Cuba′s Covid vaccine rivals Pfizer, Moderna | Hacker News Reader

Cuba′s Covid vaccine rivals Pfizer, Moderna

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406 pointscolinprince382 comments

It is a 3-dose protein vaccine. [1]

"The second of these candidates and the fourth from Cuba uses yeast as a receptor binding domain protein and alumina as an adjuvant." [2]

I suspect there is a translation issue here. I would hope this means they are recombinantly expressing some portion of the RBD in yeast, not that they are using yeast as a vector.

[1] https://www.nytimes.com/2021/06/22/world/americas/cuba-vacci...

[2] https://www.bmj.com/content/371/bmj.m4654/rr-6

According to this [1] it's cultivated in yeast:

> Su cultivo se realiza en células de levadura, lo que la diferencia de "Soberana 2"

"Iit's cultivated in yeats, what differentiates it from 'Soberana 2' " (Another Cuban vaccine)

[1] https://www.swissinfo.ch/spa/coronavirus-cuba--previsi%C3%B3...

Excellent news but there's a translation error or misunderstanding in this article.

> The scientists are using yeast as a receptor-binding domain.

I think they must mean they're using yeast as the protein expression medium and encode the receptor binding domain of the spike protein (along with the rest of the spike?) with yeast-y promoters and base sequence preferences. I guess there's nothing on the spike protein that needs to be glycosylated so non-mammal cell culture works.

I was reading about the mRNA approach recently and wondered why not just inject the spike protein itself? Why have our body make the protein instead? Does anyone here know? It's interesting to see that both approaches yield such good results, and the end result, triggering immune response to the spike, seems about the same.

That's what the Novavax vaccine does, but it's still in testing and approval stages (although the trials results for now look like it works fine). As far as I understand, part of the problem is finding a way to produce the correct protein efficiently.

> Why have our body make the protein instead?

Not so easy to make enough, and handle it just like every isolated biological molecule?

It's expensive and difficult to scale when you're trying to make millions of doses.

It boils down to the mRNA process being faster and more of a sure thing for a novel virus. I hope there are eventually many more effective protein based vaccines approved.

The problem with expressing your protein in some animal cell is that often times there are sugars that cells add to proteins and they differ by lifeform type. So the protein will end up shaped different in a yeast than in a animal cell. Additionally, growing in a third party host lifeform often leads to situations where you can't get it to grow in the host anymore because the virus changes.

The sure thing for a novel virus, as I understood, is an inactivated vaccine.

For everything else, you are never sure if the biotech tricks, with all their intricacies, will work in that individual case.

Well, you're sure to get something with an inactivated viral particle. But you're not sure to get a usefully efficient protection from exposure to it.

The problem with inactivated viral particles is the inactivation process, neccessarily, breaks the proteins and cause them to be liable to take up non-realistic shapes. When your immune system trains on the non-realistic shape the antibodies don't neutralize as well. See the sinovac inactivated sars-cov-2 vaccine for an example of this type of vaccine not working out (ie, <50% efficient).

There's nothing medically wrong with the approach, however protein based pharmaceuticals are slow and expensive to manufacture, which isn't ideal when you are trying to vaccinate millions of people, cheaply.

To manufacture a protein you need to create a genetically modified bacteria that contains the DNA for that protein, grow a large batch of this bacteria (which can be difficult at scale), and then break open the bacteria filter out all the other proteins and just keep the one you want.

This is why the mRNA is so elegant, it gives your body the instructions to manufacture the protein itself.

Great answer, thank you!

The mRNA vaccines are sliced out of plasmids grown in bacteria (as DNA which is then transcribed into RNA).

https://www.nytimes.com/interactive/2021/health/pfizer-coron...

The nice thing about mRNA vaccines is that this has to be done only infrequently. The crucial point is that this DNA should be able to be transcribed into many mRNA molecules. Else, I have no idea how the one plant where the DNA is grown could supply the whole world.

The article I link implies they use each bottle of DNA in a day (not each batch, a bottle from the batch that they thaw for use).

I imagine it's a quality control thing.

The short answer is that proteins are too complex to manufacture, and it’s more effective to instruct your body (which has a lot of protein manufacturing capacity) to produce the protein.

There are attempts to use peptides. They are much shorter chains of amino acids , they are easy to produce, but it’s difficult to find peptides that reproduce the external structure of the virus. There is an experimental Russian vaccine based on peptides, but the results haven’t been published yet.

When the mRNA vaccine is injected into your arm muscles some of it ends up in the cells of the muscle and some of it ends up in the intercellular fluid. The latter drains via the lymphatic system and will end up in the lymph nodes in the upper body on the side you got the shot it (which is a good place to end up since the lymph nodes are a major site for immune response). Some will end up in the blood, and so might end up elsewhere.

Whatever cells it ends up in, the mRNA has them make the spike protein. That spike protein ends up attached to the outside surface of the cell that made it and it stays there [1].

If you injected spike protein directly, it could end up anywhere. I don't know if this has been tested in humans yet, but there has been research in mice where spike protein injected damaged their lungs [2].

[1] https://blogs.sciencemag.org/pipeline/archives/2021/05/04/sp...

[2] https://www.contagionlive.com/view/spike-protein-of-sars-cov...

Spike protein moving around free has been proposed as a potential source of the problems with the adenovirus vector vaccines.

(errors in the transcription process end up preventing it from properly attaching to the cell)

> will end up in the lymph nodes in the upper body on the side you got the shot in (which is a good place to end up since the lymph nodes are a major site for immune response)

Would it be worthwhile to get the first shot in the left shoulder and the second in the right shouder (or vice versa) so you have lymph node immune response from both sides of the upper body?

Aren't spike proteins moving freely, specifically, concentrating in the ovaries what is concerning Robert Malone? [1]

[1] https://bit.ly/2Td5gWz

E: curious why downvotes, am I misinformed?

No, they don't concentrate in the ovaries. That's choice morsel of bullshit antivax disinfo.

For a backgrounder of what actually happens, see Derek Lowe's recent blog[1]. Most of the lipid nanoparticles end up in the liver, which is exactly what you expect. There's a detailed debunk of the ovaries issue in [2].

Thanks for being curious about your part in spreading covid misinfo. I suspect most people aren't aware of what they're doing, just repeating stuff they heard from people they trust but probably shouldn't.

[1]: https://blogs.sciencemag.org/pipeline/archives/2021/05/04/sp...

[2]: https://byrambridle.com/

The talk I linked came out last week, they specifically discuss the articles you've linked.

Specifically, the reasoning your articles give for spike proteins being harmless is that they stay in the local injection site and lymphatic system. But we now know this is not the case and that these spike proteins do travel around the blood stream and concentrate in the ovaries.

The claims that guy made on the radio a while back were wrong but there is new information coming out about this and we specifically do not know the ramifications yet. Phizer is looking at the new data package right now.

At least, that is the argument currently being put forward, I don't know how much of it is fact based and how much is conjecture but it has me concerned at least somewhat.

Calling everyone an antivaxer really doesn't help anything. This shit is a moving target.

And you are not repeating stuff you read from other people? Details on safety and efficacy of vaccines for different sub-populations are still subject of study, new data is being generated, and as new information comes out, our ideas on the risks and benefits may keep changing.

Thank you for the links but please keep the arrogant tone down.

After vaccinating half the population, with the rate of discovered issues being hard to measure because it is almost background noise, the data is unlikely to substantially change for the other half of the population. PCPs already are aware of some subgroups that warrant additional caution and study, and additional study is ongoing to refine our knowledge. I would not classify that as expecting our understanding to change.

He linked to a meta analysis that links to many other studies to carefully support each statement. That is not the same as making claims that are not based in current data or statistics.

> the rate of discovered issues being hard to measure because it is almost background noise

Efficacy of post-vaccine follow-up and reporting may change with time, and hopefully will. The problem is that there is no meticulous data gathering from all vaccinated persons. Reports of issues are voluntary in most cases and in some cases institutions are not even notified by the vaccinated persons.

According to one study of VAERS frmo 2020, a passive reporting system, the real amount of issues is underreported; depending on the effect, the reporting efficacy is somewhere between 12-76% [1]. This is not a great system and because of that data gathering is not as fast as could be.

[1] https://pubmed.ncbi.nlm.nih.gov/33039207/

That is what I meant to say also.

So not to beat a dead horse, but there is no meticulous data gathering from unvaccinated people either, and we know that also suffers from vast underreporting. The one data set (being unvaccinated) simply also has a very strong signal of known serious health issues, while the other data set (getting almost any current vaccination) has a very weak signal of very rare, usually minor issues.

> If you injected spike protein directly, it could end up anywhere. I don't know if this has been tested in humans yet

Isn't that what the Novavax vaccine does? I'm not a medicine expert by any means, but my understanding from press reports was that they inject the spike protein directly (possibly attached to some substrate protein to carry it along).

https://en.wikipedia.org/wiki/Novavax_COVID-19_vaccine

Practical reason is that life sci VCs want to fund “platforms” in recent years, and mRNA can be pitched as a “platform,” so that’s what got funded.

One of the big reasons is that mrna is also much easier to manufacture than proteins. If I wanted to, I could pay for a arbitrary mrna sequence delivered to be within the week. Its basically been commoditized.

Conversely, getting a protein at scale requires the engineering of an organism to synthesise the protein of interest. This results in increased delay in manufacture.

> According to the state-run biotech corporation, BioCubaFarma, Abdala has proven about 92.28% effective against COVID-19 in clinical trials, which would put it the same league as the most effective vaccines BioNTech-Pfizer and Moderna. Huge applause erupted in the auditorium of the CIGB this week when the impressive results were announced.

One thing to be careful about is the the regulating authority and the testing authority and the developing authority are all the same and have a huge incentive to have good numbers, not the least of which is national pride.

I would be careful with those numbers.

I think you have a good point. Not sure why you're downvoted or "almost invisible".

I agree too. I look forward to Cuba allowing third parties to corroborate their results.

Absolutely, this number may be confirmed when tested by a third party. Medias were cautious on the russian's vaccine claims until the Lancet published a study on its efficacy.

Edit: grammar

The Lancet publishing data does not mean the data is correct, they do not verify it. It's all based on trust.

The Lancet published Andrew Wakefield's study on the connection between vaccines and autism, and the recent study on hydroxychloroquine based on entirely fabricated data.

Also note efficacy can be misleading. Pfizer was 100% effective at preventing death or serious illness in their trials, which is what's really important. It was "only" 95% effective against getting the disease at all, which isn't particularly important.

i.e. even a vaccine that has 0% efficacy (doesn't prevent mild cases at all) and yet is ~100% at preventing severe cases would be on par with Pfizer's, whereas one that does the converse (prevents all mild cases but no severe ones) would be drastically worse. Not saying these extremes are likely, but we need numbers on the former rather than the latter to say whether another vaccine truly 'rivals' that of Pfizer.

P.S. (rant): Why don't we just define a single word for the metric for what really matters and just use that?? It boggles my mind.

Another example: Sinovac's Vaccine is 100% effective (at preventing death in Brazil) and 50.7% effective (at preventing symptoms in Brazil)

Coronavac efficacy in Brazil has been way higher than 90% at preventing death, right: https://www.bbc.com/portuguese/geral-55639265 ?

Yep, fixed. Copied the wrong number.

Preventing infection is very important in reducing spread of the disease to others. Vaccines in the end work best when we reach herd immunity, and that occurs by preventing most infection, and thus the possibility of mutation.

> Preventing infection

I agree! I didn't say anything about the importance of preventing infection.

Getting the disease is being infected. It is important that people not get it in the first place, so they can't transmit it to others.

Not quite. As far as the terminology goes, I don't think they're the same, since to me having disease implies feeling ill—note "disease" = "not at ease" = "COVID-19"—whereas infection implies merely carrying the SARS-CoV-2 virus in your body regardless of any visible effects. (Having SARS-CoV-2 does not imply you have COVID-19!) But in any case, let me clarify this.

What I agree with (and in my initial comment I said nothing about) is that it matters if people can spread the virus to others.

What I don't with is that it matters if you're "infected" if you can't spread it to others (and don't have severe symptoms).

The important thing here is that, from what I recall Dr. Fauci said a month or so ago, there have been promising indications that vaccinated people who get infected with the virus are both significantly less likely to get the disease (COVID-19) and to transmit the virus (SARS-CoV-2) to others (independently of the disease, COVID-19). You can read about this on the CDC website [1]. (And my assumption was that was a big factor in why they lifted the mask mandate... because fewer people are capable of spreading it even if they get the virus.)

So no, it doesn't matter if you merely get infected. What really matters is how many people can become severely sick as a result of your infection, whether that's you or others. Which is important because these vaccines seem to limit transmission itself.

[1] https://www.cdc.gov/coronavirus/2019-ncov/science/science-br...

If you have the virus in you, there is always potential for illness, transmission, and mutation. Even if chances are reduced, not getting it in the first place is better; and all else equal, a vaccine that does a better job of stopping infection is better than one that does not. Since virus mutations are an unknown, "past performance does not guarantee future results" very much applies. So although I agree how sick people get is very important for a vaccine, and in the short term certainly the most important aspect, it is not the only important criterion to measure.

As to why the US CDC lifted the mask mandate while the WHO is recommending vaccinated people wear masks to try to stop the spread of the Delta variant, and there have been many documented cases of large parts of groups of vaccinated people getting the Delta variant as well as other variants - some of whom have gotten seriously ill - I have no comment.

You're splitting hairs at this point. Yes, all else being equal, I'd prefer not to get the virus too. All else being equal there are lots of things I'd prefer over other things, but they turn out to be negligible and stop mattering in the presence of so many bigger fish to fry.

And I'm not saying they should stop measuring anything either. They should measure whatever they feel like. All I'm saying is most people's #1 concern (including that of those in healthcare) is "will I/others get severely ill", and IMHO that means that's the information that needs to be conveyed as accurately as possible to the public first and foremost. Especially when there seems to be such a highly likely possibility that many people who merely "have" the virus will feel no effects. Of course nothing is a guarantee and it's even possible the vaccines will turn out even worse than the disease in a few years. Nobody claimed otherwise.

Well this has gotten old.

You stated that the current form of measurement was not very good. I pointed out that we care about transmission and mutation for long term eradication of the disease - hence the measurement that is used. It's obviously not negligible or the entire professional world would not use it as a measuring stick for vaccine effectiveness.

My comment wasn't about what measures the profession uses to do their work. My comment was about what measure they're communicating to us, random members of the public. These need not be the same thing.

That is fair enough. However it would still backfire, because the general public can't listen to anything responsibly.

If we report the vaccine is 99.5% effective at preventing serious illness, people will not listen to ANYTHING about being cautious and wearing a mask after they are vaccinated. I predict a nasty wave of COVID this fall/winter including in relatively highly vaccinated areas due to just this attitude already.

> If we report the vaccine is 99.5% effective at preventing serious illness, people will not listen to ANYTHING about being cautious and wearing a mask after they are vaccinated.

Uhm, the CDC literally told vaccinated people they don't need masks indoors or outdoors. [1] At that point it's kind of silly to say quoting 99.5% does or will a detrimental impact.

> I predict a nasty wave of COVID this fall/winter including in relatively highly vaccinated areas due to just this attitude already.

No; if it happens, it certainly wouldn't be due to this; at best ('best' for your argument), it would be due to their overriding guidance re: not wearing masks, which I mentioned above. However, I predict if this happens, it'll be due to changing circumstances like worse variants breaking through the vaccine (which the CDC admits they do not have sufficient data on [2]), not due to their current advice being bad due for current variants.

[1] https://www.webmd.com/lung/news/20210513/cdc-vaccinated-you-...

[2] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vac...

I believe it is 95% effective at getting the disease with symptoms. I understand they never tested people who had no symptoms in their trials.

Oh interesting. Would you have a link on this?

That's what I have seen mentioned repeatedly on HN. Some of the comments link to articles and studies, but not being a doctor myself, I have not verified them

https://hn.algolia.com/?dateRange=pastYear&page=0&prefix=fal...

Ok thanks. Btw, I think my comment is actually correct with that definition, given how having the disease (COVID-19) implies having symptoms. IIRC that's precisely when they say you have SARS-CoV-2 (the virus, which you'd be an asymptomatic carrier of), but not COVID-19 (the disease).

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The main problem is that you need a lot more data to make confident statements about severe cases than just about symptomatic cases. That 100% number of the Pfizer trial had a huge uncertainty interval. So even though severe cases are what you care most about, you usually don’t want to wait for a study that gives you good data on those and measure (and compare) symptomatic cases instead. Zeynep Tufekci discussed this issue of study endpoints in one of her recent articles: https://www.theinsight.org/p/vaccine-efficacy-statistical-po...

But couldn't they just tell people about the uncertainty? (like "90-98% effective"?) Or underestimate the efficacy (in some objective way, like "at least 90% effective"). Or something else, as long as they're ultimately measuring what matters and what people actually care about. It's not like that 100% with their sample sizes would realistically ever suddenly turn into 50%, would it? It seems just inherently wrong to measure the wrong thing and convey it with certainty than to measure the right thing and convey it with the associated uncertainty, does it not?

They actually had a table on the efficacy for severe cases in the supplemental material of the original Pfizer study (table S5 in [1]), but all it shows is that the study doesn’t really give any information on this. The 95% confidence interval given for severe cases after the first vaccine is 20.1–99.7%.

From what I understand, it’s really a trade-off between waiting for proper data about the efficacy you’re most interested in, or starting to vaccinate people as soon as you have efficacy data for an endpoint that’s still meaningful but easier to reach. Having much fewer symptomatic cases is already a pretty good result, and I think it was expected that the protection would also extend to severe cases.

[1]: https://www.nejm.org/doi/suppl/10.1056/NEJMoa2034577/suppl_f...

How much data (read: jabs) is necessary to evaluate the ability to prevent hospitalizations when even without the jab only a small percentage of cases lead to hospitalization? How much care is given to ensure the jab group's demographics reflect the "control" (i.e., the broader population).

For example, ppl getting chemo aren't given the jab, are they? Yet they are counted if they get the virus, end up in hospital, etc. The point being, extrene Covid preys on the (immune) weak. Yet the jabs aren't tested on ppl who profile as such. How is that accounted for in evaluating a vaccine?

I'm a layman so I don't know if I can really give a satisfying answer to your question. All I know is what I see just doesn't make sense to me.

Even in April 2020 we had rough but useful numbers on the hospitalization rate. Just some quick Googling turns up e.g. [1] which says that around 20% of those who test positive end up hospitalized. Now the Pfizer vaccine by itself had like 40k participants, with 9 severe (out of 162 confirmed cases) of COVID-19 in the placebo group, and 1 severe case (out of 8 confirmed cases) in the vaccine group. [2] [3] So right off the bat it looked pretty promising, and IMHO they could've just cited these numbers and let people judge for themselves... it's not like people don't have the intuition to realize that 1 patient couldn't have been 2-3 instead. But even if you think that wasn't enough data to be convincing, at least now we have mass vaccination rates they could be citing. Like literally ~40k people have been hospitalized with COVID-19 in just the last week and nearly all COVID deaths are among the unvaccinated now, and it's not like the vaccine just came out last week.

An Associated Press analysis of available government data from May shows that “breakthrough” infections in fully vaccinated people accounted for fewer than 1,200 of more than 853,000 COVID-19 hospitalizations. That’s about 0.1%. [4]

How is that still not enough data to switch metrics at this point? Why do they still think efficacy rates are more relevant for people instead?

[1] https://www.tfah.org/wp-content/uploads/2020/04/COVIDunderly...

[2] https://www.pfizer.com/news/press-release/press-release-deta...

[3] I don't know why this reporting differs from the 100% I see claimed elsewhere; 1 severe case doesn't sound like 100% effective at preventing severe cases? I don't know if they're discussing different trial phases or have different thresholds for "severe" or something else... but regardless, it's irrelevant to my point.

[4] https://apnews.com/article/coronavirus-pandemic-health-941fc...

I think the 100% number comes from the fact that the one vaccinated severe case in the original study just was just barely below the threshold of oxygen saturation they had defined but the person required no medical care, so it wouldn’t be classified as severe by “regular people’s standards”.

Ah, thanks!

More questions, if you don't mind...

Is it really scientific (?) to compare the first 6 months to the second? That is, for example, Covid ravaged extended care facilities. Was that the virus of too many facilities being ill prepared?

As for recently, "unvaccinated" is fairly broad and in aggregate hides important details. That is, are those ppl unjabbed by choice, or by necessity (i.e., immune compromised, pregnant, nursing homes, etc.) Why isn't this important distinction made?

I'm not a CDC spokesman, sorry. You'll have to ask them. All I can do is to try to exercise a bit of common sense. And my common sense says you shouldn't wait for an RCT for "science" to tell people parachutes save lives...

Disclaimer: layman here, just repeating what I heard and read the past months/years.

> How much care is given to ensure the jab group's demographics reflect the "control" (i.e., the broader population).

This is mostly done through sampling all ages. In general, older people have a weaker immune system than younger, so older people can serve as a model for younger, immune-suppressed people. That's not ideal, but generally preferable to testing new drugs in chemo patients.

In cases where people have an elevated risk (chemo, pregnancy, other immune suppression situations like after transplants), the best you can do is vaccinate as many of the contact persons around them.

(Regarding pregnancies, I don't know how much of that is actual risk regarding vaccination, and how much is related to the difficulty of testing drugs on pregnant women. For example in Germany, drug tests are on pregnant women are a very delicate topic and mostly avoided by pharma companies, mostly due to https://en.wikipedia.org/wiki/Thalidomide_scandal )

There's not a lot of information about exactly what this vaccine is or how it works. I'd be cautious about drawing conclusions based on press statements.

> There's not a lot of information about exactly what this vaccine is or how it works. I'd be cautious about drawing conclusions based on press statements

+1. Waiting for the results in a peer reviewed paper. Science by media is a bad paradigm as a lot of things during the pandemic have shown :)

> The Cuban vaccine is neither a vector vaccine nor does it work with mRNA technology. Instead, it's a so-called protein vaccine.

> That means it carries a portion of the spike protein that the virus uses to bind to human cells. It docks onto the receptors of the virus' own spike protein, thus triggering an immune reaction.

"thus triggering an immune reaction" because...? (genuinely asking - I know nothing about vaccines)

A vaccine is effective by triggering a small immune reaction within your body. They are essentially very small amounts of X virus, so that your body can trample it and build an immunity to the real thing.

...very small _pieces_ of X virus...

I think the question the OP was trying to ask can be rephrased as "why does a random piece of protein trigger an immune response?"

I mean the short version is "everything does". The human immune system is psychotic to the point that we have organs it has to be kept isolated from or it will destroy them.

That's immune privilege, right?

https://en.m.wikipedia.org/wiki/Immune_privilege

Because foreign proteins are immunogenic.

https://www.fda.gov/vaccines-blood-biologics/biologics-resea...

The fact that it is a different type of vaccine seems quite significant

Having domestic vaccine development and production capabilities probably didn't seem that important to a lot of countries until recently.

I bet a lot of countries are going to try and developer their own capabilities as a result of this crisis.

Point them to SciHub!

> "The CIGB Research Institute has 30 years of experience in vaccine research. I trust the results that have been published. These are serious studies, with the participation of researchers and institutions committed to science," Moya said.

We at least have one expert epidemiologist vouching for the results.

Perhaps a false equivalency, but how many epidemiologists were on Twitter and elsewhere in 2020 strongly contesting the lab leak theory?

Note that this lab leak theory is, at the current stage, still a theory. At best, time will tell whether it was true.

This is good news regardless, but I wish these articles had more detail. Some number of "% effective against COVID-19" is not meaningful on its own. Effective at doing what, exactly? Preventing symptoms? Preventing transmission? Preventing death?

Comparisons between different vaccines aren't at all meaningful without this context, and I hope the authors realize this, despite not mentioning it.

> Effective at doing what, exactly?

I think at this point all the 'efficacy' numbers given by drug companies for the various vaccines on the market are: relative risk reduction of hospitalization or death.

Not uninteresting per se, but would be even more interesting if paired with the absolute risk number [1].

1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996517/

Absolute risk will ebb and flow with the abundance of the virus in a population, so it wouldn’t be useful as a comparison or as a predictor for the future since every trial will be different.

There are basically 4 effectiveness numbers, based on whether you measure:

* positive PCR tests

* showing symptoms

* hospitalization

* death

I share kube-system's frustration with the media glossing over those details quite often.

Here in Germany, there were numbers thrown around such as the mRNA vaccines being 90%+ effective, and the AstraZeneca being only in 60ies or 70ies (which was likely based on PCR tests). Which made many Germans hesitant to get that vaccine.

Turns out, AstraZeneca prevents hospitalization at a roughly 90% effectiveness rate (recent numbers from England, don#t have link ready right now), which sound much better than 65% number.

A recent study put the Pfizer vaccine at a 97% hospitalization prevention rate, which is much better than the AZ one. How comparable all these studies is a good question.

https://www.cidrap.umn.edu/news-perspective/2021/05/real-wor...

The US vaccines use a different spike protein than the AZ vaccine. It's likely that they are truly more effective.

My understanding is that “effectiveness” in these studies means that it is x% effective at preventing covid-19. So comparing these numbers is not the most important thing. Most all of the vaccines on the market are very, very effective at stopping death and hospitalization, which is the most important thing.

> preventing covid-19

That could still mean several different things.

I'm not questioning whether or not any of them are effective enough to be useful. I got the first one I could. I'm questioning whether or not the comparisons that others are making are meaningful.

I skimmed the article you linked to[1], but I still don't understand the advantage of using the absolute risk reduction rather than the relative risk reduction (or the point of reporting both). It seems it's like the same information expressed differently. I'm guessing that there must be an intuitive advantage like measuring the fuel economy of a car in gallons per 100 miles rather than the usual miles per gallon, but I'm not seeing it. Can you explain further?

[1] Quoting the article's explanation of AAR vs RRR: "The vaccine and placebo groups in Figure 1 each have 100 randomly assigned individuals with no history of infection, and an event is defined as the incidence of infection among all individuals during the course of the trial. The percentage of events in the vaccine group is the experimental event rate (EER) or the risk of infection in the vaccine group (1/100 = 1%), and the percentage of events in the placebo group is the control event rate (CER) or the risk of infection in the placebo group (2/100 = 2%). Absolute risk reduction (ARR) is the disease risk difference between the placebo and vaccine groups, i.e., the CER minus the EER (2% − 1% = 1%). The ARR is also known as the vaccine disease preventable incidence (VDPI). Relative risk reduction (RRR) or vaccine efficacy (VE) is the reduced risk from vaccination, the ARR or VDPI, relative to or divided by the risk in unvaccinated individuals, the CER (1%/2% = 50%)".

I share your skepticism. Personally, I have talked to people (educated and intelligent people) who refuse to get the vaccine because "it is only ~1% effective". Using ARR seems to cause more confusion and misunderstanding that RRR.

> I'm guessing that there must be an intuitive advantage like measuring the fuel economy of a car in gallons per 100 miles rather than the usual miles per gallon, but I'm not seeing it. Can you explain further?

Sure, ARR is more interesting for risk/cost benefits analysis. So much so that it is part of the official FDA guidelines expressed in this document ("Communicating risks and benefits: An evidence based user guide" [1]).

"Another statistical choice is between reporting relative or absolute risks. Because there is no way to infer the latter from the former, absolute risks are always more informative. Doubling a risk means very different things if that entails going from 10% to 20% or from 0.001% to 0.002%.Even when they contain the same information, different summaries can highlight different perspectives, hence bias choices."

Besides, if you compare the ranks of the main vaccines in each stat, you can see that it is not the same information expressed differently:

ARR: AZ 1.3%, Moderna 1.2%, J&J 1.2%, 0.84% Pfizer RRR: 95% Pfizer, 94% Moderna, 67% J&J, 67% AZ

1: https://www.fda.gov/media/81597/download

I'd say the opposite: maybe the news reports should have less detail. The efficacy percentages of different vaccines mean different things but the way they have been publicized has lead many people to think one vaccine is better than the other. We're starting to see some people refuse to get vaccinated, because they're shopping aroung for a vaccine that they think is more effective. At the end of the day, what really matters is vaccinating as many people as soon as possible.

I disagree. Hiding data from the public in the name of public good has been the basis of every censorship throughout history.

I don't see a problem with the information being available. But in my opinion it shouldn't be in the headline. IMO, it would be better if the headline just said that the vaccine is safe and effective.

While I share your frustration with the general public's opinion on vaccination, I don't think that the idiots who can't comprehend the details would be convinced with fewer details. Those people aren't paying attention to the details anyway.

For instance, when the J&J clot "issue" hit the news cycle, vaccinations across the board went down, even for vaccines other than J&J. These people aren't looking at any kind of details or data and getting confused by them, they're just making a decision based on word-of-mouth sentiment from their social/media circles. They would have never been confused by details in the article, because they never read it.

I agree - way too many people think they know what they’re talking about. Data is only helpful if you know how to use it.

The data should be publicly available, but that doesn’t mean it belongs in an article for general consumption.

And how would you achieve that? If data is publicly available, somebody somewhere will decide to write an article based on it. And if it sounds interesting, it will spread.

In just saying it’s not a good editorial decision to include excess data in an mainstream news article.

If a more specialized publication wants to offer a more explanatory story, fine.

But I don’t think that’s what people are looking for from a regular newspapers.

Knowing a vaccine is considered by experts to be effective is sufficient. The exact rates of reinfection aren’t important and can be confusing.

In a free media market, editorial decisions are made based on audience engagement. If the readers are more likely to read the article with more numbers (and thus see the ads in it), that's what will be published.

In a free market, editorial decisions are made based on advertising revenue.

That’s not always a good thing. Simply because something is factually true and increases audience engagement doesn’t mean it’s relevant or responsible to include.

For example, COVID had a fatality rate of 2%. That’s a fact. It also will increase engagement amount certain media markets.

But that’s also very misleading. 2% of the world is 140 million people.

The fact that it’s piece of “true data” that increases audience engagement doesn’t mean it belongs in mainstream articles.

Oh, I'm not saying it's a good thing. I just don't see what you can do about it within a capitalist framework without some kind of centralized censorship - which is even worse in the long run.

I don’t think misleading data increases user engagement that much. And editors usually do a pretty good job not naming victims of sexual assault, reporting in suicides, etc.

Most editors want to maintain high standards, and that means excluding irrelevant data.

Isn’t that 2% of CFR (particularly also hospitalizations), not IFR? Still many people (and thus is the reason that historically regions of the US, dating back to George Washington, mandated some vaccines), just not the whole world.

> Knowing a vaccine is considered by experts to be effective is sufficient. The exact rates of reinfection aren’t important and can be confusing.

Sufficient to whom? Experts often disagree and if they disagree, I want to know where and why and what the data is. Just because I am not expert on the topic does not mean I can't make judgements on incomplete information.

You are seriously underestimating people that may want to read mainstream sources, as if they need to be told what to think.

True, MSM unfortunately regularly does that instead of impartial reporting, but how could anyone be a proponent that all MSM articles being like this is desirable for informed society. The increased focus on narrative pushing from MSM is the source of distrust in MSM and the reason why people turn to alternative sources.

> At the end of the day, what really matters is vaccinating as many people as soon as possible.

This position is absolutist and a mark of a totalitarian thinking and a large portion of population does not share it.

For most people, individual people freedoms matter too and in democracy, these freedoms are stronger than the institutional desideratum to vaccinate as many people as technically possible. What is best for the whole country isn't always best for the individual living there.

Curiously, I recently learned that George Washington imposed a mandate on the troops that required them to get the new vaccine, the first ever such idea. This means we owe the existence of our freedoms to mandatory vaccinations.

https://www.history.com/.amp/news/smallpox-george-washington...

I think you can safely assume it means it's good are preventing a non to minor reaction to the virus in 92% of the cases, and be close enough. That's rather meaningful. It's no reason to say "this article is useless"

Nah, not really, don’t believe those numbers, I’m from there, I know this is just political BS. Family and friends (some of them fully vaccinated) still struggle with COVID.

This is pretty exciting news. Cuba has a long history of sending medical aid to other developing countries, and right now the vaccine timeline for a lot of poor African countries is really, really bad. If this pans out, it could save a lot of lives.

> This is pretty exciting news. Cuba has a long history of sending medical aid to other developing countries, and right now the vaccine timeline for a lot of poor African countries is really, really bad. If this pans out, it could save a lot of lives.

Does Cuba have the capacity to produce enough vaccines for those nations? That would be really surpising to me

They'll probably be more likely to share enough technical know how that production elsewhere is possible.

I don't know the answer to that question, but since this is a protein vaccine it should at least be much easier to manufacture at scale.

Cuba is also known to train African doctors and return them back to Africa. They also helped South Africa during the apartheid regime

That has no relation to vaccine production at all.

It relates in terms of Cuba's attitude to international aid and the possibility of doing something similar with the vaccines.

It does. Cuba has strong international public health ties and is believed to be setting up production for the vaccine abroad.

I have never heard of this. The African National Congress (ANC), which fought against Apartheid for decades, had close ties with communist regimes in Angola and Mozambique. Those countries in turn had Cuban help in the fight against (South Africa-backed) right-wing rebels.

The South African government at the time was rabidly anti-communist -- think Eugene McCarthy and the red scare in the U.S. -- so I doubt they would have much to do with Cuba.

They helped South Africa, not the South African government, which was somewhat famously hostile to the majority of South Africans.

They also attacked French, and South Africans in Angola, btw, fyi

And then the apartheid croaked everywhere south of 17th parallel

I'll add another trivia: they also throw you in jail if you speak badly of the current regime, which btw doesn't allow free elections.

I think everyone already knows you go to jail in Cuba and most other authoritarian countries for speaking against the government.

this is what i am looking forward to, as an African what do you think we can do to accelerate vaccine access

Ask Cuba to help you set up a factory. The vaccine is not very complicated to produce from available information, and they seem willing to let other countries make it.

You mean they force cubans to work abroad while the dictatorship charges dollars for it, that's some kind of modern slavery.

Ungodly amounts of mis-education in this comment.

Not really, they get sent abroad and a lot of them defect, happened in Venezuelan and other countries. They get paid a misery while the dictatorship gets dollars from their work.

Gusanos lmao

As a cuban I can tell you Cuba definitely doesn't have the means of producing vaccines at scale. They barely have the capacity to keep hospitals clean and sterile. They do have, however, a great history of propaganda.

Vietnam and probably a few other countries, that certainly have the capability, will help in production.

Beyond that, this vaccine is insanely easier to produce than the mRNA vaccines.

This is a great example. It's incredible than in all latin america no other country has developed a vaccine, having huge countries like Brazil, Mexico and Argentina.

Brazil partnered with a lab in China. Their govt made a lot of mistakes, but this doesn't seem to be one of them.

> Their govt made a lot of mistakes, but this doesn't seem to be one of them.

The FEDERAL government did made this mistake. Repeatedly: https://oglobo.globo.com/brasil/veja-10-vezes-em-que-bolsona...

We do have a few vaccines in development here, but the federal government seems to want to block them all.

There is ButanVac, there is one in development in UFPR and I'm sure there are others. Sadly, our federal government is beyond terrible right now, but I imagine we could have developed one of our own already.

A state government partnered with China. The president criticised the vaccine that came from the partnership because the governor is his political rival.

I see, thanks.

Can't believe people is so eager to believe in this without any real scientific publication of vaccine efficacy.

Cuba lacks things so common as soap, to the point that you can bribe police officers or even pay sex workers with a tiny hotel soap bar or shampoo flask.

Your ignorance is unsettling.

I ask you 2 questions: - Have you ever been to Cuba? - Have you ever read a scientific publication of vaccine efficacy? Let alone a medical paper of any form?

have you lived in Cuba to say otherwise? Do you have family in the island without access to US dollars?

This is the problem when people live a life devoid of real hardship. They get enamored with intellectually sounding bites and abstract papers. They lack common sense.

Why do you see Cubans risk their lives on a raft for over 90 miles to migrate to the USA? If the country had such great means of production and wealth why is there a mass exodus?

Cuba, as a dictatorship, is in the business of pushing propaganda, that's it! Everything they do is to secure an appealing international image (sending doctor's overseas while their own people die giving birth because of contaminations in the operating room, promoting ideals of fairness, etc). It's all bs.

Have you gone to Cuba? I have.

I'm calling you out right now, there is no widespread child mortality or shortage of soap in Cuba. I have been there.

People leave Cuba nowadays because they are fleeing the law, or want to become rich which they can't in Cuba.

It is in no way an exodus. Cuba has a net emigration rate of -0.11% per year, and has been decreasing every year for a decade or so.

This is fairly normal of developing countries close to developped countries. To cite a number, Morocco which is similarly a sea away from the EU has an emigration rate of -0.14%.

So indeed, Cuba's emigration rate is quite normal.

The reason why people leave Cuba in rafts is because they don't have money for other forms of transport and/or because they are illegally immigrating. You'd be surprised but it's really hard to get into the US.

> a net emigration rate of -0.11% per year

Does a negative rate means there's more immigration than emigration?

No, it means more emigration. It's counterintuitive but that's how the data is stated.

Ok, in case you didn't get it by the tone of my post, I am that cuban immigrant.

I find it fascinating that Cuba is a country notorious for spreading propaganda and yet not a single comment in this post asks whether the data in that article is true... People just take the numbers at face value and rationalize their way into how such a small nation achieved such tremendous feat. Btw, I have family in the island still getting sick after being administered such a great vaccine...

> I'm calling you out right now, there is no widespread child mortality or shortage of soap in Cuba. I have been there.

Wrong. Plenty of children carry parasites because of lack of hygiene and dirty water. I won't even get into how many families lose children at birth because of bad hospital conditions. Did you do a blood test on children when you visited too?

> People leave Cuba nowadays because they are fleeing the law, or want to become rich which they can't in Cuba.

wrong again. People leave Cuba for multiple reasons including oppression, no freedom of expression, lack of resources. Just so you have an idea, the govt removes the ability to buy milk for children aged past 7. The govt makes it illegal to buy meat (particularly from cows) and other forms of seafood. I spent an entire year where my only source of protein was from eggs (if there were any) because everything else was inaccessible.

> It is in no way an exodus. Cuba has a net emigration rate of -0.11% per year, and has been decreasing every year for a decade or so.

Is this a joke? Have you ever heard of El Mariel or Peter Pan operations?

> The reason why people leave Cuba in rafts is because they don't have money for other forms of transport and/or because they are illegally immigrating. You'd be surprised but it's really hard to get into the US.

Nope. The govt has a hold on who can leave the country. You need to be awarded a permit just to visit another nation (part of the reason why Cuban's revere tourists). Only way to exit the island is illegally (through a raft), whenever some nations allow for legal migration through an application process (e.g., Canada but even then the govt needs to vet who gets to leave — doctors never allowed) or through some connections with the govt.

Do the internal issues have anything to do with USA completely blocking their ability to improve and import? "Do you have family in the island without access to US dollars?" - My point exactly, this is an issue the US has exacerbated, as a form of propaganda AGAINST Cuba.

I am, and have family, from a very similar South American country.

The blockade is a spin by the govt to excuse its oppressive power. Exhibit A https://twitter.com/cubabella13/status/1414619267794886656?s...

1. Yes. Twice.

2. Yes. Happy to read the Cuban vaccine one, do you have a link?

Yeah this is insanely false. I've been to Cuba, people have smartphones and laptops (though internet access was limited as of 2013), soap is certainly not lacking.

Telco equipment, foreign currency, parts that rely on US technology, and so on is difficult to obtain. You'd be a lot more sucessful with a 4G base station, a boat full of crate engines, or mesh networking gear.

I've attended some scientific conferences in cuba in the medical field and i can tell you while the country is extremely poor, they are very advanced in the medical field. Cuba has the highest number of doctors per capita of any country and university-level education in the medical field is basically free so it is accessible to a wide percentage of the population.

A lot of this is due to the unnecessary Cuba embargo and US aggression towards it. The US supports and has supported various dictatorships all over the world yet they pick unnecessarily on our neighbor to the south which offers 0 military threat to us.

They didn’t need to because they aren’t embargoed like Cuba is.

Cuba can freely trade with Rusia and China.

Overdependency on the Soviet Union had extremely painful consequences for Cuba after their collapse.

There is an Argentine Covid vaccine in development https://www.infobae.com/salud/ciencia/2021/04/23/la-vacuna-a... (in Spanish)

I see no linked evidence therein; to either clinical trial results or equivalent accredited sources. Sounds like good news, but without any accompanying evidence this is just random click-bait.

At least the early news report I have read about the Biontech/Pfizer and the Moderna vaccines didn't have links to the scientific studies either. This seems to be pretty standard for new these days :-(

Even if the effectiveness number doesn't pan out to 92%, every working vaccine is another useful tool in the toolbox. I could imagine that many South- and Middle American countries have higher trust in Cuban than in US or European vaccines.

There are a few comments / questions about yeast in the cooments. According to this [1], quoting:

    Abdala, basado en la formulación de la proteína RBD (Dominio de Unión al Receptor) recombinante adyuvado en hidróxido de aluminio, emplea la proteína que se expresa en la levadura Pichia pastori, con un diseño que utiliza el RBD ACE 2, es decir, es el motivo que une al receptor y a través del cual el virus penetra a la célula e infecta al individuo.

Abdala, based in the formulation of the RDB protein (receptor binding domain) adjuvanted* recombinant* in aluminum hydroxide, employs / uses the protein that expresses in Pichia Pastori yeast, with a design that uses the RDB AC 2, meaning, is the motiv that unites the receptor and thru wich the virus penetrates the cell and infects the subject.

* & * I don't even know what these words mean in Spanish. I used G Translate for these 2 (I'm obviously way out of my pay grade here)

[1] https://instituciones.sld.cu/hospmiguelenriquez/2021/04/22/i...

I expect the protein is being described as recombinant (the yeast has been altered to produce it) and the vaccine is adjuvanted with the aluminum hydroxide.

Cuba has in general an outstanding health care system: https://www.iflscience.com/health-and-medicine/cuba-has-elim...

> The best proof is the fact that 80% of all of Cuba's vaccines are produced in the country itself, Moya said. He was not surprised by the high efficacy of Abdala, saying it was simply the logical consequence of a health care system that had been performing steadily well for decades.

It is impressive that a country like Cuba, subject to a long-lasting USA economic embargo, is able to keep a healthy health care system. More impressive if you compare child mortality (U5M under 5 years old) rates below 5.5 per 1000 live births, only bested in the Americas by Canada.

I hope that the vaccine works as expected. To stop new mutations to appear so fast we depend on having as much world population vaccinated as possible.

I think that is what happens when there are few opportunities on public services for corruption or exorbitant profit: efficiency soars. Actually "exorbitant profit" in critical areas may not be that different from corruption, nevertheless.

> "exorbitant profit" in critical areas may not be that different from corruption, nevertheless.

I agree. In a capitalist country an "exorbitant profit" for a long time is a failure of the system. Why nobody else is producing the same service if there is so much profit to be gain? And, if there is competition, why is not shrinking that margins to compete?

Capitalism is great when there are many small competitors that need to push quality up or prices down. If you only have 1 big corporation dominating each market, that's just communism with extra steps. The economy is just a planned economy and no competition nor capitalism is happening.

Monopoly is what happens when capitalism is not working right. Of course, that is not the single source of monopoly, but it should not exist when capitalism works correctly.

There are probably many people who dream of capitalism as a chance to become a billionaire, not only such a possibility is very small, it actually frequently unfair: you need much more than honest merit to become one. The best part of capitalism is how it is a good system for the buyer and the costumer not for the seller or producer.

I think whether your statement is correct or not depends on how you define “capitalism working right”

In a purely free market with no outside checks, monopolies are very common and almost inevitable. As Adam Smith says in Wealth of Nations:

> People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.

Effective regulation is needed to prevent monopolies and cartels.

> I think whether your statement is correct or not depends on how you define “capitalism working right”

I agree, even I will say that it depends on how do you define "capitalism".

> Effective regulation is needed to prevent monopolies and cartels.

That's why regulations are and always have been part of capitalism.

A " purely free market with no outside checks" is Neo-liberalism or anarchy, even if there has been a push to label anything to the left of Neo-liberalism as "communism". Such a push have gained a lot of traction, and I see that many people in the general public thinks that Neo-liberalism = Capitalism, that it is not the case.

So, maybe the definition of capitalism is changing. And maybe the push have succeed and now "capitalism working right” just means the rich getting richer and has nothing to do with the original work of Adam Smith. That would be sad, thou. Capitalism is a good system as defined by Adam Smith, Neo-liberalism is just a pantomime that promotes authoritarianism dressed as free-trade.

Ok, then I agree with you. I was worried that what most people hear when they see “capitalism” is unregulated markets.

Maybe we could entertain the idea that even with all the wisdom contained within Adam Smith’s work, it might at least somewhat wrong.

Monopoly also happens when socialism works right. “State monopoly” is a real thing.

The difference being that state monopolies pay 100% of their profits to the treasury and have a much, much better track record.

State monopolies don’t necessarily pay their profits back to the treasury. I can’t think of any that do. Which state monopoly are you thinking of that does that?

Huh? EDF, Hydro Québec, almost all Chinese SoEs, etc..., aactually I can't think of any that don't.

You were right; I was wrong.

I was thinking of local utilities - which are often run as non-profits (or at a loss). Not a fair comparison.

And even in regard to utilities, I’d need to look into it more.

A socialist worker model of co-ops can provide competitive marketplaces as well.

> A socialist worker model of co-ops can provide competitive marketplaces as well.

Yes, co-ops are also a recognized type of organization in capitalist countries. They exist all over the world in and compete in the markets where they participate.

Indeed - nothing non-capitalist about co-ops. If a company wants to decide to structure its ownership that way then why not?

In this case it is both capitalist and communist at the same time. I wouldn't be so sure that something that involves no capitalists and no private ownership of capital is capitalist though (communal ownership being different from private ownership).

> (communal ownership being different from private ownership)

This seems like subjective definitions; cooperatives certainly work by issuing a segment of their ownership to each private individual who works for them.

This is up to them because they're operating in a capitalist model where organisations decide for themselves their ownership model and the allocation of their resources; contrasted with a central planning model.

This is a ridiculous statement. Look at the latest cancer treatments, they are produced by for profit companies. Not Cuba.

What about CimaVax-EGF?

https://en.m.wikipedia.org/wiki/CimaVax-EGF

Historically, research spending has been mostly done by the government, although in the US the proportion of research funded by the government has fallen in recent years [1].

[1]: https://www.sciencemag.org/news/2017/03/data-check-us-govern...

Basic funding, so that figure ignore actual development costs. NIH has a budget that is about half that of big pharma.

It’s mostly private money.

It really is a great achievement. As an African I hope our leaders are taking inspiration from the Cubans. If we put our minds to it we should also be able to produce our own vaccine.

I’ve seen a lot of cynical responses to this. People are quick to forget that Cuba’s healthcare system & medical research are world leading. They have far more physicians per person than any other country in the world [0].

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645168/

They are not world leading. Number of doctors is not a metric of how good your medicine is.

If you look at most good and great novel drugs and madical devices, they mostly are designed and made in the US or Europe. Mostly US.

>> If you look at most good and great novel drugs and madical devices, they mostly are designed and made in the US or Europe. Mostly US.

Citation needed!

The US is so far ahead of other countries, it invents more new novel drugs than the next 5 countries combined.

And then poor countries enjoy the cheap generic versions of these drugs, basically subsidized by the US.

https://qph.fs.quoracdn.net/main-qimg-1a70c72f3bbb329d1dfee4...

The US is incapable of making medications accessible to its own population. And not even willing to provide broad health insurance. That's not a country with a working or high quality medical system.

Does the chart you link say anything about generic versions?

Pleas link to the original source rather than a picture on a CDN that may have been altered.

Additionally, where is Cuba on this chart? Does a new, poorly performing pill (eg: a failed heart drug resubmitted to the FDA as an ED pill) counts as a newly discovered medication?

https://www.ineteconomics.org/perspectives/blog/how-cuba-bec...

It is ahead in development but way behind in providing that healthcare to it's citizens.

https://www.cia.gov/the-world-factbook/field/infant-mortalit...

Life expectancy in Cuba is higher than that of the US (72.5 vs. 71.9). Health workers have eliminated polio, tuberculosis, typhoid fever, and diphtheria. Malnutrition incidence amount 1-15 years olds is 0.7% compared with 5% in the US[0]

[0]https://pubmed.ncbi.nlm.nih.gov/2315760/#:~:text=Life%20expe....

If the US didn't subsidize all the other countries, you'd see a much different picture. It's easy to provide better healthcare, when someone else is paying for all R&D and manufacturing.

Let's be entirely honest here, the US could provide health care for all, in the same way the NHS operates in the UK. It is not the R&D costs that are preventing this, it is a very powerful medical insurance lobby that prevents it.

And no, it is not easier to provide better healthcare, even without doing the R&D.A higher GDP is what enables better provision of healthcare and the US has the highest GDP and is in the top 10 per capita, Cuba is at 87th.

GDP PPP is more appropriate. Cuba has a fairly good PPP per capita GDP.

Your 2nd source is from 1990 and is at odds with the CIA World Factbook, the first source, which says that current life expectancy at birth is 80.43 in US, 79.41 in Cuba: https://www.cia.gov/the-world-factbook/field/life-expectancy...

They're both basically similar in both years, which is astounding given the vastly higher material wealth of the US.

Nice to know that both have increased a lot since 1990, though! I thought 72 sounded a bit young.

That's a straw man and off topic from the discussion which is what countries has the most pharmaceutical advances. Everyone knows that the US health care system is awful compared to most other companies unless you're rich or have good company provided insurance plan, which covers maybe 65-75% of the population, the rest are told to pound sand and go bankrupt or just not get any care at all.

Why are patented drugs or medical devices your metric for a good health system. Those just sound like ways for people to profit from a sick population. If we had better health outcomes for citizens, I would cite that.

All the science cuba used to develop the vaccine is american or european.

"If I have seen further it is by standing on the shoulders of Giants." -Newton

All science is based on the work of others, and it always has been.

Woah

It seems like an awfully convenient metric too, just pick the thing that western nations are guaranteed to have and the poorer nations can’t have (and forget about China).

I see a little chicken and egg problem here. This reminds of Stephen J. Gould’s Mismeasure of a Man. People would say that intelligence could be seen by measuring the size of the skull—knowing off course before hand that white people had the largest skull—and hence were the most intelligent (!) Until of course they actually measured the skulls properly, and found out it wasn’t any bigger, then they just moved on to the next metric that conveniently showed that white people were more intelligent.

https://fee.org/articles/the-myth-of-cubas-glorious-health-c...

While I don't debate the efficacy of their healthcare system (wether it's a myth or not) I am surprised their medical research is on par. I would have thought these are two different fields without much overlap. Is it not ? And if it is not how can we explain a country with decades of embargo has an efficient and healthy research medical field ?

Maybe having nothing to steal, and vanishingly few opportunities for corruption in academia leads to people actually doing the research they are supposed to be doing because there's nothing else to do?

Yes, clearly Cuba has achieve the socialist paradise where human nature has been fundamentally changed.

Yet here they are, with a standard of life incomparably higher than their neighbors, and an effective vaccine despite tiny resources. How do you explain that?

Perhaps human nature is that people actually do useful work in some conditions when allowed to?

Higher standard of life than what neighbors? Your average Cuban is far poorer than their neighbors.

Or are you arguing that keeping people in a state of poverty is a good way to motivate their altruistic tendencies?

What are the neighbors of Cuba? What are their GDP PPP per capita?

The only countries next to Cuba that are richer are the US, the Cayman, and the Bahamas.

Two of those don't even have enough population to make it into the 100 biggest cities.

Cuba is below the regional average for the Caribbean at $8,800 per capita. Plenty of wealthier countries.

https://www.statista.com/statistics/802613/gross-domestic-pr...

You must use GDP PPP for Cuba. Cuba is not a market economy and is blockaded, nominal GDP is literally meaningless. This analysis has to provide services such as free housing and so on, which is why most don't give a good estimate.

Then you find 20-26k USD.

Saying the average GDP is 20-26k USD per person is quite laughable. If you've talked to people who have traveled there, it's nowhere close. When you cant even get basic consumer items (medicine, bandages, computers, etc) and certain food products aren't available, you don't have an average GDP of 20-26k USD.

The CIA estimates it at $12k. At $26k USD it would have a standard of living similar to Russia, Turkey or Greece. Which it most certainly does not.

> Then you find 20-26k USD.

Citation needed. You can't just make up your own GDP figures.

Not sure that's the reason why, not all research is done in academia. Pharmaceutical research specifically is mostly done in research centres, such as the CIGB, featured in the article, where the vaccine was developed.

There are plenty of opportunities for corruption in academia in Soviet-style "socialist" countries. It just takes forms other than money.

Cuba's healthcare system is no slouch, but they're not world-leading. The ones who are world-leading started vaccinating their populations last year.

I'm not sure what physicians per capita has to do with the quality of their healthcare system and research. Is Bhutan the world leader in agriculture? They have more farmers per capita than anywhere in the world.

Does the UD led embargo prevent them from important vaccines? This may be why they haven't started yet and have had to develop local vaccines. The fact they have 5 potential vaccines is significant, given that the rest of the world probably has produced 5 effective vaccines between them.

> given that the rest of the world probably has produced 5 effective vaccines between them.

China alone has 7.

There's 18 vaccines already authorized for use in various places around the world. https://en.wikipedia.org/wiki/COVID-19_vaccine#List_of_autho...

Effective is an important qualifier in my statement.

https://www.businessinsider.com/china-vaccines-questioned-af...

China may have 7, but are they as effective as they claim?

Chinese vaccines have infinitely more peer-reviewed data than the amount of peer-reviewed data we have to support the Cuban vaccines: zero.

Either way, there's 11 other vaccines in use that aren't Chinese, still more than 5.

They have only 110 deaths per 1M population, which is pretty good especially when taking into account that they started vaccination pretty late. They are better than at least 131 other countries.

USA, by comparison, has 1,861 deaths per 1M population. They are one of the worst 20 countries.

Their resistance about importing vaccines can be debated, and may not reflect the quality of their health care, being mostly a political decision.

> They have only 110 deaths per 1M population

Where are you getting this number from? Any numbers coming from the Cuban government have to be treated as unreliable, as it is common practice to restrict doctors from what can be reported, unless they want to lose their license.

In this case your belief is fully unfalsifiable.

Governments with the same governance structure as Cuba (Vietnam, China) have been achieving even better numbers, despite lifting all measures and being full of foreigners. Because of this I expect actual evidence the data is false.

That is possible, but we don't have actual proof and I personally don't expect a huge difference between the reality and published numbers as they responded to the pandemic pretty quickly and effectively from the beginning [1]:

> Cuba’s reaction to the coronavirus threat was swift. A “prevention and control” plan, prepared in January 2020, included training medical staff, preparing medical and quarantine facilities, and informing the public (including tourism workers) about symptoms and precautions. So, when the first three reported cases were confirmed on March 11, arrangements were in place to trace and isolate contacts, mobilise medical students for nationwide door-to-door surveys to identify vulnerable people and check for symptoms, and roll out a testing programme.

[1] https://theconversation.com/coronavirus-response-why-cuba-is...

USA isn't a relatively isolated island nation and it doesn't have complete control over the populace and can only make recommendations to the public and do things like lockdowns. Cuba's government has complete control and people know not to go against the government in such matters or they will be severely punished.

The point is they did well and the rest is pure speculation. I don't believe all the countries that did better than the US are more isolated and/or have complete control over the populace.

Before all this fawning over Cuba’s health care system, consider that they use their physicians abroad as revenue streams and propaganda to show the world how high their physicians per capita is. Those Cuban physicians are heavily restricted in what they are allowed to do [0]. Unless you have lived under a dictatorship as I did, you naively assume honesty and integrity from Cuba’s version of their “great” health care system. Ask the many Cubans in exile, how often they have to send life saving medication to their families on the island.

[0] https://www.nytimes.com/2017/09/29/world/americas/brazil-cub...

Cuban healthcare is the left-wing version of "Mussolini made the trains run on time." Both are just idealizing the concept of a benevolent dictatorship ostensibly getting one thing right and ignoring all their other human rights violations.

Not comparable. You are making some bold assumptions that people in the comments are using Cuba’s successful healthcare system as an excuse to justify the communist regime in Cuba. I see no such things. I see people simply pointing out that Cuba has a successful healthcare system irrelevant of the fact of how their government runs their country.

The parable of Mussolini and the trains running on time was however such justification. I.e. “Mussolini’s fascist regime can be excused by the fact that he got the trains running on time”. Some people might be of the opinion that “Cuba’s authoritarian government can be excused by the fact that their healthcare system is successful“, but that is not the sentiment I’m getting from the posts here. Particularly not from your GP.

Not in the comments here, but it is, in fact, a fairly common sentiment on the American fringe left (to which I belong myself, so I see it a lot in private conversations).

> Ask the many Cubans in exile, how often they have to send life saving medication to their families on the island.

Well, not to excuse the dictatorship in Cuba, but there is the small issue with embargo and trade restrictions the US places on that particular one. Theoretically, medicine is exempt, but in practice it isn't: https://medicc.org/ns/documents/The_impact_of_the_U.S._Embar...

The Castro brothers and their lackeys have used the embargo to explain away every disastrous strategic plan they’ve concocted over the last 60+ years: Es el bloqueo. El bloqueo.

Furthermore, take a look at the many countries which have trade with Cuba [0]. Their problem is mostly self-created through their monetary policy and the severe restrictions entrepreneurial Cubans face. The Castrista government must have its hands on every little thing that generates money. The slightest deviation from the party line results in significant punishment including prison.

[0] https://webgate.ec.europa.eu/isdb_results/factsheets/country...

Do you expect Cuba to produce literally every single drug in the world? No? Then you cannot ad-hominem the blocus away.

> Before all this fawning over Cuba’s health care system, consider that they use their physicians abroad as revenue streams and propaganda to show the world how high their physicians per capita is.

So a bit like the US having their military all over the planet to show the world how high their military spending per capita is?

> Ask the many Cubans in exile, how often they have to send life saving medication to their families on the island.

No offense, but people living in exile from regimes they disagree with, are very likely not exactly the most unbiased people on the issue, often having a lot of emotional baggage on the topic.

Case in point: One could also ask the many Cubans not in exile about their views and opinions. Why shouldn't those matter also?

Cuba actually has 5 vaccine candidates, and 2 of them have greater than 90% effectiveness. A great showing for a small, socialist island nation under decades of embargo by hostile anti-communist forces.

https://www.telesurenglish.net/news/Cubas-Soberana-02-COVID-...

But also not surprising because despite the decades of restrictions which have limited Cuba’s ability to import medical supplies, they have one of the best medical systems in the world.

> they have one of the best medical systems in the world.

citation needed

I believe the quality and breadth of Cuba's medical system rises to the level of conventional wisdom[1][2].

Edit: I forgot to link statistics for the country itself, not just the doctors they send abroad. They perform admirably against both the U.S. and most European countries[3].

[1]: https://en.wikipedia.org/wiki/Cuban_medical_internationalism

[2]: https://time.com/5467742/cuba-doctors-export-brazil/

[3]: https://en.wikipedia.org/wiki/Healthcare_in_Cuba#Health_stat...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645168/

The citation is the first result of any search related to Cuba and medicine on any search engine.

Here's a ranking from the WHO: https://www.who.int/healthinfo/paper30.pdf

39 out of 191, 2 places behind the US.

While being free of charge

It well-known that Cuba has an impressive healthcare system and does not particularly need to be cited unless specific claims are made. Cuba is famous, for instance, for exporting doctors to other nations.

In any case, here is a short paper showing Cuba's healthcare outcomes are comparable to Canada and US: https://globalhealth.washington.edu/sites/default/files/50%2...

Cuban doctors' don't seem to be very happy with that, according to the NYT and BBC:

https://www.nytimes.com/2017/09/29/world/americas/brazil-cub...

https://www.bbc.com/news/uk-48214513

While important to you and me, the attitude of the doctors is not in question here, just the level of Cuba's medical expertise.

The same applies for Iceland. Nurses keep striking, doctors call for more funding, health care experts keep complaining about lack of facilities. Yet Iceland has one of the best health care system in the world.

Be it a capitalist country like Iceland or a socialist like Cuba, with enough funding and an educated workforce you can run a pretty successful healthcare system, despite the fact that it could be better. And perhaps that is precisely why the workers in a successful healthcare system complain. They are educated enough to know how it could be improved even further.

Your answer is not related to the content of the articles.

The articles are about Cuban doctors complaining about their working conditions and compensation as they are sent abroad. You used them as a way to answer your parent, who’s central claim was that that it is a well known fact that Cuba’s health care system is good actually. They provide the fact that Cuba exports doctors as an example of how successful their healthcare system is.

To me it sounded like you were using the fact that doctors complain about their working condition as evidence against parent’s claim. So it felt natural to explain that a healthcare system can be successful despite the fact that the workers in said system have complaints about it.

Ideally these workers should be paid a fair share for their labor (particularly when their boss—the Cuban Government—claims to be a socialist). But regrettably that is not the world we live in. I wouldn’t be surprised—if the numbers were crunched—that a doctor employed by a for profit hospital in a capitalist country also only received a tenth to a quarter of the profits they generate, after their bosses take their profits and their governments take their taxes.

> they have one of the best medical systems in the world.

This feels like a specific claim being made.

For everyone downvoting me, just want you to know that yellow is one of the worst colors in the world.

Most of the reports I've read about Cuba's healthcare metrics are heavily reliant on trusting data released by the Cuban government (particularly around life expectancy and infant mortality), not subject to independent audit. Haven't looked closely at the sources in your citation, though.

Is this not the case with all basic metrics of every nation?

No: NGOs, academia, a free press... None of these to my knowledge are able to operate in Cuba with what most of us would consider trustable autonomy from the government in publishing information that constitutes an independent research.

There are scientific publications every year by cuban doctors that corroborate that data. None disputes the superiority of cuban health system

Cuba has a life expectancy of 78.8, just under the United States' 79.1. Their infant mortality rate 5.1 deaths per 1000 births, slightly better than 6.5 in the US. Cuba also has the highest rate of physicians per citizen in all of latin america, and has a huge medical diplomacy progam, sending doctors all over the world.

It's a pretty controversial topic, though- https://en.wikipedia.org/wiki/Healthcare_in_Cuba#Contrasting...

It's widely known. No citation needed.

https://www.who.int/bulletin/volumes/86/5/08-030508/en/

structurally, it's a good target model. materially, capitalist embargoes have prevented import of drugs and equipment that isn't already manufactured locally.

https://theconversation.com/is-the-cuban-healthcare-system-r...

they also provide medical education for free, even to foreign citizens.

notably, che guevara was a doctor before he was a soldier, and this probably informed the cuban communist party's healthcare policy.

World Bank puts Cuba's public health statistics largely on par with the United States, at about one-tenth the per-capita cost. Of course, compared to other developed countries, the USA hardly delivers great healthcare to its population. So Cuba might not be a top country for healthcare in the world, but what they do have is impressive given the circumstances.

> World Bank puts Cuba's public health statistics largely on par with the United States, at about one-tenth the per-capita cost.

The average Cuban makes in the neighborhood of $30 a month. Cuban doctors make about $70 a month. US doctors make something around $30,000 a month.

As it turns out, it is much easier to have a cheap medical system when you pay basically nothing for labor. However, this is a feature of a system which is otherwise rather unenviable.

The unenviable part is the $30-70 range, not the 2x income spread.

Indeed. We would surely be living in fantastical, glorious times if the US median income were to rise to ~$180,000. (In real figures, of course, not just hyperinflation.) I believe this would require us to triple GNP, if not more.

I am almost entirely in favor of this proposal, except that it would probably be preferable in such a case to admit immigrants from less prosperous parts of the world who would go on to earn substantially less than that. This would bring the overall income figure down, but would still be a major win for the world's overall prosperity.

You imply that the bulk of the costs are labour costs, but medical invoices in the US suggest otherwise.

Cubans are paid in peso. And what they get paid is enough to provide for what they want. Granted what they want is limited by the limited choice of consumer goods. On the other hand consumerism is worse

HN at its best... this is known for a very long time. I don't know how much GDP budget they put into medical system, or what other miracle they managed to perform long term, but its true.

Of course its relative - is it better than Switzerland? Of course not, but comparing to peers in 3rd world, they are absolutely stellar. Cheap/free advanced medicine and care, tons of foreign missions around the world.

I recall from cold war, Cuban medical scientists and doctors were regarded as top notch in eastern bloc and many exchange missions were done to get some of that to other parts of the world. From Cuban perspective, cold war didn't end with fall of USSR

Cuba legitimately has one of the best medical education systems in the world. It's one of the regime's successes.

On the other hand, many of these doctors are sent to work in Cuba's allies, where most of their pay goes to the Cuban government. At home, their medical system goes through some pretty rough patches from time to time, and you have people who need to turn to the black market to buy the iodine necessary for disinfection of their own surgeries.

I heard it's mid-tier, but nowhere near "the best". For example, developing countries would appreciate it if Cuban doctors came to volunteer, but they aren't at the standard of US doctors.

Please don't post flamebait and/or unsubstantive comments to HN.

https://news.ycombinator.com/newsguidelines.html

Maybe it is not that hard to run a basic medical system if some leadership, administrative proves, and money put together?

Do you think it's hard to run it to better outcomes than the US?

No, one have to try really hard to mess it up as bad as it is in US

As far as cost efficiency, this is certainly true. That said, I come from a country that is economically in a very similar situation to Cuba, and their healtcare system is much superior.

Last week an Argentinian news(/infotainment) program covered a Cuban TV PSA for a vaccine they'll soon be administering to kids. Besides the nationalistic bent (which I'm personally OK with, given the circumstances), one of the tidbits I found interesting is they mention it requires three jabs.

https://www.youtube.com/watch?v=vqUq6kO8DyA

Every year for the last 30 years or so the UN General Assembly calls for US to end Cuba embargo. Every single year the US along with Israel vote against it, being the only 2 out of nearly 200 or so countries.

We were on our way…

https://en.m.wikipedia.org/wiki/Cuban_thaw

Maybe the blockade has been an accidental blessing. Cuba has done a damn good job with these vaccines. They have good healthcare and education. The "standard of living" is lower, but I'm sure you get used to it in a month. People seem to get along. And it's a beautiful island in the Caribbean. Looks kinda like paradise to me.

> anti-communist

This is a positive thing

Agreed. It's disgusting how HN has become communist.

Taking this thread straight into ideological flamewar hell was not a good call. Please don't do that to HN. Of course the real damage is caused more by the upvoters, not the original comment, but you've started it by tossing egregious flamebait in the first place.

I will mark this off-topic now (which downweights it on the page) and we'll see how good or bad the other comments are, but at the time I'm typing this, it doesn't matter how good or bad the other comments are, or whether this thread even has any actual comments about Cuban vaccines, because the flamewar you started has filled it with low-rent internet flaming about (god help us) communism, Israel, and who knows what else. Such flamewars have nothing to do with the mandate of this site. They convince no one of anything, except how right they are and how aggrieved they are and therefore how justified they are in doing whatever they want to the other side.

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor...

https://news.ycombinator.com/newsguidelines.html

---

Edit: I'm getting the feeling that I may have left some people with the impression that I lack sympathy for Cuba or admiration for the achievements of Cuban researchers. Not at all. I think this is a great topic for HN to discuss. In order to be able to discuss it, we need to avoid flamewar and to avoid flamewar we need to avoid flamebait. That's all I mean, and I see that I put it in an excessively flamey way myself. Sorry!

If you don't see how the GP comment is flamebait, that might be because you're not aware of how large and geographically/politically/ideologically distributed this forum is. What to some readers reads as a bland factual statement is guaranteed to land with others as an outright provocation. That is obvious to me because I deal with these divisions in this forum every day. But I can see how it might not be obvious to others, and that's no doubt why my comment came across as excessive. Perhaps this was conditioned by spending the bulk of yesterday dealing with political flamewars on HN.

I find your language much more inflammatory than the comment you are referring to.

"Of course the real damage is caused more by the upvoters, not the original comment"

Original comment invited political flaming by throwing in the "great showing" jab at the end.

Except for the word "great" the entirety of that comment is factual, and as many pointed out, the embargo is the main reason why this piece of news is so remarkable. I fail to see the "invitation" to flame honestly. It's more about how the moderator interpreted the comment rather than what it's actually there.

It's possible to state factual things in a way that invites heat instead of light.

> I fail to see the "invitation" to flame honestly.

Many people will end up interpreting "A great showing for a small, socialist island nation under decades of embargo by hostile anti-communist forces." as "A great showing for a nation being oppressed and bullied for decades by the big bad US and its bully friends". And, well, the knee jerk reaction is to defend yourself if you think someone is accusing your country of bullying another country for no reason.

Wow, I think that interpretation says way more about the reader than the OP.

I hear you. Seeing HN threads on fire does that to me sometimes.

> I hear you.

Do you? Agreeing with parent implies that you consider your own comment to be highly inflammatory (and implicitly against HN code of conduct etc.). If that is the case, you can take it down or edit it with an apology.

NOTE: I'm not saying I agree with parent, just pointing what seems to me to be a logical necessity stemming from your agreement with parent.

"I hear you" doesn't mean "I agree with the maximalist interpretation of what you say". It means "we have common ground, and I'm willing to give something".

The problem with your logical inference is that you're applying binary logic and human interactions are profoundly non-binary.

I have just now read the edit of your parent comment. I appreciate your clarifications as well as your willingness to nuance your position.

I can't really imagine the amount of effort you have to put into keeping HN on track. I thank you for that as well.

I do however want to mention that the US cultural context is not always that apparent for a non-American (such as myself). My comments were made taking into account strictly the GP and your comment, not any pre-existing cultural context. Back where I'm from (broadly speaking the EU) simply mentioning that Cuba is socialist or that the embargo is anti-communist doesn't come across as particularly controversial or flame-bating.

I know that's true and I hear you :) - the challenge is to get a large community like this to understand and respect how differently things land among the different subgroups in the community. I mean, an internet forum is in one way an utterly trivial thing and at the same time, if we can really get this right it is actually a contribution to the practice of peace in the world, which is not a trivial thing at all. A strange incongruity.

I wrote about that here if you (or anyone) are interested: https://news.ycombinator.com/item?id=23308098

Thanks for pointing to your extended comment.

I can say that in my case confronting people with wildly different political opinions has pushed me to become more dispassionate/detached in my replies, as well as to focus on the substance of the argument. I have started taking things more literally (which is probably what lead to our present conversation) and providing more precise and detailed rebuttals.

All of this I consider to be intellectual progress on my part, so to me HN has provided challenging and fruitful waters to swim in. For that, again, I am grateful :)

Despegar's comment gets to the heart of why the Cuban vaccine is interesting. Nobody would be surprised if a nation with open trade with the US could manufacture something at this quality level; most of them are manufacturing Pifzer and Moderna.

Good point, but it doesn't matter because the ideological bullhorn drowns that out and guarantees a flamewar. Just look at the responses it generated. We made it to "you want all the Jews in Israel to die" in three hops.

That seems to have less to do with what Despegar actually wrote - which is the focus of your criticism - and more to do with the increasingly conspiratorial "conservative" (i.e. memetic-right) portion of its audience HN's moderation has tolerated over the years. (The shift is not specific to HN, but different moderation policies could have provided better outcomes, and have in other fora.)

Everyone thinks the problem is caused by the people they disagree with. After dealing with literally hundreds of thousands of HN comments I can tell you that experience has taught me entirely otherwise.

This goes along with the view that the forum would be a peaceful and productive place if only those people (the ones I disagree with) were moderated and banned, and therefore it is the moderators' fault when flamewars happen on HN. Much as I'm deeply interested in improving as a moderator, I don't think this view is realistic. In fact the solution is in the opposite direction: less blaming of the others, more effort to see one's own contributions more clearly. Needless to say this applies irrespective of political or ideological or geographical identification.

(And yes, I need to do more of this too - for example it's clear that I could have handled this particular case much better. I was hasty and (ironically?) a little inflamed myself, not because of anything to do with Cuba or vaccines but because I didn't want to spend a second afternoon in a row dealing with a really nasty political flamewar. As a result I created a meta version of the same thing. Such lessons are expensive, which is fortunate.)

p.s. I see that your replies are getting rate-limited. That doesn't seem fair, so I'll turn that off for now. In return I'd appreciate it if you'd refrain from this sort of destructive comment in the future: https://news.ycombinator.com/item?id=26848534. That's why we rate limit accounts. Actually you've done so much of that that we could easily have banned you and a rate limit was a mild response; but I don't want to throttle anyone from responding to me in a discussion about moderation.

> we could easily have banned you

"oh no"

(You're not really engaging the points raised and I find the low-key threat hilarious, so no, I won't be responding further.)

Daniel, the truth of the matter is that "you want all the Jews in Israel to die" type of post can, and is being thrown everywhere completely regardless of the merit of original conversation.

And yes, it's a perfect tactic to sink any topic on a site with any kind of automoderation.

You cannot properly discuss anything moderately controversial if any topic can get framed, and sunk as "flamebait" because moderately controversial topics are "flamebait".

People have heated discussions about matters of ideology, that's the very obvious truth of life.

The more important is the matter, the more, longer, louder, and more emotionally people will argue.

That's an argument for unmoderated flamewar. That's not what HN is. If you're imagining a version of HN that is "like the current HN, but without the current moderation practices," you'll have to forgive me for considering that a fantasy.

There's also no evidence that anybody said that as a "discussion sinking" tactic. On the contrary, the simplest explanation easily applies: people responded to flamebait with more flamebait, which cascaded into flamewar. This is one of the most common phenomena that exists here, and one doesn't need sinister constructs to understand it.

I am not calling for it, what I told is topics turning into flamewar regardless of merits of original conversation, and that any important topic sinks very quickly.

How is that off-topic? It's the whole reason the story is remarkable at all.

The flamewar it predictably produced is off topic. There are other ways of posting about this that don't lead to flamewars.

Please give an example of how they could have written it.

Another user gave such an example already: https://news.ycombinator.com/item?id=27654775

Not sure parent should be considered as inflammatory as you take it to be. The core idea was that having 5 vaccines that performed well is a good showing for a small country, especially one that has been under heavy embargo for many decades.

If the GP had posted that sentence instead, it would of course have been fine. The problem is when it comes in the form of ideological boilerplate.

The following is the entirety of the GP, quoted here for ease of access:

> Cuba actually has 5 vaccine candidates, and 2 of them have greater than 90% effectiveness. A great showing for a small, socialist island nation under decades of embargo by hostile anti-communist forces.

Which part is ideological boilerplate? Is it false that Cuba is a small, socialist island nation? Is it false that it has been under decades of embargo? Is it false that the forces that are imposing the embargo (mainly the US) are hostile to Cuba and anti-communist?

NOTE: You should not infer any agreement or disagreement to GP from my comment. I simply find it to be literally, factually correct. If it isn't please point me to sources that invalidate any of the factual points I mentioned.

Ideological boilerplate doesn't mean "not true".

It does seem to imply that. If the statements are simply factually true, what makes them ideological? Is it merely typing the words socialist and communist?

I’d argue that the parent post you’re replying to is relatively positive and factual, and it’s the knee-jerk responses that it triggered that are the problem.

Now you can argue that this is why the parent post is a flamebait, but since the sole fact that Cuba is such a small, socialist country is why this vaccin is interesting in the first place, you may as well ban this vaccin from being discussed on HN entirely.

When a comment contains flamebait, which the GP obviously did, it bears responsibility for the knee-jerk responses that it triggers.

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor...

> you may as well ban this vaccin from being discussed on HN entirely

I'm sorry, but that makes no sense to me. The situation seems rather simple: non-flamebait, non-flamewar discussion of the vaccine story is welcome. Flamebait and flamewar, about this story or any other story, is not.

I screenshot despegar's comment when it was the top one and sent it to my tech friends (with the implied meaning - see how useless HN has become, it's been overwhelmed by the ideologues, it's a write-off). So thanks for trying to defend the formerly great site.

And separately: in the last 5 years i took a break from the Silicon Valley and spent most of the time in Latin America, traveling and learning Spanish. Check my IP history. Had to deal with the medical system and with the so called "Cuban doctors" in various countries. The original comment completely distorts the factual truth about Cuban medicine.

Ok, but I'm not commenting about Cuba, for or against. I'm commenting only about internet flamewar dynamics. The comment would be the same if the political polarity were reversed, so it's a misreading to take it as ammunition in favor of any political position.

> A great showing for a small, socialist island nation under decades of embargo by hostile anti-communist forces.

Did they edit their post because there is nothing even remotely ideological or controversial in that statement?

We must be looking at this from different perspectives. From my perspective that sentence is ideological boilerplate, the sort that would appear in a political pamphlet. (That doesn't mean I disagree with it!) Because the audience here is extremely varied along many axes: ideological, geographical, you name it, that sort of rhetoric about a divisive topic is guaranteed to land as a provocation with certain sectors of the audience, and this is extremely likely to produce a flamewar. HN commenters are asked not to post comments that are extremely likely to produce flamewars. We all have that responsibility on a large, public, optionally anonymous internet forum dedicated to topics of intellectual curiosity (which is what HN is), because otherwise such a forum literally can't exist.

I still don't see it.

> A great showing

This part is subjective, so perhaps is the most problematic, but I don't think we normally react negatively to calling scientific achievements "great".

> for a small,

Factual.

> socialist

Factual (although I would have expected "communist").

> island nation

Factual.

> under decades of embargo

Factual.

> by hostile anti-communist

I think even pro-embargo folks would be ok with this description.

> forces.

Small problem here maybe?

It's trivial to write a flame-generating comment made entirely of facts, 'factual' isn't quite the defense against this you might think it is.

As pvg pointed out, "facts" are a red herring here. You can make non-factual statements that aren't flamewar and you can make factual statements that are. Sticking to "facts" is actually one of the favorite tricks of trolls (I'm not saying anyone was trolling in this case—it's just an instructive example) because then when you say "please don't troll" they can say "what part of my perfectly factual statement do you have a problem with". https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...

The problem with the flamebait sentence I was objecting to was twofold: (1) it was political rhetoric of precisely the kind you would read in a political publication or hear in a political broadcast, and (2) it took the thread on a generic ideological tangent, that is it replaced the topic of Cuban work on covid vaccines with a much larger, more general, and more inflammatory one. Yes, it's related; the word "tangent" implies that; but that's not enough. It reliably leads to much worse discussion, and predictably did so in this case. I've been trying to explain this to HN for many years:

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor...

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...

There's nothing different about the moderation practice in this case—it was utterly routine. But two things were different: (a) I wrote more hastily than I usually do and didn't calibrate my language very well; and (b) something about the specific question of Cuba appears to land differently with HN's internationally distributed community than most subjects do.

The items I labelled "Factual" are things like "island" or "small" -- I was very careful about highlighting the possibly controversial parts of that sentence.

However, the funny thing is that there was no ideological flame war in response to the comment. Why? Because there was nothing there that anyone even disagrees with or find inflammatory.

In fact, the only reactions have been to your (in my opinion) overreaction.

> there was no ideological flame war in response to the comment

To which comment? If you mean the original comment (https://news.ycombinator.com/item?id=27654110), that's quite wrong. The flamewar reactions were why I replied in the first place. Some of them are dead and/or collapsed now.

I am very pleased by the way you moderate discussions on HN in general, but I really think you are very wrong on this. It is pretty clear that you are only thinking about the US perspective on things.

I'm not doing anything different from what I do every day! Come to think of it, that would even be rather hard, after so much practice.

I sense that some people may be taking my comments as if they are expressing a perspective on the topic of Cuba. I'm not. My comments are strictly limited to internet forum dynamics, since that's what it's my job to deal with.

I assure you I'm not thinking from "the US perspective on things", but very much internationally. I believe this is a case of people in different parts of the world not understanding each other, and underestimating how differently the same statement can land elsewhere. (I wrote about that here, if anyone's interested: https://news.ycombinator.com/item?id=23308098.) Of course it's easy to take the position, "The fault lies with the others; my perspective is the valid one," but the problem with that is that it's a recipe for flamewar at scale. That isn't in any of our interests because it destroys the capacity of this place to remain interesting.

People don't need to change their views in order to take this into account, but they do need to adjust to the presence of other people. Across the kind of differences that we're dealing with in a large international community like this, that is not easy.

That Cuba is ruled by a communist party is, unfortunately, relevant to this conversation: there is a significant chance the claimed results are pure fabrication. First line of the article: "Cuba's health authorities said this week the domestically produced Abdala vaccine has proven to be 92% effective against the coronavirus in clinical trials.".

Personally, I hope this is one of the rare times when communist authorities tell the truth. Or hopefully Cuba 2020 has a different relation to the truth than Eastern Europe 1980. But count me skeptical until independent trials confirm the results.

People that lived under a communist party regime learned the hard way that communist regimes engage routinely in fake data. From 99% elections to the incessant claims that the quality of life is superior to the "decadent capitalist West", when reality on the field looks like this: https://dustyoldthing.com/inside-soviet-grocery-store.

It's not socialist in the European sense though, it's an authoritarian controlled bureaucracy.

El Che Guevara made free medical education rampant and commonplace. When there was a breakout of Ebola some years back, Cuba was there, FIRST, front and center. Rival that, anybody? No surprise here that their vax is superlative. ALSO, when nobody would allow disease-stricken cruise ships to dock for medical help,at the initiation of Covid-19,Cuba took them. That is how Cubans contracted Covid. Beautiful, good, excellent, time-capsule Cuba.

Che Guevara also killed innocent political rivals by a firing squad, and put gay people in labor camps.

What about their health?

Whataboutism is rarely a good response to a comment, and almost never improves the conversation.

It’s a very appropriate response to a hagiographic description of a man who was directly responsible for the death and suffering of innocents. That’s not “whataboutism”.

Whataboutism would be if the commenter were to point out that eg. Bill Gates is also really pro-healthcare and used his capitalist-derived billions to improve the lives of countless millions more people than the aforementioned homophobic communist tyrant.

I disagree.

Such a truly enriching riposte. It will take me eons to unpack it.

I didn't see the value in an argument.

Please don't post unsubstantive and/or flamebait comments.

https://news.ycombinator.com/newsguidelines.html

We should have the same cynicism towards american leaders. Barak Obama is a mass murdered (far worse than Che). Bush killed more than a million iraqis (far worse than Che). Clinton bombed a pharma factory killing millions (far worse than Che).

So if you want to do whataboutism start with the US first, the single biggest perpetrator of violence in the world.

Please keep canned arguments like "whataboutism" off HN. It's a form of name-calling in the sense that the site guidelines use that term, and also a shallow dismissal.

It's legit to point out inconsistencies and/or comparables in what someone else is saying (I'm not saying the GP did that—I'm just speaking generally). If you feel that something isn't really an inconsistency or isn't really comparable, you can always make an argument for why, but trying to shoot down the entire category of discussion with a label is not an argument. In fact, in this case the label itself is a fallacy.

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...

https://news.ycombinator.com/newsguidelines.html

We're literally discussing the same guy.

If you have some person who helps older ladies cross the street, but then murders people at night, he is not a good person. You're judged by the combination of your actions, not for the cherry picked good ones.

Please don't take HN threads further into flamewar. That's exactly the wrong direction for the kind of discussion we want here.

https://news.ycombinator.com/newsguidelines.html

Why is this something to be surprised of?

Antiviral vaccines, let alone inactivated ones are sixties-seventies era biotechnology.

Any country with any much substantial industry can make one in 18 months, let alone during national crisis, and an emergency law, unless its government can't even tie its own shoelaces.

You made it sound like child's play, and yet how many countries have been able to produce their own COVID vaccine and use it for their own people? And under US embargo no less, that's actually the most impressive part.

> yet how many countries have been able to produce their own COVID vaccine and use it for their own people?

One of the best things about international economy is that not every country needs to invest in their own $anything if they can import it from the best, especially for cheaper. Therefore it is wrong to equivocate the number of countries that has developed their own vaccines with the number of countries that can develop them.

Cube, seems like, developed it because they had no choice, not as a tour de force of their medical know-how.

I believe one does not rely on international trade during a global pandemic.

If anything international trade dependency robbed Canada and many other nations of the ability to develop a vaccine and vaccinate their population in a timely manner.

Only those nations with capable vaccine development and manufacturing capabilities were able to first or second in line to vaccinate their population.

I believe even countries which are wastelands industry wise can easily make some if it's nation level project.

Even Bangladesh, out of all places, got a vaccine plant built on its own.

Even freaking Rwanda seem to be about to start vaccine manufacturing.

> One of the best things about international economy is that not every country needs to invest in their own $anything if they can import it from the best, especially for cheaper.

In general, yes, but vaccine is one of those things that you do NOT want to rely on someone else, and every country would prefer to be able to produce their own, even if it's more expensive. This pandemic has clearly shown that when shit hits the fan, every country will prioritize their own citizen first, which is perfectly understandable.

The embargo has been in place for quite some time. I think Cuba has figured out how to deal with it by now.

> You made it sound like child's play, and yet how many countries have been able to produce their own COVID vaccine and use it for their own people?

Most of the countries that bothered to start vaccine development projects, also have successful vaccines, am I right? As far as I know, only France and Australia launched projects but didn't get there.

Socialism will always be playing catch-up to free markets. See the space race.

Wasn't the USSR first in space? First ICBM , first artificial satellite, first man in space etc?

They had all the firsts expect for the last one, which someone decided was the only one that counted.

Also first interplanetary landing and first space station. To this day the cheapest and most effective way to send humans to LEO is still Soviet.

Please don't take HN threads into generic ideological flamewar. It's tedious, nasty, and the last thing we want here.

https://news.ycombinator.com/newsguidelines.html

Moderna is 94.1% effective.

Pfizer is 94% effective.

So it's almost as good.

You can't compare efficacies of vaccines across clinical trials because all of them aren't performed in the same environment.

And you should really look at the confidence intervals on those point estimates

Not really, I’m from there and I can totally assure this is just political BS. Family and friends (some of them fully vaccinated) are still struggling with the virus.

I have absolutely no idea about biology, vaccines and stuff, but don't vaccines need like a shitload of testing? That was the reason the Russian vaccine wasn't accepted by the European Union for quite some time AFAIK. Now Cuba has a vaccine and is already giving it to their citizens. Are they guinnea pigs?

Latin America being Latin America, if the Cuban vaccine works, other Latin American countries will most likely import it or manufacture it locally and apply it to their citizens, disregarding if it's properly tested or not. Because politics.

Argentina is trying to mix second doses because it ran out of Sputnik (while there are some studies about mixing some vaccines, the government wants to mix two non-tested vaccines). And being the totalitarian government than it is, they will probably end up mixing it.

Argentina doesn’t have a totalitarian government.

Then we agree to disagree :) I live in Argentina and we have very little freedom. The economic freedom is basically non-existant (can't buy foreign currency), and [private property is violated](https://www.reddit.com/r/argentina/comments/o6zfxq/usurpaci%...) by the government to buy votes.

Then you don't know what a totalitarian government is, you can disagree all you want :)

Also mixing and matching is not as horrible a thing as you make it sound. Canada is doing it too for the second. Given that a largely white country is also doing it, does that now make you feel better about it?

Argentina is a largely white country:

https://en.wikipedia.org/wiki/Ethnic_groups_of_Argentina

I'm not sure what point you're trying to make there.

The very fact that you're able to complain about this online, and not get in serious trouble, is evidence that it's not totalitarian. Authoritarian, perhaps.

That’s a crappy illiberal government, but a better example of a totalitarian government is the PRC: the Party is the highest authority there is, and all matters of society, private, public, spiritual, foreign and domestic (at least as long as you’re of Chinese or Uighur descent) are subordinate to the Party’s interests and considered political.

The Brazilian far-right frequently claims the previous governments, led by a center-left party that’s pretty much social democratic in policies, were communist. What you have in Argentina is a very timid socdem government, at most. We can agree to disagree, but that doesn’t make it totalitarian. That coming from an Argentinian is surprising, because Argentina had a pretty violent US-sponsored dictatorship for quite some time.

> That coming from an Argentinian is surprising, because Argentina had a pretty violent US-sponsored dictatorship for quite some time.

We had many dictatorships, all over Latin America. But there is a reason to say that. Sure, people is not disappearing (cough Nisman cough), but they break our constitution and don't give a fuck, like declaring "estado de sitio", I think it's translated "state of siege", because of COVID. Not allowing people free transit (breaking the constitution), arresting protesters, not allowing people to open their businesses, making them go broke. An excessively long quarantine which totally ruined the already poor economy even further. As a business owner you can't even fire people, they won't let you. And don't get me started on union mafias making deals with the government.

I mean sure it's not as bad as North Korea but still I would say it's totalitarian.

There are several "Russian" vaccines. The one you are likely referring to is often called Sputnik V. It is tested (phase III should have ended in May 2021). Preliminary results published in February 2021 indicate that it is effective and safe.

It is expected but it very sad that due to political reasons there is so much BS about it.

Well, the Russians jumped the gun a bit and tried to roll it out before the trials concluded.

I am sure it is a fine vaccine, but stuff like that undermines the hard work of the scientists.

Could you provide a reliable source for that claim? As you day, there is a lot of BS out there.

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