsyPilot wrote:
| People have voluntered for fucking one way trip to Mars.
| Maybe you think they are mad, but thats a different problem.
| Symmetry wrote:
| I and a ton of other people signed up for challenge trials
| through 1 Day Sooner (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.
| tass wrote:
| 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 wrote:
| 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.
| tass wrote:
| 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.
| natechols wrote:
| 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-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]
| milliondollar wrote:
| 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]
| Gatsky wrote:
| 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.
| chuckcode wrote:
| 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
| standardUser wrote:
| 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 wrote:
| 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 wrote:
| 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.
| Florin_Andrei wrote:
| > _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.
| azangru wrote:
| > 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 wrote:
| 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 wrote:
| 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?
| doliveira wrote:
| Honestly, I would. The way things are going down here in
| my country (Brazil) I will get infected eventually, at
| least by participating in challenge trials it would help
| other people.
| mortehu wrote:
| Tens of thousands of people have signed up for this at
| 1daysooner.org. I didn't even volunteer for any of the
| ongoing trials myself.
| ClumsyPilot wrote:
| That's an difficult and potentially eternal question -
| some people volunteer to go to space or cross the ocean
| on a canoe because to them its worth the risk. Some do it
| for the money. Some are just mad or obsessed.
|
| Back in my time at uni, volunteers had to be unpaid to
| ensure they do it kf their own free will. Its unclear
| which is better / worse.
| nickpp wrote:
| For a nice sum, a whole bunch of people would probably
| volunteer.
| pgodzin wrote:
| 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
| ls612 wrote:
| I'm 25 and healthy. If they paid me $1000 and provided
| medical treatment if necessary I would have volunteered
| for such a trial last spring.
| sna1l wrote:
| +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-
| pf...
| jimbokun wrote:
| > 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.
| maxerickson wrote:
| 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_2...
| GavinB wrote:
| 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...
| natechols wrote:
| Oh thanks I was looking for followup on the Gates thing,
| that blog post is superb. And depressing.
| Animats wrote:
| The article says that RNA encapsulation is the big bottleneck.
| This is a touchy microfluidic process. That needs to be
| accelerated. While few companies make those parts, more could.
| They're made by a process similar to that used in a wafer fab. A
| low-rez wafer fab, like the ones used to make MEMS gyros and
| such.
|
| Part of the problem may be that wafer fab people and drug
| production people don't talk to each other much. Someone should
| get them talking. Might come to nothing. Might lead to "oh, we
| can make that easily".
| foofoo55 wrote:
| Here's a commercial RNA encapsulation system:
|
| https://www.precisionnanosystems.com/platform-technologies/p...
| Animats wrote:
| Right. That's the next stage up, pumps, plumbing, and
| instrumentation. The "cartridge" mentioned is the hard part.
|
| Here's a company which makes the "chips" which go in such
| cartridges.[1] And here are some chips.[2] Making those
| involves etching tiny patterns in glass, lining the channels
| with various coatings, and assembling the layers of glass
| into devices. All this has to be done in a very clean
| environment. Note the similarity to the processes in a wafer
| fab.
|
| The point here is that the semiconductor industry has many
| processes and tools which might be helpful if there's a need
| to manufacture microfluidic components in quantity.
|
| [1] https://www.dolomite-microfluidics.com/
|
| [2] https://www.dolomite-microfluidics.com/product-
| category/micr...
| Accujack wrote:
| A chip isn't a complete device. What about the rest of the
| machinery? The software? Construction of the devices,
| calibration, testing and commissioning? There are probably less
| than 10 people worldwide capable of determining if machines
| like this (that probably only exist within the vaccine
| manufacturers) are set up correctly and working right.
|
| I suspect if you track down what's needed, you'll find that all
| the manufacturing capability for making more of those machines
| is already in use by the vaccine makers. Bespoke microfluidics
| devices aren't common or easy to make, although some components
| are.
| xjlin0 wrote:
| There are many fancy kitchen machines out there. But even you
| buy me one, it's impossible for me to cook great dishes
| overnight. Same things goes to wafer fab, buying me the most
| advanced limask alignerhography machine can not make me to be
| able to produce great 5nm chips in a few years.
|
| Also the instrumental parameters from manufacturer A probably
| cannot be applied directly to the instrument from manufacturer
| B. It is an entire process/system that can not be reproduced
| overnight. It takes time.
| danvoell wrote:
| "Part of the problem may be that wafer fab people and drug
| production people don't talk to each other much." - Another
| part of the problem is probably regulation. Water companies
| don't want to inadvertently bypass FDA regulation. Drug
| production folks don't want to teach water folks the FDA
| approval process, such that, they could become future
| competition.... Sheer speculation.
| rossdavidh wrote:
| If we had a long-term bottleneck here, there might be some
| possibility here, but then again if there were a long-term
| bottleneck we could just build more capacity. However similar
| they are, I doubt you can just turn this on in a month or two
| without serious potential issues, and given how many people the
| vaccine is going into you have way more potential downside than
| potential upside.
|
| Which is really the issue with all potential fixes: either they
| are unknown and thus unacceptably risky for something we will
| use on hundreds of millions (or billions) of people, or if we
| take the time to get to acceptable risk it will be too late to
| really help with this issue.
| ericb wrote:
| I love Derek's writing, but aren't we likely within a few weeks
| of non-RNA vaccines in the US via Johnson and Johnson, though?
|
| He didn't really answer--can _that_ one be scaled since it has
| more standard dependencies? If so, isn 't the "naive" question
| perfectly valid in that case?
| tpm wrote:
| He is responding to a tweet that explicitly mentions Pfizer and
| Moderna.
| bluGill wrote:
| J&J doesn't really need to be scaled up because they alone have
| the ability to produce so much of it.
|
| That said, I'd prefer to get the mRNA vaccines as they seem
| much more effective, so any scaling up done there is still
| useful even if J&J alone could get rid of Covid in the US in a
| few months. (pending need to vaccinate kids for herd immunity,
| Pfizer is the farthest along that path, but not close to mass
| vaccination)
| ericb wrote:
| I don't think it will be clear that Pfizer is "more
| effective" until we see the two-dose J&J study come in.
|
| > J&J doesn't really need to be scaled up because they alone
| have the ability to produce so much of it.
|
| I'd bet 100 dollars that J&J ships less than a billion doses
| before July.
|
| Are you willing to take the other side of the bet? If I'm
| right, that means that they could have "used help" even
| though they "have the ability to produce so much of it."
|
| Edit: Before you take my bet, which I'm happy if you do, you
| may want to read this:
|
| https://www.nytimes.com/2021/01/13/health/covid-vaccine-
| john....
| whycombagator wrote:
| > I'd prefer to get the mRNA vaccines as they seem much more
| effective
|
| I am still unsure which route seems best.
|
| Don't mRNA vaccines target the spike protein?
|
| The spike is a topic of debate currently as mutations/changes
| to the spike (South African variant etc) may affect mRNA
| vaccines more?
|
| Moderna themselves are developing a booster shot targeting
| the SA variant & a separate booster for all the other
| variants (U.K. et al) for this very reason (read: you'll need
| 2 doses of vaccine & 2 booster shots for full protection
| against all current forms of COVID/virus)
|
| So the mRNA route might well be 4 shots for just the variants
| we know about.
|
| That isn't to say non mRNA vaccines (AstraZeneca, J&J) won't
| also have the same issues (decreased effectiveness against
| the mutated virus ) but from what I've read it seems more
| likely to affect mRNA
| chaganated wrote:
| Even though I know very little about vaccines, this article has
| a paid PR smell. These kinds of technocratic problems have
| short and long answers. He skipped one, and danced around the
| other.
| natechols wrote:
| He's been writing on these subjects for years, and nothing in
| this article would be a surprise to anyone who has read him
| before or has even a passing familiarity with the pharma
| industry. (Also, he's always been totally up-front about his
| conflicts of interests and political views, and acknowledges
| when pharma companies screw up.) I think there are fewer
| serious long answers to this problem than you expect - they
| tend to hinge on "wave hands and solve central planning
| problem".
| vernie wrote:
| Derek's blog is great but he's a bit of a stooge for his
| industry, so he plays dumb sometimes.
| firebaze wrote:
| Influenza typically has a mortality of around 0.8%1. There
| usually is a vaccine against the current strain of influenza,
| which usually hovers around 45%2 efficacy (tops out at ~60%).
|
| With covid, we have a mortality rate of something between 0.3%
| and 3%3. The CFR of influenza includes - to the best of my
| knowledge, since i can't find any sources - vaccinated people. So
| without vaccination, influenza would have a CFR around 0.8% *
| (100% / 45%) ~= 1.78%. This is within the error bars of covid19
| CFR, since there was no vaccine until now.
|
| I don't want to downplay covid19. I _do_ want to question the
| effect on the society, and the personal responsibility of
| everyone involved.
|
| @Downvoters: just state why please.
|
| If you disagree, please be so kind and educate me why.
|
| 1https://en.wikipedia.org/wiki/Influenza
|
| 2https://en.wikipedia.org/wiki/Influenza_vaccine
|
| 3https://coronavirus.jhu.edu/data/mortality
| EthanBar wrote:
| Do you mean influenza typically has a mortality of around 0.8%
| for those 65 and older? It has a mortality of < 0.1% for
| everyone from the same Wikipedia article.
|
| And CFR, case fatality rate, won't include vaccinated people
| who didn't get sick so your final calculation doesn't make
| sense.
| agd wrote:
| > I do want to question the effect on the society, and the
| personal responsibility of everyone involved.
|
| What does this mean?
|
| There are many factors at play here. Aside from mortality, you
| also have to look at the R0. Covid 19 has a significantly
| higher R0 than seasonal flu (estimated 1.5 vs 2.5+).
|
| In addition, many people have some immune resistance to
| seasonal flu, but there was no existing resistance to Covid 19.
|
| You only have to look at the health situation in Italy,
| Portugal, UK and elsewhere to see the difference between the
| two. Or look at the excess death graphs.
| firebaze wrote:
| Covid19 is a new disease, noone is primed (by natural
| immunity) against it. It will be more deadly _by nature_
| since this is what nature is.
|
| I _doubt_ our response is good. We _must_ protect vulnerable
| people, and we have the means to. But this is what we are
| neglecting, and this is what causes deaths.
|
| And while we're not protecting vulnerable people, we're also
| harming (to a not yet known degree) people who are not
| vulnerable at all: the young. The're being deprived of their
| education (at least in europe), of their young years, of
| living their young life. Even my parents in their 60s say
| they'd rather protect themselves or die instead of causing
| depression among the young.
|
| But who cares.
| [deleted]
| sfteus wrote:
| This is like using only GDP to compare economies; it's a useful
| data point, but it doesn't tell the whole story.
|
| From what we've seen, yes, the mortality rate of COVID19 is
| similar to the flu. However, the mortality rate of the flu is
| without other interventions aside from the flu vaccine. In a
| regular flu season the public doesn't social distance; they
| tend to group even closer indoors because of the cold weather.
| The US has never normalized mask wearing; people in the
| beginning stages of the flu will go about their lives, and work
| places actively encourage people to continue to work in-person
| unless they are too unwell to do so. I would wager most people
| in the US don't improve their hygiene during a regular flu
| season either. We've done all that (to an extent) with COVID19
| and we've barely managed to make an impact.
|
| Look at some other important data points. Average US flu deaths
| / year: 36k [1]. COVID19 deaths in the US in only 11 months:
| 445k. [2] If we assume the first COVID19 death in the US was in
| early February as some report, that's over 12x the deaths/year
| than the flu. If current trends hold (~3k deaths/day for the
| next 27 days) until March 2 (the first officially confirmed
| COVID19 death in the US), we'd be at 526k deaths, or more than
| 14x as many deaths/year as the flu. If this ran at this rate
| for the entirety of the next 365 days, we'd hit nearly 1.1
| million deaths, or over 30x as many deaths/year as the flu.
| That's assuming we don't have any massive improvements with
| vaccine rollout.
|
| The contagiousness of the two is also orders of magnitude
| different. Flu is estimated to have an R0 value of ~1.5 [3].
| Some estimates put COVID19 at an R0 value of 5.7 [4].
| (Remember, R0 is without interventions). The way to estimate
| "herd immunity" rates is the Critical Vaccination Threshold
| formula: (1 - (1/R0)) / E, where E is the effectiveness of a
| vaccine. With an R0 of 1.5 and an efficacy of 67% (from your
| second link. Remember, this is the effectiveness of the
| vaccine, not the effectiveness in a real-world population,
| which factors in vaccine rates), we would need roughly 50% of
| the population to vaccinated to start preventing illnesses in
| those that are unvaccinated. With an R0 of 5.7 and an efficacy
| of 94% (Pfizer vaccine), COVID 19 would require nearly 88% of
| the population vaccinated to achieve the same rate. Even using
| the lower-quoted R0 value of 2.5 (R-value _with_ other
| interventions, such as social distancing, mask wearing,
| improved hygiene), we'd need nearly 64% of the population
| vaccinated.
|
| You're also ignoring the fact that, despite our interventions,
| there are currently 3 other strains of COVID19 spreading, all
| of which are speculated to be both more contagious _and_ more
| deadly. [5] While the current vaccines are _effective enough_
| against the strains, there's nothing saying a new variant
| couldn't emerge that is resistant to the current vaccines,
| starting a new pandemic. And you're also ignoring the long-term
| cases of COVID19 [6] as well as the long term effects post-
| infection outside of death [7], including chronic
| cardiovascular damage, kidney damage, neurological effects,
| among many others.
|
| So yes, the mortality rates are similar, but literally nothing
| else is. We don't know enough about this virus to let it run
| rampant, and the world should have done more from the get-go to
| keep it contained.
|
| [1]: https://www.cdc.gov/flu/about/burden/past-seasons.html
|
| [2]: https://covid.cdc.gov/covid-data-tracker/#datatracker-home
|
| [3]:
| https://www.vdh.virginia.gov/coronavirus/2020/12/07/covid-19...
|
| [4]: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
|
| [5]: https://en.wikipedia.org/wiki/Variants_of_SARS-CoV-2
|
| [6]: https://en.wikipedia.org/wiki/Long_COVID
|
| [7]:
| https://en.wikipedia.org/wiki/Coronavirus_disease_2019#Longe...
| Robin_Message wrote:
| The wikipedia page you reference gives all-age mortality of
| 0.096% for the US 18-19 flu season.
|
| So, with your 0.3%-3% CFR, Covid-19 is three to thirty times as
| deadly as flu. Call it ten times as deadly; it is also more
| virulent (R0 of 1.4 vs 3-5 for Covid-19).
|
| That's why it is being treated more seriously than flu.
| inglor_cz wrote:
| CFR isn't the main problem about Covid, the 5 per cent of cases
| that end up in hospital is - and for how long they stay there.
|
| People with bad cases of Covid routinely spend weeks in ICU
| before they either get better or die. This is an enormous
| workload for doctors and nurses.
|
| Also, we do not know for sure how long haulers will fare. I
| myself had heart arrythmia after an otherwise very mild case of
| Covid. Fortunately, a simple beta blocker helped me and there
| are no traces of anything worse on my heart, but the doctors
| that took care of me told me that they have a surge of youngish
| patients with myocarditis and similar problems. Some of those
| are actually sportsmen.
| DeRock wrote:
| > Influenza typically has a mortality of around 0.8%
|
| The Wikipedia article has a graph, which I assume you're
| referring to with this figure, which shows the mortality rate
| of 0.8% only applies to those ages 65+. The blended rate for a
| typical flu season, given in a table below, is <0.1%.
| firebaze wrote:
| This is the (approximately) same graph for covid19 patients.
| If influenza was a "new" disease to the immune system of
| western people, it quite probably would be way more deadly.
| Original american natives would probably agree.
| mcguire wrote:
| " _The CFR of influenza..._ "
|
| Case Fatality Rate, in case anyone else lost their acronyms.
|
| According to worldometers.info, the US has reported 27,101,847
| cases of COVID19 and 460,398 deaths, giving a CFR of about
| 1.70%, so that's about right.
|
| I have reservations about your influenza mortality number of
| 0.8%. Most of the numbers I've seen have been significantly
| lower. If you look at [1], there were an estimated 29,000,000
| _symptomatic_ cases of influenza in the US in 2016 and an
| estimated 38,000 deaths, giving an estimated CFR of 0.1%,
| including any effects of vaccination. Correcting for
| vaccination and making the assumption that everyone were
| vaccinated, that would result in a unvaccinated CFR of around
| 0.2-0.3, right?
|
| " _If you disagree, please be so kind and educate me why._ "
|
| We've been dealing with COVID19 for about a year, no? We've had
| 27,000,000 cases and 460,000 deaths, right? That's about the
| same number of cases and _10x_ the number of deaths.
|
| You may not be trying to downplay COVID19, but I suspect you
| are doing it.
|
| [1]
| https://en.wikipedia.org/wiki/United_States_influenza_statis...
| godtoldmetodoit wrote:
| One thing I hope we take away from this is that just like we way
| over provision food production here in the States as a matter of
| national security, we should build out massive amounts of vaccine
| manufacturing capability.
|
| The federal government should massively invest in MRNA
| manufacturing or whatever other vaccine technologies make the
| most sense and lease the facilities out at a loss if need be to
| pharma during normal times. Or just subsidize pharma to have
| massive amounts of capacity ready to churn out 5-10 million doses
| a day. I don't really care how it happens, I just want the
| capability as a society and I'm willing to pay for it.
| m-ee wrote:
| This already exists, it's called BARDA
| peytn wrote:
| We could have a futures market for doses. That way the
| government doesn't have to pick winners in the drug development
| arena, something it historically isn't very good at.
| maxerickson wrote:
| We could have ordered 300 million courses each of the top 5
| or 10 vaccine candidates for, in essence, peanuts.
|
| $2 billion for Oxford.
|
| $3 billion for J&J.
|
| $20 billion for Novavax.
|
| $24 billion for Pfizer (at worst price).
|
| $48 billion for Moderna (again, worst price).
|
| You end up with a billion vaccines you don't need, you give
| them away.
|
| This is likely an over-investment if you consider the US in
| isolation (for instance, all 5 vaccines work well to reduce
| symptomatic and serious infections).
| atleta wrote:
| It's partially a transient problem: mRNA vaccines is new
| technology that has never seen commercial use, so it's expected
| that initially you'll have production capacity problems. (Not
| to say that countries should not prepare for future pandemics.)
___________________________________________________________________
(page generated 2021-02-03 23:01 UTC)