Tuesday assorted links
The Distribution of Vaccines in the 19th Century
Distributing a COVID vaccine to billions of people will be challenging. We will require vials, needles, cold storage, air travel, trained health care professionals and much more. The challenge of distributing a smallpox vaccine in the 19th century was even greater because aside from fewer resources the vaccine, cowpox, was geographically rare and infected humans only with difficulty. Moreover, the best method of storing the vaccine was in a person but that worked only until the person’s immune system defeated the virus. Thus, a relay-race of vaccine couriers was created to distribute the vaccine around the world.
In 1803, the [Spanish] king, convinced of the benefits of the vaccine, ordered his personal physician Francis Xavier de Balmis, to deliver it to the Spanish dominions in North and South America. To maintain the vaccine in an available state during the voyage, the physician recruited 22 young boys who had never had cowpox or smallpox before, aged three to nine years, from the orphanages of Spain. During the trip across the Atlantic, de Balmis vaccinated the orphans in a living chain. Two children were vaccinated immediately before departure, and when cowpox pustules had appeared on their arms, material from these lesions was used to vaccinate two more children.
The British tried the same thing to get the vaccine to India but heat and shipwrecks led to many failures until, as Andrea Rusnock writes, Jean De Carro successfully delivered live cowpox to Bombay from Vienna via Baghdad.
De Carro, a Genevan who had received his M.D. from Edinburgh and who practiced medicine in Vienna, became one of the staunchest supporters of Jenner on the continent. It was through De Carro’s effort that vaccination was introduced in Austria, Poland, Greece, and the cities of Venice and Constantinople. In a letter to Jenner, De Carro carefully described his successful shipping technique. First he saturated lint with cowpox lymph and then placed the lint between two pieces of glass, one concave, one flat. He then sealed it with oil. “To prevent the access of light,” De Carro continued, “I commonly fold it in a black paper, and when I was desired to send to Baghdad, I took the precaution of going to a wax-chandler’s, and surrounded the sealed-up glasses with so much wax as to make balls. With this careful manner it arrived still fluid on the banks of the Tigris.
In the United States, Thomas Jefferson also wanted to be vaccinated but after several failures to deliver live cowpox from the Harvard Medical School, “Jefferson designed a new container: An inner chamber would hold the fluid lymph, while a surrounding chamber, filled with cool water, insulated the lymph.”
[Later] President Thomas Jefferson gave some cow lymph to Meriwether Lewis and William Clark to take on their explorations west of the Mississippi River. Antoine Saugrain, the only practicing physician in St. Louis when Louisiana was purchased by the United States from France in 1803, received some cowpox lymph from Lewis and Clark and began to vaccinate individuals free of charge, including Native Americans. Saugrain’s free vaccination program established cowpox in the Mississippi valley roughly a decade after Jenner published his inquiry.
Talk about Operation Warp Speed!
Even when delivered, the vaccine had to be kept alive so each cohort of vaccinators was incentivized to provide the vaccine for the next cohort:
In Glasgow, parents had to put down a deposit of 1 shilling (1801) and later 2 shillings (1806) to be refunded only when the child was returned to the clinic [and more cowpox could then be extracted from the children’s lesions]. In Boston, Waterhouse resorted to paying parents to vaccinate their children in order to keep a supply of cowpox.
Occasionally, herd immunity would be reached but that meant there was no way to store the vaccine for the next generation! Physicians, therefore, looked to newly created institutes that shipped the vaccine by one method or another around the world.
Returning to the British and India, after cowpox was delivered through De Carro’s efforts to Baghdad an Armenian child was infected and lymph from his arm was taken to Basra where an East India Company surgeon established a an arm-to-arm relay race that brought cowpox to Bombay:
On 14 June, 1802, Anna Dusthall became the first person in India to be successfully vaccinated against smallpox. Little else is known about her, except that she was “remarkably good tempered”, according to the notes of the doctor who vaccinated her…The following week, five other children in Bombay were vaccinated with pus from Dusthall’s arm. From there, the vaccine travelled, most often arm-to-arm, across India to various British bases – Hyderabad, Cochin, Tellicherry, Chingleput, Madras and eventually, to the royal court of Mysore.
As today, there was fear and opposition to the vaccine, especially in India, because it was foreign, threatened local healers who used variolation, and the use of vaccine couriers meant that “the vaccine was passing through bodies of all races, religions, castes and genders, and that ran counter to unyielding Hindu notions of purity.”
To counter the opposition, the British started an advertising campaign featuring Indian royalty. The picture above, for example, according to one compelling interpretation shows three Indian queens of Mysore with the queen on the right prominently portraying her arm where she has been inoculated with cowpox while the older queen on the left shows the discoloration around the mouth associated with smallpox. Thus, the younger queen on the right symbolizes health, vigor and the value of British science.
The challenges of delivering a vaccine in the 19th century–storage, transportation, fear, and incentives–are surprisingly similar to the challenges we face today. The 19th century effort to deliver the smallpox vaccine was impressive. Within years of Jenner’s pamphlet, the vaccine had made its way around the world. The 21st century effort will need to be much larger. Our civilization has many more resources than that of the 19th century. I hope we can match their will and ingenuity.
How should America regulate TikTok and other Chinese tech companies?
I say focus on data protection but let them keep the algorithm. From my new Bloomberg column here is one excerpt:
A second principle for good policy is that the U.S. government should not cut off the U.S. — including of course Chinese Americans and visiting Chinese — from the Chinese internet. Let’s say TikTok and WeChat are banned altogether, along the lines of the (now court-halted) Trump executive order banning WeChat. Are all Chinese apps to be kept out of the country? How about clicking on Chinese links, which also could compromise security? Would Chinese newspapers (including from Hong Kong) be allowed?
The costs of these restrictions would be very high, most of all for Hong Kong, but for America too. Americans would become more ignorant about China, and China would fall out of touch with America. Chinese students and tourists would find it much more difficult to come to the U.S. and stay in touch with home, and as a result many of them would avoid the U.S. altogether. America’s world knowledge and soft power would decline. These too are major national security disadvantages, in addition to their economic costs.
More generally, China is America’s No. 1 trading partner. Can it really make sense to cut off the flow of so much information across the internet? For how long?
There is also a problem of enforcement. The rest of the world is unlikely to take a comparably harsh approach to Chinese technology. Will the U.S. also have to stop Americans from downloading an app from a privately owned joint Cambodian/Chinese company? Where exactly will these lines be drawn?
Regulating the algorithm won’t work, so the deal on the table, despite its ugly, politicized origins, is perhaps the best we can do at this point. There is much more at the link, and here is more from Elaine Ou at Bloomberg.
Unintended Consequences of Criminalizing Sex Work
We examine the impact of criminalizing sex work, exploiting an event in which local officials unexpectedly criminalized sex work in one district in East Java, Indonesia, but not in neighboring districts. We collect data from female sex workers and their clients before and after the change. We find that criminalization increases sexually transmitted infections among female sex workers by 58 percent, measured by biological tests. This is driven by decreased condom access and use. We also find evidence that criminalization decreases earnings among women who left sex work due to criminalization, and decreases their ability to meet their children’s school expenses while increasing the likelihood that children begin working to supplement household income. While criminalization has the potential to improve population STI outcomes if the market shrinks permanently, we show that five years post-criminalization the market has rebounded and the probability of STI transmission within the general population is likely to have increased.
That is from a new NBER working paper by Lisa Cameron, Jennifer Seager, and Manisha Shah.
Monday assorted links
1. More detail on the Venus phosphine discovery.
2. Wes Pegden on herd immunity and transmission rates.
3. Ross Douthat on the Ginsburg seat (NYT).
4. “In short, academic institutions systemically promote exactly the sort of short-term optimization of which, ironically, the private sector is often accused. Is entrepreneurship a trap? No; right now, it’s one of the only ways to avoid being trapped.” Link here.
5. Rethinking the roots of Chinese civilization we know so little about the ancient world.
6. Expanding the Measurement of Culture with a Sample of Two Billion Humans.
What should I ask Audrey Tang?
I will be doing a Conversation with Taiwanese Digital Minister Audrey Tang, so what should I ask? Here is Wikipedia with further information. I am looking forward to this one.
America, meet India
Tata group has received approval from the Drug Controller General of India (DCGI) for the commercial launch of the country’s first CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) coronavirus test ‘Feluda’, the Council of Scientific and Industrial Research (CSIR) said on Saturday. This test uses an indigenously developed, cutting-edge CRISPR technology for detection of the genomic sequence of SARS-CoV-2 virus, CSIR said in a statement.
The Tata CRISPR test achieves accuracy levels of traditional RT-PCR tests with quicker turnaround time, less expensive equipment and better ease of use.
Here is the full story, via Alex HR.
From my email, on QAnon
This is perhaps a bit whacky, but along similar-ish lines to the uniqueness theory, I have been wondering whether QAnon’s big differentiator is it’s comparative defensibility, powered by its complexity.
If you accept that social movements need their legitimacy-granting myths and “narratives” to hold up for at least as long as they are niche or otherwise unacceptable to the mainstream, and that one of the large effects of TV and the internet is to ease (and encourage) the voicing and wide dissemination of counter-narratives, then perhaps you should expect the best performing movements which do emerge to have key memes which cluster at either end of the “vague -> precise” axis.
Sitting at one of the two extremes is a great way to survive in an ideologically adversarial environment: vagueness gives converts a way to dismiss attacks out of hand (at the cost of rate of growth and cohesiveness, perhaps. Crypto might be an example), while highly detailed and well defined concepts (especially when hard to access) makes it too expensive for outsiders to build a case which will feel coherent and convincing to insiders.
QAnon is quite the cocktail, with its anonymous founder (can’t attack the credibility of an anonymous poster with no accessible history!), highly detailed yet easy to wield lore transmitted through word of mouth on semi-private Facebook groups or in person, no easy experiments which raise internal contradictions (the downfall of flatearthers), and the highly emotionally potent mix of corruption and child abuse.
Are there really any competing groups which offer anything remotely as attractive, all encompassing, and seemingly (to insiders) unassailable?
Will be interesting to see if it loses strength over time. I suspect there will be enough events which can be interpreted as confirming key points over the next 10 years for it to keep growing. Its rate of conversion is also pretty incredible, compared to previous cults/religions.
That is from Arnaud.
America fact of the day
…according to recent polls from Quinnipiac and Monmouth, 38 percent of registered Hispanic voters in 10 battleground states may be ambivalent about even voting…
Progressives commonly categorize Latinos as people of color, no doubt partly because progressive Latinos see the group that way and encourage others to do so as well. Certainly, we both once took that perspective for granted. Yet in our survey, only one in four Hispanics saw the group as people of color.
Here is more from Ian Haney López and
Sunday assorted links
1. More American soft power: it seems BLM is one reason why Barbados might cast off its ties to Queen Elizabeth (NYT).
2. Would you settle for one billion horses?
3. Stephen F. Cohen, historian of Russia, has passed away (NYT).
4. They want to rename the town named Asbestos, but can’t come up with anything good.
5. Joel Miller on whether we should accelerate infections in low-risk persons. It does not sufficiently address the economic (and thus also human) benefits of a speedier resolution, but nonetheless makes some good points.
What does QAnon stand for?
Here is my Bloomberg column on that question. This is not my central point, but it is the excerpt I have decided to give you:
There is the related possibility that QAnon’s main appeal is in the sheer complexity of the conspiracy itself, rather than the details. QAnon is often described often as a rabbit hole, offering users an initially simple story that gradually becomes more complicated. Some evidence suggests that conspiracy theories need to offer “uniqueness” to their adherents — that is, the promise of exclusive knowledge. The more complex and detailed the theory, the more likely that uniqueness becomes, and thus the greater the appeal. But just how big a factor is that?
Recommended. If you could do a factor decomposition on QAnon, which features of it really would matter to its adherents? (For instance, for most Christians I suspect Mother Mary holds much more appeal than John the Baptist, fine fellow though the latter may be.) I’ve been reading MR comments for long enough to know there is more here than might meet the eye.
Claims about antibodies and T-cells and Sweden
Buggert’s study in Sweden seems to support this position. Investigating close family members of patients with confirmed covid-19, he found T cell responses in those who were seronegative or asymptomatic. While around 60% of family members produced antibodies, 90% had T cell responses. (Other studies have reported similar results.) “So many people got infected and didn’t create antibodies,” concludes Buggert.
That is from Peter Doshi, mostly a survey on pre-existing immunity, interesting and useful and properly agnostic throughout. Here is a version of the Buggert piece, also with a link to the published version.
Note two things. First, “the kooks” saw this possibility first, and insisted on its relevance, to their credit. Second, many of “the kooks” are overly dogmatic, not always to be trusted, and they commonly shift the goalposts (when predictions about cases are falsified, they switch to pretending those were predictions about deaths). Often the non-kooks do that too of course.
For a sobering worry, here are some recent numbers from Spain.
The key to interpreting the literature is to focus on the data, and to keep an open frame of mind, rather than digging in to a particular position. Right now I am focused on observing what kind of second wave London is going to have, and how mild or bad it will be, as that is most likely to induce me to update my positions, in one direction or another.
For the pointer I thank E. Ward.
Saturday assorted links
1. New York Film Festival looks strong this year.
2. Tattoo artists in Japan no longer need medical licenses.
4. Messi vs. Massi: “Footballer Lionel Messi can register his name as a trademark after a nine-year legal battle, the EU’s top court has ruled.”
5. Day one of voting the polity that is Fairfax.
6. The making of a Harvard department chair (somewhat depressing, actually). “Nearly half of the 40 department chairs in Harvard’s Faculty of Arts and Sciences received tenure within Harvard and nearly three-quarters have been teaching at the University for more than 15 years, an analysis by The Crimson found.”
7. The importance of protein folding, with a role for citizen scientists too (New Yorker).
Our Antibodies, Our Selves
In 2013 I wrote, Our DNA, Our Selves, arguing against the FDA’s crackdown on genetic readouts from firms like 23andMe. The FDA, however, proved succesful in its crackdown and that is why rapid at-home antigen tests are not available today and why tens of thousands of people are dying from COVID unnecessarily. Regulations have unintended consequences.
Let’s recap:
Consider, I swab the inside of my cheek and send the sample to a firm. The idea that the FDA can rule on what the firm can and cannot tell me about my own genes is absurd–it’s no different than the FDA trying to regulate what my doctor can tell me after a physical examination or what my optometrist can tell me after an eye examination (Please read the first line. “G T A C C A…”).
The idea that the FDA can regulate and control what individuals may learn about their own bodies is deeply offensive and, in my view, plainly unconstitutional.
Let me be clear, I am not offended by all regulation of genetic tests. Indeed, genetic tests are already regulated. To be precise, the labs that perform genetic tests are regulated by the Clinical Laboratory Improvement Amendments (CLIA) as overseen by the CMS (here is an excellent primer). The CLIA requires all labs, including the labs used by 23andMe, to be inspected for quality control, record keeping and the qualifications of their personnel. The goal is to ensure that the tests are accurate, reliable, timely, confidential and not risky to patients. I am not offended when the goal of regulation is to help consumers buy the product that they have contracted to buy.
What the FDA wants to do is categorically different. The FDA wants to regulate genetic tests as a high-risk medical device that cannot be sold until and unless the FDA permits it be sold.
Moreover, the FDA wants to judge not the analytic validity of the tests, whether the tests accurately read the genetic code as the firms promise (already regulated under the CLIA) but the clinical validity, whether particular identified alleles are causal for conditions or disease. The latter requirement is the death-knell for the products because of the expense and time it takes to prove specific genes are causal for diseases. Moreover, it means that firms like 23andMe will not be able to tell consumers about their own DNA but instead will only be allowed to offer a peek at the sections of code that the FDA has deemed it ok for consumers to see.
Ten years later we now need rapid antigen tests but the issue, as Michael Mina points out in an excellent interview with Malcolm Gladwell, is that we have medicalized all tests and readouts. Instead of thinking about the individual as having a right to know about their own body, we treated every test or readout as if the only user were a physician. Thus, instead of thinking about the value of these tests for individuals and for public health, the FDA failed to approve rapid antigen tests because it regarded them as inferior to PCR tests, for a physician diagnosing disease.
Here’s Mina (roughly transcribed and lightly edited)
The only pathway that we have to evaluate tests like this are medical diagnostic pathways, pathways designed specifically to ensure that a physician like a detective is getting all the information they need to diagnose a sick person… We have so devalued and defunded public health…that we don’t have a regulatory pathway to approve a test whose primary objective is stopping an epidemic versus diagnosing a sick person. And that has held everything up. All the companies that could be producing these rapid tests in the millions and millions, they have been sitting on these tests trying to hone them so they can pass FDA standards as a medical diagnostic.
It’s not just slowing down their approval it’s actually bottle necking the companies into creating tests that are not going to be as scalable as they are having to use more expensive reagents and packing the tests with instruments so they can pass FDA review when in reality they are just these little pieces of papers. If we can do the cheap version they can be made very fast but the just won’t get through the FDA.
Gladwell: I find your explanation unconvincing. How dumb is the FDA?…If you make the exact argument you made to me…the FDA is not going to see your logic?
It’s not that they are not smart it’s that this is a regulatory body, they just don’t have a pathway. You can’t apply for approval for a public health test tool…In our country the medical establishment is extremely strong, you can’t go to get a cholesterol test without getting a prescription from your doctor. Why can’t we know that? It’s all through this very heavy medical lens and changing that, getting that big ship to turn is turning out to be a very, very difficult task but leading to potentially tens or hundreds or thousands of deaths that don’t need to be happening.
Papers that have come from Fast Grants
Here is a non-complete list. I am reluctant to speculate on what I see as some very positive reports, but in due time I will be discussing the results of the research in more detail. Here is one earlier post on SalivaDirect.