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Comment by forkexec | Hacker News Reader

The rationale against mass inoculation with an untested vaccine stems partially from the botched 1976 Fort Dix swine flu H1N1 outbreak and vaccine. The volunteers of successive regular clinical trial phases play Russian roulette on our behalf, and this takes time.

https://en.wikipedia.org/wiki/1976_swine_flu_outbreak

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The dengue fever vaccine disaster on the Philippines is another good example why one should be cautious. Dengue fever is the canonical example of antibody-dependent enhancement - someone who has antibodies against a certain strain of dengue fever will show a very serious reaction when he is infected with a different strain of the virus. That's why people who are given the dengue vaccine must have been infected with dengue previously.

On the Philippines, they gave the dengue vaccine to schoolchildren, a substantial number of whom were seronegative. The disease in that population was much more serious than it would have been otherwise, there were unnecessary deaths, and a good number of parents avoided the measles vaccine for their children, and a measles outbreak promptly followed.

Could you clarify which elements of the response were botched?

>On December 16, a one-month suspension of the vaccination program is announced by CDC head Sencer. William Foege of the CDC estimates that the incidence of Guillain-Barré is four times higher in vaccinated people than in those not receiving the swine flu vaccine.

The rushed vaccine apparently substantially increased the risk of Guillain-Barré syndrome in those receiving it. The syndrome is fatal in up to 5% of those that contract it and can cause permanent damage to the peripheral nervous system.

First, do no harm.

Increasing the risks of catching the disease from 2 per 100,000 to 8 per 100,000 does not sound that bad. It’s an additional 6 cases per 100,000 and ~0.3 deaths per 100,000.

Clearly a significant issue, but less so if it was likely to prevent a serious illness. The real issue was the vaccine was administered for a disease that never gained a significant foothold.

The vaccine was thought "likely to prevent a serious illness", but that didn't pan out. So that's why testing is important, to make sure that the cost is worth the benefit.

Only about 200 cases of swine flu and one death were ultimately reported in the U.S., the CDC said.

More than 500 people are thought to have developed Guillain-Barre syndrome after receiving the vaccine; 25 died

https://www.latimes.com/archives/la-xpm-2009-apr-27-sci-swin...

So in this case, the cure was literally worse than the disease.

The cure was worse than the risk not the disease. If it had actually infected people and had 1 death per ~250 people x say 50% of the population that absolutely dwarfs 25 excess deaths.

Which is my point, the problem was mass vaccination for a non issue. Saving 500,000 lives at the cost of 100 lives is a really easy tradeoff to make. Costing 25 lives to save 0 is a problem.

The cure was better than the risk of the disease, which was not well understood. The cure was worse than the actual disease.

Given the choice between contracting the disease or taking the vaccine you would take the vaccine. But, as the spread had stopped, it was a choice between taking the vaccine or having a 0% chance of catching the disease which had already died out.

Maybe in a truly utilitarian, rational society, but here in the USA, we expect the risk of a vaccine to be near zero, with no adverse consequences, before we give it to everyone.

This isn’t as irrational as you make it sound- I think it has to do with how we assign blame for actions. Less blame is assigned for failure to prevent hurt than blame for acting in a way that hurts someone directly. This reflects both the practical difficulty in assessing what harm could have been prevented vs what harm was direct caused by an action, and reflects our justice system’s role as a deterrent for people harming others, and less as a tool to compel helpful behavior.

From another practical concern, we need to preserve the public perception that vaccines are low risk to them, not just that they are lower risk to society than the hypothetical alternative, before healthy people will get vaccinated.

I meant rationality in the economic sense, where we would purely look at the cost-benefit of the decision, and where everyone else would look at it the same way. In that case, even a slight net savings in lives would be OK, even if that meant that administering the vaccine would cause some deaths.

I'm not saying that is how we SHOULD act. I'm definitely not saying that's how we DO act. Clearly, taking into account all of the factors that you mention, we have a very high standard for action, and that's a rational choice given the realities. It's still not a rational choice from the economics perspective, which strictly looks at cost/benefit.

I don't have any objection to developing and distributing a vaccine, but it's deployment without sufficient testing. Had the disease become widespread, as you note it would have been worth the additional risk, but in the event, it made the occurrence of any serious side effects seem more egregious. These kinds of things just feed into the anti-vaccination movement and if that overall hurts vaccination rates long term, rushing a vaccine that ends up having side effects could negatively affect public health.

I am not sure how you can catch something that’s at 6 per 100,000 without giving it to an very large group of people. There are so many unusual conditions that such problems are going to look like statistical noise until your distributing something to around a million people.

And this comapny's particular approach to vaccination has never been approved for any indication. I can't imagine why this company would be considered a first-line relative to classical approaches to vaccination (inactivated, attenuated live, made by recombinant hen egg, etc., etc.) that we roll out regularly and successfully.

They got the vaccine out for testing much faster. The technology was created for rapid response.

I can produce placebo pills for you by tomorrow. Speed doesn't matter if it doesn't work.

All approaches need to be considered at this time because we don't know which if any will work. We also don't know what the side effects of the ones that will work might be.

When we get farther along in testing we will have more information and should re-evaluate. Maybe something will prove to work well (we can do a new flu shot in a few months because we have approved the process to create a new one), maybe everything else will fail. Maybe this will fail. We don't have enough useful information to work with now though.

You say these things like you know something about the field. In fact, we're talking about a technology for vaccination that is far less likely to work than many tried and true ones. It has never been FDA approved for anything.

That doesn't mean that it won't work, or that the others will work. If the others turn out to work and because they are more tried in general great, but right now all approaches are worth exploring

The vaccine being test _does not contain the virus_.

Did you read the wikipedia article? The problem is not related to the virus being present in the vaccine- the vaccine caused a immune disorder that damages the nervous system.

Not to mention we already have a problem with anti-vaxxers causing outbreaks, and that's without any actual facts on their side. I shudder to think what they would do given any real reasons to distrust vaccines.

There are real reasons to distrust the safety of at least some vaccines. I did not get too much into it(it is tiresome as you are quickly in tinfoil hat territory), but what I took away is, that the procedures to check and regulate the safety of vaccines could definitely improved.

Don't let antivaxxers be a reason to hide real facts and statistics.

That's... not what I said at all. The argument was against premature mass-application of a new vaccine before it's been fully tested.

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