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Comment by occz | Hacker News Reader

I think this is the correct analysis - the focus should be to provide vaccines to the rest of the worlds nations that have not yet gotten widespread access to vaccines. This is likely to cause the greatest benefit in the form of fewer global deaths, and reduced global spread of the disease.

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But we do not have a limited number of vaccines. At this point there has been plenty of time supply chains to produce the necessary precursors so we are limited entirely by demand. If we are distributing extra vaccines to other countries it is because we don’t want to not because we can’t or because we’re fighting over a single scarce resource.

There is no evidence that we have to choose between boosters or sending vaccines to other countries.

This is the same flawed logic that officials made when they spread doubt about the effectiveness of masks early in the pandemic, hoping to “conserve” masks for healthcare workers.

The assumption of vaccine scarcity is actually a hidden assumption made outside the expertise of those who aren’t deeply knowledgeable about vaccine supply chains.

Source? Everything I’ve read talks about that decision being very real.

Source? Are you suggesting that Moderna and Pfizer have factories-worth of unused capacity sitting around idle?

I'd agree in the ideal world that's exactly what should happen, however in reality there are a load of unadministered doses in the US (https://twitter.com/EricTopol/status/1437617018782449668?s=2...) which will go to waste if not used, so it would seem to make sense to use those for boosters where they're available.

By the time these are distributed the virus will have drifted and these legacy doses likely not as effective with the new strains.

Which is why we should use them as soon as possible.

What about sending the unused doses to developing countries? Then they wouldn't go to waste.

yeah ideally that should happen :) Just it hasn't so the choice isn't "use locally or send abroad" it's "use locally or let them go to waste"

TBF I guess this must be a really complex logistical challenge.

Not sure about logistics, so. Sure it i challenging, but there are well established vaccination programms run by expierenced NOGs in developing countries already. These folks would, I guess, be really happy to take those doses and set something up. They are also rather capable of doing so.

initially, that was part of the EUs over-ordering. Take those doses and give them to poorer countries. Good for public health, good PR and really good at gaining soft power in the world. No idea why that isn't happening. Russia and China are grateful for that I guess, so.

I read that it wasn’t the logistics of sending them out that’s challenging; rather it’s trying to collect them back from the 100k+ pharmacies, hospitals, distribution sites etc in the US, most with poor records. The us mounted such a large and effective campaign to get them out there, would take just almost as large an effort to bring them back

True, that is a a challenge, I didn't think of that... It's definitely easier to use those doses still sitting in central warehouses somewhere. Funny how demand can be off so much from estimations. I, and it seems I'm not alone with that, really did expect demand for the vaccine to be much higher than it turned out to be.

The US government, to secure the doses, committed to indemnify the suppliers if anything went wrong and not to transfer the doses to any country that would not (or in some cases, they had to commit to not transferring the doses at all). Most countries are refusing to indemnify the companies.

So the US government would be in breach of contract and could be sued for sending the doses overseas.

Oh I see, didn't know that. Thanks for explaining! That being said, the government could also give the doses back to the manufacturers for a small fee who could then sell it abroad themselves, because right now it seems to me that their production capacities are maxed out and they produce less than they could sell.

Oh yes. Or renegotiate the contracts. And, IIRC, Biden got around that in the case of Mexico by "loaning" them the doses against their preorder that Pfizer couldn't fill yet.

And, for a selfish western pitch: reduce the chance that bad new variants develop.

How will these vaccines that don't produce immunity lead to less severe variants? If they mute severity of illness they will lead to more severe variants. This is basic.

They do provide immunity in 95% (conservative) of cases, so it massively reduces the population that mutations can happen in.

They reduce severity of illness, and don't produce sterilizing immunity and eliminate transmission. And that's the problem, if you pick up a nasty mutation but because of vaccine you are able to still function, you are more likely to be out and about spreading it.

And when your limited immunity wanes in a few months this mutinous bastard copy you pushed on the masses may come back to bite you in the ass.

Maybe not though if you got your booster in time and if they designed it to match. Better hope your country went with the gold subscription.

What data are you referencing to claim that the vaccines do not provide some immunity? But importantly, the vaccines do reduce transmission. See the below study along with others.

https://www.nejm.org/doi/full/10.1056/NEJMc2107717

Admittedly, one weakness of the above study is that it took place before Delta was widespread. There isn't a lot of data yet on how much the vaccines reduce transmission with Delta, but the likelihood is that they still do even if to a lesser degree.

Reducing transmission isn't good enough! If you have an R naught above one you're still in trouble. It's common knowledge that countries with highest vaccination rates have spikes in cases right now. Israel and Gibraltar for example. Herd immunity for this was always impossible.

Israel isn't among the countries with the highest vaccination rates anymore, quite a few other countries have overtaken it.

Ok well you can't beat Gibraltar at 99%. But you look at other countries. New Zealand is a good one. Their hospitals are getting swamped with kids right now with severe RSV. Why? They've had their immune systems degraded from some of the most severe lockdowns I the planet. And admittedly they aren't in a covid spike but the effective lockdown has created other problems.

This shouldn't be down voted. It appears to be correct and is a subject of active concern in NZ.

https://www.auckland.ac.nz/en/news/2021/08/02/fight-against-...

I down-voted because that has nothing to do with a "degraded immune systems". Many of the more common respiratory viruses also died out in New Zealand with the quarantine. Kids never got a chance to develop immunity to those particular diseases previously and now it's coming on in a wave as they are reintroduced. It's not that their response is special, in normal circumstances kids would have gotten sick and been hospitalized, that it's happening all at once is.

No, they would have stronger immune systems from repeated exposure without the extreme lockdowns NZ introduced and less hospitalizations.

Respiratory viruses don't die out, they can persist in animal populations indefinitely. Sars Cov2 antibodies detected in 40% of NE deer populations for instance. Not to mention cats and dogs...

I assume you have evidence of the claim that by being regularly sick your immune system is stronger? Sure, it's run into more things it has learned to fight, but just because it knows how to fight a catalogue of things it doesn't mean that it will be better with the next novel pandemic, right?

The risk is more around autoimmune conditions like asthma and allergies. If the immune system doesn't start fighting off a variety of pathogens from an early age then it might go haywire later.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841828/

We should be focusing on overall health rather than just individual infectious diseases.

I don't much care for the hygiene hypothesis for allergies. I grew up on an acreage with all sorts of animals. I'm allergic to all of them, so much so that my parents got my allergy shots for several years. I'm most allergic to horses, which we had a trio of. It just doesn't make a lot of sense to me. And if it were true I'd much prefer more allergies to COVID.

Of note in that paper they are suggesting therapeutic strategies that involve controlled exposure of particular items, and how those exposures are fraught with potential dangers as well.

Singapore has an 81% full vaccination rates but is experiencing a rise in symptomatic cases.

https://www.reuters.com/world/asia-pacific/seriously-ill-cov...

As a counterpoint, Portugal currently has 81.10% fully vaccinated and 86.85% vaccinated once (meaning they'll be vaccinated again in 4 weeks or earlier), and the new infections are going down slowly but continuously for a while now.

My point is not that you're wrong, but that you were cherry picking examples and there can be numerous other reasons for spikes in infections such as relaxed measures and mask mandates, holiday season, schools re-opening, etc. It requires a more careful analysis than yours.

Yes, lock down and social isolation does work to prevent transmission but it also weakens the healthy immune systems and makes the population more fragile going forward.

Better to inoculate the most vulnerable, not the entire population for a fast mutating respiratory virus.

Polio can't really mutate and it makes a lot of sense to inoculate everyone for this.

The original clinical trials didn’t measure immunity, and, in fact, the claim from day one has been that the vaccines were designed to reduce serious disease and death.

> They do provide immunity in 95% (conservative) of cases

So not conservative. Real world data has all of them at under 80% now.

https://www.yalemedicine.org/news/covid-19-vaccine-compariso...

I heard against the Delta variant, RNA vaccines help divide the chance of contaminating others by at least two, even if you're asymptomatic (because basically, the virus last half the tine in your body). And also, since you're contaminated for less time, there is fewer chance of a variant popping out of a vaccinated person.

Take it as someone who heard someone talk about it, did not research himself (because i don't really care) and isn't really sure of what the truth is. See this comment as a clue if this stuff interest you.

You are not protected againts new mutations just because they originate from another place in the world. You are not reducing the chances for new mutations.

Keeping the vaccine to yourself will not help you.

I think you're misunderstanding the intent of the parent post.

They are saying letting vaccines go to the rest of the world is still the right course of action even if your motives were purely selfish. By reducing the number of infections elsewhere, the virus has fewer chances to mutate and return to and endanger you.

While in principle that's clearly sound - fewer viral particles means fewer future variants appears to be the consensus opinion - I'm skeptical that the decision to recommend boosters after 8 months will have a measurable impact on that.

First of all, even under rosy vaccine acceptance trajectories that's not going to be many doses vs. the unvaccinated population; secondly, you need 1 dose for a booster, yet 2 for a full vaccination; thirdly, the data for hospitalisations may not be in, but for mere infections it is clearly showing a reduction in efficacy well before a that 8 month mininum so the opportunity cost of not vaccinating half a person will be offset in terms of transmission by the booster dose; fourthly not all vaccines are easily distributed, and as long as the US needs to have a readily available supply to entice the unvaccinated stragglers, you might as well use doses nearing expiration dates for boosters rather than throwing them away; fifth: we're not at 8 months yet for most people, and if the minimum delay is 8 months the average might be considerably more such that by the time this matters vaccine production should be higher and thus the loss relatively less impactful.

Some of those effects might be trivial or zero, but at the very least the small number of doses overall affected probably isn't. I'd be really surprised if the US reaches 100 million booster doses by next spring; and even if we did that's just not a huge number if your aim is to reduce transmission (as opposed to suffering).

I think he is stating the exact opposite: to actually give doses to those countries without, exactly for this reason

Was going to answer to say exactly this.

The more vaccinated, the merrier the world with less variants

What if it works the opposite though?

Simple evolutionary biology suggests resistance develops from roadblocks or mechanisms to stifle. We see it all the time in antibiotic resistance, resistance of insects to pesticides used in crops, all kinds of areas.

I don't see a reason this case would be different.

because you are giving the virus less chances to replicate and therefore less chances at mutation

I might be wrong, but it seems obvious to me that this should reduce variants

But developing countries pay less, so BionTech and Pfizer will have less profits. As cool as having a company like Biontech, run by immigrants, founded in Germany they always rubbed me the wrong way in terms of PR and business conduct since the start of the pandemic. With huge support from German media and politics. The continued dissing of Astrazeneca is just one example, the push for booster shots is another.

It's fascinating how the vaccine makers have come out of this smelling like roses to so many and I wonder how long it will last. Not long ago, the NYT could write "the turpitude of the pharmaceutical industry is so commonplace that it has become part of the cultural wallpaper.” [0] Now we all seem very happy to accept their products and believe their claims. Truly wonderful to behold.

I can recall books and arguments that made a good case that big pharma operates most like a mafia. I also recall hearing some tthatime ago that drug pharma execs themselves consider the vaccine guys to be like the mob, with a habit of aggressive shakedowns and pressure campaigns the norm in that industry, and thought they gave the industry a bad name.

Citation https://www.nytimes.com/2020/12/17/opinion/covid-vaccine-big...

Yeah, and the one company that did the right thing (TM), AZ, by selling the vaccine at cost is the one who's image suffered the most. Strange times we live in.

Well, I'm assuming people were more critical before covid because it's easy to thrown stones when there isn't an epidemic going on a millions dying?

Are you suggesting the criticism was/is unfounded?

No, I’m suggesting it’s easy to criticize when you aren’t immediately benefiting.

Fake news alert: Biontech/Pfizer never "dissed" AZ.

They never commented on AZ. You can not blame BT if everyone wants "the best" for themselves.

There is active and passive dissing. Like publicly confirming deliveries when your competition is announcing delays. Or re-publishing your vaccine efficiency numbers when those of the competition are in doubt. I guess we can agree that this is a form throwing shade, or dissing, your competition. Just doing it in a smarter way than saying "AZ sucks".

>Like publicly confirming deliveries when your competition is announcing delays.

Sorry but that is nonsense. When in spring 2021 AZ had big delays, everyone was nervous that the same might happen to BNT. So politics, the public and the press asked them about it. At this time we had almost daily reports on deliveries because it was THE news item in spring.

BNT deliveries were rock solid and mostly on time in the EU in spring 2021, while AZ had plenty of delays. And you are now holding this against BNT?

The US and other developed countries have purchased vaccine doses from the manufacturers at the negotiated price and then donated some of those to developing countries. So did those doses at least the profit was the same.

Hum, anyway they are making a lot of effort to sell doses around here (Brazil), even with an uncooperative government. And they indeed are asking for a smaller price than on the developed countries.

I guess the rich countries applying a 3rd dose is a net benefit for them, but they seem to be playing the "we will sell as much as we can" game, not the monopolizer "restricting supplies leads to more lucrative prices" one.

These strategies are not mutually exclusive, are they?

You either sell as much as you can or you restrict how much yo sell. You can't do both.

If they can keep the Moderna, and Pfizer vaccine, at below freeing?

I just picture America the "great" delivering vaccines, and there's no infrastructure on the other end.

On a selfish note, I wouldn't mind closing all ports of entry until this virus is truly under control.

I don’t understand what closing all ports of entry will do (in USA) at this point. The virus is already here and all travel to USA requires a negative covid test taken at most 72 hrs before flight.

Good luck closing the U.S. southern border.

That’s not really the concern. Foot travel is ridiculously slow. This virus travels by air, first class.

People board buses and planes once they cross the border.

Not likely planes. The most mobile people are the richest.

It's not expensive if you're not paying for it. Immigration administration flies people from the border to the interior for processing and release.[0]

"U.S. Customs and Border Protection, which turns over border crossers to ICE after arresting them, has begun flying migrants to other cities for processing and is releasing them directly into communities without going through ICE, saying their own facilities are at capacity." [1]

[0] https://www.expressnews.com/news/local/article/ICE-says-780-...

[1] https://apnews.com/article/us-news-ap-top-news-mi-state-wire...

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