Semi-grunching here, but I think that everyone is kind of right:
- Weāre doing a shitty job on the vaccines.
- Itās a very difficult problem.
Iāve said this a couple of times, but I think that the main bottleneck is the categorization of recipients.
The main reason we have a bunch of vaccine sitting around is that governments have said that only certain people can get it right now. I think this is a mistake.
It probably sounded like a good idea because it seemed like we would run out of supply before all the high risk people got shots. But it is now clear this is unlikely to happen because:
- Weāre not that efficient at getting the shots in the arms. This buys more time to make more vaccine
- Tons and tons of health care workers and elderly nursing home patients just donāt want it.
If you look at people in these groups who want the vaccine, most of them have access to it. The one group that has the biggest problem is people who work in small, private health care facilities. For example, if you are a hygienist in a standalone dentistās office, getting vaccinated by now is going to require some hustle on your part (it shouldnāt be that way, but it is).
I think half of our problem will be solved if we just eliminate these categories today. That absolutely will result in some high risk people who miss out and get vaccinated later than we would like. But overall we will get far more people vaccinated more quickly and that benefit will outweigh the drawback.
Even doing that wonāt solve all of the problems, but it is by far the best first step we can take.
You realize they pumped this vaccine out in record time, right?
Trying different vaccine schedules and comparing them would have slowed down the process.
That kind of data would be nice, but they were kind of in a hurry (and reasonably so).
Also, all of the speculation about delaying the second shot is not just a random guess. Apparently delaying a second dose works fine in all of the other vaccines in which this has been studied*.
*Iām going by a single source here, so I could be wrong on this point, but I havenāt seen anything to contradict it.
How do you know this? What was the bottleneck? At a minimum, why not have Moderna and Pfizer try out different schedules, since their vaccines are biologically ~the same?
Itās a matter of simple logic.
If you wait 2 extra months to give the second dose, then you have to wait 2 extra months to get the efficacy data at 3 months post second vaccine, 6 months post, etc. Hell, we didnāt even have great data on immunity at 6 months post-vaccine at the time of FDA emergency approval.
And we likely wonāt because all of the people in the placebo groups are being offered the vaccine because it has shown enough efficacy that it is now considered unethical to withhold the vaccine from them in the name of research. And since they volunteered for the study, they get priority (and hopefully no one begrudges them this).
So if you tried a longer schedule, you would very likely run into this problem as well (i.e., you couldnāt maintain the placebo group long enough to get good data before the point that it would be considered unethical to withhold the vaccine from them).
The two month delay would mean that the results on 12 weeks versus 3 would be rolling in right about now, just in time for some decisions to be made.
āConsidered unethicalā is an eyebrow-raiser. Who, exactly, has determined that conducting this kind of research would be unethical? Is there any appeal from their determination?
This is a well-established tenet of medical ethics. Studies are ceased all the time when a treatment is considered effective enough that it is not considered ethical to continue give certain subgroups what you discover to be inferior treatment.
Any investigator is going to have a lot of explaining to do to their institutional review board if they tried something like that.
According to Bloomberg, 33% of the shots distributed to the states have been administered. If we assume that no one has gotten more than one shot since it is less than three weeks since December 14 when they were first available, you could consider that as about 2/3 of the people for whom they have both shots available have gotten the first one.
https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/
There are more doses sitting in warehouses waiting to be distributed to the states. Iāve seen some talk that reduced holiday hours are one reason that the roll-out has been slow. Iām fine with not pressing healthcare workers to go into overtime to administer as many shots as possible during the holiday season.
The Defense Production Act has usually been discussed in terms of manufacturing. Can it be used to speed up delivery and distribution as well?
Perhaps, but you still have to enroll patients for these studies, recruit centers and investigators to do them. That stuff takes time and money to do and itās not that easy. Itās hard enough to get people to get the vaccine now. How hard to you think it is to get volunteers when it is completely unproven?
These things are not trivial to do when your deadline is āAs quickly as fucking possibleā.
To be blunt, people who are actually informed on evidence based medicine and human experimentation.
I donāt think the DPA will have any impact on either production or distribution. It is not like the bottlenecks are companies not willing to produce the vaccine or refusing to ship it because they prefer to produce/ship other things. The only thing it can be used for is to prevent exporting the vaccine and that will cause a massive backlash from countries that bought it.
I donāt recall voting for any institutional review boards. Itās quite odd that, in democratic societies, decisions of such critical importance would be made by faceless institutional review boards rather than political actors.
And by āodd,ā I mean that absolutely no one should be surprised that we get horrible results when no one is held accountable for even the most catastrophic failures. Weāre just fundamentally unserious about this whole thing.
Grunching. Arent there two seperate tasks here.
- Approve the vaccine.
- Distribute the vaccine.
The US did 1 much faster than then rest of world, rightly or wrongly.
Because the rest of world started 2 considerably later (or hasnt yet started) its not an apples to apples comparison. The rest of world being behind overall says very little about the USās relative competence on task 2.
Look bob, I really donāt have time to explain this fully, but trust me when I tell you that this issue is something that lots of very smart people have given lots of thought to. Lots of books and papers have been written about this precise issue. There is more or less no debate about it.
Or as caffeine put it:
Itās a neat little circle. We have to use a 3-week dosing schedule because thatās the only thing supported by the data. We donāt have data on other options because the people who know best have decided that getting more data would be unethical. Problem solved!
lol
You could do a 3 week group v 12 week group I guess. Seems easier to just follow the 3 week guideline.
Edit: I donāt remember how they figured out the 3 week protocol. It could be they knew 3 weeks was the sweet spot from their early phase trials.
You really think u can catch covid walking by a stock person where u both have masks on?
Something like this, where thereās a little battery operated fan constantly running to keep the costume inflated
https://www.amazon.com/Smiffys-Mens-Inflatable-Snowman/dp/B01J86VTV0
I think there are some people in this thread who think that it is an unacceptable risk for themselves.