Results for “first doses” 86 found
The contentiousness is much worse in Europe, where zero- and negative-sum thinking is the order of the day. That is the theme of my latest Bloomberg column, here is one bit:
In most of Europe, it’s hard to see much good news. It’s one thing not to have a vaccine. It’s far worse to turn on television or go on the internet and see people in other countries being vaccinated as their pandemics recede. Most of Europe will not be making significant vaccination progress until April, and even then shortages may remain.
At stake is the very legitimacy of the EU. Most of the vaccination contracts were handled at the EU level, although Germany sidestepped the agreed-upon procedures and cut some deals. If the EU fails at the most significant crisis in a generation, it may not maintain much legitimacy.
When people judge how painful an experience was, they often place a high value on first and last impressions. The last impressions of the U.S. and U.K. will be pretty positive. Most of the U.S. pandemic will be over by July, even under a subpar vaccination schedule. And it may turn out that mRNA vaccines are more protective against the new strains of Covid than any alternatives….
Many European countries may end up with fewer deaths per capita than the U.S. But at the end of the pandemic many Europeans may feel like their leaders failed them, that they suffered lockdowns for many months but received little in return. Right now vaccine politics is all about momentum, and so far only a few countries have it.
According to the Guardian the First Minister of Wales explained their policy of doling out the Pfizer vaccine evenly over the next six weeks:
the Pfizer vaccine has to last us until into the first week of February.
…We won’t get another delivery of the Pfizer vaccine until the very end of January or maybe the beginning of February, so that 250,000 doses has got to last us six weeks.
That’s why you haven’t seen it all used in week one, because we’ve got to space it out over the weeks that it’s got to cover.
Bonkers! A vaccine isn’t like a limited supply of water that needs to be rationed until you arrive at the next oasis. The sooner you get the vaccine out the better! Start lowering R now! If you run out of vaccine, well scarcity is bad but running out means that at least one part of your system is working well! It’s a bad idea to kill people to make it look like you are following some sort of numerically neat plan.
One year into the pandemic and people still don’t understand vaccines or viral growth.
Hat tip: Arthur Baker.
Pepvar’s first goal should be supporting the production of enough doses to vaccinate the entire world within a year. It is estimated that building such capacity for an mRNA vaccine like Moderna’s would cost less than $4 billion — that’s significantly less than the U.S. government already spends each day on Covid-19 relief — with the cost about $2 per dose. Of course, making the vaccines is just the first step: Pepvar must
People, even if that estimate is off by a factor of ten or more…etc. Here is the NYT link, bJames Krellenstein, Peter Staley and .
Here is the source, of course Alex Tabarrok was there first. For now give everyone one dose rather than two, and enjoy the partial but more broadly spread protection. Here are the reactions from two epidemiologists:
Professor Wendy Barclay, from the department of infectious disease at Imperial College London, said Mr Blair’s idea was interesting but agreed it was “too risky” to try without further evidence.
And Professor Neil Ferguson, also from Imperial, added that the UK regulator had authorised the vaccine on the basis that people would receive two doses.
Administering one dose only would require “an entirely different regulatory submission”, he told a Commons committee.
A Department of Health and Social Care spokesperson said: “Over the coming weeks and months, the rate of vaccinations will increase as more doses become available and the programme continues to expand.”
Where are their cost-benefit analyses? Letting people get infected at current and indeed accelerating rates is also “too risky,” yes? Is there an epidemiologist or public health expert out there willing to show his or her work, either for or against this idea? A genuine query, and of course comments are open. How about one dose for Moderna only? If we are to defer to their expertise, they do actually have to step up and be the experts, right?
From the FDA report:
Two doses is great but one dose already looks good even though sample is small. “Efficacy against severe COVID-19 occurring after the first dose was 88.9%.” (Added. n.b this is over the entire sample.)
Based on the number of cases accumulated after Dose 1 and before Dose 2, there does seem to be some protection against COVID-19 disease following one
dose; however, these data do not provide information about longer term protection beyond 21 days after a single dose.
This is potentially important as we could vaccinate more people in a hot-spot and potentially delay the second dose. Noting, however, that this is a post-hoc analyses and the second dose came within 3 weeks.
As expected, a bit of pain, swelling and fatigue in a minority of participants are the biggest issues. No major safety concerns. Of course, we still need to monitor long-term.
Serious adverse events, while uncommon (<1.0%), represented medical events that occur in the general population at similar frequency as observed in the study…. No specific safety concerns were identified in subgroup analyses by age, race, ethnicity, medical comorbidities, or prior SARS-CoV-2 infection.
Hat tip: Biostatistician LucyStats.
Since back in April, Michael Kremer, myself, and the AHT team have been advising governments to go big on investing in vaccines. The US, to its credit, made early purchases but they made two mistakes. First, they didn’t buy enough as the Washington Post indicates:
Last summer, Pfizer officials had urged Operation Warp Speed to purchase 200 million doses, or enough of the two-shot regimen for 100 million people, according to people knowledgeable about the issue who spoke on the condition of anonymity because they weren’t authorized to discuss the situation. But the Warp Speed officials declined, opting instead for 100 million doses, they said.
“Anyone who wanted to sell us … without an [FDA] approval, hundreds of millions of doses back in July and August, was just not going to get the government’s money,” said a senior administration official.
But last weekend, with an FDA clearance expected any day, federal officials reached back out to the company asking to buy another 100 million doses. By then, Pfizer said it had committed the supply elsewhere and suggested elevating the conversation to “a high level discussion,” said a person familiar with the talks who spoke on the condition of anonymity because they were not authorized to share the conversation.
In our discussions, we were talking about at least a $70 billion dollar program and optimally double that and we continually faced the sticker shock problem. Investing in unapproved vaccines seemed risky to many people despite the fact that the government was spending trillions on relief and our model showed that spending on vaccines easily paid for itself (the mother of multipliers!). I argued that this was the world’s easiest cost benefit calculation since Trillions>>Billions. But it was hard to motivate more spending—not just in the United States but anywhere in the world. For reasons I still don’t understand anything out of the ordinary–big spending on at-risk vaccines, spending on testing and tracing, challenge trials–was met with a kind of apathy and defeatism. As I said in July:
Multiple people [in Congress] have told me that things move slowly, no one is stepping up to the plate, leadership is absent. “Who is John Galt?,” they sigh. Ok, they don’t literally say that, but that sigh of resignation is what it feels like in the United States today at the highest levels of government.
OWS was actually the one area where there was some action. But there was a second mistake. We argued that governments shouldn’t buy doses but capacity, i.e. they should cover the cost of building a factory or production line in return for an option on doses from that line. The problem with buying doses is that if you buy without a timeline then the company takes all orders and pushes the low-priced orders to the back of the queue. If you demand a timeline, however, that puts a lot of risk on the firms, since not everything is under their control, and that’s expensive and difficult to contract for and monitor. Thus, we advocated for push funding to de-risk capacity construction for the firms. Capacity construction is well understood–double this line–and thus much easier to contract for and monitor. (Contracting on capacity is also cheaper than a traditional AMC for reasons explained here and also in my discussion with Tyler here.) The nice thing about buying capacity is that it changes the dynamic from one where countries are scrambling to buy before others do to one where early purchases increase capacity that is later available for everyone. OWS, to its credit, did fund capacity construction for Moderna but we wanted more and other governments didn’t step up to the plate.
OWS has been a success. In combination with investments from other governments and organizations like CEPI it will save trillions of dollars and many lives. It could have been better but the main takeaway is that the case for going big is still strong. We have solved the scientific problem of making the vaccine but step two is getting billions of doses in arms. If we can increase capacity enough to vaccinate millions more people next year than currently planned that would still pay for itself many times over. Increasing capacity is not impossible. China is increasing capacity for its vaccines. It will be harder to increase capacity for mRNA vaccines since the technology is new and bespoke but it can be done. We need a second Operation Warp Speed, OWS: Delivery and Distribution.
As Tyler said yesterday, Williams wants a cow! We want billions of vaccine doses quickly. It can be done, it should be done.
Doses of the coronavirus vaccine developed by AstraZeneca and the University of Oxford could be available for purchase in India as soon as March, according to one manufacturer, in the first sign that the sought-after jab will make its way on to the private market.
Serum Institute of India, the world’s largest vaccine manufacturer, has a licence to produce the shot and has already manufactured 40m doses. Once the job is approved for use, Serum will initially supply the Indian government but then expects to sell 20m-30m doses to private facilities, according to Adar Poonawalla, chief executive.
“Everybody’s asking ‘When can I access the vaccine?’ I’ve told those guys it’s probably going to be March or April,” Mr Poonawalla told the Financial Times.
…the future availability of vaccines for sale privately in other countries, such as India, increases the likelihood of a secondary market developing for vaccines where locals or foreign visitors could pay for a vaccination if not eligible to be inoculated under their own government’s scheme.
Here is the full FT article, via J., the price is expected to be around eight dollars.
Previous research has isolated the effect of “congressional dominance” in explaining bureaucracy-related outcomes. This analysis extends the concept of congressional dominance to the allocation of H1N1, or swine flu, vaccine doses. States with Democratic United States Representatives on the relevant House oversight committee received roughly 60,000 additional doses per legislator during the initial allocation period, though this political advantage dissipated after the first 3 weeks of vaccine distribution. As a result political factors played a role in determining vaccine allocation only when the vaccine was in particularly short supply. At-risk groups identified by the Centers for Disease Control (CDC), such as younger age groups and first responders, do not receive more vaccine doses, and in fact receive slightly fewer units of vaccine.
That is from an Economic Inquiry paper by Matt E. Ryan. Via Henry Thompson.
Graduating in a recession can be rough. Wages start lower and advance more slowly. It’s hard to get hired at a top firm which means it takes longer to get on a rapid ascent career path. As Till von Wachter notes in a review of the long-term consequences of initial labor market conditions, failure to takeoff leads to choices which often makes things worse.
…initial labor market conditions persistently increases excessive alcohol consumption (Maclean 2015) and leads to higher obesity and more smoking and drinking in middle age (Cutler, Huang, and Lleras-Muney 2015)…College graduates entering during the 1980s recession experience higher incidence of heart attacks in middle age (Maclean 2013). Following all labor market entrants from these cohorts, Schwandt and von Wachter (2020) find that starting in their late 30s, unlucky entrants begin experiencing a gap in mortality compared to luckier peers that keeps increasing in their 40s, driven by higher rates of heart disease, liver disease, lung cancer, and drug overdoses.
…Marital patterns of unlucky cohorts are affected from the time they enter the labor market up into middle age, when these cohorts have fewer children (Currie and Schwandt 2014), are more likely to have experienced a divorce, and are more likely to live on their own (Schwandt and von Wachter 2020). Initial labor market conditions also have been found to have effects on attitudes towards economic success and the role of the government (Giuliano and Spilimbergo 2014) and to lead to increasingly lowering individuals’ self esteem (Maclean and Hill 2015).
Don Peck had a good popular survey of these effects in The Atlantic in 2010 that remains vital:
Andrew Oswald, an economist at the University of Warwick, in the U.K., and a pioneer in the field of happiness studies, says no other circumstance produces a larger decline in mental health and well-being than being involuntarily out of work for six months or more. It is the worst thing that can happen, he says, equivalent to the death of a spouse, and “a kind of bereavement” in its own right. Only a small fraction of the decline can be tied directly to losing a paycheck, Oswald says; most of it appears to be the result of a tarnished identity and a loss of self-worth. Unemployment leaves psychological scars that remain even after work is found again, and, because the happiness of husbands and the happiness of wives are usually closely related, the misery spreads throughout the home.
Especially in middle-aged men, long accustomed to the routine of the office or factory, unemployment seems to produce a crippling disorientation. At a series of workshops for the unemployed that I attended around Philadelphia last fall, the participants were overwhelmingly male, and the men in particular described the erosion of their identities, the isolation of being jobless, and the indignities of downward mobility.
Of course, most people who graduate during a recession do just fine in the grand scheme of things.You could have graduated in Sierra Leone. But if you want to be on a rapid ascent career path remember that your first job is not your last job, look for opportunity, and be prepared to take a risk and switch jobs early. Stay off drugs and alcohol.
The box most bioethicists are in is so small their thinking can’t extend beyond a few target people. In this case, the control group in a vaccine trial.
The subjects could be paid for the risk, which is what we do for jobs all the time. Those risk/reward amounts for risky jobs are used to make estimates for the value of human life. Life insurance would allow high-risk people (us geezers) to join the trials.
Their box doesn’t even consider human challenge trials (HCT) that give you very rapid and accurate data on efficacy even with pay and insurance to cover the risk. The lives saved by a month faster approval is in the 10’s of thousands more than offsetting and risk to a few people. Tracking the first million doses for side effects would provide the side effect data that is usually within days of injection.
Outside their mental box, 1000 people per day are dying for each day they study the issue and delay a decision, but those lives are not included in their thinking and analysis.
That is from Dallas. I would stress there are higher costs yet from delay, noting the hundreds of millions of people in developing nations who are falling back into poverty while the pandemic continues to rage. Some of them are dying too.
Importantly, this was the first study of an inactivated SARS-CoV-2 vaccine to include participants older than 60 years—the most vulnerable age group for this infection. In the phase 1 dose-escalating trial, the vaccine was given at a two-dose schedule at three different concentrations (2 μg, 4 μg, and 8 μg per dose) and was well tolerated in both age groups (18–59 years and ≥60 years). The older age group had lower rates of solicited adverse events than the younger adults: the overall rates of adverse events within 28 days after vaccination were 34 (47%) of 72 participants in the group aged 18–59 years, compared with 14 (19%) of 72 participants in the group aged 60 years and older. At the same time, in both age groups the vaccine was similarly immunogenic: the geometric mean anti-SARS-CoV-2 neutralising antibody titres measured by a 50% virus neutralisation assay 14 days after the booster dose were 88, 211, and 229 in the group aged 18–59 years and 81, 132, and 171 in the group aged 60 years and older for 2 μg, 4 μg, and 8 μg vaccine doses, respectively. Moreover, the authors tested cross-reactivity of the neutralising antibodies against several drifted SARS-CoV-2 isolates and showed the potential of their vaccine to protect against evolutionary diverged viruses, should they appear in circulation.
The current study is the second to report the interim results of safety and immunogenicity of inactivated SARS-CoV-2 vaccine, with the first being the another β-propiolactone inactivated aluminium-adjuvanted whole-virion SARS-CoV-2 vaccine developed by Wuhan Institute of Biological Products.
Both studies showed very similar levels of adverse events and neutralising antibody titres post vaccination, which indicates the reproducibility of clinical results of similar vaccine modes produced by different manufacturers.
All good news of course, and this vaccine exists right now. Just not for you! Here is the piece from The Lancet, and here is associated commentary, also seeming to confirm the positive results. A phase III trial is underway in the UAE to measure efficacy. I cannot speak to data reliability issues, but presumably the referees at The Lancet find this credible enough to recommend publication.
Via Alan Goldhammer.
Once upon a time, there were some herd immunity theorists. They claimed that once a certain percentage of the population had been infected, the R for Covid would fall below one and the disease would become far less common and less significant. Since these analysts were especially aware of heterogeneity issues (though common in the broader scholarly literature), these same herd immunity theorists tended to be less pessimistic than many of the mainstream forecasts.
To be clear, everyone knew that herd immunity was a general and universally accepted concept in the literature. But these particular herd immunity theorists were the ones saying it really would matter, and they did so in the bold and fearless manner. As I mentioned earlier, the NYT didn’t really start covering this issue until this August, a kind of unbelievable (and appalling) communications failure from public health experts who didn’t want to say anything that might be construed as minimizing expected risk.
Now, I don’t recall many of those theorists early on making a prediction about a specific number required for the herd immunity threshold to be reached. Nonetheless, when deaths and hospitalizations collapsed in Sweden, London, and New York at about 20 percent seroprevalence, obviously it seemed that might be the critical level for herd immunity to kick in. (Higher measured levels of seroprevalence, such as for the slums of Mumbai might just come from the speed of ripping through a very dense and exposed community.) And a lot of the observed later waves were in fact coming in other parts of these countries or regions, such as Barcelona following Madrid, or Arizona following New York.
These herd immunity theorists were correct in predicting an “earlier than the mainstream is telling you” collapse in deaths and hospitalizations in the hard hit regions. And that is very much to their credit.
You will note that part of their prediction or implied prediction was that past the herd immunity point cases should fall, not just deaths. Transmission just would not be very effective or speedy any more, so cases should be low whether or not people die in the hospitals or the hospitals can save them. I’ll be coming back to this.
Then things started to go askew in the last few weeks. First, it seems like a bad second wave came to an already fairly hard hit Madrid. OK, you could say Madrid was never had 20% seroprevalence to begin with. And then what appears to be a second wave has started coming to Israel, with rising hospitalizations. Finally, it is believed that in Britian R equals about 1.7, and that a second wave of cases is on the verge of hitting London and Southeast England. That hasn’t quite happened yet, but the informed authorities greatly fear it, and the numbers so far seem to indicate that as the trend.
Added all up, those data points are not decisive in rejecting the claims of these herd immunity theorists. But they do make the herd immunity theorists look less correct than they did say three weeks ago. Those “partial second waves,” or whatever they turn out to be, seem more active than one might have expected. Again, though, the story is still unfolding and we should not rush to final conclusions. But in the meantime we should update!
In response, many of the herd immunity theorists strike back and ask “where are the deaths“? But that is not the right question for testing herd immunity claims. Those claims were about transmission slowing down, and those claims should be true about Covid-19 cases whether or not more people are surviving in the hospital. (Imagine for instance a perfect antiviral that saved everybody — would that mean herd immunity was true a priori? Nope.)
Another claim from some of the less careful herd immunity theorists is that cases are rising again because testing is rising. That doesn’t seem to explain observed patterns in Israel, Spain, or England, where in all instances actual Covid cases are rising above and beyond what is going on with testing policy, and by some considerable margin. It probably does explain some parts of America, however.
It is very likely that death rates will be much lower this time around, because of better procedures, younger victims, lower doses, and possible (speculative!) variolation through mask use over time, exposing people to lower doses repeatedly and boosting their immune responses.
There is a temptation to say “few deaths, we don’t need lockdowns!” Indeed, the more partisan of the herd immunity theorists are obsessed with the lockdown issue. Lockdowns are important questions, but don’t let your lockdown views skew your interpretation of the numbers, and furthermore there are many other important Covid questions of interest, for instance:
1. How much more should we invest in better hospital procedures? Better biomedical fixes? And how much should we hurry? If transmission is mostly over, you can relax much more, but ongoing cases both will bring some long-term damages (short of death) and also some ongoing panic, whether rational or not.
2. How do we deal with the fact that case numbers per se will scare people for a long time to come? Again, if transmission is winding down, you don’t need as big a long-term plan here.
3. Should you let large swarms of tourists into your currently semi-protected region, say it is Venice, Italy or the less infested parts of Hawaii?
4. To the extent there is current herd immunity or semi-herd immunity as I call it, how fragile is that arrangement with respect to a possible rotation of potential super-spreaders? And what might set off those fragilities?
For those questions, and indeed many others, it matters a great deal whether the original herd immunity prediction about “permanently low cases past the herd immunity threshold” is correct, or not. Whether the death rate is high or low. You really do need to understand about the cases in their own right, once you see this broader spectrum of issues at stake.
The more partisan herd immunity theorists wish to debate “how terrible will this be and will that justify a lockdown?”, and then they seek to talk you into a mood of not being so terrified, because frequently they are lockdown skeptics. Again, that is a super-important question. But don’t let it distract you from the other important questions at hand.
And for those other questions, as I’ve already stated above, the trajectory caseload predictions of the herd immunity theorists are looking worse than they did a few weeks ago.
Of course I will be giving you updates on this matter as time passes. But this is the very latest, namely that some of the herd immunity theorists are on the precipice of being dogmatically wrong about matters of real import, just as were some of the most pessimistic mainstream predictions from March and April.
Or a partial such allocation, at least. Here is my latest Bloomberg column:
The renowned economist Erik Brynjolfsson recently asked: “At least so far, I haven’t seen any one suggesting to use the market system to allocate vaccines. Not even those who strongly advocate it in other areas. Why is that?”
As one of several people copied at the bottom of the tweet, I feel compelled to take up the challenge.
I readily admit that a significant portion of the vaccines, when they come, should be allocated by non-market forces to health care workers, “front line” workers, servicemen on aircraft carriers, and so on. Yet still there is room for market allocation, especially since multiple vaccines are a real possibility:
If you had to choose among those vaccines, wouldn’t it make sense to look for guidance from market prices? They will reflect information about the perceived value of both protection and risk. On the same principle, if you need brain surgery, you would certainly want to know what the brain surgeon charges, although of course that should not be the only factor in your decision.
The market prices for vaccines could be useful for other purposes as well. If scientific resources need to be allocated to improve vaccines or particular vaccine approaches, for instance, market prices might be useful signals.
Note also that the scope of the market might expand over time. In the early days of vaccine distribution, health-care workers will be a priority. Eventually, however, most of them will have access to vaccines. Selling off remaining vaccine doses might do more to encourage additional production than would bureaucratic allocation at a lower price.
Say China gets a vaccine first — how about a vaccine vacation in a nearby Asian locale (Singapore? Vietnam?) for 30k? Unless you think that should be illegal, you favor some form of a market in vaccines.
In any case, there is much more at the link. Overall I found it striking how few people took up Erik’s challenge. Whether or not you agree with my arguments, to me they do not seem like such a stretch.
In the worldwide race for a vaccine to stop the coronavirus, the laboratory sprinting fastest is at Oxford University.
Most other teams have had to start with small clinical trials of a few hundred participants to demonstrate safety. But scientists at the university’s Jenner Institute had a head start on a vaccine, having proved in previous trials that similar inoculations — including one last year against an earlier coronavirus — were harmless to humans. That has enabled them to leap ahead and schedule tests of their new coronavirus vaccine involving more than 6,000 people by the end of next month, hoping to show not only that it is safe, but also that it works.
The Oxford scientists now say that with an emergency approval from regulators, the first few million doses of their vaccine could be available by September — at least several months ahead of any of the other announced efforts — if it proves to be effective.
Here is more from the NYT. I do not have a personal opinion on the specifics of this development, but it seems worth passing along.
Walmart, Amazon and other firms are developing safety protocols for the COVID workplace. Walmart, for example, will be doing temperature checks of its employees:
Walmart Blog: As the COVID-19 situation has evolved, we’ve decided to begin taking the temperatures of our associates as they report to work in stores, clubs and facilities, as well as asking them some basic health screening questions. We are in the process of sending infrared thermometers to all locations, which could take up to three weeks.
Any associate with a temperature of 100.0 degrees will be paid for reporting to work and asked to return home and seek medical treatment if necessary. The associate will not be able to return to work until they are fever-free for at least three days.
Many associates have already been taking their own temperatures at home, and we’re asking them to continue that practice as we start doing it on-site. And we’ll continue to ask associates to look out for other symptoms of the virus (coughing, feeling achy, difficulty breathing) and never come to work when they don’t feel well.
Our COVID-19 emergency leave policy allows associates to stay home if they have any COVID-19 related symptoms, concerns, illness or are quarantined – knowing that their jobs will be protected.
Amazon is even investing in their own testing labs.
Amazon Blog: A next step might be regular testing of all employees, including those showing no symptoms. Regular testing on a global scale across all industries would both help keep people safe and help get the economy back up and running. But, for this to work, we as a society would need vastly more testing capacity than is currently available. Unfortunately, today we live in a world of scarcity where COVID-19 testing is heavily rationed.
If every person, including people with no symptoms, could be tested regularly, it would make a huge difference in how we are all fighting this virus. Those who test positive could be quarantined and cared for, and everyone who tests negative could re-enter the economy with confidence.
Until we have an effective vaccine available in billions of doses, high-volume testing capacity would be of great help, but getting that done will take collective action by NGOs, companies, and governments.
For our part, we’ve begun the work of building incremental testing capacity. A team of Amazonians with a variety of skills – from research scientists and program managers to procurement specialists and software engineers – have moved from their normal day jobs onto a dedicated team to work on this initiative. We have begun assembling the equipment we need to build our first lab (photos below) and hope to start testing small numbers of our front line employees soon.
Actions and experiments like these will discover ways to work safely till we reach the vaccine era.