Results for “south africa”
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Against alcohol, #6437

This paper evaluates the impact of a sudden and unexpected nation-wide alcohol sales ban in South Africa. We find that this policy causally reduced injury-induced mortality in the country by at least 14% during the five weeks of the ban. We argue that this estimate constitutes a lower bound on the true impact of alcohol on injury-induced mortality. We also document a sharp drop in violent crimes, indicating a tight link between alcohol and aggressive behavior in society. Our results underscore the severe harm that alcohol can cause and point towards a role for policy measures that target the heaviest drinkers in society.

That is new research from Kai Barron, Charles D.H. Parry, Debbie Bradshaw, Rob Dorrington, Pam Groenewald, Ria Laubscher, and Richard Matzopoulos.  To be clear, the “policy measure” I favor is absolute individual boycott, not some kind of soporific Pigouvian tax scheme that won’t attract any real extra attention.

Fractional Dosing Trials

My paper Testing fractional doses of COVID-19 Vaccines, co-authored with Kremer et al., has now been published at PNAS. I covered the paper in A Half Dose of Moderna is More Effective than A Full Dose of Astra Zeneca and other posts so I won’t belabor the basic ideas. One new point is that thanks to the indefatigable Michael Kremer and the brilliant Witold Wiecek, clinical trials on fractional dosing on a large scale have begun in Nigeria. Here are a few key points:

WHO SAGE Outreach: The authors have met and presented their work to the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization (SAGE), with follow-up meetings to present evidence coming from new studies.

DIL Workshop and Updates: In the fall of 2021, the Development Innovation Lab (DIL) at UChicago, led by Professor Kremer, hosted a workshop on fractional dosing, collecting updates from clinical researchers from multiple countries conducting fractional dosing trials for COVID-19 vaccines. The workshop also covered issues relating to trial design and included participants from Belgium, Brazil, Ghana, the Netherlands, Nigeria, Thailand, South Africa, UK and the US. 

CEPI Outreach: Professor Kremer has also presented this research to The Coalition for Epidemic Preparedness Innovations (CEPI), which is now pursuing a platform trial of fractional dosing.

Country Trials – Nigeria: With the support of DIL and the research team and generous support and advice from WAM Foundation, the charitable arm of Weiss Asset Management and Open Philanthropy, a trial is being conducted in Nigeria by the Nigerian Institute of Medical Research, National Institute of Pharmaceutical Research and Development, National Agency for Food and Drug Administration and Control, and the National Primary Health Care Development Agency, in coordination with the Federal Ministry of Health.

A comprehensive list of all the trials on fractional dosing conducted to date is at the link. Fractional dosing may come too late for COVID-19 vaccines but perhaps next time a shortage of a vaccine looms we will be more quick to consider policies to stretch supplies.

52 things Tom Whitwell learned in 2021

Always a good list, here is this year’s edition, and an excerpt:

  1. Beauty livestreamer Li Jiaqi sold $1.9 billion worth of products in one twelve hour show on Taobao. That’s slightly less than the total sales from all four Selfridges stores during 2019. [Jinshan Hong]
  2. 10% of US electricity is generated from old Russian nuclear warheads. [Geoff Brumfiel]
  3. Some South African students sell school Wi-Fi passwords for lunch money. Residents walk up to 6km to connect to schools because 4G data is so expensive. [Kimberly Mutandiro]
  4. Productivity dysmorphia is the inability to see one’s own success, to acknowledge the volume of your own output. [Anna Codrea-Rado]

For the pointer I thank Nabeel.  And here is Whitwell on Get Back and the principles of creativity.

The Covid pandemic is not taking the very best of turns

This was emailed to me, but I am not doing a double indent…in any case I fear the person might be right…

“The prevailing sentiment is that the COVID pandemic is close to over. The vaccines are of course miraculous but we are not currently on a good trajectory.

  • It is increasingly clear that two shots plus a booster of our current vaccines are the least one needs to have effective medium-term protection. Almost nowhere (least of all the US) is on track to reach this kind of coverage. The messaging in the US remains mistaken, where the CDC to this day recommends boosters only for those aged 50 and older. More broadly, the institutional confusion around boosters shows that the adults are not yet in charge.
  • Even though Delta arose in the spring, we are still vaccinating (and boosting) people with the original Wuhan strain. This is insane, and probably meaningfully less effective, and yet nobody is up in arms about it.
  • Severe outbreaks are manifestly possible even in exceptionally vaccinated populations, especially when booster uptake is low. See: Singapore, Gibraltar, Ireland. One should assume that almost every part of the US will see significant waves before COVID “ends”, whatever that turns out to mean. Note that just 60% of the US population is vaccinated today with two doses.
  • There is early suggestive evidence from Israel that boosters may wane.
  • Waning aside, it’s clear that breakthrough infections in boosted individuals are not uncommon. While the vast majority of those infections are not severe, this does mean that there will still be plenty of mutagenesis.
  • It’s unclear that longitudinal cross-immunity is strong. Getting COVID is not enough to confer long-term protection. We probably can’t just “get this over with”, even if we are willing to tolerate a large number of one-time deaths.
  • The currently-breaking news about the South African Nu strain shows that arguments about how the spike protein is running out of mutation search space are almost certainly wrong.
  • While the fog of war is thick right now, the early data on Nu suggests that it may be a big deal. Even if it’s not, however, it has been obvious since we got the vaccines that vaccine escape is a concern. You can debate whether the probability of a vaccine escaping variant is 20% or 80%, but in any case we need effective contingency plans in place. If we fail to respond effectively to Nu, that will be a considerably greater institutional failure than anything that happened at the outset of the pandemic. We’ve had almost two years since the first COVID case and one year from the vaccine approvals to prepare. So I ask: what is the plan for the vaccine-escaping variant?

On current trends, it looks like we will probably need one of two things to effectively end the pandemic: (1) very effective COVID therapeutics (paxlovid, molnupiravir, and fluvoxamine all being candidates but my guess is that none is a silver bullet) or (2) pan-coronavirus vaccines (with broader protection than what is currently available).

It isn’t over yet.

P.S. Has any U.S. health body recommended the clinical use of fluvoxamine (an already-approved drug), or has the FDA given any guidance as to when it might approve paxlovid? If not, can they outline their reasoning? 1,600 Americans died of COVID on Nov 24.”

Nu, a variant of real concern

Here is the Eric Topol thread.  Do read it.  Here is the scary graph, based on preliminary data.  Here is Bloom Lab.  Here is a layperson’s take from the Times of London:

When was the variant first discovered?
South African authorities raised the alarm at 2pm on Tuesday of this week, when they found samples with a significant number of worrying mutations.

The samples dated from tests taken on November 14 and 16. On Wednesday, even as scientists were analysing the genome, other samples were found in Botswana and China, originating from travellers from South Africa.

Why were scientists initially concerned by this variant?
The spike protein is the tool a virus uses to enter cells, and the part of it our vaccines are trained to spot. This variant had 32 mutations in the spike — meaning it would look different to our immune system and behave differently when attacking a body. As a virologist at Imperial College put it, it was a “horrific spike profile”.

Why has worry increased over the course of the week?
When geneticists and virologists looked at the mutations they realised there was a high likelihood they could increase its transmissibility or help it evade immunity. But these concerns were still theoretical. However, today South African scientists spotted a quirk in the testing regimen. PCR tests look for three genes in the coronavirus and amplify them. If, however, the virus was this variant they were only able to amplify two.

In the province of Gauteng, where the proportion of tests coming back positive has rocketed to one in three, they found the proportion in which only two genes were amplified has also rocketed.

What does this mean?
There are three options. It is still possible — though unlikely — this is chance, with the variant’s apparently increased spread relating to an unusual cluster. If it does have a genuine advantage, then it is either better able to spread or better able to infect people who have prior immunity — either from vaccination or infection. Or, it is both.

This might come to nothing, but it is definitely a matter of concern.  One more general point is that even if Nu is a non-event, it seems to show that the space for possible significant mutations is largely than we had thought.

Thursday assorted links

1. “If one wishes to stop the virus, only one goal matters: Getting the reproduction rate below one. e to the 3 t is not a lot less exponential growth than e to the 6 t.”  Is that nowadays a cancellable thought?

2. NPR covers Fast Grants.

3. New Danish data on vaccine effectiveness against delta.  And Bergstrom on Simpson’s paradox.  Based on UK data, Eric Topol has a contrasting view.

4. The economics of Mexican indigenous languages.

5. Austria and Croatia set “expiry dates” for vaccinated travelers — 270 days.

6. “The current landscape sees Economists lobbing impeccably crafted papers into any conceivable area of social science inquiry.

7. Why no Lyme disease vaccine?  (New Yorker)

8. Data fabrication?

9. Thomas Quasthoff update.

10. Has eighty percent of South Africa already had Covid?  (Bloomberg)

What I’ve been reading

1. Richard Zenith, Pessoa: A Biography.  942 pp. of text, yet interesting throughout.  Brings you into Pessoa’s mind and learning to a remarkable degree.  (Have I mentioned that the world is slowly realizing that Pessoa’s The Book of Disquiet is one of the great works of the century?)  His favorite book was Dickens’s Pickwick Papers, and he very much liked Carlyle’s Sartor Resartus.  This biography is also interesting about non-Pessoa topics, such as Durban, South Africa in 1900 (Pessoa did live there for a while).  I am pleased to see Pessoa finally receiving the attention he deserves — definitely one of the books of this year.  Here is a good review of the book.  For a man who never had sex, this book covers his sex life a great deal!  And what a short and lovely title, no long subtitle thank goodness.

2. Nicholas Wapshott, Samuelson Friedman: The Battle over the Free Market.  Quite a good book, though it is interior to my current knowledge set and thus better for others reader than myself.  Contrary to what I have read elsewhere, Wapshott points out that Samuelson did not support Nixon’s wage and price controls, but this LA Times link seems to suggest Samuelson thought they were a good idea?

3. Jamie Mackay, The Invention of Sicily: A Mediterranean History.  While it was less conceptual than I might have preferred, this is perhaps the single best general history of Sicily I know of.  Short and to the point in a good way.

4. N.J. Higham, The Death of Anglo-Saxon England.  In 1066, five different individuals were recognized as de facto King of England — how did that come to pass?  Why was Aethelred the Unready not ready?  (He was only 12 when he assumed the throne, though much of the actual criticism concerned the later part of his reign.)  I find this one of the most intelligible and conceptual treatments of Anglo-Saxon England out there.  I don’t care what the Heritage Foundation says, beware Danish involvement in your politics!

Peter Kinzler, Highway Robbery: The Two-Decade Battle to Reform America’s Automobile Insurance System is a useful look at where that debate stands and how it ended up there.  Here is a good summary of the book.

It does not make sense for me to read Emily Oster’s The Family Firm: A Data-Driven Guide to Better Decision-Making in the Early School Years, but it is very likely more reliable information than you are likely to get from other sources.

A Step Closer to General AI

From Google’s Deep Mind:

In recent years, artificial intelligence agents have succeeded in a range of complex game environments. For instance, AlphaZero beat world-champion programs in chess, shogi, and Go after starting out with knowing no more than the basic rules of how to play. Through reinforcement learning (RL), this single system learnt by playing round after round of games through a repetitive process of trial and error. But AlphaZero still trained separately on each game — unable to simply learn another game or task without repeating the RL process from scratch.

…Today, we published “Open-Ended Learning Leads to Generally Capable Agents,” a preprint detailing our first steps to train an agent capable of playing many different games without needing human interaction data. We created a vast game environment we call XLand, which includes many multiplayer games within consistent, human-relatable 3D worlds. This environment makes it possible to formulate new learning algorithms, which dynamically control how an agent trains and the games on which it trains. The agent’s capabilities improve iteratively as a response to the challenges that arise in training, with the learning process continually refining the training tasks so the agent never stops learning. The result is an agent with the ability to succeed at a wide spectrum of tasks — from simple object-finding problems to complex games like hide and seek and capture the flag, which were not encountered during training. We find the agent exhibits general, heuristic behaviours such as experimentation, behaviours that are widely applicable to many tasks rather than specialised to an individual task. This new approach marks an important step toward creating more general agents with the flexibility to adapt rapidly within constantly changing environments. (Bold added, AT).

Hat tip: Daniel Kokotajlo at Less Wrong who notes “This seems like a somewhat big deal to me. It’s what I would have predicted, but that’s scary, given my timelines.” See also the LW comments.

In other news, South Africa awarded the first ever patent to an AI.

Ann Bernstein interview with Lant Pritchett

Ann Bernstein: From your knowledge of India and Indonesia, what are the core causes of their lack of educational
progress? These are places with highly qualified civil servants and, at least in India’s case, a democratic
government. How do you see this problem? How do we get out of this trap?

Lant Pritchett: I’m head of this very large research project called RISE and we’re spending millions of dollars to
find out the answer to that question. One of the countries where education improvements have been dramatic
is Vietnam. At a tiny fraction of the spending in most countries – including South Africa – Vietnam is achieving
OECD levels of learning. When we asked our Vietnam team why the country has produced this amazing success,
they told us: ‘because they wanted it’.

On one level, that seems silly; on another level, it is the key. Unless, as a society, you agree on a set of achievable
objectives and actually act in a way that reveals that you really want those objectives, you cannot achieve
anything.

Recommended throughout.

Patents are Not the Problem!

For the last year and a half I have been shouting from the rooftops, “invest in capacity, build more factories, shore up the supply lines, spend billions to save trillions.” Fortunately, some boffins in the Biden administration have found a better way, “the US supports the waiver of IP protections on COVID-19 vaccines to help end the pandemic.”
Waive IP protections. So simple. Why didn’t I think of that???

Patents are not the problem. All of the vaccine manufacturers are trying to increase supply as quickly as possible. Billions of doses are being produced–more than ever before in the history of the world. Licenses are widely available. AstraZeneca have licensed their vaccine for production with manufactures around the world, including in India, Brazil, Mexico, Argentina, China and South Africa. J&J’s vaccine has been licensed for production by multiple firms in the United States as well as with firms in Spain, South Africa and France. Sputnik has been licensed for production by firms in India, China, South Korea, Brazil and pending EMA approval with firms in Germany and France. Sinopharm has been licensed in the UAE, Egypt and Bangladesh. Novavax has licensed its vaccine for production in South Korea, India, and Japan and it is desperate to find other licensees but technology transfer isn’t easy and there are limited supplies of raw materials:

Virtually overnight, [Novavax] set up a network of outside manufacturers more ambitious than one outside executive said he’s ever seen, but they struggled at times to transfer their technology there amid pandemic travel restrictions. They were kicked out of one factory by the same government that’s bankrolled their effort. Competing with larger competitors, they’ve found themselves short on raw materials as diverse as Chilean tree bark and bioreactor bags. They signed a deal with India’s Serum Institute to produce many of their COVAX doses but now face the realistic chance that even when Serum gets to full capacity — and they are behind — India’s government, dealing with the world’s worst active outbreak, won’t let the shots leave the country.

Plastic bags are a bigger bottleneck than patents. The US embargo on vaccine supplies to India was precisely that the Biden administration used the DPA to prioritize things like bioreactor bags and filters to US suppliers and that meant that India’s Serum Institute was having trouble getting its production lines ready for Novavax. CureVac, another potential mRNA vaccine, is also finding it difficult to find supplies due to US restrictions (which means supplies are short everywhere). As Derek Lowe said:

Abolishing patents will not provide more shaker bags or more Chilean tree bark, nor provide more of the key filtration materials needed for production. These processes have a lot of potential choke points and rate-limiting steps in them, and there is no wand that will wave that complexity away.

Technology transfer has been difficult for AstraZeneca–which is one reason they have had production difficulties–and their vaccine uses relatively well understood technology. The mRNA technology is new and has never before been used to produce at scale. Pfizer and Moderna had to build factories and distribution systems from scratch. There are no mRNA factories idling on the sidelines. If there were, Moderna or Pfizer would be happy to license since they are producing in their own factories 24 hours a day, seven days a week (monopolies restrict supply, remember?). Why do you think China hasn’t yet produced an mRNA vaccine? Hint: it isn’t fear about violating IP. Moreover, even Moderna and Pfizer don’t yet fully understand their production technology, they are learning by doing every single day. Moderna has said that they won’t enforce their patents during the pandemic but no one has stepped up to produce because no one else can.

The US trade representative’s announcement is virtue signaling to the anti-market left and will do little to nothing to increase supply.

What can we do to increase supply? Sorry, there is no quick and cheap solution. We must spend. Trump’s Operation Warp Speed spent on the order of $15 billion. If we want more, we need to spend more and on similar scale. The Biden administration paid $269 million to Merck to retool its factories to make the J&J vaccine. That was a good start. We could also offer Pfizer and Moderna say $100 a dose to produce in excess of their current production and maybe with those resources there is more they could do. South Africa and India and every other country in the world should offer the same (India hasn’t even approved the Pfizer vaccine and they are complaining about IP!??) We should ease up on the DPA and invest more in the supply chain–let’s get CureVac and the Serum Institute what they need. We should work like hell to find a substitute for Chilean tree bark. See my piece in Science co-authored with Michael Kremer et. al. for more ideas. (Note also that these ideas are better at dealing with current supply constraints and they also increase the incentive to produce future vaccines, unlike shortsighted patent abrogation.)

Bottom line is that producing more takes real resources not waving magic patent wands.

You may have gathered that I am angry. I am indeed angry that the people in power think they can solve real problems on the cheap and at someone else’s expense. This is not serious. I am also angry that they are sending the wrong message about business, profits and capitalism. So let me end on positive note. Like the Apollo program and Dunkirk, the creation of the mRNA vaccines by Pfizer and Moderna should be lauded with Nobel prizes and major movies. Churchill called the rescue at Dunkirk a “miracle of deliverance,” well the miracle of Moderna will rescue many more. Not only was a vaccine designed in under a year, an entirely new production process was set up to produce billions of doses to rescue the world. The creation of the mRNA vaccines was a triumph of science, logistics, and management and it was done at a speed that I had thought possible only for past generations.

I am grateful that greatness is still within our civilization’s grasp.

Addendum: Lest I be accused of being reflexively pro-patent, do recall the Tabarrok curve.