Moderna raises 2021 vaccine output forecast to at least 600M doses | Hacker News Reader

Moderna raises 2021 vaccine output forecast to at least 600M doses

reuters.com

201 pointsKoftaBob238 comments

Are these US only numbers? 600M sounds like very very few doses given worldwide population and even western world population.

>600M sounds like very very few doses given worldwide population and even western world population.

Which is why people are so keen on getting more vaccines approved (in the US and abroad). Pfizer is targeting 1.3B doses manufactured in 2021, 600M from Moderna, which still leaves the world plenty short (remember each person needs 2 doses). It's a group effort, and there are additional vaccines under development/review that will hopefully contribute to the effort.

There's also discussion around whether Moderna's vaccine can be reduced from 100ml to 50ml while retaining the same efficacy, which would obviously double the amount of doses provided by Moderna.

> each person needs 2 doses

That's not quite true. You need 2 for full effectiveness, but it's not like missing the second dose leaves you with no benefit at all. In fact, it's far from clear, from a global perspective, that having twice as many people with less-than-full-effectiveness would not better than half as many people with full effectiveness.

That's true, but the FDA EUA specify that Pfizer & Moderna stick to the dosage regime as tested. It's very likely that a half dosage/reduced dosage might be deemed acceptable, but AFAIK no national authority has allowed a dosage regime deviation from what was tested in the Phase III trials. The closest would be the UK allowing upto a 12 week gap between doses of the Oxford vaccine. I agree that it's probably worth it to half the dosage and double the number of people who can be covered when initial supplies are so limited, but till the FDA makes that call, we have to stick to the dosage as specified.

No national authority has had to deal with a world-wide pandemic for the last 100 years. Treating this situation as if it were business as usual and following the normal rules may not lead to the best outcome.

I don't disagree with you, but they also have to balance risk. They need numbers to work on, and those numbers barely even exist right now. The 2K in the Moderna trial who received the single dose is a statistical blip compared to the hundreds of millions for whom the FDA would make decisions.

The EUA is their attempt to manage the health risk to the population - an investigational vaccine using an entirely unproven novel technology stack poses some unbound risk (likely small), vs the benefit of an effective vaccine. Once we change the dosage, the effectiveness also become unclear, while the risk remains (eg, potential trace contamination with precursors in the lipid carriers triggering shock in a untested population subset. Perhaps prescription statins greatly reduce the effectiveness of the vaccine, etc etc). It's the job of the FDA to err on the side of caution and see risks where we would not. I agree with you that the situation is unprecedented, but I also do not blame the FDA for only working with the data they have. I suspect that Pfizer & Moderna will conduct Phase IV trials with different dosage regimes based on which the FDA can modify the terms of the EUA.

I'm not so sure that a less effective vaccine is better than no vaccine at all. If the virus has a less-effective immune response, it could have a better chance of mutating into something that's resistant to the vaccine, in which case all the work creating the vaccine goes out the window.

I vaguely remember reading something along the lines of "You're thinking of antibiotics. Vaccines and viruses are different".

Anyone got any solid insight into this?

I found the article.

> “My concern, as a virologist, is that if you wanted to make a vaccine-resistant strain, what you would do is to build a cohort of partially immunized individuals in the teeth of a highly prevalent viral infection,” Bieniasz told STAT. Even rolling out the vaccine at all when there is so much transmission occurring is far from ideal, he said, suggesting it would have been safer to beat down the amount of virus in circulation before beginning the vaccine deployment.

>“You are essentially maximizing the opportunity for the virus to learn about the human immune system. Learn about antibodies. Learn how to evade them,” he said.

[1] https://www.statnews.com/2021/01/04/britain-takes-a-gamble-w...

> In fact, it's far from clear

Seems clear from my perspective. Two doses are recommend by manufacturers. Anything more or less is pure speculation at best. Why speculate in absence of a way to test your hypothesis?

> Anything more or less is pure speculation at best

There are two lines of evidence. The first is empirical. It It appears that one dose of Moderna _is_ highly effective, perhaps 85% or more. Note the treatment-control divergence after about fourteen days [1]. The second is theoretical. From our ample medical experience with other vaccines, there is strong prior reason to think that one dose is likely to work well, and that a second shot in the distant future would be even better than a second shot after three or four weeks. Booster shots are given a.) as backup for people who don't seroconvert after one dose b.) to trigger a secondary immune response. In light of a.), we shouldn't be surprised by the 85% number (most people seroconvert; there's no partial immunity, you either seroconvert or you don't). In light of b.), we should be very skeptical of the four week interval, especially since the secondary response takes about two weeks to develop. It's shorter than the interval for every other vaccine.

[1] https://arstechnica.com/science/2020/12/fda-releases-data-on... [2] https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolesc...

Agreed. It's also important to remember that the 3/4 week dates for the second dose were not chosen based on it being the most effective timeline, but because it was the minimum time needed to complete the studies as quickly as possible. If they'd chosen 8 weeks we wouldn't have US approval yet. If they'd chosen 12 weeks we wouldn't even know if they were effective yet.

The manufacturer doesn't know anything about this that isn't public information.

Yes, two doses are almost certainly better than one. But those are not the choices.

When there are far fewer doses than the number of people to vaccinate, the question is if it's better to give N people 2 shots, or 2N people 1 shot.

The test data looks like 1 dose gives ~80% protection vs ~95% for 2 doses. The 2x80% scenario is clearly better than 1x95%.

And, of course, everyone would get the second dose as soon as production catches up.

The main unknowns aren't around short-term efficacy, but long term immunity. If it turns out that a single dose provides ~80% protection but only for 3 months, whereas the second dose provides strong long-term protection, the one-dose scenario would be significantly worse.

Longer term, everyone gets a booster shot as soon as they're available.

What if it takes 9 months to have the booster shots available? People will be vulnerable for 6 then.

Vulnerability isn't binary. You're not immune one day and susceptible the next. It's much more likely that immunity to getting sick might start decreasing over time, but still remain relatively high. So, perhaps 80% in 3 months, 60% in 6 months, and 30% in 9 months to use made up numbers. Additionally, production is still ramping up so it's highly unlikely that we'll have less vaccine in 3 months than currently. We'll also likely have 1-3 more approved vaccines by then as well.

Unfortunately, we don't know the exact numbers so following this strategy (which I agree might make sense) is somewhat of a gamble. Maybe the numbers are not very favourable therefore the choice shouldn't be portrayed as such a simple one as in the comment I replied to.

All choices here are gambles.

Because the manufacturer recommendations are based on achieving the best outcome for the individual receiving the treatment. But we're in a global pandemic, a situation the world has not faced in living memory. A different quality metric might be appropriate under these circumstances.

So even though the manufacturers (the companies that developed the vaccines, the scientists, the people running the trials, the ones that know the data and went through a full year of tests) keep on recommending 2 doses and the advice given to the UK government was still to stick to the 2 doses, we're now going the way that "we think we know better and it's better to try something new and untested because it's a pandemic and it might be better to have less efficiency to more people, than full efficiency to less people", even though it's, again, not tested and a shot in the dark?

Was there any testing done comparing 2 doses to one? I think it was speculation that led us to test with 2 doses because we'll, we don't have much time, 2 must be better than one.

https://www.wbur.org/commonhealth/2020/12/18/coronavirus-vac...

The study we have of a two-dose COVID-19 vaccine with one dose administered showed 67% effectiveness, in line with vaccines for other diseases (including eradicated ones - polio vaccine is 80%).

Giving one dose increases the probability of someone catching COVID and the virus evolving resistance within this person. I don’t know how likely that is but the impact could be huge.

Is there evidence of this?

I think it's too early to have evidence of this I think but knowledgeable people seem to have some concerns:

https://www.statnews.com/2021/01/04/britain-takes-a-gamble-w...

That the impact could be huge doesn't take much imagination: We could be back to square 1 with the vaccination process and the evolved virus might be more dangerous.

People tend to forget the ex-us vaccines.

SinoVac Planned to have capacity for 600 million doses/yr in China by the end of 2020, with more production in Indonesia, Brazil, and India.

Russian Sputnik V also will have several hundred million dose production.

It is quite likely this will already surpass our ability to administer the vaccines or the willingness of people to take them.

To add to the list, India plans to domestically produce 1 billion doses of AstraZeneca this year, with 50 million already produced.

Total production. It's an increase of their previous estimates. It's enough for 300 million people following the schedule studied in the US trial that led to FDA emergency use authorization.

Pfizer projects making more than that.

The AstraZeneca vaccine has much larger production, and the J&J vaccine will also, if it is approved.

My understanding is that both the Moderna vaccine and the BioNTech one are being made in only a couple sites each.

Is there any reason why more labs across the globe couldn't start producing the vaccines, under a license from those companies? Is the technology needed to create them so unique that it literally can't be made anywhere else?

In this particular case the mRNA technology Moderna (and Pfizer) is completely new, these are the first two vaccines approved. Yes they spent a lot (including OWS money) to ramp production, all previous mRNA vaccine production was <1M doses per year in 2019 and before. So between Moderna and Pfizer, we are looking at probably 1.8 billion - 3 billion doses produced.

There are many genuine complaints about the vaccine ramp up, but this is one of the few cases where these numbers are a "good job".

This is why its so important for the FDA to give EUA to Astrazeneca now, that is a technology that can be scaled quickly. They should also encourage a readout now of J&J, which is almost certainly over the efficacy threshold and can also be scaled. With these two approvals, we can have enough vaccine for a 1st dose for everyone within the next 60 days.

The Sputnik adenovirus vaccine is easier to manufacture and they are allowing some countries to install their own capacity. I don't know if they improved the accuracy of their tests, they were kinda sketchy when they announced it.

The PR and marketing is not targeting the US for some reason, maybe because they think no one will want a "Russian" vaccine in the US or maybe because it's more expensive... but in other countries it's going to be "the" vaccine, so I hope it works.

They would need to do an FDA supervised trial.

Edit: the Oxford AstraZeneca and J&J vaccines are adenovirus and are nearing completion of their trials, so we are on track for much wider availability.

I suspect that the Chinese vaccine will be the most used outside of US and Europe.

It's more the difficulty in standing up a new site for GMP (good manufacturing practice). Closest analogy in the tech word would be standing up a new fab, but quite a bit cheaper. It takes time to iron out all the kinks and show that everything is being produced correctly and safely. And skipping this would be disastrous, since we are already reaching dangerous amounts of vaccine hesitancy.

That depends on what the bottleneck is. If it's a precursor or component then more sites won't help at all. Others have commented that it's either vials or clotting factor.

Yes. I've got relatives in the Philippines and they're not expecting to get vaccinated until 2023/2024, assuming the virus doesn't get to them first.

We're amazingly lucky in the developed world and U.S. in particular. Wealth makes it possible to buy up all the supplies (which, reportedly, the U.S. has done) and make sure your people get first in line for it. This is also why the U.S. is both idolized and hated in much of the world.

> Yes.

I think you are implying "no"? A "yes" would imply "in addition to those doses there are many more doses being produced for other countries".

"Yes" meaning the parent poster's incredulity is justified.

> 600M sounds like very very few doses given worldwide population and even western world population.

I believe it is a first case of hopefully many others of vaccine producer coming up with conservative estimate and then increasing it as they optimize the production process and remove the bottlenecks in the supply chain. One example of the bottleneck would be a limited supply of special glass vials produced somewhere in China.

https://news.cgtn.com/news/3355544f34514464776c6d636a4e6e626...

I love when things like this gets visible (even if I may not love why, or the result from it).

Eg how a very large percentage of the worlds christmas decorations are made in one Chinese city, or large % of harddrives in Thailand, or quartz movements for basically all of the worlds watches are from one-two suppliers, etc etc.

Opens your eyes to both how fragile some niches of the world are, and to how some markets are completely commoditized under a shallow layer of branding (most headphones, many phones, etc).

Fragile, yes, but also beautiful. The Chinese "single product city" is something of a free-market wonder. I visited Dehua (a ceramics city) and spent the time fascinated at how anything related to ceramics production is cheap in that city. It is no one individual factory that achieves economy of scale, but rather the full city, and everyone in it benefits. Small producers can achieve globally competitive pricing on their goods without having to take delivery of truckloads of input materials.

This works really really well until it really really doesn't. There's a reason why these towns don't exist in the West anymore, Detroit being the biggest example (though they got out of their predicament by trying to diversify).

There's still a pretty huge concentration of automakers and suppliers in the greater Detroit area.

Hence the keyword "trying".

When I started composing my reply, your comment read "This works really really well until it really really doesn't. There's a reason why these towns don't exist in the West anymore, Detroit being the biggest example."

Perhaps our edits overlapped.

Reminds me of Tula, the Russian city where a huge number of accordions were made. I'm not sure if it was dictated by the Soviet government or whether it happened organically, but I'm not sure it was due to a free market.

If anything, Tula is famous for metalworking, weapons, and gingerbread before anything else.

weapons and gingerbread, now there's a combination that tickles the mind :)

I'll take the accordions thanks.

Beautiful samovars.

There is nothing beautiful about this I see.

Yeah there's a part of AntiFragile that I'm reading right now about the average calories burned to transport consumable calories on average.

The soviet union focus on agricultural production efficiency achieved the opposite effect right after the breakup.

Crops were produced inefficiently compared to centralisation, but after the breakup the calories to transport vs consumable calories ratio was close to 1:1, compared to a 12:1 in the USA at the time, because the crops were grown super close to where they were consumed.

Same with toilet roll availability in lockdown... lots of control built in over the years to give the appearance of reduced volatility.

So when relatively minor real volatility came in the form of an uptick in demand over a shorter period of time, it had a drastic effect.

We should be thankful these lessons are being doled out in the form of toiler paper, Christmas decorations and hard disks instead of food and meds.

> compared to a 12:1 in the USA at the time

That doesn't sound quite right.

After a quick google, here's some typical numbers for shipping meat: a big rig with refrigeration can transport more than 40000 pounds of meat; at about 1000 (kilo)calories per pound, that's abotu 40 million kcal. Such a rig travels about 500 miles per day, has a fuel economy of about 6 mpg and burns an extra 15 gallons for the refrigeration, all in all, about 100 gallons per day. At about 35000 kcal/gallon, that's about 3.5 million kcal to travel for one day. So you need to move around for more than 11 days to get just to a 1:1 ratio.

>at the time

Your numbers need adjusted for 30 years of fuel efficiency improvement (but to be honest I think your calculations would still illustrate the same point).

The passage I'm reading doesn't cite an exact study/paper except to cite that it's from the works of Dmitri Orlov.

I think the point was more likely centred upon 1:1 calorie transport/consumption of the variety of staples needed rather than taking one of the most calorie dense categories of food like meat for the purpose of back of the envelope math. I also took a quick glance at a passage from Google from Orlov's book which takes all the calories involved in the growth of the food as well, so there's probably a little more to it.

Most people don't realize how huge chemical energy is compared to mechanical energy.

Here's a different way to look at the same thing: one gram of carbs has an energy content of 4.2 kcal. That's about 18000 Joules. One Joule is the same as 1 kg*m2/s2; it takes one Joule to lift a mass of 1kg to a height of about 10cm (because the gravitational acceleration is about 10m/s2). So, with 1 Joule you can lift one gram to a height of about 100 meters. With the energy content of 1 gram of carbs, you can lift 1 gram of matter to a height of 1800 kilometers, i.e. more than 4 times higher than the orbit of the International Space Station. When shipping things around, we don't change the elevation too much, for the simple reason that the highest elevation on Earth is less than 10km. Moving 1g of matter 1km in the horizontal direction requires much, much less energy that 1km on the vertical.

Now food has some water content, the energy does not get converted with 100% efficiency, etc. But the idea that the energy used in transportation is anything close to the energy content of food is quite far fetched.

Let's put it differently: it's hard to lose weight. It's damn hard. Precisely because the energy content stored as chemical energy in our fat cells is so large compared to how much we burn by performing mechanical actions. For example, an average runner burns about 100 (kilo)calories per mile. Since one pound of fat has about 3500 kcal, you need to run about 35 miles to burn that. If you want to burn all the energy stored in all your body, you need to run more thousands of miles. And we humans, are very inefficient. We don't have wheels in particular.

Or, let's put it yet another way. One of the most inefficient ways to transport things around is by rocket. The planned Starship will have a launch mass of about 5000 tons and a payload of 100 tons in orbit. That's a ratio of 50:1. So, to take one gram of stuff from being stationary on Earth to moving at orbital speed (8km/s) perpetually in the sky it takes about 50g of propellant (fuel plus oxidizer). When we move things on Earth, we obviously can use the Oxygen that's all around us. Of the 50g of propellant, only about 11g are actual fuel, so you end up with a ratio of about 11:1 of fuel vs payload, using the most inefficient way of moving things around.

On top of that we can't eat hydrocarbons, but we can use them to move food around.

I think in their metric, the wheat that the US occasionally shipped to the USSR counts as a downside to US agriculture.

I suspect warehousing and other distribution logistics factor in as well. 'Transport' is from farm to plate.

Makes you wonder, though, to what extent there are market opportunities in identifying weak product chains like that, preparing to look like a viable alternative, and then staging a marketing campaign based on drawing public attention to the risk and pushing demand for second source contracts.

My understanding is that the primary bottleneck is clotting factor, which is still harvested naturally from horseshoe crabs. So it's a balancing act between maximizing yield while not collapsing the population.

There's an artificial version, but it was only recently approved by the FDA, so there's not significant industrial capacity.

Artificial version was denied by the FDA I believe https://www.theguardian.com/environment/2020/may/31/crab-blo...

Unless it has since been reversed?

Sounds like they’re also made in other countries

> Most of the tubes are imported from other countries, like Germany and Japan

It seems more like the majority of borosilicate vials are produced outside of China. It doesn't even look like China has any significant domestic production capacity for the type of high quality chemically inert glass needed for vaccine vials, that's why the tubes for production are mostly imported.

Main producers of vials seem to be SCHOTT, Stevanato Group, Gerresheimer, Corning, and DWK Life Sciences, from Germany, Italy and the US.

SCHOTT alone is looking to increase production until the end of 2021 by about seven billion vials [1], which would be 3.5 times more in additional production output than the complete annual production capacity of Zhengchuan Pharmaceutical, which according to the article is one of China's largest producers.

[1] https://www.pharmtech.com/view/readying-glass-vials-for-vacc...

Fun fact: SCHOTT Glass is also headquartered in Mainz, the same city BioNtech is in :)

It also says there are 60 other companies working in China.

> China has some 60 glass medicine container providers

Plus we’ve seen markets adapting really quickly already a ton of times through out the pandemic.

This could be wishful thinking, but it would not surprise me if these numbers will go up for many or all of the vaccines. If the numbers of doses we've heard so far are contractually agreed upon, I would make sense that the manufacturers erred on the safe side regarding the number of doses they promise to deliver.

Is this in response to reports the US is considering cutting dosing requirements? The Reuters story is pretty bare (the title of this HN post essentially covers it), so without added context, this really feels like the cause.

In re: dosing - https://www.cnn.com/world/live-news/coronavirus-pandemic-vac...

This is the first large production run Moderna has managed, there's not much reason to assume it is anything more than their information about supplies and so on firming up.

It's probably in response to the entire planet wanting as many doses of vaccine as they can possibly get their hands on.

Unless they're counting both doses as a single "dose" in their announcement, I doubt it.

Is this vaccine immunity lifelong ? Or do you have to take it every few months/years?

last time I checked, the answer was "we don't know". There seems to be a >=8 months figure floating around now, though.

https://www.cidrap.umn.edu/news-perspective/2020/12/two-stud...

We have only had the vaccine for 9 months so there's not enough data to know.

With common cold coronaviruses we see that reinfection is possible for many people after a year, though they don't seem to develop symptoms if they get it again so quickly. I'm sure if you look at enough people you'll see a wide variation in response though.

Natural anti-bodies to other coronaviruses in the same group seem to last more than a decade. People who had SARS in 2003 still show an immune response 17 years later. There's a good chance this vaccine is a one-time thing or perhaps just a couple of times in your life.

https://gulfnews.com/uae/how-long-does-immunity-to-sars-coro...

https://www.nature.com/articles/s41586-020-2550-z_reference....

I am so grateful for their hard work.

They developed a 90% effective vaccine in weeks, before proving safety and efficacy, and scaling up to 600M doses in months.

It makes me emotional to think of the number of lives they will save.

I didn't think this was possible and I hope I one day get the chance to thank some of the people that worked on this in person.

It took 25days from the time the Covid-19 sequence was published to make the Moderna vaccine.[1]

[1]https://www.bostonmagazine.com/health/2020/06/04/moderna-cor...

Holy cow. That's absolutely incredible. Does the use of mRNA make these vaccines faster to develop?

There is a large caveat, though: The virus is a SARS variant, which in turn is well-studied. Prior research sped up sequencing and analysis significantly. I think we had the first PCR test even before the full genome was sequenced. It is also somewhat easy to target with the mRNA approach. So don't expect the same speed for everything else.

I think this particular virus was one of the best possible for a pandemic. One the one hand it causes a serious, potentially deadly, illness. But on the other hand the illness does not immediately destroy our health system, let alone our industrial basis. It is also ideally suited for the relatively new mRNA vaccines.

This might be cynical, but the whole thing might turn out to be a net positive. Many more viruses could be attacked now. Personalized, immediate cancer treatment could be just one step away after this. Heck, we might even have found the solution to the problem with antibiotics resistent bacteria.

Yes. You could almost think of the mRNA as being "printed".

The real technology in these vaccines is actually encasing them in a lipid, which prevents your immune system from attacking the mRNA.

mRNA vaccines can be printed on a DNA printer! You might be interested in this article: Reverse Engineering the source code of the BioNTech/Pfizer SARS-CoV-2 Vaccine https://twitter.com/sytses/status/1345854099464470528 It lets you see the exact mRNA contents of the BNT162b2 vaccine, and for most parts understand why they are there!

As of December 18th, 2020 deaths in Sweden are only the 3rd highest for the past decade:

https://www.statista.com/statistics/525353/sweden-number-of-...

So its unlikely that COVID has lead to much excess death outside of what could be expected from an unusually strong 'flu year'.

However the avoidable major driver of death is lockdown (from suicides, overdoses, homicide, destitution, interrupted medical care) and mismanagement (eg. sending symptomatic people back into nursing homes as in New York).

This whole state of affairs has been great for Billionaires though - who have increased their wealth by 36% in the past 9 months thanks to egregious money printing and economic disruption:

https://yubanet.com/usa/net-worth-of-u-s-billionaires-has-so...

From the WHO (https://www.who.int/news/item/13-12-2017-up-to-650-000-peopl...)

> Up to 650,000 people die of respiratory diseases linked to seasonal flu each year

Current COVID-19 deaths: 1.85 million. That's more than double the flu. This is not the flu. Sweden is not representative of the rest of the world. You do not know what long-term complications to longevity COVID-19 has. It's quite possible you live a full healthy life or it's possible you drop dead in 5 years because of permanent damage to the lungs and/or cardiovascular system.

Deaths from the current year can take a while to be finalized, and Decembers can be one of the deadliest months. If the U.S. hits 500k excess deaths this year, that's still a 20-25% hike on our normal death rate (2.7M give or take). Seems like Sweden will surpass past years in the end, perhaps by a similar percentage.

If we linearly extrapolate the December 18 data to December 31st, we get 91773 * (366/353) = 95,152.

Which would indeed be the highest level this decade, but still only 3.2% higher than 2018.

Sweden's 2019 deaths were also the lowest in the decade, so there was a lot of built up 'dry tinder'. In fact the excess deaths in 2020 match up almost exactly with the 'non-deaths' of 2019.

This concept is also matched by research:

https://www.news-medical.net/news/20201116/Study-compares-de...

"In Sweden, the observed increase in all-cause mortality during Covid-19 was partly due to a lower than expected mortality preceding the epidemic and the observed excess mortality, was followed by a lower than expected mortality after the first Covid-19 wave. This may suggest mortality displacement."

Referring to fragile humans as "dry tinder" is really something.

Thanks for posting this. I do think we are greatly overreacting to this. The drug industries have wanted to push mRNA treatments for years and have never been able to get them approved. They have a vested interested in leveraging this perceived crisis.

Vitamin D, ivermectin and even some inhaled steroids have all shown to been effective in treating the worst cases. The insanely high amplification of PCR assays are padding case numbers with false positives. Any contradictory information and academic viewpoints are getting censored on every major platform. This is totally madness.

NIH developed the vaccine, Moderna and Pfizer are manufacturing it.

Nothing is true about this statement.

My Understanding is that the stabilized Spike Protein sequence was developed and patented by UT Austin and the NIH. This was hen encoded using Moderna's mRNA delivery technology. I'm sure there were also countless other technology innovations that contributed to the quick rollout. It seems very reductive to attribute credit to one individual or organization over another.

Not Invented Here /s

And monetising it.

Oxford vaccine is slightly less effective, but about an order of magnitude more affordable.

They are all incredibly affordable, measured against the benefits to individuals and society.

You can say they are cheap compared, but affordable is what can actually be afforded. And for a country like India with a billion people, paying ~$1 per dose VS something like $15 for moderna is a huge difference.

All I'm saying is you should give more credit to companies doing the right thing and essentially giving the vaccine away at cost while there's a pandemic, even if their vaccine isn't quite as good.

The companies giving this away at cost are obviously doing something good for the world. That's not my point.

I just find it odd that companies like Pfizer and Moderna are about to lift the world out of a catastrophe in unprecedented fashion, and we have people complaining about prices which are not overly high when compared to the benefit, even in the developing world. India's GDP in 2019 was almost 2.9 trillion and the virus has knocked 300 billion or more off that just this year. Even under your extreme example they aren't going to care about spending an "extra" 14 billion.

I’m not complaining about the prices. I think they’ve done something amazing for sure. I just think the companies doing that same thing, and at cost are more amazing.

Without the Oxford one, a lot of countries around the world would still be just as screwed as they are today.

But don’t get me wrong I think what they all have done is amazing. And it makes me happy.

In India the Pfizer vaccine works out to $35 per dose, and AstraZeneca at $3

* [Pfizer Vaccine's Price May Be Throwing off Indian Government, Report Says - The Wire Science](https://science.thewire.in/health/pfizer-vaccines-price-may-...)

I agree, but those are not in contradiction. 1000x affordable vaccine is still an order of magnitude more affordable than 100x affordable vaccine.

This is the list of what the EU is paying:

Oxford/AstraZeneca: €1.78 (£1.61). Johnson & Johnson: $8.50 (£6.30). Sanofi/GSK: €7.56. Pfizer/BioNTech: €12. CureVac: €10. Moderna: $18.

Compare with the price of 1 liter of hand sanitizer. These vaccines are incredibly affordable.

Yes, they are, but companies doing it at cost should get more credit than those doing it for profit.

Given a choice between producing enough doses in 1 month for $10 each, and producing enough doses over 10 months for $1 each, which would you prefer they do?

The cheap-slow version costs a million lives, and several billion extra man-months of lockdown, in return for a globally insignificant cost savings. Valuing lives at maybe $1000 each.

Increasing production 10x for 10x the cost is pretty typical of things where you build a lot of special-purpose equipment which is then worthless after the production run.

That isn't the calculation though.

No-one is saying make it slower for less money. The Oxford vaccine is being rolled out fast, millions of doses available - actually millions more because, since they aren't so concerned with making money, India are able to make their own locally.

This isn't a questions of scale - everyone is doing this at maximum scale. Some are just making more money from it than others. The Moderna one is more expensive because it's for-profit not because they've spent more money scaling up.

If anyone knows otherwise let me know.

What defines this supposed "maximum scale"?

No manufactured product has ever been found to have a maximum scale. Many complex products are produced in the billions per month.

The only limit is willingness to invest money to hire more people to build and run more factories in parallel. Those budgets were ultimately set by governments, unwilling to spend a few billion to save millions of lives and avoid trillions in economic damage.

Maybe some vaccines are more expensive to produce? Do we know the profit margins on each of these vaccines?

From wikipedia, comparing it to the old fashioned method:

> RNA vaccines can be produced faster, more cheaply, and in a more standardized fashion

So should be cheaper if anything rather than more expensive.

It’s not the cost of vaccines. It’s the transportation and special refrigeration units that are expensive. Many hospitals have to install that infrastructure.

Could be worth it if mRNA tech becomes the norm for other vaccines.

I am really excited about mRNA vaccine technology. It’s brilliant.

I'm very much opposed to the current news cycle about the vaccine when the much more immediately available fix is available on the shelf at any store that carries vitamins or milk.

https://vitamind4all.org/letter.html

The evidence for the effectiveness of the vaccine is stronger than this: https://www.medrxiv.org/content/10.1101/2020.11.08.20222638v...

The vaccine won't be available to 10% of the world's population for at least 1 year.

Pfizer is aiming for 1.3 billion doses this year. That alone gets us to 10%. The WHO also rough guessed that there are already 750 million people who have been infected with the virus. So that's another 10% who likely don't need a vaccine this year. Then there's the 600 million from Moderna. AstraZeneca is aiming for a billion doses plus partner producers, e.g. Siam Bioscience to produce 200 million doses. We're probably getting to 30%-40% globally by the end of the year. Less populous western countries will probably be fully vaccinated by the end of the year.

https://www.cnn.com/2020/12/14/us/pfizer-ceo-albert-bourla-v...

https://www.nationthailand.com/news/30400664

That still doesn't help the hundreds of thousands of people that will be dead because they or their doctor didn't know that vitamin D is actively saving people's lives right now. Even after a diagnosis. This advice will save more than one life right? I think that's more important than just pushing the vaccine.

Is that the next magic cure you people are pushing for?

Noe that when deployed properly, we MIGHT not need 85% if we have secondary protocols to inhibit the growth of covid.

For example, requiring all airline passengers or anyone leaving their state to be vaccinated and vaccinating frontline workers including those that work at grocery stores, etc.

Does the vaccine prevent transmission?

AFAIK we don't know yet.

Let’s hope this is also going to be the case for all the other companies producing Covid-19 vaccine. Hopefully we will have enough vaccine manufactured in 2021 to significantly slow the spread of this virus around the world.

I am hoping the incoming administration invokes the defense production act to help with production of vaccine and testing supplies, as well as providing a comprehensive policy at the federal level regarding vaccine distribution. The current admin is basically letting things roll out on their own. What I am seeing is that if we do everything right, which up to now we have not, early fall is a good target for things starting to turn back to normal. I wonder if a more concentrated effort could shave a month off that. And given the projected estimates of how many tens of thousands will die in the next few weeks, and the additional surge after everyone decided to travel for the holidays, February is likely to be straight up lethal.

Upvoted because although I agree with your sentiment, the arguably free market in this case, at this point is going to ramp up production as efficiently as possible. I assume all of these companies are each going to make $ billions even if they overproduce. They're also making a name for themselves/furthering their brand awareness, no doubt every 5-10 years we may have a similar pandemic to counter if bad actors rally to spread viruses, at an exponential rate too via different factors. The best defense is a good offense: UBI so people can survive regardless of working, and culturally people not believing that being safe and wearing a mask isn't preventing their freedoms; culturally that this is an issue is a sign of multi-generational dis-ease progression from citizens not being given enough, organized suffering/suppression of the masses for control/submission purposes. Andrew Yang's core policies will break apart the duopoly and "take the boot off of people's throats" - and then people can start to heal these deep wounds, open their hearts, allow their IQ and reasoning skills to open up/develop, to develop empathy, etc.

Pfizer is reporting that they have vaccine doses ready that nobody is picking up. Besides, I personally don’t believe the free market is capable of telling states what to do or even knows what would be the most efficient way to distribute the vaccines.

> I personally don’t believe the free market is capable of telling states what to do

States, as functional governmental bodies, are supposed to be able to handle this.

The free market is a tool and it's a good tool for some things like maximizing vaccine production. It's not the best tool for things like resource distribution when those resources need to be distributed at a loss - we literally want to spend money to fix this and it's ok to be less efficient on the cost side if it leads to better immunity.

Many, if not most, state level public health authorities have been chronically underfunded. States are facing massive budget shortfalls. Congress has given states and cities approximately 0 relief.

State and local governments are struggling right now. "Supposed to be able to handle" and "actually able to handle" are two different things.

You realize states are supposed to fund their own public health authorities right?

States also collect their own taxes. It's on the state to manage their own budget by passing taxes and limiting expenses.

> You realize states are supposed to fund their own public health authorities right?

States can't deficit spend, which is why the Feds tend to step in for natural disasters - hurricanes, floods, pandemics, etc.

That's not how the US actually works. The federal government does quite a bit of wealth redistribution from the states that are net producers to states that cannot generate enough revenue on their own: https://www.usatoday.com/story/money/economy/2019/03/20/how-...

I encourage you to read your own sources:

> Money from the federal government is redistributed back to states in the form of grants, aid programs for the needy and payments to major government contracting firms such as defense companies.

That isn't open funds, it's earmarked grants and things like foodstamps.

So earmarking money for specific programs for testing and PPE and vaccine distribution is possible and quite normal?

Yes but states should not depend on the fed as the basis of their budget, and should instead be responsible enough to have their own budgets and planning for the vaccine.

But we are not talking about states budgets in general. We are talking about the COVID-19 vaccine.

Let's make this simpler and more accessible. You are the CEO of Google you wake up on March 1, 2020 and realize that a malware worm is spreading across your servers, damaging systems and in some cases even the hardware. The long term impact on the systems that are infected and later recovered is unclear but early evidence already suggests it's not good. Do you:

(a) Drop everything and concentrate all your resources on containing and eradicating the worm, using all available internal and external methods.

(b) Tell each department head that the worm is their problem and continue to pretend that it's business as usual. The subcontractors will figure this out because it's in their best interest to do so. Free market works.

If you choose (b) please show your work.

The problem with that line of logic is that states are a lot more like contractors than employees - the feds can only exert so much control. And a lot of the states are frankly incapable of taking direction even if they wanted to.

These are entities that run DMVs like, well, DMV offices - no amount of oversight/yelling/etc from the feds is going to get new IT systems online at the state level in short order in many states.

That's just incorrect. This isn't an issue of states' rights. This is an issue of e.g. the federal government directly distributing vaccines/PPE/testing supplies to hospitals: something they can absolutely do. Think about it: a hurricane hits Florida. Can FEMA respond? What do you think "national emergency" means?

I didn't say anything about states rights - I was speaking to incompetency in state government.

I worked for years in state government IT and with a contractor that worked with state IT in most states. Their ability to make and perpetuate messes is almost incomprehensible to the crowd here - it's that bad.

Imagine if you as the CEO actually started ripping servers out of the data center and erasing them! Of course you're supposed to work with your department heads to allow them to run a response - and your departments with 4000 employees are going to handle that task differently than the departments with 40.

Even your example is flawed. The United States is not one giant government - it's a collection of smaller governments. The President does not pass laws in Texas or North Dakota. The Fed has no power on internal state matters.

Work with, not say "just handle it". The CEO is playing golf.

The federal government funds states. States like KY and TN for example are a net negative money-wise for the USA. They take in more money than they produce in tax revenue. States like NY, TX, and CA fund their operations. Moreover, the federal government can use its resources to physically drive the vaccines around, help set up vaccination and testing sites, etc. In your worldview, what is the purpose of the USA as opposed to 50 separate countries?

> The federal government funds states.

Wrong, try again. States are self funding entities. The fed does give grants for some projects (bridges, rails, etc). Some states do receive more tax/grant benefits than they give, but those funds are earmarked - states can't use that money for any old reason.

> Moreover, the federal government can use its resources to physically drive the vaccines around...

Correct, the Fed can help make resources available to the states but the states have to request and allow the resource. The fed for instance can have the military perform interstate logistics, or rent out all the frozen delivery trucks and lend them to states.

The fed can not force states to take the grants, or perform operations in the state without approval.

> In your worldview, what is the purpose of the USA as opposed to 50 separate countries?

Alaska isn't overly qualified to run a military, form treaties with foreign powers, regulate interstate commerce or run the FDA. The fed does have a place, but the fed doesn't have the power to control states or boss them around (in theory - in practice federal grants do give a fair amount of power over many states). The fed is limited to interstate (that is, things involving multiple states) actions, and can't dictate the internals of a state.

The federal government effectively controls things like highways speed limits in all the states. The department of education does a whole lot of wealth redistribution and exerts a ton of control over every single public school in the country. Just some examples. The federal government is also the largest employer in the country.

> The fed can not force states to take the grants, or perform operations in the state without approval.

Fine. States that don't want the vaccine are free to refuse it. Do you think they won't play ball if the fed says "we will deliver and distribute the vaccines and you don't have to pay for them"? In what universe will this be something a state refuses saying "we want to pay for this ourselves"?

If it helps your mental model, you are the CEO of Alphabet, and Google is California, yet the worm is affecting all your subsidiaries.

The highway near my house runs at 70 and goes up to 80 in parts. Grants are conditional but also optional and that matters.

In general yes, the Fed does have an important part in what are basically non-capitalist practices - foodstamps, WIC, social security, etc etc. There are also state programs that are non-fed and also occupy a similar role.

None of that disagrees with the basic assertion - the Fed does not fund states general revenue. States are supposed to manage their own budgets and collect their own income. The fed is not an endless income stream.

Nobody is saying the fed shouldn't assist states with the vaccine. The states shouldn't however be entirely dependent on the fed for that help - they are supposed to be functional on their own. If the state is not functional without the fed then the state has screwed up.

Fine, semantics aside, the federal government is in a unique position to distribute vaccines and testing supplies and PPE with a higher efficiency coefficient than the collection of the states and territories individually. There are people arguing against this in this very thread. In generally, sure the states shouldn't rely on the fed to do everything. In this case it's better for the states to let the fed handle this. If not, why not?

Well, we only need to look at the last time there was a mass vaccination drive. New York City had a smallpox outbreak and administered millions of doses in record time.

https://twitter.com/MarkLevineNYC/status/1345407042769580032

The city was able to mobilize hundreds to thousands of distribution points, call up city workers (who the Fed has no power over) and run vaccine administration 24/7.

The state knows more about their interior, they have more resources on the ground and more control over schools and other public buildings (libraries, community centers, etc), more ability to use private businesses if needed, and control the local health infrastructure.

Did the whole country have a smallpox outbreak? No? So it sounds like it was localized to one state.

The point is that this is a nation-wide problem, and the federal government is in a unique position to be the most efficient at handling production and distribution of vaccine/testing supplies/PPE. What exactly is your argument around why it should have little or no role? There is a shortage of these things and production happens in a few centralized places. It makes sense that one centralized entity coordinate the production and distribution. What is the problem with that? Please show your work on how 50 states plus territories would handle it better.

> It makes sense that one centralized entity coordinate the production and distribution

Centralized planning can work, but when it doesn't work, it's disastrous for everyone. Decentralized systems trade off a little bit of hypothetical efficiency (again, it depends on the central planner being competent) in return for guaranteed antifragility.

If what you're saying is accurate, then we really ought to have a global government (say, the UN) coordinate distribution across the entire planet. Countries like Israel, Taiwan, New Zealand, and Singapore shouldn't be allowed to set up their own distribution systems, rather they should all play into the same globally centralized distribution system. It's a global pandemic after all, right?

How. The. Fuck. Is. This. So. Difficult?

We are in a pandemic. How we handle this does not change how we govern ourselves outside of a pandemic. It doesn't even change how we govern ourselves during a pandemic. We aren't talking about forming a world government. We aren't talking about expanding the federal government's powers. We aren't talking about Hunter Biden, the pee tape, the impeachment, chem trails, or mega churches. Put that out of your mind. Try to think like this isn't US politics because that's clearly clouding your judgement.

A centralized entity coordinating a nation-wide effort to distribute the vaccine, testing supplies, and PPE is normal. What exactly would go wrong there that the states couldn't mess up. By your logic, the FDA and the CDC shouldn't have been approving the vaccines. It should be left up to each state, no? Because what if the FDA got it wrong. Better let 50*2 smaller, less well funded agencies decide individually than one well funded agency, right?

How could the states possibly do better than a national strategy for handling the pandemic.

Note: national strategy != central government. National strategy does not expand any powers. The federal government already has all the powers it needs. No new laws would need to be passed. No new powers granted. It's literally using the resources already there for what they are meant to be used for: responding to an emergency. Why do you thing agencies like FEMA exist?

I'm done with this topic because it really seems there is a number of people here willing to bend over backwards and give themselves a cranial colonoscopy just to not blame the current admin for its utter failure to do its most basic job. If you really think this is going better than the ebola outbreak, a disease much deadlier and more contagious than COVID, then I can't do anything to pull you out of your alternative reality. That is on you.

We all understand your point of view, but beating your chest and “How. The. Fuck. Is. This. So. Difficult”ing your way around actual discussion isn’t going to change anyone’s minds.

> By your logic, the FDA and the CDC shouldn't have been approving the vaccines. It should be left up to each state, no? Because what if the FDA got it wrong. Better let 50x2 smaller, less well funded agencies decide individually than one well funded agency, right?

This isn’t even a “what if”, the FDA was disastrously slow in granting EUA’s for rapid testing. The fact that 50 states were hamstrung by the federal FDA exacerbated the pandemic. You can visualize what the FDA/CDC bottleneck looked like early in the pandemic here -> https://twitter.com/balajis/status/1238981855812055041

By your logic, why should 200+ countries have drug agencies? Why have sovereignty at all? The argument is that while central coordination is well and good, you don’t want a system that’s overly reliant on it.

And if the problem is that mobilization will be difficult for some States due to underfunded health agencies, now is the perfect time for their legislatures to increase funding via taxes and bonds. A once-in-a-century pandemic is the perfect use for State bonds, since it won’t be a recurring expense.

Do you have any evidence that suggests Pfizer is pretending that it's business as usual or is doing anything short of producing and distributing vaccine as fast as they possibly can?

I am making the analogy to the federal government, not Pfizer.

Right, I remember seeing that headline - that's due to the Trump administration's incompetence and/or treason; can't do much about that except correct the system, break apart the duopoly and the power of what has become the limited players in mainstream media; Andrew Yang's Journalism Dollars and Democracy Dollars both would help counter this adequately, along with his UBI/Freedom Dividend policy and Ranked Choice Voting - 4 simple policies, along with government option for healthcare - would powerfully shift the system immediately, and put the US on an exponential path again, without so much friction, allowing thriving for everyone; the buying power of "$1,000"/month increases exponentially as we automate more and more processes.

Edit to add: Sorry about lazy people downvoting you, whenever I talk about Bitcoin - pro-Bitcoiners don't qualitatively engage, just a quick hit of dopamine satisfies them and suppresses contrarian thoughts that aren't financially incentivized like their Bitcoin propaganda and behaviour is.

I don't really think production of vaccines or test supplies is limited in a way that could be improved significantly with DPA. Vaccine production for both the US approved mRNA vaccines is highly specialized and those companies are heavily incentivized to deliver vaccines as soon as possible since they have a de-facto duopoly for an unknown amount of time. Testing supplies are a probably a lot more scalable, but I haven't heard about supply shortages with tests in months.

The areas where executive policy could make a difference are timelines for approval of additional vaccines and optimizing vaccine delivery to hit the highest number of individuals as soon as possible. Prioritizing quick approval and distribution of the Oxford/AZ vaccine and doing the same for the Johnson & Johnson vaccine when data becomes available would likely save thousands of lives over the next few months, but neither the current nor future US administrations seem to be taking an interest in this.

There are lots of things the DPA can help with. Testing for one. PPA. Cold storage pods needed for vaccine distribution. Raw materials for any of the above.

It's not production that's the problem. It's distribution right now.

We can see states with good resources are vaccinating as quickly as the doses come in (a few days of lag time, but otherwise doing good).

But many states are stuck in logistics hell. These vaccines need -80C or -20C storage to remain unspoiled. And the administrators are overworked nurses who haven't had rest for months, due to the pandemic.

Once a dose leaves the -80C or -20C storage center, you only have a few days before the dose is ruined. So you need careful planning, maybe even allow a bit of waste for easier distribution.

The military / national guard can help with distribution, but once again the nursing shortage is biting America in the ass. I'm not really sure how to solve that issue. (Well... I dunno how to solve it this year. Ultimately we just need more immigrants and/or students)

They aren't seperable. If you have lots of vaccine, there is no reason to do prioritization and things will inevitably go faster. I'd put myself on a list for the hospital to call me any time to come in for a vaccine, but they don't have anywhere near enough vaccine to spend the time making that list (doses for about 5% of the county available, I'm towards the end of prioritization).

Investing in the education of your citizens is a proven and popular technique for having a higher quality and quantity of work force.

Both production and distribution are problems. Hence why I hope the new admin addresses both with DPA and a comprehensive strategy respectively.

It'd be late for that. Logistics takes weeks, or even months, to ramp up.

This is stuff that needed to be planned out last October if we wanted it working this month or next month.

I guess better late than never. But... don't hold your breath. We're going to be having these logistic / distribution problems for many weeks moving forward.

Right. Should have done this 20 years ago so we would have plenty of nurses today. Should do this today so that when the next pandemic hits in 20 years we are better prepared.

Even with vaccinations, this virus will be around for another 10 years. It took 185+ years to eradicate smallpox (mostly from a big WHO push in the 60s/70s). It's still not possible to eradicate Polio. Even with a massive push, it's not like a vaccine will make this go away.

We have a lot of information now about how to treat and not treat this virus. A bunch of early deaths were due to overuse of high pressure ventilators and the Governess of NY and Michigan putting sick elderly people with healthy elderly people in nursing homes without adequate isolation (most had 2 or more people per room) killed a lot of people in the first three months. We overreacted to the virus, like a social auto-immune response.

We also know the fatalities are 95% over 55. This virus has mostly reduced our life expectancy. By 5 years? 1 year? That's difficult to determine at this point. Everyone is going on about "long covid" now, but if you actually read the papers, the whole things starts to break down to a couple of case studies of 40~50 people each. There may be long term effects for heavily exposed people (health care workers) and the elderly, but the "long covid" narrative is another one if abuse and fear; not grounded in hard science and accurate risk analysis.

For things to go back to normal, the vaccine is not the solution. The solution is to stop spreading constant fear. The Great Barrington deceleration has been shunned and dismissed by all major media outlets, yet it's signed by many doctors, academics and professionals and it makes a lot of sense.

Humanity has a new virus and we need to learn to live with that. The countries who have avoided it can keep shut down, but at some point it's no longer going to be feasible to do so.

The reality is that today in southern california, ICUs are at capacity. Most people end up ok. My whole family got it and had basically just congestion for two weeks, including the 90 year old ancients we though were sure goners when they contracted it (we just turned up their oxygen and they were feeling a lot better).

That being said, enough people do need medical care, and thats enough people to entirely burden our capacity to treat any sort of medical emergency, and cases are still going up. It’s not good right now.

California had some of the strongest lockdowns and stay-at-home orders of any state and they're still having ICU issues, meanwhile Florida is not? Tennessee has similar policies to Florida and they have high cases .. Sweden has meanwhile dropped to zero.

If you really look across the board at all countries, there is ZERO corroboration between any of these arbitrary measures and the results. It's all complete random superstition nonsense. COVID response is a new religions ideology, and ideology is "doing without knowing."

Also, why are ICU beds at capacity? Is it all COVID, or tons of people who didn't get the heart surgery they needed?

Your own experiences show that your family survived this and likely has long term immunity (and will continue to do so as long as they get exposed at regular intervals).

The alternate reality is that the virus is real, but the way we've reacted to it will kill more people in the long term. I wrote about this back in March, COVID19 is two diseases. The virus and our over-reaction to it: https://battlepenguin.com/philosophy/covid-19-is-two-disease...

Check out newer sources for that Sweden claim. They've both admitted that the strategy failed plus their measures are now at least equivalent to those of their neighbors.

https://m.youtube.com/watch?v=SSkGkmY9FcM

"If you really look across the board at all countries, there is ZERO corroboration between any of these arbitrary measures and the results. "

Care to link a published study or a report from a reputable agency? Because it sounds like this is just your hunch.

I don't think anyone is talking about 100% eradicating the virus.

Getting old people and people at risk vaccinated basically means 99% of death would be avoided and hospital would go back to pre covid numbers. Once people over 40-50 are vaccinated it's game over for covid and most of things will go back to normal.

Of course the virus won't totally disappear and people will still die of it.

> Humanity has a new virus and we need to learn to live with that.

The lockdowns / travel restrictions are part of the "learn to live with that", you can't just ignore it and run major hospitals at 110% capacity forever.

I am.

We have a global adversary. This is exactly what humanity needs to unite. We should put aside our differences and fight together.

https://www.youtube.com/watch?v=uROpyjnwgAk&list=PL0KBVEO7tI...

Even if 100% of the dead are in the risk/old group (which is not true), it's hard to achieve a 99% reduction with a 95% efficient vaccine. For that to work, you have to assume that the main way of infection is from inside the group. I think this is highly unlikely in a scenario where you say: protect the weak, let everybody else just get it.

We should 100% eradicate the virus. We have inexpensive vaccines available. Like you say, much of the harm is controlled well short of eradication, but it wouldn't be expensive to do it (it may even be cheaper to eradicate it than to continue to deal with it).

That may be an unrealistically high bar. Only smallpox has ever been successfully eradicated, which speaks to the difficulty in completely eradicating a disease. And since some animals can carry and spread the virus, eradicating this virus may be impossible with current technology.

Let's try it and find out if it is realistic or not.

The top infectious dresses expert in the country certainly disagrees with a lot of what you are saying. Yes it will stick around. Yes the vaccine will help a great deal. What exactly is your point? That there is no reason to rush?

https://www.cnn.com/2021/01/04/us/coronavirus-pandemic-year-...

and meanwhile people are losing this businesses, their livelihoods, their mental health and absolutely everything. A women in California invested heavily in outdoor dining equipment, only to be shut down, and then she sees a movie production company setup a full catering set right next to her restaurant.

The top infection dresses experts can be wrong. Don't appeal to authority. There are literally thousands of other doctors and scientists who say further lockdowns are not helping. The WHO is saying lockdowns should not be used except as a last resort!

Don't listen to just one person. Look at all the options. Lockdowns don't work.

Lockdowns 100% work. Just like the medieval term "quarantine" proved that it works, 500 years ago. They're very effective at stopping infectious diseases. You don't have to be a brain surgeon to figure out why they work.

The side effects of lockdowns suck A LOT, but less than uncontrolled spread of a virus amongst 8 billion people. Besides the fact that it would completely destroy out healthcare systems, in which case we're back to the Middle Ages, we're a few mutations away from a much deadlier disease. It would be ultimately irresponsible to allow Covid to run rampant.

We should be careful here because a lockdown and a medieval quarantine are not the same. In the middle ages quarantine typically meant keeping a ship at port and preventing from landing - and that's a very doable thing. You literally just prevent them from dropping their gang plank, and they have supplies and everything they need on board.

The same does not apply to lockdowns. People need groceries, many people have limited cooking capabilities, and homes are not self sufficient - you need maintenance people, regular supplies, so on. And, those people who live in apartments and other small domiciles are not going to stay cooped up forever on end - they are going to go get food and visit people and no amount of threats is going to prevent that.

And that's the issue. Lockdowns always have a maximum timetable that they're effective for and then they suddenly become less effective - and you don't get to reset that timer all that easily. Masks help but they are a partial solution - they have a relatively low effectiveness rate that is fine individually but in mass don't hold up.

Many governments - and I'll pick on California specifically - keep locking down tighter and tigher. Curfews, dining restrictions, gathering restrictions and more that have been going on for more than 6 months now. Do you really think getting more restrictive will be helpful at all?

Right. Quarantine that is suggested, like it's been in the US, and quarantine that's enforced are very different. Again, national strategy for "let's all stay exactly where we are for four weeks while people in hazmat suits deliver you groceries" would have been closer to medieval quarantine.

Show me the evidence. You look from nation to nation, region to region, and there is no effect at all from masks or lockdowns. You are imagining they work because the TV tells you to, but they don't.

Here is the first result from google scholar: https://academic.oup.com/jtm/article/27/3/taaa037/5808003?lo.... Seems pretty effective to me

> The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China

Wuhan, where they literally welded people in their homes?!

https://www.youtube.com/watch?v=meRUCxlleUc

Are you seriously advocating for elimination this virus by eliminating people's basic human rights?!

What tells you that what you are seeing there is them welding people inside their apartment buildings? I see someone welding something. I don't see how you can tell who they are or what they are doing or why based on this video.

Um, the part where the guy opens the door and sees a bar welded in front of it?! There are Chineese sources that show bars being put up against peoples' doors:

https://www.youtube.com/watch?v=QfzQ8Dag8V8

There are tons of these videos by the way:

https://www.msn.com/en-ae/news/other/is-china-locking-up-ent...

But they are difficult to confirm because China heavily restricts all coms in and out of the country, or are you going to try to deny the Great Firewall of China or extreme media censorship exists next?

Here's an opinion piece from the WaPo by a Chinese citizen also stating people were welded into their homes:

https://www.washingtonpost.com/opinions/2020/02/06/warning-c...

and here are a list of Chinese sources as well:

https://skeptics.stackexchange.com/a/46045/15222

Every time they impose a stricter lockdown where I am, numbers go down. They relax it, they go up.

It's a roller coaster of disease.

What have you got against lockdowns? Is it some philosophical hatred? You're not alone, governments also hate them. They do it because they have to.

The actual numbers are totally opposite of what you say. Please show some sources. I think Shapiro covers the arguments against lockdowns very well: https://www.youtube.com/watch?v=ymD9ipSm-eg

I'm against them because they literally do not work, and they violate our basic civil rights. A man in Canada was shot months ago for not wearing a mask, after he left the store, outside his own home. In Quebec over New Years Eve, police arrested someone for having more than five people in their homes. New York wants to pass ordinances that lets them put people in camps if they're infected.

This is absolute insanity. The virus is an excuse to violate all our basic human rights. The United States constitution is basically suspended at this point.

Look at this woman who was arrested for trying to save her deteriorating mother locked in a care home:

https://www.youtube.com/watch?v=S1E390UHzTY

There you go, see the links and abstracts below.

But you're emotional, I doubt these sources will change your mind. Have a nice day!

https://www.benjaminborn.de/publication/bdm_lockdown_2020/

> While most countries imposed a lockdown in response to COVID-19, Sweden did not. To quantify the lockdown effect, we approximate a counterfactual lockdown scenario for Sweden through the outcome in a synthetic control unit. We find, first, that a 9-week lockdown in the first half of 2020 would have reduced infections and deaths by about 75% and 50%, respectively. Second, the lockdown effect starts to materialize with a delay of 3-4 weeks only. Third, the actual adjustment of mobility patterns in Sweden suggests there has been substantial voluntary social restraint, although the adjustment was less strong than under the lockdown scenario. Lastly, we find that a lockdown would not have caused much additional output loss.

https://www.thelancet.com/article/S0140-6736(20)32034-1/full...

> Lockdown therefore appears to have been successful not only in alleviating the burden on the intensive care units of the two most severely affected regions of France, but also in preventing uncontrolled epidemics in other regions. These simple observations support results from other studies which have estimated the impact of lockdown on SARS-CoV-2 spread to be strong.

https://www.sciencedirect.com/science/article/pii/S204908012...

> COVID-19's daily increasing cases and deaths have led to worldwide lockdown, quarantine and some restrictions. This study aims to analyze the effect of lockdown days on the spread of coronavirus in countries. COVID-19 cases and lockdown days data were collected for 49 countries that implemented the lockdown between certain dates (without interruption). The correlation tests were used for data analysis based on unconstrained (normal) and constrained (Tukey-lambda). The lockdown days was significantly correlated with COVID-19 pandemic based on unconstrained (r = −0.9126, F-ratio = 6.1654; t-ratio = 2.40; prob > .0203 with 49 observations) and based on Tukey-lambda (r = 0.7402, λ = 0.14). The lockdown, one of the social isolation restrictions, has been observed to prevent the COVID-19 pandemic, and showed that the spread of the virus can be significantly reduced by this preventive restriction in this study. This study offers initial evidence that the COVID-19 pandemic can be suppressed by a lockdown. The application of lockdown by governments is also thought to be effective on psychology, environment and economy besides having impact on Covid-19.

> https://www.benjaminborn.de/publication/bdm_lockdown_2020/

Literally a pre-print. There's only an abstract. I don't see the actual one on Sci-Hub or anywhere. I can read it.

> https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820...

The full text of the 2nd paper is literally only two pages and only appears to look at regions in France and not other countries. There are literally no graphs, no detailed explanation of the methodology and the very next article is literally "Is COVID-19 being used as a weapon against Indigenous Peoples in Brazil?" which speaks of this very weird identity politics finding its way into major academic journals. There are references to an Appendix that I can't seem to find the full-text of, but it bothers me the paper itself doesn't seem to have a detail methodology section, risk analysis and also lists some pretty big financial incentives/interests.

The 3rd study is the only really detailed source provided, yet it only covers data up to May 5th. It also has this interesting quote:

> In addition, it is claimed that, besides the positive aspects of the lockdown, people who comply with this restriction cause a weakened immune system. The main reason for this is that there is too much food consumption and limited mobility. The effect of the lockdown caused by the COVID-19 pandemic on human health may be the subject of future work

It also tries to look at environmental impacts and mentions the inconsistency of lock-downs across all areas. I'm also having a hard time understand the "Transformed data" as it doesn't seem to correlate to either of the two preceding graphs at all. Also keep in mind, correlational near r=1 shows that Ice Cream sales can lead to Polio:

https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2F...

That combined with the limited window and inconsistent lock-downs should at least throw question on this study.

I want your sources.

"We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus," Dr. David Nabarro (World Health Orginization).

You can find multiple articles that quote this from the WHO and link to the full 1 hour interview with the Spectator. The full interview goes on further to talk about how continued lockdowns will lead to move poverty and devastation.

There's also this study that tears apart the models used by many:

https://www.medrxiv.org/content/10.1101/2020.07.22.20160341v...

Also you know that 2-million Neil Ferguson model? Here's the source code for it. It's disastrous: non-reproducible results and 3 different random seeds. They literally ran it multiple times and took averages (with ranges of fatalities varying by up to 60k). Also it has race conditions and can't be run in parallel. Fucking mess:

https://github.com/mrc-ide/covid-sim/blob/e8f7864ad150f40022...

As far as independent journalists that give you a different point of view:

James Corbett (who covers the origin of the lockdown policy): https://www.youtube.com/watch?v=nuDQ_3g53qc

Ben Shapiro makes an excellent case as well: https://www.youtube.com/watch?v=ymD9ipSm-eg

Which one is more likely to be right:

A) Tens if not hundreds of governments, with wildly different agendas, ranging from dictatorships to ultra liberal democracies, converge on enforcing different degrees of lockdowns. Tens of different graphs I've seen have infection rates go down, like clockwork, roughly 10-14 days after stricter lockdowns are enforced. Keep in mind that they're all aware of the economic costs, mental health issues, etc. They're not doing this for fun. And they're not going to lock us forever, there is no "freedoms" slippery slope here.

B) A rather fringe group of libertarians, freedom fighters and the like, who dislike government overreach, prove that models used by all those governments are all wrong, thus indirectly confirming their long held beliefs and biases.

In Romanian we say: "If someone says you're drunk, ignore them. If two people say that you're drunk, go to bed even if you haven't touched a bottle of liquor."

The odds of your sources being a scientific revolution are low. They're much more likely to be Nostradamuses (Nostradami?) than Galileos.

Plus, using Ben Shapiro as a source? Isn't he obviously an agenda pushing hypocrite? I mean, a broken clock is right twice a day, but still :-)

What part of hospital over-crowding are you having difficulty understanding? I am sure someone here can explain it to you.

Some of these hospitals are being over-crowded because people haven't been able to come in for basic surgeries. People have died because they haven't gotten heart surgeries. If someone comes in for getting their wisdom teeth out, and tests positive for CoV2, they're listed as a COVID case, even if they have zero symptoms (and with 40+ PCR amplifications for each test, the false positives are high).

Hospitals are over-crowded ever year in the winter for all kinds of seasonal illnesses including flu, strep and others. The Bakersfield doctors said as much back in March and were censored on all platforms for it. They're also overcrowded because America's health system is just bad as expanding care for bad seasons in general, and we haven't really noticed until this crisis.

At current rate of vaccination in the US, it’s going to take more than a full year to get it done.

Using the current rate as the constant rate over the next 12 months makes absolutely no sense.

Why? States have known since this summer that a vaccine was coming, likely by the end of the year, and somehow they have all neglected to prepare.

We've got what is by all measures a modern miracle, an answer to the most horrifying global event of the last century, given to us by a bunch of scientists who have been working nonstop for the last year to give it to us, and state health workers are doing things like taking weekends off and only opening a single vaccine site.

And then they also seem to concerned about fairness WRT to the vaccine distribution that they are willing to simply let this literal miracle go to waste on a shelf, rather than accidentally give it to somebody who didn't deserve it.

The way that almost every state seems to be treating these vaccines are not in any way in alignment with what I would expect from the worst pandemic in the last 100 years. It is infuriating.

And why not? What makes you think it will improve? Specialty distribution is not something you can easily scale in a short period of time.

"Specialty distribution is not something you can easily scale in a short period of time."

You admit distribution is something that can increase over time, so it should be plainly obvious that capacity will increase as time moves on (as opposed to staying stagnant or slowing down), especially considering everyone involved in the process has explicitly stated it will.

The additional vaccines that are close to approval give us further reason to expect the rate of vaccinations to increase significantly.

We have no reason to believe the current rate of vaccinations will remain stagnant or slow down, and many reasons to believe it will increase significantly in the coming months.

> Specialty distribution is not something you can easily scale in a short period of time

That doesn't mean that you can't scale it at all, and one would assume that scaling over a super short period of time (like, weeks) is harder than scaling over a slightly longer time span (like months).

On that basis, is it not fair to assume that there'll be at lease some non-linearity in production and distribution rates over the next year or so?

I think Pfizer has already found a cheaper and easier to manage dry ice based distribution method. If there's a will, there's a way.

For starters, distribution is currently restricted to a very small slice of the population.

Yes, it seems like ultimately the distribution problem will come down to communicating who can get vaccinated and when. Like right now I have been hearing scattered reports that there are places where doses of the vaccine are available and not being used. So if I wanted to go get one could I? I'm certainly not in any demographic that should be prioritized, but if it's just sitting there then someone should use it.

It's a logistical nightmare. It won't be improved. It could be, but it won't. At least, not in time for it to matter.

We're only about half way done with this.

This is a bad take, vaccinations are rapdily increasing in the USA and around the world:

https://ourworldindata.org/grapher/daily-covid-19-vaccinatio...

It's worth remembering that there's a need for 2 doses per person to vaccinate - don't think the article talks about dose as "the amount needed to fully protect one person"

This particular points concerns me the most. All the numbers we have now should be considered "half vaccinations". Very soon (if this hasn't already happened), we'll be hitting the point where people start getting the second dose. Assuming the second dose takes as long to administer as the first dose, the rate of people getting the first dose will be cut in half.

I think the logistical challenges of administering the second dose will be even worse. You have to contact and schedule all of the first dose people, you need to have them actually show up when they are supposed to, and you need to have sufficient doses on hand.

I am expecting that a large number of people will, voluntarily or otherwise, either not receive the second dose or receive it later than they are supposed to.

Areas of the US that are looking "good" now in terms of the rate of vaccinations may look far worse very soon.

That's a lot; yet it's still nowhere near enough. We've got ~over 9~ around 8 billion who need vaccinations.

EDIT: Even with 5+ different vaccines hitting 600M (some of which require multiple doses per person), we're still talking years to achieve herd immunity. Years of continuing our current conditions.

Yeah, but they don't all need it at the same time. Plus there are multiple companies producing vaccines. There's Moderna, Pfizer/Biontech, Astra Zeneca/Oxford, the Russian one, the Chinese one.

> they don't all need it at the same time

We're talking about years, even if all of the existing vaccines can hit the same or similar production quotas. Compounded by individuals requiring multiple doses of some of the vaccines.

Years is a long time to wait for herd immunity.

Not sure I understand you. If most of the US is vaccinated, do you think the US will have to continue lockdown simply because most of Africa hasn’t yet gotten the vaccine? Substitute whatever country you are worried about.

I fully suspect that once the older folks and health care get vaccinated, at some point ICUs will start clearing out and lockdowns will start coming off.

> If most of the US is vaccinated

These vaccines aren't all going to the US (or at least, not that I've heard about). I've been hearing 600,000 vaccinations (granted, this is from politicians, so ready your salt) this year in the US.

> ICUs will start clearing out and lockdowns will start coming off

In which case they'll fill right back up (as is being aptly demonstrated in the US right now). It's not just the elderly who are filling those beds - slightly over half of the hospitalizations are under 65, pretty consistently throughout the pandemic.

> I've been hearing 600,000 vaccinations (granted, this is from politicians, so ready your salt) this year in the US.

I don't know where you're hearing that, but the US is already doing more than 300,000 vaccinations per day (302,000 on 1/1 and 325,000 on 1/2.) If we maintain that rate we'll have 100% vaccination before the end of the year. Of course not everyone will take the vaccine, but "600,000 vaccinations this year" is wrong.

It's one of 5 vaccines currently in use, with at least a couple more expected to be approved in various countries this and next month. So it does not need to be enough.

Even if all 5 produce 600M doses a year, it'll still take years. Some of those also require two doses per person.

India alone plans to produce 1 billion doses of the AstraZeneca vaccine this calendar year, with 50 million already produced. These vaccines were just approved in a few countries and production is just starting to ramp up. Not a great time to be making projections. Give it a month.

You mean 8 billion?

2 doses per person... No need for 100% vaccination (some will die before being vaccinated, some immunity from already being infected, some too poor to buy it, etc.)

> some will die before being vaccinated

And their replacements (plus a few) will be born, also requiring a vaccination until we hit herd immunity.

To be clear, none of these vaccines are approved for young children (though it helps that they are poor vectors and super low-risk).

It doesn't have to be newborns who replace the dead from the vaccination pool - it can be children outside of the age range growing into the vaccination range.

One thing I don't understand, is why government don't give free money to manufacturers ? Locking down is costing so much to society and governments. Instead of giving money to people who don't work, just give money to produce vaccines faster and let those people work ASAP.

Why we don't do that ?

It is the rate of vaccination that is interesting to me. Doctors and nurses are turning down the shot at rates that are surprising. These are supposedly the most informed group - the group that counsels everyone else.

Why?

Look at these death totals by age

Age 25-34: 2087 deaths. Age 35-44: 5398 deaths. Age 45-54: 14496 deaths.

https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

These are small numbers.

I don't think we're going to get herd immunity without vaccine mandates.

I too have been surprised. I'm more surprised about physicians turning it down than nurses. I love nurses, we've got 15 on our payroll, they're kind and wonderfully exceptional people. But they operate heavily under various protocols outlined for them, and while they have more health knowledge than your random person when it comes to the nitty gritty details they are naïve.

The number of nurses who think that the mRNA vaccines permanently alter your DNA would surprise you.

My hope is that after the roll out and the number of serious adverse events is shown to be miniscule, people will be less reluctant to take the vaccine.

I’m not even in health care and I have a reasonable understanding of how dna, rna, translation and transcription work. Do nurses not learn this stuff?

Not sure about nurses, but a broad section of the population does not know how percentages work. This is true for almost all countries. The width in science skills is breathtaking.

lol. no. no way. I would guess that about 2/3 of our nurses could give you the 8th grade explanation of dna - "a sperm and an egg each contribute half of each chromosome and that is the instruction book on how to make every cell blah blah blah". rna, translation and transcription. I don't think a single one would know. They need to know the common drugs in their field, how to take vitals, when to raise the red flag to a physician. That's it. That is all still super important, if they don't use it at least once a year, they're not going know.

You’d be surprised how many software developers have no idea how https works.

IMHO, there either has to be a mandate or a personal incentive to get to herd immunity faster. With the low fatality rates for younger people, the personal incentive to get the vaccine is not high. This leaves mandates. Workplaces and schools can do this.

> Why?

overall rates for a group contain millions or tens of millions of people probably aren't going to be dominated by a single explanation. maybe they want to leave them free for groups that are at higher risk? not every kind of doctor is dangerously exposed to risky patients.

Any group that is offered the vaccine but turns it down at any significant rate is a useful data point in projecting the date date we reach herd immunity.

For example, consider if vaccine uptake was 100% - we would immediately know that we were supply and rate of delivery limited. Alternative consider if the vaccinate uptake rate was 10% - then we have the opposite problem. Demand is too low.

In this case, with some doctors and nurses rejecting the vaccine, it is reasonable to project that overall demand for the vaccine across the general population will be low. This means that the date we reach herd immunity is farther in the future than if the uptake rate was 100%.

i was quoting your "Why?", not asking you a question.

and if you continue to treat a group of millions as a homogenous unit, you can't have thoughts like "maybe the doctors turning it down right now will accept it after the elderly are all vaccinated" which wouldn't slow down the overall vaccination rate.

"maybe the doctors turning it down right now will accept it after the elderly are all vaccinated" - This is a conjecture and not a fact observable in any collected data about vaccine uptake.

What your thoughts or my thoughts are really don't matter. What matters is observable facts and how they inform us about future policy decisions.

To me, medical professionals turning down the vaccine when offered suggests that public policy makers should consider vaccine mandates if we're to reach herd immunity faster.

Only if you think the doctors' decision, right now, is broadly generalizable to the entire population at the moment the vaccine is available to them. To me, this is a massive leap.

Broadly, however, you are right: we should be (and are!) studying vaccine uptake. It is not a wise decision to put much weight on the doctor data, as it's not been shown to be generalizable.

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