Tuesday, April 20, 2021

mRNA's Cherry On Top: The EU Buys Another 100M Pfizer Vaccines

The EU exercised its option to buy another 100 million doses of Pfizer/BioNTech COVID-19 vaccine, bringing the total to 600 million. Combining that with the 1.8 billion dose order drafted earlier in the month, this means the EU has essentially gone all-in on mRNA. Reviewing my post on the situation back in February, this means the EU has 3.365 billion mRNA vaccine doses either delivered or deliverable. Presumably CureVac's doses are still on order as part of that sum.

The buy makes it appear that the EU has lost faith in Sanofi's protein subunit vaccine, which had trouble with efficacy in the key older group. Sanofi has since shifted gears, and on March 12 announced with partner Translate Bio, that they, too, would have an mRNA vaccine candidate, with phase 1/2 trials commencing soon (?), but these are not expected to conclude until Q3, 2021.

Saturday, April 17, 2021

COVID Vaccine Bullets

  •  The European Union is negotiating a 1.8 billion-dose order with Pfizer to be delivered in 2022 and 2023 (!!!) and will not renew contracts with AstraZeneca or Johnson & Johnson. The doses will be manufactured in the EU.
  • For all that mRNA manufacturing has generally scaled well, we finally have a story of missed shipments from Moderna, who has announced they will cut vaccine deliveries to Canada and the UK due to manufacturing problems.

    While the company didn’t specify how many doses would be cut and where, Canada’s Procurement Minister Anita Anand said Friday that its shipments will contain 650,000 doses this month instead of the expected 1.2 million. 

    Moderna also warned up to 2 million of a planned 12.3 million shots scheduled for delivery in the second quarter would be delayed until the following quarter, according to a report from Reuters. However, a company spokesperson also told the news agency that its deliveries to the European Union and Switzerland remain on track.

  • Pfizer's CEO now says there will likely be a need for COVID booster shots, possibly annually.
  • CureVac plans on releasing trial data of its mRNA vaccine in the coming weeks.
  • Moderna is putting its mRNA influenza and HIV vaccines into phase I trials this year.
    Current flu vaccines in the market have efficacy rates in the regoin [sic] of 40-60%: which Moderna believes its mRNA technology can improve on. It also says that its technology has several advantages over egg-based vaccine production: not only in terms of production advances but in accurately targetting vaccines against strains (egg-based production has the potential to cause unintended antigenic change to the vaccine virus).
    They also released phase I trial data for a respiratory syncytial virus (RSV) vaccine, and a cytomegalovirus (CMV) vaccine.

The Bogus Story About Vaccine Racism

The woke crowd has unsurprisingly turned to its favorite hobgoblin of "structural racism" (i.e. this piece in Journal of the American Medical Association) as explanatory for differing rates of COVID-19 vaccine uptake. Per recent polling by the Kaiser Family Foundation, Hispanics (61%) and blacks (55%) say they have either already gotten a COVID vaccine or plan to do so as soon as possible. The big problem the "structural racism" argument has is this reticence is more or less mirrored in historical data for influenza vaccines. Blacks (by about 15%) and Hispanics (~13%) lag white vaccination rates considerably for the most vulnerable age group (69.9% for ≥ 65 years). Otherwise there is a lag, sometimes quite noticeable, other times not so much, but the idea that COVID vaccine reticence is somehow driven by systemic racism fails to heed the historic story.

Friday, April 16, 2021

The Trouble With Labels And Facebook's Censorship

 The New York Post has a story about BLM co-founder Patrisse Khan-Cullors buying four million-dollar-plus homes in the New York area, scoping out property in the Bahamas, and last month buying a $1.4M home in Malibu. This is in addition to homes in the Atlanta and Los Angeles areas.

 BLM, of course, is a label, which means anyone can use it. There really is no unified formal organization, which has led to grifters capitalizing on the brand's goodwill. BLM Global Network Foundation, Khan-Cullors' particular instance, is one among many:

Founded by Khan-Cullors and another activist, Kailee Scales, the nonprofit Oakland, Calif.-based BLM Global Network Foundation was incorporated in 2017 and claims to have chapters throughout the US, the UK and Canada, and a mission “to eradicate White supremacy and build power to intervene in violence inflicted on Black communities.” The group does not have a federal tax exemption and donations are filtered through ActBlue Charities and Thousand Currents, two nonprofits that manage the cash.

This, of course, sounds awfully familiar; the whole point of ActBlue is to hide the operations of political scam artists. What makes this worse is Facebook censoring attempts to share the story, something mainly reported by News Corp. outlets. (Twitter has not, so far, attempted to step on this.) What good can come from this? The fact that the BLM name is being openly used by grifters is bad enough; that Big Tech covers for them is appalling.

Wednesday, April 14, 2021

The Insane, Reckless "Pause" Of The Johnson & Johnson Vaccine Will Cost Lives

 The FDA and CDC have called for a "pause" of deliveries of the Johnson & Johnson (Janssen) COVID-19 vaccine. This is absolutely insane based on relative risk alone: one woman died among the six women affected (all 18-49 years old), versus over seven million vaccinated. Meantime, the CDC's own best-guess infection fatality ratio shows twenty deaths per million infected among the 0-17 years age group. So the FDA and CDC are stopping vaccinations that could save the lives of twenty times the number of people even in the best case scenario. The most likely case, the 18-49 age bracket, sees an IFR of 500, which means you are looking at two orders of magnitude more risk of death than without vaccination. The FDA has a history of safetyism overriding sense, and this will kill people, especially as it means fewer vaccines will be available.

 In a sense, the pause may not matter, because the vaccines wouldn't be available even if these thrombotic events hadn't happened. Johnson & Johnson took over production at contract manufacturer Emergent BioSolutions following production errors there that mixed up their vaccine with AstraZeneca's, and this caused the destruction of up to "15 million doses". Accordingly, the CDC announced it expects J&J to cut supply by 80%, putting the overall annual goals of 100 million doses in the US and one billion worldwide in jeopardy.

Lastly, for anyone who wants to get into the weeds on this subject, Derek Lowe has a good explainer on the subject. This seems to be a problem shared with the AstraZeneca ChAdOx1 vaccine as well, and while I recommend the whole post, I wanted to highlight this one section in particular:

Is this blood clotting happening with the mRNA vaccines, too?

No. That seems quite clear – to the best of my knowledge, there have been no reports like this at all with either the Moderna or the Pfizer/BioNTech vaccine. That’s good news, and it tells us a lot. For one thing, this blood clotting problem is not a general feature of trying to vaccinate people against the coronavirus. It also means that it apparently has nothing to do with inducing the coronavirus Spike protein in people, since that’s what both the adenovirus vectors and the mRNA vaccines are doing, in the end.

The version of that protein brought on by the AZ/Oxford vaccine is slightly different from the others (it doesn’t have a key set of protein-stabilizing mutations), and when the clotting problems showed up in Europe some people were wondering if that had anything to do with it. But the appearance of such side effects with the J&J vaccine would seem to rule that out. Instead, what those two have in common is that they’re both adenovirus vector vaccines [emboldening mine — RLM]. Oxford used a chimpanzee adenovirus, and J&J picked a less-common human one. Which means that if this is a side effect shared by adenovirus vectors, it’s shared at a pretty basic level, isn’t it? I’m not enough of an adenovirus jock to tell you in detail about the similarities between the proteins in the ChAdOx vector versus Ad26, and at any rate it’s probably more about the antibody response to these things (and why, in a small number of people, that goes awry with the PF4 protein).

It's becoming increasingly obvious that the vectored virus vaccines are a technological dead end: harder to manufacture at scale, more likely to generate weird side effects, and less effective than mRNA vaccines. But any of them are still better than getting COVID.

Update 2021-04-15: Alex Tabarrok has a useful thread detailing post-vaccination thrombotic events in the UK. The mRNA vaccines maybe have dodged a bullet on this?

Monday, March 29, 2021

What Does Pandemic's End Look Like?

 The pandemic will go on a lot longer than people are probably comfortable with, to the extent that the disease is likely to become endemic. And it's likely to drag on a while: Moderna has committed to making 1.4 billion doses of its COVID-19 vaccine in 2022, which suggests a couple of things:

  • Moderna thinks other vaccine platforms won't actually be able to scale. This is somewhat laid out by the continuing manufacturing problems Astrazeneca has had in Belgium, Mexico, and a Dutch plant that hasn't been certified for production yet. Johnson & Johnson has similarly had manufacturing problems delaying shipments and putting commitments at risk. Likewise, the Russians are also facing similar problems scaling their Sputnik V vaccine. One might be excused for thinking this is a trend among vectored virus vaccines.
  • And/or, a variant booster will become necessary. Moderna has already committed to work on a vaccine for the the B.1.1.7 and B.1.351 variants.

For its part, Pfizer says they do not foresee strong demand for their COVID-19 vaccine in 2022, although they are similarly lining up for possible variant boosters, this mainly on the strength of many entrants to the market. Assuming Moderna is right and Pfizer is wrong, this could mean a COVID shot becomes an annual affair, like influenza. The good news, to a certain extent, appears that the virus is convergently evolving, i.e. the same mutations are showing up in different places. That is, we have a pretty good idea where the beast is headed. We also now know that the impact of the variants on T-cell reactivity is "negligible". Antibodies are nice, but they're not the whole immune system. In all, this makes it look like we're getting very close to this pandemic coming to an end.

Update 2021-03-30: Some interesting polling data:

  • First, a Washington Post poll showing "one in three" health care workers are not confident the vaccines have been adequately tested for safety and effectiveness.
    While about 2 in 10 health-care workers said they had scheduled a shot or were planning to, 3 in 10 health-care workers said they were unsure about getting vaccinated or not planning to do so. As many as 1 in 6 health workers said that if employers required them to get vaccinated, they would leave their job.
  • Next, the Wall Street Journal summarizes a U.S. Census Bureau poll showing that for the first time since polling began in December, "will not take" is now below 20% ("about 17% of adults said they would either definitely or probably not get vaccinated, down from 22% in January"). Good news.

Thursday, March 25, 2021

The Pandemic Isn't Over, But It's Getting Closer

 Coyoteblog (somewhat prematurely, I think) declares the pandemic over, at least in Arizona, this based on Arizona Department of Health hospitalization data. The obvious rejoinder to this is that we have previously seen downturns in hospitalization, but this time we have vaccinations. Arizona recently surpassed 40% of its population with one or more jabs, which the ADH boils down to 26.8% of its population vaccinated. 

Costco may have quietly come to their own conclusions on this matter:

There's reason for hope. Hopefully next month we start seeing the large vaccine increases promised back in February. Of course, this won't help if we continue to see vaccine hesitancy in younger groups — or in ethnic groups otherwise disinclined to get vaccinated. This is already being chalked up to, in part, Russian disinformation (some of which is probably due to Sputnik V vaccine marketing). But none of this makes sense against the background of historical influenza vaccination uptake.

 In the Kaiser Family Foundation's most recent poll, 51% of whites, 52% of Hispanics, but only 42% of blacks either had already been vaccinated or planned to get vaccinated as soon as possible. Yet, if you look back a ways — to this 2013 NIH study on influenza vaccination — you would see that whites lead inoculations in all age categories, with blacks trailing around 10% and Hispanics a similar percentage. As only 32.2% of whites 18-64 got inoculated in the 2010-11 season, that means about a 20-point shift in confidence and/or necessity. That's pretty impressive when you consider all the shade thrown at the vaccines as "rushed" or whatever other imagined flaws they might have.


Monday, March 15, 2021

The Coming Need To Sell The COVID-19 Vaccines

Dr. Scott Gottlieb recently tweeted something of great import about the COVID-19 vaccines:

As we move from scarcity to plenty, we also move to more-averse age groups. A large cohort of people either refuse to get the vaccine at all (about 15% in recent polls) or will only if forced (7-9%):

This is not encouraging, especially considering there is a very large group that will not be able to get a vaccine for many months: children. As of February, Moderna is only testing their vaccines on children from 12-17, with the trial concluding "around midyear 2021", followed by a second trial of children aged 6 months to 11 years. Given children 17 years and younger amount to 22% of the US population, if you combine that with the roughly (and optimistically) 20% who refuse to take the vaccine under any circumstances, you're left with only 60% who will take the vaccine — far below the 70% needed for herd immunity (at a bare minimum). We had better hope a lot of those people get immunity somehow.

This sales job is not helped by the CDC's message that, even after vaccination, we will still have to mask and keep away from other people (emboldening mine).

"Currently, we do not have enough data to be able to say with confidence that the vaccines can prevent transmission," National Institute of Allergy and Infectious Diseases Director Anthony Fauci said last month. "So even if vaccinated, you may still be able to spread the virus to vulnerable people," he continued, and therefore you should continue to wear a mask and socially distance. Don't go back to normal, he advised, even after you've gotten the shot that is supposed to put things back to normal. In fact, we may still be in masks in 2022, Fauci added a few weeks later. Guidance from the Centers for Disease Control (CDC), expected to be released this week, strikes similar notes.

This is not how we should be talking about vaccines and the return to normalcy. However good the intent—and the intent is almost certainly to discourage reckless behavior that could undermine the vaccines' impact on disease transmission—the effect is discouraging and detrimental. Insofar as it might dissuade some people from getting vaccinated, advice like Fauci's might even be dangerous.

Getting vaccinated is a step — the biggest step — toward normalcy. It's too bad the CDC doesn't appear to see it that way.

Friday, March 12, 2021

The EU Campaign To Shame Vaccines Out Of The US

 The ongoing fracas over AstraZeneca's ChAdOx1 vaccine and its sketchy trial data has not stopped its use in most countries. Indeed, as I learned today from Marginal Revolution, the New York Times writes that there's plenty of that vaccine in the US, whose manufacturing was started long ago (emboldening mine as usual):

About 30 million doses are currently bottled at AstraZeneca’s facility in West Chester, Ohio, which handles “fill-finish,” the final phase of the manufacturing process during which the vaccine is placed in vials, one official with knowledge of the stockpile said.

Emergent BioSolutions, a company in Maryland that AstraZeneca has contracted to manufacture its vaccine in the United States, has also produced enough vaccine in Baltimore for tens of millions more doses once it is filled into vials and packaged, the official said.

…But although AstraZeneca’s vaccine is already authorized in more than 70 countries, according to a company spokesman, its U.S. clinical trial has not yet reported results, and the company has not applied to the Food and Drug Administration for emergency use authorization. AstraZeneca has asked the Biden administration to let it loan American doses to the European Union, where it has fallen short of its original supply commitments and where the vaccination campaign has stumbled badly.

 Given that the US has no apparent interest in using those doses, at least in the short run, this would seem like a reasonable request. However, there's an interesting detail in the Times story that merits further comment:

The European Council president, Charles Michel, said the United States, along with Britain, “have imposed an outright ban on the export of vaccines or vaccine components produced on their territory.” Asked on Thursday about the American supply of the AstraZeneca vaccine, Jen Psaki, the White House press secretary, told reporters that vaccine manufacturers were free to export their products made in the United States while also fulfilling the terms of their contracts with the government.

The link in that graf points to a remarkably self-serving and frankly nonsensical press release, claiming there would be 

  1. No vaccines without Europe. This is demonstrably false, because outside of AstraZeneca, the three other approved vaccines were all (first) manufactured in the US. (Germany's BioNTech developed the Pfizer vaccine, but Pfizer manufactured it.) This is even more ridiculous when you realize that mRNA vaccines now constitute a majority of the EU's vaccine buy.
  2. Without Europe, many countries would not yet have received their first doses. On the other hand, the Netherlands, Italy, Germany, and France might have had their doses sooner. And in any case, "first doses" are mainly symbolic judging by overall vaccinations:

  3. Europe is the most inclusive world power. This is mainly about funding COVAX, the effort to get vaccines to the rest of the world, but this is happening mainly symbolically while the EU waits for more vaccine.
  4. Europe is an exporter. Here he expounds on what I can only believe is the purest of ignorance of his audience, raising the "outright ban" charge. Yet Our World In Data shows Pfizer and Moderna vaccines being deployed in many nations in and outside the EU, and if the recent, belated efforts at starting up mRNA manufacturing in Europe are any indication, production at scale wasn't possible there (and won't be for many months). Edit: the claim is made that "Most of the doses with which Israel embarked on its mass vaccination programme were sent from Belgium", but "most" is not "all", and this is important.
  5. Europe is set to become the leading vaccine producing continent before the end of the year. This might be true, but only because they're producing vaccines licensed from US companies — including Johnson & Johnson. 

It's the third point that causes me to raise my eyebrows: if anything, the US is exporting vaccine to Europe. What else do they want? One expects this is a bid to shame additional doses contracted and paid for under Operation Warp Speed out of the US — at a bargain price. But as the EU itself shows with this point, doses go first to member nations — and only after local demand is satisfied will the rest of the world see any.

Wednesday, March 10, 2021

No, Israel Is Not Over 90% Vaccinated

 If, like me, you had accepted at face value the marvelous gift of 91-DIVOC.com, you probably assumed all the figures there were taken directly from the underlying data sources, and that any errors were due to their sources. This led me to the conclusion that Israel has already vaccinated over 90% of their population.

Unfortunately, it does not appear this is true. The Our World In Data repository at GitHub in their README.md file for country vaccination data says that the total_vaccinations field is 8,975,914 for 2021-03-09 — which is also the figure being shown on the graph above. Unfortunately, this field only tells us how many shots have been given, so a two-dose regime double-counts such individuals. When we use the people_fully_vaccinated and people_vaccinated fields, the graph looks like this:


I've fired off an email to Prof. Fagen-Ulmschneider, and we'll see if he responds.

Update 2021-03-22: Much overdue, but the good professor back on March 11 acknowledged my contribution on his main page, and has made appropriate corrections.

Tuesday, February 23, 2021

COVID-19 Bullets

Saturday, February 20, 2021

EU Crowns mRNA The Winning COVID-19 Vaccine Technology

 Thursday, the EU contracted with Pfizer and Moderna to purchase 350 million more doses of their SARS-CoV-2 vaccines, making for 2.6 billion doses in the pipeline altogether. Between those two and CureVac, this means mRNA vaccines account for 1.465 billion doses:

TechnologyManufacturer(s)Number of Doses
(Millions)
% of total
mRNAPfizer/BioNTech, Moderna, CureVac1,46554%
Vectored VirusAstraZeneca, Johnson & Johnson80029%
Protein SubunitSanofi GSK30011%

 Sanofi earlier this week reported they would not have a COVID-19 subunit vaccine ready this year, so this purchase looks like the plugging of a hole rather than an increase. More importantly, it seems to me that if Peter Hotez is right as to what types of vaccines are going to be the "the workhorse of this epidemic", it is getting awfully late for any technology other than mRNA.

Update: it's probably worth mentioning that once you subtract the 300M vaccines Sanofi can't deliver, suddenly mRNA has 61% of EU sales. That's quite a vote of confidence.

Sunday, February 14, 2021

COVID-19 Vaccine News

 Most of this is from Biopharma-Reporter.com, which looks promising as a future source of news in this space:

Friday, February 12, 2021

COVID-19 Bullets

  •  New York Gov. Andrew Cuomo is in hot water now that the state "has reported 8,600 nursing home deaths tied to the coronavirus since the pandemic began. Overall COVID-19 deaths in the Empire State exceed 40,000. ... New York only counted residents who died on nursing home property, rather than any who were transferred to hospitals. But according to the report, most of the deaths occurred in hospitals.
  •  The vaccination situation in Canada is even worse than that in the US. "The Canadian deficit is mostly because they don’t have enough vaccine. Canada bought doses but they didn’t invest in capacity and a deal with China fell through. As a result, Canada won’t be getting lots of vaccine until March or April."
  • I mentioned mRNA scaling as an update to my roundup of recent Derek Lowe blog posts, and also in the comments there. Someone was kind enough to give an extended reply, which I repost here in its entirety:

    It is possible BUT there are several hurdles to overcome.

    1) Raw materials. You need recombinant *GMP quality* (as in, NOT lab quality) enzymes. These can certainly be made, the technology existed even when I was an undergrad back in the Clinton/Kurt Cobain era. Bacterial fermentation at smallish scale and relatively easy to do. Since they’re being used for industrial processing and not put into humans, you can do convenient things to improve the process like stick 6his tags on the end and tether them to IMAC resin to better control the reaction rate and set yourself up for continuous methods.

    2) Liposome/LNP formulation needs to be done by process engineers who actually know a little something about liposome manufacturing. Sanofi has these, or should have, or can afford to hire them and keep them.

    3) Different kinds of lipids and a wider variety need to be at least tried out, instead of this whole getting married to just one other startup’s lipid and then having a patent pissing contest with them. Never restrict yourself to a single source of anything, there is far too much risk that one source will go out of business and you’ll be screwed, unless you plan for vertical integration and make the lipids yourself at a small molecules site within your company. Which Sanofi also has the resources to do if they choose.

    4) The medicinal chemists need to choose targets appropriate for the PK of intracellular transient expression. Alnylam did an excellent job of thoroughly understanding the PK of their modality, and Sanofi should follow their example.

    Hope That Helps!

Wednesday, February 10, 2021

The Zero COVID Brigade

The "lockdowns forever" crowd won't stop once we get the population vaccinated.  Israel now has just over 60% of its people inoculated with at least one Pfizer shot, and here come the "vaccines aren't enough" brigade (emboldening mine):

Naftali Bennett, the former defense minister who coordinated much of the nation’s initial virus response and is now running to replace Netanyahu, accused the government of adopting a strategy that, in his words, can be summed up as, “We’re not going to manage the crisis in this country, we’re going to put all our eggs in the one basket: vaccines,” he told Intelligencer.

“Israel’s entire strategy relies on the hope that no variant will escape the vaccine,” he continued. “If a mutation that can bypass the vaccine appears tomorrow, we’re in trouble.”

On Thursday, at a cabinet meeting convened to debate the future of a partial, fraying lockdown, which is scheduled to end on Sunday, Netanyahu acknowledged that “the British mutation is running amok in Israel,” driving 80 percent of Israel’s recent COVID-19 fatalities.
That public health officials, driven by a messiah complex, might not want to surrender emergency powers is scarcely a new thing, but the idea turns up again and again. Freddie Sayers in Unherd did a good writeup on the subject of Zero COVID, a movement he claims is "crucially distinct from people who support ongoing lockdown measures to suppress the virus to a level where it is safe to reopen — for ZeroCovid believers, we cannot rest until that level is zero."

This distinction does not actually matter. The reason for this is that the main response to outbreaks has in fact been more stringent and longer lockdowns. Essentially, whether you want to call it Zero COVID or not, what it means is putting the US in a state of permanent emergency should the virus become another of the endemic respiratory viruses. The Biden administration is waffling on whether it wants to actually do this:

So far, the Biden administration has tried to have it both ways—coddling those who appear to welcome a perpetual pandemic while assuring those who don’t that deliverance is near at hand. In a pre-Super Bowl interview with CBS News, President Biden said that it was necessary and possible for schools to reopen safely in accordance with CDC guidelines, which will be forthcoming shortly (never mind that the CDC produced just such a set of guidelines as far back as last August). But a sprawling White House COVID-19 strategy memo released by the Biden White House last month also provides for the possibility that “new coronavirus variants that may have a higher transmission rate” might forestall the resumption of full-day, in-person education. And, in a late January call with teachers’ unions’ representatives, Fauci said that those variants, which “may” be more resistant to vaccines, are likely to scuttle the president’s desire to see K-8 classrooms reopen nationally.

 But once we get vaccines that, at least, will prevent hospitalization and death, there has to be some level of disease burden we're willing to tolerate rather than stay hunkered down indefinitely. The most recent bad influenza season, 2017-18, saw over 800,000 hospitalizations and 61,000 deaths (estimated). Meanwhile, in Israel, over 90% of the 60+ population has been vaccinated, and the results are quite striking:


 Yes, younger cohorts now make up a larger fraction of new cases (per the New Yorker article, 44% under 19 years old and an increasing number from the under 50 crowd). But given what we know about outcomes, these groups are unlikely to get severe disease. At some point, we'll have to ramp up vaccine production and learn to live with this disease. We don't really have a choice.

Tuesday, February 9, 2021

Three Four From Derek Lowe On Vaccine Efficacy, Manufacturing

Some great stuff, as always, from Derek Lowe’s In The Pipeline blog at Science magazine. I’ve been a little behind in following him, and he’s been quite prolific lately (as befits the circumstances).
  • “Vaccination Against The New Variants: Real-World Data” tackles the thorny problems posed by the B.1.1.7 (UK) and B.1.351 (South African) variants. Excerpt:
    Now to the vaccinated-patient plasma samples, because that’s what a lot of people are really wondering about: how well does being vaccinated with the current agents provide you with protection against the new variants? The authors studied serum from 12 patients that had been given both doses of the Moderna vaccine and 10 patients who had had both doses of the Pfizer/BioNTech one. The activity drop against the B.1.1.7 variant was only about 2-fold in both groups, whereas the overall activity drop against the B.1.351 variant was 6.5-fold in Pfizer vaccinnees and 8.6-fold in Moderna ones.

    ...

    What about those activity drops, especially the larger ones against the B.1.351 variant? Does that still leave room for protection? Here’s the good news: it very much does.
    This is why, frankly, I find South Africa's halting of its AstraZeneca vaccination campaign to be utterly insane: what is the point? Even if the vaccine only confers protection from severe disease, that is still worthwhile. Of course, Lowe doesn't mention that in this post, but small-scale data (n=2,000) thus far points in that direction.
  • In “Myths of Vaccine Manufacturing”, Lowe tackles a subject that has been on many a mind lately: how do we increase production? There are a lot of potential bottlenecks, but the biggest single one is mRNA encapsulation. As usual, emboldening is all on me:
    Turning a mixture of mRNA and a set of lipids into a well-defined mix of solid nanoparticles with consistent mRNA encapsulation, well, that’s the hard part. Moderna appears to be doing this step in-house, although details are scarce, and Pfizer/BioNTech seems to be doing this in Kalamazoo, MI and probably in Europe as well. Everyone is almost certainly having to use some sort of specially-built microfluidics device to get this to happen – I would be extremely surprised to find that it would be feasible without such technology.

    ...

    These will be special-purpose bespoke machines, and if you ask other drug companies if they have one sitting around, the answer will be “Of course not”. This is not anything close to a traditional drug manufacturing process. And this is the single biggest reason why you cannot simply call up those “dozens” of other companies and ask them to shift their existing production over to making the mRNA vaccines.

    ...

    And let’s not forget: the rest of the drug industry is already mobilizing. Sanofi, one of the big vaccine players already (and one with their own interest in mRNA) has already announced that they’re going to help out Pfizer and BioNTech. But look at the timelines: here’s one of the largest, most well-prepared companies that could join in on a vaccine production effort, and they won’t have an impact until August. It’s not clear what stages Sanofi will be involved in, but bottling and packaging are definitely involved (and there are no details about whether LNP production is). And Novartis has announced a contract to use one of its Swiss location for fill-and-finish as well, with production by mid-year. Bayer is pitching in with CureVac’s candidate.
    Bottom line is that, once again, calls for the use of the Defense Production Act on the grounds that other pharma companies are twiddling their thumbs are delusional.
  • A post summarizing the Gamelaya Institute's Sputnik V vaccine, which uses an adenovirus-26 and adenovirus-5 vector for the first and second doses respectively. Two-dose efficacy is 91.6% on a test population of 15,000.
    My expectation is that it will deal with the B.1.1.7 [variant] at nearly the same efficacy and drop down to the 50-60% efficacy range against the B.1.351 strain, as has been seen with the other vaccines where we have such data. Based on the numbers we have, I see no reason why this vaccine can’t make a solid contribution to fighting the pandemic, and I’m very glad to have another efficacious one out there for use. Update: a skeptical take on the publication here!

    The article in that final link suggests the trial involved some possibly shady dealing in terms of patient samples, using mainly young people for the Phase II trial, and unexplained dropouts of trial subjects during the test. More worrying, serological testing was done by "convenience sample", which speaks to possible monkeyshines on immunogenicity.

  • Back to manufacturing, next Lowe writes about vectored virus vaccines. As mentioned by others, this is a pretty complicated process, and there are many places where it can go wrong. Ignoring the political baggage arising from the use of aborted fetus kidney cells as a feedstock (the cell lines were originally created in the 1970s, but have been cloned for decades), the big technical hangup is the fact that
    Human cell culture – any cell culture – is simultaneously a scientific process and an art form. Ask anyone, literally anyone who’s done it, and if you can find someone who’s worked on it at an industrial scale, they’ll confirm that all the more vigorously. This is (or can be) the weak point of the entire viral-vector production process. When everything is working, this method for infecting living cells and turning them into virus factories is hard to beat. But it doesn’t aways work the way it’s supposed to. It appears that AstraZeneca has been having problems because one of their largest production facilities has been experiencing problems with low yields of virus, even though everything should be the same (same viral DNA, same cell line, etc.)

Some food for thought as we slowly improve on our vaccination efforts in the US.

Update: I wanted to come back to the Yahoo News story about using the Defense Production Act, but mainly for this quote from Peter Hotez about mRNA vaccines:

Baylor College of Medicine’s Dr. Peter Hotez, another top vaccine expert, said the current demand is pushing the limits of manufacturing a brand new technology, messenger RNA, at scale.

“We knew the mRNA vaccines were not going to be the workhorse of this epidemic. It’s a new technology, it doesn’t have that capacity for scale like other technologies do,” Hotez said.

Hotez is the Dean of the National School for Tropical Medicine, so presumably should know a little whereof he speaks. He repeats that sentiment in the Houston Chronicle, saying

This gets to the problem of the mRNA vaccines. We were never supposed to rely solely on the mRNA vaccines. It’s not a mature technology. It doesn’t have the capacity to do the job. We’ve known that for the whole year of 2020.

That was the whole rationale behind Operation Warp Speed: The mRNAs would be the first to get up, but then we would have later vaccines come along that are more robust in terms of production and the ability to vaccinate large numbers of people. That’s why you have the two adenovirus-based vaccines and the particle vaccines: They were they were supposed to be the worker bees on this. The mRNA was to get started, and then the others would follow it.

The multiple failures of both AstraZeneca and Janssen to scale (with the Sputnik V vaccine not even launching at scale yet) strongly suggests that Hotez — who is working on a protein subunit vaccine with Indian pharma company Biological E — is at odds with Sanofi CEO Paul Hudson's recent remarks to Barron's:

During a single-antigen pandemic, where speed is a key consideration, "I think we have to accept that ... mRNA is probably the first go-to," Hudson told the publication. But in disease areas where there are established vaccines, mRNA candidates will have to “compete with the standard of care” shots that feature a “well-characterized safety profile.” There, the “bar is high,” he added.

In other words, if you have a moving target (check) and/or a new disease (check), mRNA is the way to go. The price of a recombinant protein subunit vaccine might be cheaper once you get all the problems nailed down, but it's pretty clear that there are some very big problems with vectored virus vaccines versus mRNA.

Wednesday, February 3, 2021

Belated: Scott Greenfield's Recent History Of The ACLU's Decline

This needs to be cast in amber, to the extent anything is on the Interwebz. (Note that the link image at the bottom is not one of the top three links.)

Monday, February 1, 2021

What Does A Successful COVID-19 Vaccination Campaign Look Like?

With Israel vaccinating over 50% of its population, I have been thinking for some time about the parameters of a successful vaccination program in the US. 

Assumptions

  • Mutations (i.e. variants with demonstrably biological differing properties) will continue to occur. Already the B.1.351 (South African) strain has exhibited "immune escape" from convalescent plasma, i.e. antibodies for the older strain were much less effective at fighting the virus.
  • Vaccine nationalism, i.e. the country of origin will get priority for their own production, is inevitable and will continue to be a factor going forward. This is not to say it will always break down this way, as Israel attests, but it seems a general pattern until manufacturing can keep up.
  • Manufacturing delays and shortfalls will persist for longer than anyone is comfortable with, in addition to pratfalls by the EU itself that prevented early vaccination rollouts. (Another post on that later.) AstraZeneca, Pfizer, Moderna, Johnson & Johnson, and Novavax have all had manufacturing problems at one point or another. (Novavax particularly had manufacturing issues that caused them to postpone their Phase III trial.)
  • I assume that by now the problems of vaccine spoilage and overly specific prioritization criteria have been laid bare, and people recognize that flexibility is important. Every arm with a shot in it is an arm closer to victory.

 What Needs To Be Done?

  • Manufacturing agility and volume is key. mRNA can turn around fastest of all the technologies, from what I can tell, and in fact both Moderna and Pfizer are already looking at boosters for the new variants. Vectored vaccines appear to have a complex manufacturing process that makes scaling difficult. Protein subunit and inactivated vaccines are also slower to turn around (it appears) than mRNA. The worst-case scenario is that the developed west will have to build out a lot of mRNA manufacturing capacity to inoculate whole populations in a couple months.
  • Transportability and refrigeration. Vectored virus vaccines (Johnson & Johnson's Janssen, AstraZeneca) seem to have better storage requirements than the mRNA vaccines (Moderna and Pfizer). Novavax can be stored at refrigerator temperatures (2-8C).
  • The two prior factors will determine undeveloped world vaccinations. Distribution to Africa and other undeveloped countries with sketchy or nonexistent cold chains will preclude mRNA in those places. This means vectored virus/protein subunit/inactivated will be how those populations get vaccinated. Unfortunately, this opens the door to a longer pandemic with hot spots that can possibly cause serious mutations.
  • Price and manufacturing capacity will limit vaccination in eastern Europe and other mid-tier nations. One of the big problems the EU had acquiring vaccines was getting all 27 member states to sign up at a price acceptable to its poorer members, while fending off defections from the larger countries. Consequently, if Germany is lagging the UK and US, it is still well ahead of Bulgaria or Hungary.
  • Lockdowns cannot last forever. Once most affected populations are vaccinated, start reopening. Continue monitoring infections, with an emphasis on sequencing to track novel variants.

This may end up a years-long effort, especially with large-scale reservoirs of disease overseas spawning mutations. But there has to be an exit plan; the pandemic cannot be allowed to remain a pandemic out of sheer bureaucratic inertia.

Arkansas HB1218 And HB1231: Flawed, Possibly Unconstitutional, But A Necessary Discussion

 I first became aware of Arkansas House Bills HB1218 and HB1231 when Arkansas Council for the Social Studies (ACSS) President Olivia Lewis posted an open letter to the state legislature regarding those bills:




(Sorry about the formatting, but I don't see an easy way to fix this at the moment.) Bill sponsor Mark Lowery (R-Maumelle) has said

“The intention is - so that students, especially K-12 that are captive, are not subjected to humiliation in terms of trying to make a statement about whether there is inequality or inequity and that's been happening in some of these programs using critical race theory,” said Lowery.

He added, the inspiration behind the bill is a certain classroom activity he claims is being taught in some Arkansas schools.

"One of the specific examples is what is called the privilege walk - where all the students start in one line and a number of questions are asked,” said Lowery. “Do you have two parents, do you parents own their home, take steps forward and what it does then - it gives this definition of showing which students are supposedly privileged and which ones are not."

So there's really two things going on here: the first is the use of the 1619 Project materials in classrooms (HB1231), and the second is teaching of the "social justice" approach to race relations (HB1218).

The Flawed, Tendentious 1619 Project

The 1619 Project has drawn numerous criticisms for its shoddy, motivated scholarship. In Cathy Young's able essay at The Bulwark, she wrote that despite "includ[ing] some indisputably excellent material" it amounts to "bad history and misrepresented facts". She goes on to attack central author and promoter Nikole Hannah-Jones for

...mak[ing] several claims that radically disparage the rest of the American narrative. She asserts, for instance, that “for the most part, black Americans fought back alone,” a casual erasure of decades of abolitionist activism. The problem isn’t that white people aren’t getting enough credit; it’s that Hannah-Jones’s assertion is simply not true (“for the most part” is doing some very heavy work in that sentence) and that it strips the history of black America of its legacy of interracial solidarity. Dismissing it in one throwaway sentence is both inaccurate and unconstructive.

The central flaw of 1619, though, is in Hannah-Jones' claim that the colonies principally fought for independence in order to continue the institution of slavery. Young systematically dismantles all of this, citing approving correspondence from Benjamin Franklin of "antislavery sentiment as far south as Virginia" (quoting historian David Waldstreicher), and the "monumental ruling by the Massachusetts Supreme Court in the Quock Walker cases." It's clear that Hannah-Jones rewrote history to fit her narrative, omitting inconvenient facts.

But perhaps more stinging — coming as it did from a New York Times colleague — is Bret Stephens' October 9 rebuke in the Opinion section. Journalists, he wrote, "are best when we try to tell truths with a lowercase t, following evidence in directions unseen, not the capital-T truth of a pre-established narrative in which inconvenient facts get discarded." Hannah-Jones went on a tweet-discarding rampage shortly before his essay was published, with the Times rewriting embarrassing online materials containing blatantly indefensible claims. Stephens declared Hannah-Jones' embrace of "[m]onocausality" a central flaw of the project:

The 1619 Project is a thesis in search of evidence, not the other way around. Nor was this fire from the right: Both [Princeton historian Sean] Wilentz and [Northwestern historian Leslie M.] Harris were at pains to emphasize their sympathy with the project’s moral aims.

Yet, aside from a one-word “clarification” issued in March — after months of public pressure, The Times conceded that only “some” colonists fought for independence primarily to defend slavery — the response of the magazine has been, in effect, “nothing to see here.” In a pair of lengthy editor’s notes, [NYT Magazine editor Jake] Silverstein has defended much of the scholarship in the project by citing another slate of historians to back him up. That’s one way of justifying the final product.

The larger problem is that The Times’s editors, however much background reading they might have done, are not in a position to adjudicate historical disputes. That should have been an additional reason for the 1619 Project to seek input from, and include contributions by, an intellectually diverse range of scholarly voices. Yet not only does the project choose a side, it also brooks no doubt.

All of which is to say, the 1619 Project is, in the end, mainly a piece of agitprop rather than a sober reflection of the causes of the American Revolution and the founding of our nation. How did we get to this point?

Critical Race Theory, Social Justice, And The Academy

The answer, of course, is the overwhelming influence of Critical Race Theory (CRT hereafter) on the 1619 Project, something James Lindsay wrote about in his review at New Discourses. This is part of the larger project of academic historical revisionism under the aegis of CRT, described in Lindsay's and Helen Pluckrose's 2020 book, Cynical Theories. Their chapter on CRT outlines the history of the intellectual movement, with postmodernist theory predominating from the mid-1990s onward.

For the applied postmodernists … the focus on discourses is primarily concerned with positionality — the idea that one's position within society, as determined by group identity, dictates how one understands the world and will be understood in it. …

[The] core tenets [as advocated in Critical Race Theory by Richard Delgado and Jean Stefancic] unambiguously assert what is going on in critical race Theory — racism is present everywhere and always, and persistently works against people of color, who are aware of this, and for the benefit of white people, who tend not to be, as is their privilege.

The point of all this is the rejection of Martin Luther King, Jr.'s "I have a dream" speech centered on character rather than identity. Instead, "[i]dentity politics restores the social significance of identity categories in order to valorize them as sources of empowerment and community". Influential Theorist Kimberlé Crenshaw "explicitly rejected universality in favor of group identity, at least in the political context in which she wrote…." The related concept of intersectionality binds up people in racial, sexual, sexual preference, immigration status, and religious categories (among others!) into a binary caste system of oppressed and oppressors based on (mainly) properties of birth. "Social Justice", Pluckrose and Lindsay continue, "in the contemporary sense is therefore markedly different from the activism for universal human rights that characterized the civil rights movements."

These movements arose in the academy, but have gained terrifying traction outside it. Propagated with every government "diversity" edict and department, university assistant dean, and corporate diversity officer, CRT is widespread, and expanding rapidly outwards. Journalist Christopher Rufo has documented a Bay Area elementary school forcing students to rank themselves according to "power and privilege", instances in San Diego and Seattle of browbeating white pupils for "spirit murdering" black and/or native American people, and a Springfield, Missouri middle school where teachers were required to "locate themselves on an 'oppression matrix'”. It's clear that CRT practitioners "see racism as omnipresent and eternal, which grants it a mythological status, like sin or depravity", according to Cynical Theories.

The Problem With HB1218 And HB1231

So to the supposed solutions, HB1218 and HB1231. Both are crude bans, which the courts largely have not supported in legislation. Julie Underwood's piece in The Phi Delta Kappan on the state of curriculum jurisprudence catalogs a number of cases:

States have some authority over curriculum as well, insofar as they often set minimum curricular requirements for school districts. However, the courts have ruled that this authority is bounded by the constraints set by both the federal and the given state’s constitution. For example: 

In Meyer v. Nebraska (U.S. 1923), the U.S. Supreme Court found a state law prohibiting foreign language instruction in any school to be unconstitutional under the Due Process Clause as it was against the interest of private school foreign language teachers’ need for employment and parents’ desire for their children to learn foreign languages. 

In Epperson v. Arkansas (U.S. 1968), an Arkansas statute that made the teaching of evolution in public schools illegal was held to be a violation of the Establishment Clause.  

Similarly, in Edwards v. Aguillard (U.S. 1987), the U.S. Supreme Court found a Louisiana statute, which required the “equal treatment” of evolution and creation science in state classrooms, to be unconstitutional.  

And in Gonzalez v. Douglas (D. Ariz. 2017), a federal District Court ruled that two Arizona curricular statutes banning ethnic studies courses were unconstitutional. The court found an Equal Protection violation in that there was evidence of racial animus in the creation of the statute, and it found Free Speech violations in that there was no legitimate pedagogical rationale behind the statute. 

Underwood concludes that "courts generally defer to educational decision makers, while preferring to expand, rather than contract, the body of knowledge presented within schools." This makes both proposed bills look vulnerable to a First Amendment challenge.

The Timing Problem, And The Discussion We Need To Have

Remember #GamerGate? It seems a century ago. Ken White wrote a very good piece on the subject, with much wider applicability. Particularly, his point about timing resonates:

If, immediately after the shooting of Michael Brown, I started a vigorous campaign calling on society to protect convenience-store clerks from assault, people would reasonably suspect that I had a political agenda related to the shooting, not a sincere concern for the welfare of convenience store clerks.

The ACSS open letter mainly talks in generalities: the importance of "exposure to different cultures, groups, and viewpoints while in a school setting", or concerns that "secondary interpretations of history from different perspectives" will suddenly be eliminated. What's missing from all of this is an explanation of the Critical Race Theory animating much of 1619, and some of the more disturbing aspects of CRT pedagogy in the news. It is as if the Council is not particularly interested in answering any of the real objections parents might have about why public schools would want to use such divisive, biased, and politically charged materials.

The First Amendment case against HB1218 and HB1231 would seem fairly clear, but it gets murkier once you start to look more closely at CRT. John McWhorter in 2015 wrote a fine piece about the religious nature of CRT, loaded as it is with unfalsifiable first principles, carrying "clergy, creed, and also even a conception of Original Sin". But unlike Christianity, CRT offers neither grace nor atonement. Instead, "Ritual 'acknowledgment' of White Privilege is, ultimately, for white people to feel less guilty." The point is to think the right things and say the right words  — in other words, indoctrination. As Epperson v. Arkansas ironically makes clear, religious instruction in the public schools is a no-no.

But even if the courts ruled against both bills, we cannot escape the cynical, malign intent of CRT and its progeny, antiracism. Dogmatic and intolerant, the stories of Maoist struggle sessions in even elementary schools make for disturbing reading. Even if you legitimately wanted to end racism — yes, it still exists — antiracist instruction will have the opposite effect. Bullying of this sort has no place in the schools, least of all by those charged with teaching.

Sunday, January 24, 2021

Biden's Big COVID-19 Plan

 So now that Joe Biden was sworn in, it was inevitable he would come up with his own COVID-19 plan (PDF). It's not all terrible, but there are a number of troubling signs that he's about to adopt the kinds of stupid, bureaucratic responses that have hamstrung much of the local efforts, particularly with vaccination. An overview:

 The first order of business is to "[r]estore trust with the American people." To do this, he proposes the government "Establish a national COVID-19 response structure where decision-making is driven by science and equity." Okay, let's step back a minute: what the heck is "equity"? As Andrew Sullivan recently wrote in his Substack space,

...[E]quity means giving the the named identity groups a specific advantage in treatment by the federal government over other groups — in order to make up for historic injustice and “systemic” oppression. Without “equity”, the argument runs, there can be no real “equality of opportunity.” Equity therefore comes first. Until equity is reached, equality is postponed — perhaps for ever.

 Biden doesn't name his preferred groups, but I scarcely need to mention they're what the left refers to as People of Color. This was something the CDC tried and was forced to recant weeks ago in a draft vaccine rollout schedule. So once again, we're going to deal with more efforts to inject racialized everything at a time when vaccinations are ponderously slow.

The rest of that point is largely boilerplate and anodyne (although the continued use of "Biden-Harris administration" is a strong Tell that Joe doesn't intend to be around much longer). Perhaps more interesting is the plan to "Mount a safe, effective, comprehensive vaccination campaign."

Central to this effort will be additional support and funding for state, local, Tribal, and territorial governments improved line of ight into supply – to ensure that they are best prepared to mount local vaccination programs.

This legitimately will be a substantial improvement from the Trump administration's leave-the-vaccine-on-the-loading-dock-without-telling-the-hospitals approach. However, in the next graf on ensuring availability of vaccine, the piece once more raises the Defense Production Act as a means to increase vaccine manufacturing capacity. As with N95 masks, the problem isn't the will, but staffing and expertise necessary to build out specialized manufacturing capacity that doesn't yet exist. At best, it might help with simple things like stoppers, vials, or syringes, but the real bottleneck is on the vaccine supply side. With recent news stories of production difficulties with Pfizer (albeit in Europe), AstraZeneca, and newcomers Janssen (Johnson & Johnson) and Novavax, it's hard to imagine how anything else could be the case. (Michael Abramowicz gave a good background in Reason as to why the DPA is a non-solution to most production problems, and why it could actually exacerbate shortages if used incorrectly.)

As to the point to "[a]ccelerate getting shots into arms and get vaccines to communities that need them most", the "Administration will end the policy of holding back significant levels of doses." This is actually pretty funny, because the Trump administration drew significant criticism for doing exactly this over a week ago.

Skipping ahead to the next part, "Implement masking nationwide by working with governors, mayors, and the American people" is surprisingly good news coming from a Democratic president. It implicitly acknowledges, contrary to partisan fears of federal lockdowns and masking requirements, that the ultimate responsibility for such public health measures rests at the local level and not the CDC or FDA. Likewise, so is the emphasis on expanding testing — though the value of this depends heavily on whether the FDA persists in confusing diagnostic and surveillance testing.

As I've already covered the limitations of the Defense Production Act, I pass over Goal Four, "Immediately expand emergency relief and exercise the Defense Production Act". Goal Five, "Safely reopen schools, businesses, and travel, while protecting workers" seems oddly duplicative with prior efforts in this space. As with Biden's 100-day vaccination goal that was nearly met on the day he was inaugurated, his point here seems more expectations management than goal-setting. But Goal Six is a gallimaufry of "don't let a crisis go to waste" thinking, using the pandemic as an excuse to create a "COVID-19 Health Equity Task Force", followed by a call to "[s]trengthen the social service seafety net to address unmet basic needs", and "increasing data collection and reporting for high risk groups" (read: by race). "Ensure equitable access to critical COVID-19 PPE, tests, therapies, and vaccines" reads very like there will be a long list of rules for vaccine distribution of the sort that stalled vaccinations in New York.

The final section, Goal Seven, "Restore U.S. leadership globally and build better preparedness for future threats" is mostly about patching things up with the WHO, despite the latter's well-known failures. What's interesting about the "preparedness" part is that it doesn't even mention PPE stockpiles, a widely-remarked-upon failing early in the pandemic.

On whole, it's a political document more than it lays out a serious plan forward, with much derived from the Trump administration before it. There's some good parts (at least he didn't try to roll out a parallel federal health agency at the county level!), but there's serious risk of the Team Blue hidebound incompetence that has put California and New York near the bottom of arms vaccinated per capita statistics being nationalized. That must be resisted at all costs.

I tweeted about a couple (mostly better) alternative views here, and will eventually get a response to those out the door.

Maybe We're Not Helping? The Public Health Fiasco

An interesting piece in Medpage Today from a few weeks ago: "Op-Ed: Why Did Fauci Move the Herd Immunity Goal Posts?"

Late last week, Fauci told the New York Times that new science had changed his thinking on the herd immunity threshold -- but he also admitted that his statements were influenced in part by "his gut feeling that the country is finally ready to hear what he really thinks."

Specifically, the fraction of people who would need immunity to SARS-CoV-2 (either through vaccination or recovery from prior infection) to extinguish the spread of the virus was initially estimated to be 60% to 70%. In recent weeks, Fauci had raised the percentage: from 70% to 75%, and then to 75%, 80%, and 85%.

The problem with Fauci is his obvious moving of the goalposts and explicit admission that he's playing us:

"When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take 70 to 75 percent," Fauci said. "Then, when newer surveys said 60 percent or more would take it, I thought, 'I can nudge this up a bit,' so I went to 80, 85."

Similar sentiments in Bloomberg Opinion: "Pandemic Regrets? Experts Have a Few":

In the last couple of weeks, I’ve asked a number of experts what they know now that they wish they’d known in the spring, and where they think public health got things wrong. Two big trends emerged: lockdowns (too blunt) and testing (too slow). With months left to go before vaccination can curtail the pandemic, 2020’s regrets should be 2021’s lessons.

University of Minnesota epidemiologist Michael Osterholm, a member of Biden’s advisory board, said one March mistake was closing businesses in places in the middle of the country that had seen almost no cases. “Was it appropriate to shut down so many things back then when there was so little, if any transmission? I think you can argue now that probably was not the best use of resources … it clearly alienated the very populations that we needed to have work with us,” he says.

The time was squandered and so was public trust. He compares the situation to hurricane warnings. People take them seriously because they are usually right. In many Midwest states, people went into emergency mode at the wrong time.

 

Monday, January 18, 2021

The Wish For A Uniform Federal Vaccination Response Is Pure Narcissism

One of the most irritating things to come out of the COVID-19 pandemic is the repeated wish from epidemiological, scientific, and legal circles for a uniform, federal policy regarding vaccination distribution. If only such a policy were around, we are told, the problems of getting shots in arms would magically vanish. But why should this be so? Why should we not inspect the records of some of the allegedly virtuous blue states — like, say, New York, whose sclerotic vaccination policy led to many doses thrown away? His all-stick, no-carrot approach led to this, and his "fix" may still result in wasted doses. So in California. Whether you believe Govex or the CDC (data updated mostly daily, so this may change by the time you read this), California is near the bottom of getting shots into arms on a population-adjusted basis. And then there was the whole fiasco of the CDC being forced to walk back its unscientific early trial balloons that would have prioritized people at least partly on race. Surely, this didn't help to protect the elderly, the group most at risk.

Why should we believe a larger, more hidebound entity would do a better job at this? The reason this belief gets so much traction is pretty simple: because the people making this assertion believe it would be themselves (or like-minded compatriots) running the show. The same thing fuels the endless demand for socialism, and is just as wrong. Instead, we need to look at places that are actually getting things done ­— like, improbably, West Virginia, which state eschewed the federal agreement with CVS and Walgreens, instead favoring local pharmacies with existing arrangements with long-term care facilities. This should be obvious based on outcomes alone, but much that should be obvious never is.