Comment by mchusma | Hacker News Reader

Comment by mchusma | Hacker News Reader

I hope that the benchmark for approval is "for a given group, the risk of the vaccine is lower than the risk of COVID".

This has some good commentary: https://marginalrevolution.com/marginalrevolution/2020/09/on... some thoughtful commentary.

I believe that for at risk populations it is very likely that taking a phase III vaccine candidate is the safer option right now, let alone after another month of data.

I think let anyone who wants to volunteer to take it make their own risk assessment but be required to send data back. The only real arguments I have seen against this are political or paternalistic. But I also think people should be allowed to run human challenge studies on volunteers, which is also an ethical no brainier. But that doesn't seem to be happening either.

It basically feel like the world in 2020 decided the answer to the "trolley car problem" https://en.wikipedia.org/wiki/Trolley_problem. 2020 society's action seems to be: "inaction causing 5 deaths is better than action causing 1 death".

If the vaccine confers only limited immunity - but the users run off and act like they are immune for life - we could pretty quickly end up in a situation where giving a vaccine could result in 5 deaths where 1 only would have happened without it because people would have been more careful.

This is why it is important to understand not only that it doesn't kill people, but how much immunity it provides.

That's what they said about masks, and that turned out to be wrong too. Assuming that people are idiots never helps

But you have some broad idea if a mask is having some effect (e.g. if your mouth and nose are tightly covered). With a vaccine, the protection or lack thereof is invisible to you and others.

Anyone who's been getting flu vaccines surely has a pretty good idea how ineffective they can be.

Flu vaccines are effective — but the government has to try to predict which specific strains of flu will be active that season. If they mispredict, you might get the flu despite having the vaccine since you got a different strain.

For COVID-19, there is a known set of strains that hopefully won't change. So a vaccine targeted towards that set should work, at least temporarily.

The following is just me speculating: from what I have heard, coronaviruses are called such because of distinctive proteins on the outside of the cell that are hard for the virus to change. If a vaccine elicited an immune response to target such a protein, then it should be effective for all the strains.

My point was not that Covid vaccines will be ineffective, just that people have relatively little faith in flu vaccines right now (although I still get one every year, because better than nothing).

And I think people will see a covid vaccine as more like a flu vaccine than an MMR vaccine.

It's invisible to you until you actually realize it's (partly or fully) ineffective by getting sick. With a mask, you have some general idea well before you'd actually get sick. You can see if someone's wearing a mask properly, but you can't analyze their immune cells and the specific pathogen strains they might be exposed to.

Assuming that people will behave responsibly doesn't have a great track record either.

In UI design, I've found that "idiot" is not that useful a concept. I think its more useful to think through particular thought processes.

A mask is

1. A constant reminder of the presence of the pandemic.

2. Fallible in ways that humans can easily visualise.

Vaccines on the other hand are indistinguishable from magic.

Err, what do you mean? Mask usage in the US is extremely dependent on what municipality you live in, both legally and culturally. I'd say assuming people are idiots would have been very welcome at the start of this. It's a major reason why we are the worst-hit country in the world.

"they" (who?) said that ppe was in short supply and should be reserved for medical personnel.

Well obviously this depends on what you mean by "they". But a leading narrative during the early part of the pandemic was that masks were not good, for various reasons, one of which was that they didn't actually offer protection, but people think that they do, so people will be less careful.

This was so much part of the narrative that there were later pieces about how bad this narrative ended up being, e.g. in the NYTimes.

So for sure, it was a real thing.

Sure, and if we wait for too long the worldwide economy will collapse and then we'll have a gazillion deaths from side effects. We can't go down the path of wild assumptions because it won't lead us anywhere.

If the vaccine confers limited immunity we can at least do a better work at protecting the elderly who are extremely vulnerable. And then, as research progresses we'll have better knowledge on how to fight this thing.

The phase 3 trial is where the safety and efficacy of a vaccine is determined for various groups. The risk/benefit decision you suggest can’t be made until it has been done.

It’s like the trolley problem but you don’t know whether more people will be killed if you throw the switch or not.

Also, if people are encouraged to take a vaccine that later turns out to have significant, previously unknown negative side effects, they will be less likely to take vaccines in the future. Squandered trust is very, very costly to regain so needs to be accounted for in a risk analysis.

The data we have gives some information about the risks, although it not a completely clear picture. There is uncertainty, but any sort of risk/benefit analysis has to deal with uncertainty.

I don't think OP is arguing that people be encouraged to take the vaccine, just that the option be made available to them if they want it. I don't think it would squander trust if it is explicitly repeated that the vaccine is not known to be effective yet and that there are still potential side effects, and the recipient acknowledges they understand.

Absolutely this.

I'm in an at-risk population, as are the two others in my household, and this pattern of perpetually delaying is driving me insane.

I'll gladly take a 0.1% chance of an unspecified SAE over a 50% chance of death. I'm about to the point where I'd consider outright bribing someone at a research lab to slip me a dose of any of them, even if I had to administer it myself.

The Moderna trial is enrolling, I know someone who is in it. You only have a 50% chance of getting the vaccine, but given your preferences, why not sign up for the trial?

Because I've left home exactly once since the second week of April, and I'm not leaving again until I have a 100.0% chance of getting the vaccine, full stop.

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