Category: Current Affairs
Yes, the CFO of Huawei. She has been held under house arrest by Canada since December 2018, under the supposition that she will be extradited to the United States to face trial. Don’t we believe in something like a right to a fair and speedy trial? Can she get that at this point?
I am not pleading for her innocence, rather this is a major foreign policy and tactical mistake. How would the United States react if China held say Bill Gates, on the grounds that he had violated some extraterritorial Chinese law? The U.S.-China relationship is the world’s most important, so why are we partially wrecking it over such a matter?
It is also an erosion of the rule of law in the United States and Canada. You might plead “independent judiciary,” but when American law “goes extraterritorial,” as it has in this case, there are so many potential cases that the selection of charges and extradition requests cannot help but be political. How many other people have acted to “conspire to circumvent U.S. sanctions against Iran”, as are the charges here? Are they all being detailed and held? This dilemma is a good reason to limit the reach of American law into extraterritorial matters, namely that there is no objective way to apply the law fairly and impartially against a very large number of (possible) foreign perpetrators operating overseas. We go after corrupt soccer officials abroad but not corrupt chess officials at FIDE?
There is plenty of evidence (Bloomberg) that North American politicians have been interfering in this matter already, so to cancel the charges and release her would hardly be soiling our constitutional innocence. Best would be if the Canadian government would step in and end the mess.
To be clear, I am supportive of the United States working very hard to make sure its allies do not install Huawei communications equipment, as that could compromise their and our national security. Still, that is not the issue here and so it is time to free Meng Wanzhou.
Meanwhile in the non-ideological regions of the culture the deepening of decadence seems assured. The pandemic has (further) weakened every cultural institution that relies on physical presence, spontaneity and localized or mid-sized audiences, which means basically all of them except the “content” industry, the ever-expanding realm of Peak TV. The spirit of Mustapha Mond presides over the Covid era: He waved his hand; and it was as though, with an invisible feather wisk, he had brushed away a little dust, and the dust was museums, was symphonies; some spider-webs, and they were ballets and bookstores and Broadway theatricals. Whisk. Whisk—and where was the mid-size daily newspaper, the regional university, the local Protestant congregation, the urban Catholic school. Whisk—the place where the local movie theater had been empty. Whisk, the touring pop music acts, whisk, the minor league baseball teams, whisk, whisk ..
I know, I know: We can make art on the blockchain now, and do journalism on Substack, and host salons on Clubhouse.
But if these are the seeds of renaissance, I expect things to get worse before they get better.
Here is the full post, ungated, Ross will be doing free Substack for a limited time. Ross’s The Decadent Society is coming out soon in paperback, and it a new subtitle and Ross says plenty of new and original material.
Here goes, here is one good excerpt of many:
Isaac Asimov’s New Guide to Science. I read that when I was 13 or 14 and thought it was just amazing. (I was an exchange student in Germany at the time. I didn’t learn much German but I did have my eyes opened to many aspects of science that I previously knew nothing about!) Some of John Gribbin’s books, like In Search of Schrödinger’s Cat, really inspired me. Douglas Hofstadter — especially Metamagical Themas. (I read GEB when I was a teenager but found it a bit of a slog.) But, honestly, I think I was always interested in creating technology to some extent. I spent hours and hours playing with Lego when I was young and then transitioned pretty quickly to programming. I remember being pretty certain that I’d love programming before I’d ever written a line of code and, sure enough, I did. So, maybe it’s just something about how my mind is wired.
Overall, my single biggest science policy suggestion would be to pursue far greater structural diversity in our mechanisms. More different kinds of grant making institutions, more different kinds of research organizations, more different career paths for participants, etc. That’s not easy to do — bureaucracies by their nature seek to standardize which this fosters homogeneity. So, to the extent that the Endless Frontier Act can bring us closer to a more structurally varied world, I’m probably supportive relative to the status quo. My biggest qualm would probably be that it combines regional development policy with scientific policy. While the political merit is easy to see, I’m not sure that that’s a good idea. Talent clusters are real and I think it probably makes more sense to think about how best to improve those clusters than it does to foster underdog competitors.
Recommended, interesting throughout.
One objection to dose-stretching policies, such as delaying the second dose or using half-doses, is that this might increase the risk of mutation. While possible, some immunologists and evolution experts are now arguing that dose-stretching will probably reduce mutation risk which is what Tyler and I concluded. Here’s Tyler:
One counter argument is that letting “half-vaccinated” people walk around will induce additional virus mutations. Florian Kramer raises this issue, as do a number of others.
Maybe, but again I wish to see your expected value calculations. And in doing these calculations, keep the following points in mind:
a. It is hard to find vaccines where there is a recommendation of “must give the second dose within 21 days” — are there any?
b. The 21-day (or 28-day) interval between doses was chosen to accelerate the completion of the trial, not because it has magical medical properties.
c. Way back when people were thrilled at the idea of Covid vaccines with possible 60% efficacy, few if any painted that scenario as a nightmare of mutations and otherwise giant monster swarms.
d. You get feedback along the way, including from the UK: “If it turns out that immunity wanes quickly with 1 dose, switch policies!” It is easy enough to apply serological testing to a control group to learn along the way. Yes I know this means egg on the face for public health types and the regulators.
e. Under the status quo, with basically p = 1 we have seen two mutations — the English and the South African — from currently unvaccinated populations. Those mutations are here, and they are likely to overwhelm U.S. health care systems within two months. That not only increases the need for a speedy response, it also indicates the chance of regular mutations from the currently “totally unvaccinated” population is really quite high and the results are really quite dire! If you are so worried about hypothetical mutations from the “half vaccinated” we do need a numerical, expected value calculation comparing it to something we already know has happened and may happen yet again. When doing your comparison, the hurdle you will have to clear here is very high.
(See my Washington Post piece for similar arguments and additional references.).
Now here are evolutionary theorists, immunologists and viral experts Sarah Cobey, Daniel B. Larremore, Yonatan H. Grad, and Marc Lipsitch in an excellent paper that first reviews the case for first doses first and then addresses the escape argument. They make several interrelated arguments that a one-dose strategy will reduce transmission, reduce prevalence, and reduce severity and that all of these effects reduce mutation risk.
The arguments above suggest that, thanks to at least some effect on transmission from one dose, widespread use of a single dose of mRNA vaccines will likely reduce infection prevalence…
The reduced transmission and lower prevalence have several effects that individually and together tend to reduce the probability that variants with a fitness advantage such as immune escape will arise and spread (Wen, Malani, and Cobey 2020). The first is that with fewer infected hosts, there are fewer opportunities for new mutations to arise—reducing available genetic variation on which selection can act. Although substitutions that reduce antibody binding were documented before vaccine rollout and are thus relatively common, adaptive evolution is facilitated by the appearance of mutations and other rearrangements that increase the fitness benefit of other mutations (Gong, Suchard, and Bloom 2013; N. C. Wu et al. 2013; Starr and Thornton 2016). The global population size of SARS-CoV-2 is enormous, but the space of possible mutations is larger, and lowering prevalence helps constrain this exploration. Other benefits arise when a small fraction of hosts drives most transmission and the effective reproductive number is low. Selection operates less effectively under these conditions: beneficial mutations will more often be lost by chance, and variants with beneficial mutations are less certain to rise to high frequencies in the population (Desai, Fisher, and Murray 2007; Patwa and Wahl 2008; Otto and Whitlock 1997; Desai and Fisher 2007; Kimura 1957). More research is clearly needed to understand the precise impact of vaccination on SARS-CoV-2 evolution, but multiple lines of evidence suggest that vaccination strategies that reduce prevalence would reduce rather than accelerate the rate of adaptation, including antigenic evolution, and thus incidence over the long term.
In evaluating the potential impact of expanded coverage from dose sparing on the transmission of escape variants, it is necessary to compare the alternative scenario, where fewer individuals are vaccinated (but a larger proportion receive two doses) and more people recover from natural infection. Immunity developing during the course of natural infection, and the immune response that inhibits repeat infection, also impose selection pressure. Although natural infection involves immune responses to a broader set of antibody and T cell targets compared to vaccination, antibodies to the spike protein are likely a major component of protection after either kind of exposure (Addetia et al. 2020; Zost et al. 2020; Steffen et al. 2020), and genetic variants that escape polyclonal sera after natural infection have already been identified (Weisblum et al. 2020; Andreano et al. 2020). Studies comparing the effectiveness of past infection and vaccination on protection and transmission are ongoing. If protective immunity, and specifically protection against transmission, from natural infection is weaker than that from one dose of vaccination, the rate of spread of escape variants in individuals with infection-induced immunity could be higher than in those with vaccine-induced immunity. In this case, an additional advantage of increasing coverage through dose sparing might be a reduction in the selective pressure from infection-induced immunity.
…In the simplest terms, the concern that dose-sparing strategies will enhance the spread of immune escape mutants postulates that individuals with a single dose of vaccine are those with the intermediate, “just right” level of immunity, more likely to evolve escape variants than those with zero or two doses (Bieniasz 2021; Saad-Roy et al. 2021)….There is no particular reason to believe this is the case. Strong immune responses arising from past infection or vaccination will clearly inhibit viral replication, preventing infection and thus within-host adaptation…. Past work on influenza has found no evidence of selection for escape variants during infection in vaccinated hosts (Debbink et al. 2017). Instead, evidence suggests that it is immunocompromised hosts with prolonged influenza infections and high viral loads whose viral populations show high diversity and potentially adaptation (Xue et al. 2017, 2018), a phenomenon also seen with SARS-CoV-2 (Choi et al. 2020; Kemp et al. 2020; Ko et al. 2021). It seems likely, given its impact on disease, that vaccination could shorten such infections, and there is limited evidence already that vaccination reduces the amount of virus present in those who do become infected post-vaccination (Levine-Tiefenbrun et al. 2021).
I also very much agree with these more general points:
The pandemic forces difficult choices under scientific uncertainty. There is a risk that appeals to improve the scientific basis of decision-making will inadvertently equate the absence of precise information about a particular scenario with complete ignorance, and thereby dismiss decades of accumulated and relevant scientific knowledge. Concerns about vaccine-induced evolution are often associated with worry about departing from the precise dosing intervals used in clinical trials. Although other intervals were investigated in earlier immunogenicity studies, for mRNA vaccines, these intervals were partly chosen for speed and have not been completely optimized. They are not the only information on immune responses. Indeed, arguments that vaccine efficacy below 95% would be unacceptable under dose sparing of mRNA vaccines imply that campaigns with the other vaccines estimated to have a lower efficacy pose similar problems. Yet few would advocate these vaccines should be withheld in the thick of a pandemic, or roll outs slowed to increase the number of doses that can be given to a smaller group of people. We urge careful consideration of scientific evidence to minimize lives lost.
Is that what they should call it? In any case, for all the bickering over inflation, the real news to me is that the Republicans just didn’t try very hard to fight it. Partly they are left with few good arguments after their own fiscal profligacy. Partly they are consumed with their own internal squabbles. And partly their own pollsters/advisors told them the thing is going to be pretty popular, at least initially and perhaps always.
In my view, this is the watershed event for entering a new era of politics. Polarization in the old sense peaked in 2011 or so. I call the new regime “Democrats can get a lot done if they soft pedal it, veer away from the mood affiliation, pretend they do not control the presidency, and stick to ideas that are popular.”
We’ll see how long that lasts, but I think for at least another year.
The mayor of Detroit has turned down an allocation of the J&J vaccine.
Detroit Mayor Mike Duggan declined an initial allocation of the newly authorized Johnson & Johnson Covid-19 vaccine….”So, Johnson & Johnson is a very good vaccine. Moderna and Pfizer are the best. And I am going to do everything I can to make sure the residents of the city of Detroit get the best,” Duggan said during a news conference Thursday.
Sigh. What an error. Note, however, that the Detroit Mayor rejecting the J&J vaccine is exactly what the FDA has done with the AstraZeneca vaccine. Moreover none other than Anthony Fauci made exactly the same argument about AstraZeneca (an argument I criticized at the time):
But even if the vaccine ends up being approved, it will probably only have an efficacy of 60 to 70 percent. “What are you going to do with the 70 percent when you’ve got two (vaccines) that are 95 percent? Who are you going to give a vaccine like that to?” Anthony Fauci, the leading American expert on vaccines, recently wondered.
To be clear, I don’t blame Fauci for the actions of Detroit Mayor Mike Duggan. Duggan would probably have said the same had Fauci never made his error. Indeed, perhaps you might even read this as excusing Duggan (if even Fauci, “the leading American expert on vaccines”, could make this error then…).
Still, Fauci’s error has been much more costly for the United States.
Hat tip: JF.
Crazy, but then I am reminded that one year ago Britain’s Advertisement Standards Authority banned advertisements for masks ruling that:
Public Health England did not recommend the use of face masks as a means of protection from coronavirus. We understood there was very little evidence of widespread benefit from their use outside of clinical settings, and that prolonged use of masks was likely to reduce compliance with good universal hygiene behaviours that were recommended to help stop the spread of infectious diseases (including coronavirus), such as frequent hand washing and avoiding touching the eyes, nose and mouth with unwashed hands. We considered that the reference to “coronavirus” in the listing was likely to exploit people’s fears regarding the coronavirus outbreak. Particularly in a context where the relevant public health authority had not recommended face masks as a means of the public protecting themselves from coronavirus, we considered that the ad was misleading, irresponsible and likely to cause fear without justifiable reason.
We concluded that the ad breached the Code.
A good reminder that advertising bans have costs and benefits. I prefer the 1st Amendment which also has costs and benefits.
Hat tip: Steven Hamilton.
Canada’s National Advisory Committee on Immunization (NACI), a scientific advisory group to the government, has made a forceful and dramatic statement strongly favoring First Doses First (delay the second dose.) This is a very big deal for the entire world. Basically NACI have endorsed everything that Tyler and I have said on First Doses First since my first post tentatively raised the issue on December 8. I am going to quote this statement extensively since it’s an excellent summary. No indentation.
Based on emerging evidence of the protection provided by the first dose of a two dose series for COVID-19 vaccines currently authorized in Canada, NACI recommends that in the context of limited COVID-19 vaccine supply jurisdictions should maximize the number of individuals benefiting from the first dose of vaccine by extending the second dose of COVID-19 vaccine up to four months after the first. NACI will continue to monitor the evidence on effectiveness of an extended dose interval and will adjust recommendations as needed. (Strong NACI Recommendation)
- In addition to emerging population-based data, this recommendation is based on expert opinion and the public health principles of equity, ethics, accessibility, feasibility, immunological vaccine principles, and the perspective that, within a global pandemic setting, reducing the risk of severe disease outcomes at the population-level will have the greatest impact. Current evidence suggests high vaccine effectiveness against symptomatic disease and hospitalization for several weeks after the first dose, including among older populations.
- By implementing an extended four month interval strategy, Canada will be able to provide access to first doses of highly efficacious vaccines to more individuals earlier which is expected to increase health equity faster. Canada has secured enough vaccines to ensure that a second dose will be available to every adult.
- As a general vaccination principle, interruption of a vaccine series resulting in an extended interval between doses does not require restarting the vaccine series. Principles of immunology, vaccine science, and historical examples demonstrate that delays between doses do not result in a reduction in final antibody concentrations nor a reduction in durability of memory response for most multi-dose products.
- Assessment of available data on efficacy and effectiveness of a single dose of mRNA vaccine was a critical factor in assessing the impact of a delayed second dose at this time. The two available clinical trials for mRNA vaccines (Pfizer-BioNTech and Moderna) provide evidence that indicates that efficacy against symptomatic disease begins as early as 12 to 14 days after the first dose of the mRNA vaccine. Excluding the first 14 days before vaccines are expected to offer protection, both vaccines showed an efficacy of 92% up until the second dose (most second doses were administered at 19-42 days in the trials). Recently, real world vaccine effectiveness data presented to or reviewed by NACI assessing PCR-positive COVID-19 disease and/or infection from Quebec, British Columbia, Israel, the United Kingdom and the United States support good effectiveness (generally 70-80%, depending on the methodology used and outcomes assessed) from a single dose of mRNA vaccines (for up to two months in some studies). While studies have not yet collected four months of data on effectiveness of the first dose, the first two months of population-based effectiveness data are showing sustained and high levels of protection. These data include studies in health care workers, long term care residents, elderly populations and the general public. While this is somewhat lower than the efficacy demonstrated after one dose in clinical trials, it is important to note that vaccine effectiveness in a general population setting is typically lower than efficacy from the controlled setting of a clinical trial, and this is expected to be the case after series completion as well.
- Published data from the AstraZeneca clinical trial indicated that delaying the second dose to ≥ 12 weeks resulted in a better efficacy against symptomatic disease compared to shorter intervals between doses.
- The duration of protection from one or two doses of COVID-19 vaccines is currently unknown. Experience with other multi-dose vaccines after a single dose suggests persistent protection could last for six months or longer in adolescents and adults. Longer-term follow-up of clinical trial participants and those receiving vaccination in public programs will assist in determining the duration of protection following both one and two doses of vaccination. NACI will continue to monitor the evidence on effectiveness of an extended interval, which is currently being collected weekly in some Canadian jurisdictions, and will adjust recommendations as needed if concerns emerge about waning protection.
- Although effectiveness after two-doses will be somewhat higher than with one dose, many more people will benefit from immunization when extending the interval between doses in times of vaccine shortage; offering more individuals direct benefit and also the possibility of indirect benefit from increasing population immunity to COVID-19 disease. Everyone is expected to obtain the full benefit of two doses when the second dose is offered after 4 months.
- Internal PHAC modelling reviewed by NACI based on Canadian supply projections suggested that accelerating vaccine coverage by extending dose intervals of mRNA vaccines could have short-term public health benefits in preventing symptomatic disease, hospitalizations, and deaths while vaccine supply is constrained. Even a theoretical scenario analysis in which intervals were extended up to six months and protection was lost at a rate of 4% per week after the first dose also showed that extending the mRNA vaccine dose intervals would still have public health benefits. External modelling results have also suggested that extending dose intervals can avert infections, hospitalizations and deaths.
- The impact on variants of concern by extending the interval between doses is unknown, but there is currently no evidence that an extended interval between doses will either increase or decrease the emergence of variants of concern. COVID-19 mRNA vaccines and AstraZeneca vaccine have shown promising early results against variant B.1.1.7. As effectiveness of the first dose against other variants of concern is emerging, ongoing monitoring will be required.
- Vaccine distribution will be optimized through this strategy, and current vaccine supply projections will work well with an extended dose strategy that aims to immunize as many Canadians as efficiently as possible. Extending the dose intervals for mRNA vaccines up to four months has the potential to result in rapid immunization and protection of a large proportion of the Canadian population….
STAT is reporting a ‘scandal’:
The Trump administration quietly took around $10 billion from a fund meant to help hospitals and health care providers affected by Covid-19 and used the money to bankroll Operation Warp Speed contracts, four former Trump administration officials told STAT.
The NYTimes tried to create a similar scandal back in June when it reported on a diversion of funds to OWS from lung treatment research.
Coronavirus Attacks the Lungs. A Federal Agency Just Halted Funding for New Lung Treatments.
The shift, quietly disclosed on a government website, highlights how the Trump administration is favoring development of vaccines over treatments for the sickest patients.
My response at the time and today is the same. Good! The real scandal is why Congress never put big funding behind Operation Warp Speed–thus requiring the administration to fund OWS by surreptitiously cutting elsewhere. The Trump administration gets blamed for its inept handling of the pandemic but Congress is supposed to be in charge of the laws and the purse strings and Congress was an abysmal failure. Who in Congress lauded let alone funded Operation Warp Speed, the only big success of the pandemic response?
Here’s what I was shouting from the rooftops in June, Get BARDA More Money! It actually pains me to read this today because even a few extra billion then would have made a big difference.
The real scandal is how little we are spending on advanced research for vaccines–$2.2 billion is a pittance, less than a day’s worth of economic loss caused by COVID. Given their limited budget, BARDA is making good investments. Congress, however, has not allocated enough money to BARDA, one of the few agencies that had the foresight to do the right things, such as investing in emergency vaccine capacity, even before the pandemic hit. Congress’s failure to fund BARDA is why the administration is scraping the bottom of the barrel to get them all the funding they can.
We should go big, really big, on vaccines. But when I talk with people in Congress, I tell them that a big plan is ideal but if we can’t do that then at least GET BARDA MORE MONEY!
Addendum: The fact that BARDA can’t get enough funding from Congress in a pandemic is a good example of why we need a Pandemic Trust Fund.
Among young men, declines in drinking frequency, an increase in computer gaming, and the growing percentage who coreside with their parents all contribute significantly to the decline in casual sex. The authors find no evidence that trends in young adults’ economic circumstances, internet use, or television watching explain the recent decline in casual sexual activity.
The Canadian province of British Columbia has moved to First Doses First (as I suggested they would) with a four month (not three as in Great Britain) delay on the second dose. Quebec is already using FDF. I believe that the rest of Canada will follow shortly:
Also on Monday, the province announced it is extending the time between first and second doses of COVID-19 vaccine to four months. The change, as well as Health Canada’s approval of a third vaccine, means every eligible person in B.C. will receive the first dose of their vaccine by mid- to late July.
Provincial Health Officer Dr. Bonnie Henry said data from the B.C. Centre for Disease Control — and countries around the world such as the United Kingdom and New Zealand — shows “miraculous” protection of at least 90 per cent from the first dose of a Moderna or Pfizer-BioNTech vaccine.
She said the National Advisory Committee on Immunization is expected to issue a statement to align with B.C.’s decision, which frees up 70,000 doses for younger age groups.
“This is amazing news,” said Henry. “These vaccines work, they give a very high level of protection and that protection lasts for many months.”
As I wrote earlier:
… first doses first will save lives in the US but delaying the second dose and other dose-stretching policies are even more vital in countries [such as Canada] where vaccines supplies are more limited than in the United States.
Meanwhile in the United States we are vaccinating relatively quickly but in the last week we have given out more second doses than first doses. Overall, we have given out 25 million second doses–under first doses first we would have vaccinated 25 million more people benefiting them and the unvaccinated by lowering transmission rates.
The US FDA is not following the science.
A new study from Public Health England shows that both the Pfizer and AstraZeneca vaccine work well from the first dose. If that sounds familiar it’s because the results are similar to those found in Scotland. The results cover all adults in England aged 70 years and older (over 7.5 million people).
Vaccination with either a single dose of BNT162b2 or ChAdOx1 COVID-19 vaccination was associated with a significant reduction in symptomatic SARS-CoV2 positive cases in older adults with even greater protection against severe disease [approximately 80% effective at preventing hospitalisation, AT] . Both vaccines show similar effects. Protection was maintained for the duration of follow-up (>6 weeks). A second dose of BNT162b2 provides further protection against symptomatic disease but second doses of ChAdOx1 have not yet been rolled out in England. There is a clear effect of the vaccines against the UK variant of concern.
Score three for the land of Reverend Bayes: first doses first, approve AstraZeneca, approve AstraZeneca for the elderly.
The US FDA is not following the science.