[GavinB]

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.

[wahern]

> 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

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

[Robotbeat]

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).

[JamesBarney]

Why does natural infection allow us to rule out VADE while challenge trials don't?

[standardUser]

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]

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.

[jbullock35]

> 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-op...

[2] https://academic.oup.com/jid/article/221/11/1752/5814216

[Gatsky]

I don't think challenge trials would have really helped much. The issue is that obtaining an accurate estimate of vaccine efficacy in the real world is a crucial piece of information. There is a very large difference between a 95% effective and a 70% effective vaccine in terms of the roll out and who/how many need to be vaccinated. Additionally, challenge trials are fundamentally contrived in terms of the innoculum size and mode of transmission. There is no substitute for a proper randomised trial under native transmission conditions. Challenge trials would lead us into a long night of uncertainty about efficacy.

[WalterBright]

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.

[jimbokun]

> 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]

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...

[maxerickson]

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...

[Gatsky]

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_]

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.

[eloff]

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.

[milliondollar]

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?

[azangru]

> 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]

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.

[tass]

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]

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.

[chuckcode]

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

[JoeAltmaier]

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.

[Florin_Andrei]

> 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.

[sna1l]

+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...

[gus_massa]

> 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?

[Symmetry]

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.

[d7ryerh]

You make it sound as though no one would volunteer. I think you're severely underestimating the altruism of some people.

[ClumsyPilot]

People have voluntered for fucking one way trip to Mars. Maybe you think they are mad, but thats a different problem.