Our last post tackled various of the paradoxes embedded in the development of a Covid-19 vaccine, which in reductionist form come down to these two points:
- Setting everything equal, vaccine trial sponsors will be able to unblind their Phase 3 clinical trials and see if their vaccine is effective sooner if disease is spreading rapidly in the population in which they are studying their vaccine than if it is not. In other words, more cases now gets us the vaccine faster.
- Setting everything equal, vaccines that are less effective will get to a data “readout,” as the biotech folks say, faster than vaccines that are more effective. (The reasons for this are complicated and highly qualified, but the short version is that trials will be structured to read out when a set number of infection cases are registered, in the aggregate, in both the vaccine and placebo arms of the trial. If a vaccine is super effective, the vast majority of the requisite infections for a readout will have to come from the placebo arm. If it is less effective, there will also be a fair number of infections in the vaccine arm — even if still fewer than in the placebo arm — and those will help generate the requisite number of cases for the readout faster.)
With that background in mind, our love for the ironic and our fellow man leads to a number of assertions and provocations.
Assertion: Because Covid-19 is just not that dangerous for most people who get it, Americans are distancing, avoiding family and social life, staying out of crowded indoor places (meaning most fun places, plus church), and wearing masks only because they expect a technological solution — either a vaccine or a reliable treatment — in a matter of months rather than years. Vaccines have gotten by far the most attention, including from both the president and Dr. Anthony Fauci, so Americans are more focused on them than potential transforming therapies. So, it is only the prospect of a near-term vaccine that is sustaining all this social distancing, at least for the many people who are not at high risk of mortality or permanent consequences of Covid-19, or have not been scared in to thinking they are.
Provocation: Looked at this way, the Trump Administration’s Operation Warp Speed is the most important government policy sustaining American compliance, because it dangles the possibility of a near term vaccine. It, er, trumps all the bleatings of all the governors and mayors and scientists, which would not keep Americans away from each other and out of the bars — “Covideasies” would definitely become a thing — for very long if we did not expect a vaccine for, say, the usual 5-10 years.
Assertion: Donald Trump and Anthony Fauci have been more consistently aligned on the prospects for a near-term vaccine than on many, if not most, other issues. We believe that is because Fauci understands that hope for a vaccine is sustaining American social distancing. He probably also actually believes we will get a vaccine quickly, which certainly helps, but scientific reticence and regard for his own reputation might ordinarily restrain him from making aggressive Trump-esque predictions. We propose that Fauci has made those predictions because he believes that believing in a quick vaccine will help fight the disease now.
Assertion: As has been pointed out elsewhere, in the United States we have a profound division, aligned in large part by political tribe, about the purpose of social distancing, rules that shut businesses, and mask mandates. One camp, aligned with the left, believes that public policy ought to work almost without qualification toward the suppression of Covid-19 cases. This “disease suppressionist” camp believes that disease suppression is a necessary precondition to confident social and economic engagement. It further believes that disease suppression is sustainable for a long time via a regime of “testing and tracing,” whereby we test for the disease incessantly, and trace the contacts of people who test positive, presumably to isolate them.
The other camp, aligned with the right, are “flatten-the-curvists,” and believe that the point of social distancing during this pandemic, at least, is only to protect the capacity of the healthcare system to treat both Covid-19 cases and the usual diseases and injuries. The curvists do not support reducing cases of Covid-19 as an end in itself, believing both that “testing and tracing” will not work in the United States because people do not trust government and will not cooperate, and also that most people will in any case be infected eventually at little or no consequence before a vaccine becomes widely available. The curvists look forward to the day when enough people have had the disease or are otherwise immune that the chances that a still-susceptible person gets the disease in any encounter become very small. This is not the same as “herd immunity,” which is a mathematical concept, but the idea is that once infection has spread significantly in a population the number of new cases will dramatically decline regardless of government policy. A leading thoughtful articulation of this position is here. It is a long read, but worth your time.
Provocation: Disease suppressionists want to stamp out community spread of the disease over the long term, but if their policy were implemented and successful in the United States there would be no chance for vaccine Phase 3 trials to read out on anything like the promised schedule. If the political support for disease suppression is in part predicated on the hope for a vaccine sooner than the usual 3-5 years, then disease suppression is an inherently self-defeating policy because it delays vaccine trials.
When we have pointed this out to suppressionists in friendly social media interlocution, they have usually asked whether we could suppress cases in the United States and sponsor vaccine trials in other countries, such as Brazil, that have allowed Covid-19 to spread wildly. While such free-riding on developing world misery might deliver vaccine data quickly, it carries with it a host of practical and moral questions. Among them, would Americans then have the same claim on the first doses of the vaccine, either morally or lawfully? And — sometimes we crack ourselves up — do these mostly left-wing suppressionists who advocate doing vaccine trials elsewhere have a good justification for their rank neo-colonialism?
No, actually that is a real question.
Assertion: If you need spreading disease to conduct an adequate vaccine trial, how is China, which claims to have suppressed the Wuhan virus virtually out of existence, conducting vaccine trials? Partly via the aforementioned neo-colonialism:
Ironically, China is not in a position to test the vaccines on the required scale at home because it’s been so successful at containing the spread of the virus within its borders…
…China has already confirmed it is involved in official, advanced trials of a vaccine on thousands of people in countries including the UAE, Peru and Argentina.
This, however, is the seriously Commie part:
Then there’s unpublicised trials. In what appears to be linked to the emergency powers vaccination experiments, and not the official phase three trials, a group of Chinese miners were refused entry to Papua New Guinea recently after their employer revealed it was using them for vaccine trials.
Some 48 workers were injected in early August, according to a statement from the Chinese state-owned company that runs the mine in the Pacific islands nation.
The PNG authorities were concerned they’d been kept in the dark and that some of the workers may have tested positive for Covid-19.
Now, we are not against running clinical trials in special situations, such as on the employees on the insides of mines. Meat-packing plants or college campuses might be good places to recruit for vaccine trials. However, one might not be faulted for wondering, you know, out loud, whether such imperialist running dog niceties as informed consent mean anything at all when the employees in question work for a business owned by a police state.
Provocation: As the linked article makes clear, the Chinese are very interested in using their vaccine for their virus for geopolitical gain. We’ll say it: We guess that in addition to taking “volunteers” from state enterprises, the Chinese are conducting “challenge trials,” in which vaccine trial subjects are deliberately exposed to the disease. Challenge trials are rarely ethical in running dog countries, but we doubt that a Chinese institutional review board would have many qualms about approving them to speed a Covid-19 vaccine program that is an important project of the state.
Hey, wait a minute! Concentration camps are famously useful for human experimentation. How convenient that China has a few.
No Comments