Jan 22, 2021Liked by Claire Berlinski, Rachel motte
“ The solution is simple. The United States must finance and coordinate vaccination programs around the world. The implementation will be complicated, which is precisely why there must be a single coordinating power.”
Finance, maybe. Coordinate, think about that some more. In the US, fifty states are conducting fifty experiments to see how vax rollout should work. Some are doing fine. Others not so well. What if the “single coordinating power” gets it wrong?
Here’s how not to do it, as reported to me by a relative who got shot yesterday in the Bronx NY. (Vaccine shot, not street violence, the other epidemic).
The community health center they visited requires appointments. They schedule 12 appointments for “qualified” people in a single time block apparently because there are 12 doses of vaccine in each package. They also allow walk-ins if someone doesn’t keep their appointment.
To prevent waste of vaccine doses they won’t thaw a vial of vaccine unless they are certain they can use it all. When they have 12 people present — in the room — they proceed. If they don’t have 12 people present, they stop the process until they can find enough people to use all 12 doses.
Imagine what happens if it takes a while to find the 12th person and someone who has made an appointment (and is present) has to go to work. Now they need to find someone to fill that slot as well.
That’s how my relative got vaccinated. Someone who made an appointment didn’t show up. Some one who was waiting for their shot called my relative and told them to come running. Those waiting couldn’t be vaccinated until there were 12 people in the room. An hour later my relative arrived with two other people in tow. They arrived just before closing and got the vaccine.
And that’s the other thing. The health center closed for the day at 5:00 pm. They keep normal 9 to 5 hours....even during an emergency.
Claire, careful what you wish for. The “central coordinating power” in NYC (or state?) needs to go back to the drawing board. The system they designed isn’t working - fast enough.
Jan 21, 2021Liked by Claire Berlinski, Rachel motte
Learned a lot here! Definitely interesting to learn more about Russia and China's vaccines. Tying back to your previous pieces on China, hoping Biden agrees with you and makes the right call in his foreign policy. It's going to be essential to show leadership here. We have a moral duty to resist Chinese hegemony so long as China is controlled by the CCP, which has proven its willingness to enslave and torture its own citizens, and as we see here, subject foreign populations to hastily-developed vaccines that they don't trust to use on their Han majority.
Jan 21, 2021Liked by Claire Berlinski, Rachel motte
Very informative. I think you’re a little too pessimistic about the adenovirus-vector vaccines. We will hear about the J&J vaccine any day now; if it’s effective at one dose it would be the greatest thing since sliced bread. The AZ vaccine is (as of now a two dose vaccine). Sadly, AZ screwed up their Phase III trial so no one really knows what the most efficacious first dose is.
It is true that the adenovirus vector can probably only be given once, but depending on the durability of protection this might not be a problem. If it protects for a decade or more (which is possible but not certain) there’s no need to worry about whether the vector can only be administered once.
Another advantage to the adenovirus vaccines is that long term (or semi long term) safety data is available. While the mRNA vaccines are literally brand new, J&J uses the exact same technology in its Covid vaccine that it uses in its Ebola vaccine. Around 1 million J&J Ebola vaccines have been delivered in Africa with practically no safety issues. The mRNA vaccines are almost certainly safe, but it’s hard to know for sure.
There’s a third vaccine technology that wasn’t mentioned (unless I missed it)-the protein based vaccines. Novavax has one and so does Sanofi (working in partnership with GSK). Basically they provide immunity by exposing the immune system to synthetically manufactured spike protein. These vaccines tend to be weaker so they are paired with chemicals called adjuvants which make the immune system hyper vigilant. The new Shingles vaccine (Shingrix) is this type of vaccine.
Mutation of the virus is something to worry about but not panic about. Most (not all) produce immunity not by priming the immune system to recognize the entire spike protein but by priming the immune system to recognize a part of the spike protein called the receptor binding domain (the part of spike protein which chemically attached itself to the ACE2 receptor found ubiquitously on cells in the human lung, nasal passages and bowel). The receptor binding domain is probably somewhat less likely to mutate.
What regulatory agencies have gotten wrong is the emphasis on development of symptomatic disease as the primary end point in the trials. I think it makes much more sense to focus on whether the vaccines prevent severe disease, hospitalization or death. After all, if the vaccines turn a deadly disease into the sniffles, that would be pretty good.
Claire is right; the United States is ideally suited to vaccinating the world. In fact our country has played the most important role in vaccine development. While Claire can’t bring herself to admit it, the Trump Administration’s Operation Warp Speed was a brilliant and unparalleled success. Most (not Pfizer) companies in the West with the most promising vaccines took warp speed money.
It also pays to remember that the only reason that the world is blessed with a viable and dynamic pharmaceutical and biotech industry is because American patients pay almost all the freight for R&D. Almost every successful pharmaceutical company in the world undertakes the remarkably risky research needed to produce new medicines because most of their profit comes from prices paid by Americans. If Pharma ha to rely on drug prices paid by Europeans, Canadians, Australians and all the nations in Asia, the business would not be profitable enough to justify the risks. In this sense, Claire, Americans are already footing the Bill for almost all Covid vaccine discovery efforts.
Last year, the House of Representatives passed a Bill which would have severely restricted drug prices. Speaker Pelosi was a fierce advocate of the Bill. In the Senate, a less onerous but still destructive Bill was introduced.
This was one case where gridlock proved to be a great thing. Does anyone think we would have gotten Covid vaccines (not to mention new antibody treatments) so rapidly if the Pharmaceutical industry had tens of billions of dollars in reduced revenues?
As for getting shots in the arm, most American States have failed miserably. So have all European nations (with the possible exception of the UK). The only country getting it right is Israel. As of today, Israel is offering vaccines to citizens aged 40 and up. Maybe our leaders should call Benjamin Netanyahu for advice.
“ The solution is simple. The United States must finance and coordinate vaccination programs around the world. The implementation will be complicated, which is precisely why there must be a single coordinating power.”
Finance, maybe. Coordinate, think about that some more. In the US, fifty states are conducting fifty experiments to see how vax rollout should work. Some are doing fine. Others not so well. What if the “single coordinating power” gets it wrong?
Here’s how not to do it, as reported to me by a relative who got shot yesterday in the Bronx NY. (Vaccine shot, not street violence, the other epidemic).
The community health center they visited requires appointments. They schedule 12 appointments for “qualified” people in a single time block apparently because there are 12 doses of vaccine in each package. They also allow walk-ins if someone doesn’t keep their appointment.
To prevent waste of vaccine doses they won’t thaw a vial of vaccine unless they are certain they can use it all. When they have 12 people present — in the room — they proceed. If they don’t have 12 people present, they stop the process until they can find enough people to use all 12 doses.
Imagine what happens if it takes a while to find the 12th person and someone who has made an appointment (and is present) has to go to work. Now they need to find someone to fill that slot as well.
That’s how my relative got vaccinated. Someone who made an appointment didn’t show up. Some one who was waiting for their shot called my relative and told them to come running. Those waiting couldn’t be vaccinated until there were 12 people in the room. An hour later my relative arrived with two other people in tow. They arrived just before closing and got the vaccine.
And that’s the other thing. The health center closed for the day at 5:00 pm. They keep normal 9 to 5 hours....even during an emergency.
Claire, careful what you wish for. The “central coordinating power” in NYC (or state?) needs to go back to the drawing board. The system they designed isn’t working - fast enough.
Learned a lot here! Definitely interesting to learn more about Russia and China's vaccines. Tying back to your previous pieces on China, hoping Biden agrees with you and makes the right call in his foreign policy. It's going to be essential to show leadership here. We have a moral duty to resist Chinese hegemony so long as China is controlled by the CCP, which has proven its willingness to enslave and torture its own citizens, and as we see here, subject foreign populations to hastily-developed vaccines that they don't trust to use on their Han majority.
Very informative. I think you’re a little too pessimistic about the adenovirus-vector vaccines. We will hear about the J&J vaccine any day now; if it’s effective at one dose it would be the greatest thing since sliced bread. The AZ vaccine is (as of now a two dose vaccine). Sadly, AZ screwed up their Phase III trial so no one really knows what the most efficacious first dose is.
It is true that the adenovirus vector can probably only be given once, but depending on the durability of protection this might not be a problem. If it protects for a decade or more (which is possible but not certain) there’s no need to worry about whether the vector can only be administered once.
Another advantage to the adenovirus vaccines is that long term (or semi long term) safety data is available. While the mRNA vaccines are literally brand new, J&J uses the exact same technology in its Covid vaccine that it uses in its Ebola vaccine. Around 1 million J&J Ebola vaccines have been delivered in Africa with practically no safety issues. The mRNA vaccines are almost certainly safe, but it’s hard to know for sure.
There’s a third vaccine technology that wasn’t mentioned (unless I missed it)-the protein based vaccines. Novavax has one and so does Sanofi (working in partnership with GSK). Basically they provide immunity by exposing the immune system to synthetically manufactured spike protein. These vaccines tend to be weaker so they are paired with chemicals called adjuvants which make the immune system hyper vigilant. The new Shingles vaccine (Shingrix) is this type of vaccine.
Mutation of the virus is something to worry about but not panic about. Most (not all) produce immunity not by priming the immune system to recognize the entire spike protein but by priming the immune system to recognize a part of the spike protein called the receptor binding domain (the part of spike protein which chemically attached itself to the ACE2 receptor found ubiquitously on cells in the human lung, nasal passages and bowel). The receptor binding domain is probably somewhat less likely to mutate.
What regulatory agencies have gotten wrong is the emphasis on development of symptomatic disease as the primary end point in the trials. I think it makes much more sense to focus on whether the vaccines prevent severe disease, hospitalization or death. After all, if the vaccines turn a deadly disease into the sniffles, that would be pretty good.
Claire is right; the United States is ideally suited to vaccinating the world. In fact our country has played the most important role in vaccine development. While Claire can’t bring herself to admit it, the Trump Administration’s Operation Warp Speed was a brilliant and unparalleled success. Most (not Pfizer) companies in the West with the most promising vaccines took warp speed money.
It also pays to remember that the only reason that the world is blessed with a viable and dynamic pharmaceutical and biotech industry is because American patients pay almost all the freight for R&D. Almost every successful pharmaceutical company in the world undertakes the remarkably risky research needed to produce new medicines because most of their profit comes from prices paid by Americans. If Pharma ha to rely on drug prices paid by Europeans, Canadians, Australians and all the nations in Asia, the business would not be profitable enough to justify the risks. In this sense, Claire, Americans are already footing the Bill for almost all Covid vaccine discovery efforts.
Last year, the House of Representatives passed a Bill which would have severely restricted drug prices. Speaker Pelosi was a fierce advocate of the Bill. In the Senate, a less onerous but still destructive Bill was introduced.
This was one case where gridlock proved to be a great thing. Does anyone think we would have gotten Covid vaccines (not to mention new antibody treatments) so rapidly if the Pharmaceutical industry had tens of billions of dollars in reduced revenues?
As for getting shots in the arm, most American States have failed miserably. So have all European nations (with the possible exception of the UK). The only country getting it right is Israel. As of today, Israel is offering vaccines to citizens aged 40 and up. Maybe our leaders should call Benjamin Netanyahu for advice.