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kottke.org posts about vaccines

“It’s Too Late”

posted by Jason Kottke   Jul 21, 2021

Dr. Brytney Cobia treats Covid-19 patients at the Grandview Medical Center in Birmingham, Alabama, a state that ranks last in the US in fully vaccinated adults. In a recent Facebook post, Cobia shares that people are willing to get vaccinated after having to watch an unvaccinated member of their family die from Covid.

I’ve made a LOT of progress encouraging people to get vaccinated lately!!! Do you want to know how? I’m admitting young healthy people to the hospital with very serious COVID infections. One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late. A few days later when I call time of death, I hug their family members and I tell them the best way to honor their loved one is to go get vaccinated and encourage everyone they know to do the same. They cry. And they tell me they didn’t know. They thought it was a hoax. They thought it was political. They thought because they had a certain blood type or a certain skin color they wouldn’t get as sick. They thought it was ‘just the flu’. But they were wrong. And they wish they could go back. But they can’t. So they thank me and they go get the vaccine. And I go back to my office, write their death note, and say a small prayer that this loss will save more lives.

Heartbreaking.

“Maybe We Need Masks Indoors Just a Bit Longer”

posted by Jason Kottke   May 14, 2021

Since yesterday’s announcement, I’d been feeling uneasy about the CDC’s decision to update its guidance to state that fully vaccinated people don’t need to wear masks in most situations indoors or out. Zeynep Tufekci’s piece in the Times nails why.

It’s difficult for officials to issue rules as conditions evolve and uncertainty continues. So I hesitate to question the agency’s approach. But it’s not clear whether it was responding to scientific evidence or public clamor to lift state and local mandates, which the C.D.C. said could remain in place.

It might have been better to have kept up indoor mask mandates to help suppress the virus for maybe as little as a few more weeks.

The C.D.C. could have set metrics to measure such progress, saying that guidelines would be maintained until the number of cases or the number vaccinations reached a certain level, determined by epidemiologists.

The vaccine is on its way to controlling Covid-19 in the US — but we’re not there yet. We’re not the UK or Israel…they’re further along in their vaccination campaigns and their daily cases and deaths are way down, warranting behavioral changes. In the US, over 600 people/day are still dying of Covid-19 and our case positivity rate is still above 3%. Too many people, including almost all children, are still vulnerable and as Tufekci says, the CDC could have waited a few more weeks to more quickly drive down the virus levels.

Update: The CDC’s move has been sharply condemned by National Nurses United, the nation’s largest union of registered nurses:

“The union noted that more than 35,000 new cases of coronavirus were being reported each day and that more than 600 people were dying each day. “Now is not the time to relax protective measures, and we are outraged that the C.D.C. has done just that while we are still in the midst of the deadliest pandemic in a century,” Ms. Castillo said.”

And Ken Schultz notes that the needle the CDC is trying to thread here might not work out the way that they’d hoped.

Imagine the social preference ordering is:

1. Unvaccinated wear masks, vaccinated don’t.
2. Everyone wears masks.
3. No one wears masks.

Selfish, short-sighted behavior and the inability to monitor vaccination status mean that, in trying to get #1, you can end up at #3.

So I trust the CDC’s position that #1 is socially desirable from a scientific perspective. But by undermining mask mandates, they have made it more likely that we end up in #3, which science says is still risky. Living with #2 for now respects both science and social science.

‘The Last Time a Vaccine Saved America’

posted by Jason Kottke   Apr 15, 2021

In 1955, epidemiologist Thomas Francis Jr. announced the results of a field trial of the polio vaccine that Jonas Salk had developed. America erupted in joy.

Now a phalanx of bulky television cameras focussed on Francis as he prepared to report on the efficacy of the vaccine. He had good news to share: to cheers from the audience, he explained that the Salk vaccine was sixty to seventy per cent effective against the most prevalent strain of poliovirus, and ninety per cent effective against the other, less common strains. All this had been shown through what was, at that time, the largest vaccine trial ever conducted.

All afternoon and evening, church bells rang out across America. People flooded into the streets, kissing and embracing; parents hugged their kids with joy and relief. Salk became an instant national hero, turning down the offer of a ticker-tape parade in New York City; President Dwight D. Eisenhower invited him to the White House and, later, asked Congress to award him a Congressional Gold Medal. That night, from the kitchen of a colleague’s house, Salk — whose name was being touted in newspapers, magazines, radio reports, and television news broadcasts around the world — gave his first network-TV interview to Edward R. Murrow, whose show “See It Now” had exposed the tactics of Senator Joseph McCarthy a year earlier. Blushing in admiration, Murrow asked the doctor, “Who owns the patent on this vaccine?” “The people,” Salk said, nobly. “There is no patent. Could you patent the sun?”

In the days that followed, schoolchildren were instructed by their teachers to write thank-you notes to Salk. Universities lined up to offer him honorary degrees. Millions of American doctors, nurses, and parents got down to the serious business of vaccinating their children against polio, using a shot they’d been anticipating for seventeen years.

But the polio vaccine rollout had its challenges, including a manufacturing negligence & oversight failure that resulted in tens of thousands of polio cases in otherwise healthy children.

In May, the polio vaccination drive was temporarily suspended. Leonard Scheele, the U.S. Surgeon General, inspected the facilities of all six vaccine companies and fired the government officials he considered to be culpable; the director of the N.I.H. and the Secretary of Health voluntarily resigned. New safety procedures were developed, including an improved means of filtering the viral mix just before the formaldehyde was added. Better tests were developed to detect live virus, and stricter record-keeping was instituted. The incident could have created a vaccine-hesitancy crisis. But, incredibly, the American public readily accepted the medical establishment’s explanation for the failure, and its pledges to right the situation. The nation’s trust in medical progress and in Dr. Salk was so resolute that, when it was announced that a new, safe polio vaccine was available, parents pushed their children back to the head of the line. It’s hard to imagine such an outcome today.

‘Private Choices Have Public Consequences’

posted by Jason Kottke   Apr 13, 2021

This is a very good and bracing essay from David Roth for Defector about a certain type of knee-jerk libertarian response to the pandemic in the US.

In place of any actually ennobling liberty or more fundamental freedom, contemporary American life mostly offers choices. But since most of these are not really choices at all in any meaningful way, it might be more accurate to say that we’re offered selection. The choice between paying for health insurance and running up six figures of non-dischargeable debt because you got sick, for instance, is honestly less a choice than a hostage situation. But because the second outcome is still extremely possible even if you choose to pay for health insurance, it’s more correct to say that the choice is already made, and that the decision is more about choosing from an array of variously insufficient and predatory options the one whose name or price or risk you like most. Sometimes there isn’t even that, and the choice is a binary one between something and nothing. None of this is really what anyone would choose, but these ugly individuated choices are what we get.

And then:

The broader complacent and unreasoned acceptance that props up our otherwise untenable status quo is shot through all these facile “it’s a private matter and a personal choice” formulations; if you have accepted that mostly useless choices between dreary outcomes are all you could ever get as a citizen in the wealthiest and most powerful country on earth, then you have also accepted that these choices are actually very important, and that making them is the thing makes you free. None of these personal choices actually make anything better for the person making them. In the case of the vaccine, those choices have devastating downstream impacts for all the people who glance off the choice-maker as they carve their personal hero’s journeys through the world. None of this matters as much as the idea that the choice is theirs to make.

Katalin Kariko, the Scientist Behind the Groundbreaking mRNA Vaccines

posted by Jason Kottke   Apr 09, 2021

The NY Times has a profile of Dr. Katalin Kariko, who struggled for decades against a system unwilling to consider and fund her ideas about how messenger RNA could be used to instruct cells inside human bodies to “make their own medicines”. Her work has culminated in two highly effective vaccines for Covid-19 and is being extended to produce possible vaccines for HIV, the flu, tuberculosis, and malaria.

Now Katalin Kariko, 66, known to colleagues as Kati, has emerged as one of the heroes of Covid-19 vaccine development. Her work, with her close collaborator, Dr. Drew Weissman of the University of Pennsylvania, laid the foundation for the stunningly successful vaccines made by Pfizer-BioNTech and Moderna.

For her entire career, Dr. Kariko has focused on messenger RNA, or mRNA — the genetic script that carries DNA instructions to each cell’s protein-making machinery. She was convinced mRNA could be used to instruct cells to make their own medicines, including vaccines.

Stat also wrote a piece about Kariko and the development of the mRNA vaccines. It seems like Kariko will be strongly considered for a Nobel Prize in Chemistry for her achievements. The Covid vaccines will save hundreds of thousands of lives alone, and if mRNA can indeed be harnessed to protect against HIV and malaria, the effect on the world will be immense. Give Kariko all the prizes and whatever she wants to be happy in life — she’s earned it and more.

Update: From Derek Thompson at The Atlantic, How mRNA Technology Could Change the World.

But mRNA’s story likely will not end with COVID-19: Its potential stretches far beyond this pandemic. This year, a team at Yale patented a similar RNA-based technology to vaccinate against malaria, perhaps the world’s most devastating disease. Because mRNA is so easy to edit, Pfizer says that it is planning to use it against seasonal flu, which mutates constantly and kills hundreds of thousands of people around the world every year. The company that partnered with Pfizer last year, BioNTech, is developing individualized therapies that would create on-demand proteins associated with specific tumors to teach the body to fight off advanced cancer. In mouse trials, synthetic-mRNA therapies have been shown to slow and reverse the effects of multiple sclerosis. “I’m fully convinced now even more than before that mRNA can be broadly transformational,” Özlem Türeci, BioNTech’s chief medical officer, told me. “In principle, everything you can do with protein can be substituted by mRNA.”

Why Comparing Different Covid-19 Vaccines is Difficult

posted by Jason Kottke   Mar 24, 2021

Related to my post from last month about what a 95% or 66% efficacy rate of a vaccine even means, Vox made a clear and concise video about why comparing vaccine efficacy rates is difficult — trials were done in different countries with different variants under different conditions with different levels of disease — and why protection against severe illness, hospitalization and death is a better way to compare and evaluate these vaccines. As this chart from Dr. Eric Topol shows, all of the major vaccines show strong protection against severe illness.

Vaccine Chart Illness

Life After Vaccination

posted by Jason Kottke   Mar 16, 2021

I thought this interview with Dr. Ashish K. Jha, dean of the Brown University School of Public Health, was really good and useful in terms of calibrating expectations with regard to the “end” of the pandemic, vaccines, and variants. On the guidance that vaccinated people should be getting:

I think it is essential that we give guidance to people. And I think we should give guidance to people on what they can do safely once they are vaccinated. People say, “Can your behavior change?” My answer is: absolutely! That’s a major motivation for getting vaccinated. First of all, what’s very clear to me is vaccinated people hanging out with other vaccinated people is pretty darn close to normal. You don’t have to wear a mask. You can share a meal. The chance that a fully vaccinated person will transmit the virus to another fully vaccinated person who then will get sick and die … I mean, sure, people get struck by lightning, too. But you don’t make policy based on that. And we need to remind people that there is a huge benefit to getting vaccinated, which is that you are safe enough to do the things you love with other vaccinated people.

Yo-Yo Ma Plays Impromptu Cello Concert at Covid-19 Vaccination Clinic After Getting Second Dose

posted by Jason Kottke   Mar 15, 2021

After getting his second dose of the Covid-19 vaccine at a clinic at Berkshire Community College, Yo-Yo Ma got out his cello and performed a 15-minute impromptu concert for the others folks at the clinic.

When Ma had first visited the clinic for his first shot, he did so quietly, taking in the surroundings, staff said. But brought his cello when he returned for the second shot.

Staff described how a hush fell across the clinic as Ma began to play. “It was so weird how peaceful the whole building became, just having a little bit of music in the background,” said Leslie Drager, the lead clinical manager for the vaccination site, according to the Washington Post.

Why is it weird? Music is amazing. I know you could never get such a “frivolous” spending measure through an American deliberative body these days, but how awesome would it be for the government to commission out-of-work musicians to play at vaccination clinics? Ok maybe you couldn’t have anyone sing and the brass & woodwinds would probably have to sit this one out, but you could have strings, guitars, percussion, pianos, DJs, etc. there to play some relaxing, uplifting, or energetic music, according to local custom & culture. Bring back the WPA!

How Were the Covid-19 Vaccines Developed So Quickly?

posted by Jason Kottke   Mar 12, 2021

According to a study conducted by the Pew Research Center, among those people who said they probably or definitely won’t get a Covid-19 vaccine, the top two reasons given were “concern about side effects” and “the vaccines were developed and tested too quickly”. For our purposes here, I’m going to ignore the first concern — the data is pretty conclusive that, on average, the vaccine side effects are minimal when compared to the effects of actually contracting Covid-19 — and focus on the quick development timeline. If you’re among those who are apprehensive about the unprecedented speed at which the world’s governments and scientific community mobilized to create several effective Covid-19 vaccines, I hope the following will help you make a good decision.

In reading a bunch of different resources (linked below throughout), I identified six main reasons why the Covid-19 vaccines were developed so quickly compared to past efforts.

1. The need was urgent. Covid-19 changed the entire world in a very short span of time and it was evident in the absence of an effective vaccine, tens of millions more people would unnecessarily die and/or suffer and the rest of us would be living in fear of disease and death. This urgency drove several of the other factors here: the availability of funding, resources, and collaboration.

2. Funding & focus. Companies and governments threw billions and billions of dollars at this. Companies, research centers, and scientists dropped other stuff they were working on to study SARS-CoV-2 and Covid-19. Governments prioritized regulatory approval for trials, etc. From a thread by Dr. Kat Arney:

Relatively few in the scientific, pharma & policy worlds care about vaccines compared w/ drugs. Most vaccine programmes are underfunded as they’re perceived as not profitable, only relevant to LMICs, & have few research groups/companies working on them. Getting funding & research capacity for vax usually takes months/years. COVID-19 vaccine was a massive global research effort w/ $millions for multiple groups/projects in weeks. Years of funding cycles & lab research happened in months, huge amount of time saved.

And from a presentation given by Dr. Anthony Fauci:

We proceeded at risk. So people say, what do you mean by “at risk”? Are you risking safety? Are you risking scientific integrity? No, it’s a financial risk. In other words, you invest in things that cost a lot of money before you even have an answer to whether the prior step worked.

And a classic example is the production of large scale amounts of clinical lots, which have been produced and are being produced before you even know that your vaccine works, so that you have hundreds of millions of doses ready to go. If the vaccine works, you’ve saved many months. If the vaccine doesn’t, you lost a lot of money, to the tune of hundreds of millions if not billions of dollars. But it was felt it was worth that investment and that risk financially in order to save time.

More on that here. As Dr. Faheem Younus put it, “We didn’t cut corners; we cut the crap!”

3. Availability of volunteers & high incidence of disease. In order to statistically show the vaccine works, you need people to test it on and you need enough people in the studies to get sick. Kat Arney again:

To show vax effectiveness, you need a high number of people with the disease in the population — big problem with the Ebola vax is that it took so long to develop the outbreak was over & the couldn’t get enough numbers to conclusively show it worked

We’re in a global pandemic — the vaccine is being tested in places with very high community prevalence, so trials can hit pre-determined statistical milestones very quickly. Huge amount of time saved.

Hundreds of thousands of people around the world volunteered to test these vaccines — without them, we’d be months and years away from a safe, tested vaccine.

4. International & corporate collaboration. Countries and companies shared research, data, and resources because the primary goal was to develop effective vaccines and save lives, not make a profit. For instance, Chinese researchers posted the genome for SARS-CoV-2 on January 11, 2020, allowing the effort to develop a vaccine to begin.

5. We knew a lot about coronaviruses from previous work. This wasn’t an effort that started from scratch. From Bloomberg:

The Pfizer-BioNTech and Moderna vaccines may seem brand new, but they are the culmination of more than a decade of work that started during the SARS and MERS outbreaks. Vaccines were even developed against MERS but were never needed. Nevertheless, scientists learned a huge amount from working with that virus, which is from the same family as the one that causes Covid-19.

From Dr. Habibul Ahsan:

Really, most of the vaccine platform development work is already done. You just have to do the remaining part, which is adding the right viral antigens to the already-proven platform and making sure it’s safe and effective in humans. Even in just the last five to 10 years, we’ve made big leaps in developing new kinds of vaccine platforms like those being tested for SARS-CoV-2.

6. Scientific and technological capability. Ok, we know a lot about coronaviruses but humanity’s general scientific and technological abilities have never been stronger or more powerful. Again from Bloomberg:

Remember also that technology has evolved rapidly — for example, we’re now about able to sequence the genomes of every mutant version of the virus in less than a day. That helps in speeding up vaccine development.

Dr. Mark Toshner sums up the effort:

However we have collectively now shown that with money no object, some clever and highly motivated people, an unlimited pool of altruistic volunteers, and sensible regulators that we can do amazing things.

Further reading: The lightning-fast quest for COVID vaccines — and what it means for other diseases (Nature), How were researchers able to develop COVID-19 vaccines so quickly? (Univ. of Chicago), The race for the COVID-19 vaccine: A story of innovation and collaboration (Carnall Farrar), COVID-19 vaccines: development, evaluation, approval and monitoring (European Medicines Agency).

What the End of the Pandemic Looks Like

posted by Jason Kottke   Mar 08, 2021

Stat’s Andrew Joseph and Helen Branswell on the short-term, middle-term, and long-term future of the coronavirus in the US. The short-term outlook is dominated by vaccination & variants; some parts of the country will continue to be affected by outbreaks:

Conditions may be ripe for a better summer, however. Vaccine supplies should be flowing more freely, at least in the U.S.; the Biden administration now expects enough vaccine doses in hand for all adults by the end of May. With most vulnerable populations protected, there should be fewer hospitalizations and deaths. And with warmer weather, people can return to outdoor life.

Widespread transmission of the virus could be replaced by more sporadic and localized outbreaks. There’s also growing evidence that vaccines don’t just protect people from getting symptomatic Covid-19, but can reduce transmission.

And in the long-term, well, SARS-CoV-2 will be around for years and even decades to come:

Years from now, SARS-CoV-2 could join the ranks of OC43, 229E, NL63, and HKU1 — the four endemic, seasonal coronaviruses that cause a chunk of common colds every year. Essentially, our immune systems — primed by vaccines, boosters, and previous encounters with the coronavirus — will be ready to knock back SARS-2 when we see it again, potentially blocking an infection or leading to one that causes no symptoms or maybe just the sniffles.

It’s good to read stuff like this — it provides a basis to use when calibrating your optimism or pessimism for future activities and desires.

R2-D2 and C-3PO Say “Get Vaccinated!”

posted by Jason Kottke   Mar 05, 2021

Star Wars Vaccination

In the 70s, the US government enlisted the droids of Star Wars to encourage parents to immunize their kids against childhood diseases like whooping cough and measles.

American parents weren’t getting their kids vaccinated. Measles, polio and whooping cough were taking a toll on young lives. Just as it is today, the message was important but the spot itself was horrible — a sludgy, if informative script. We shot it in a faux sci-fi control room. Most memorable was the way R2 appeared to pay no attention to the laws of physics.

(via kottke ride home)

America’s Vaccine Glut and “Vaccine Diplomacy”

posted by Jason Kottke   Mar 05, 2021

After the Biden administration announced they will have enough Covid-19 vaccine supply to cover every single adult in the country by the end of May, I got to wondering about what they were going to do with the tens & hundreds of millions of surplus doses already procured for the remainder of the year. “Oh,” I thought, naively, “We’ll be able to distribute it to countries that can’t easily procure or manufacture vaccines of their own!” And I’m sure some of that will happen, if only for PR purposes. But it’s perhaps more likely that America will practice vaccine diplomacy and use the stockpile to reestablish its global leadership.

The United States has backed away from the world. This isn’t a Clinton thing or a W Bush thing or an Obama thing or a Trump thing or a Biden thing, but instead a United States thing. The American people lost interest in playing a constructive role in the world three decades ago, and America’s political leadership has molded itself around that fact. Trump may have been instinctually and publicly hostile to all things international, but Biden is only different in tone. Biden’s Buy-American program is actually more anti-globalization than Trump’s America-First rhetoric as it is an express violation of most of America’s international trade commitments. TeamBiden says it wants to reestablish America’s global leadership…but it plans to do so without any troops or money. Sorry, but that’s not how it works.

Which makes the possibilities for vaccine diplomacy wildly interesting. The United States has no responsibility to provide COVID vaccines to the world. It can — it will — distribute them, but it will want something in return.

Even if you disagree with some of the analysis here, it will be interesting to watch where America’s stockpile ends up. Given Biden’s rhetoric of “listening to the science” when it comes to the pandemic, I hope that at least some of that supply goes to places that need it most to make certain the pandemic doesn’t sputter on for years, generating potentially dangerous new variants, even if it’s politically disadvantageous.

Update: Countries now scrambling for COVID-19 vaccines may soon have surpluses to donate by Jon Cohen and Kai Kupferschmidt for Science magazine:

Like three dozen other countries, the United States contracted with multiple vaccine companies for several times the number of doses needed to cover its population. No one knew at the time which, if any, of the candidate vaccines would work or when they might prove safe and effective. But by now, most of the prepurchased vaccines appear to offer solid protection — which means many countries will receive far more vaccine than they need. The excess doses the United States alone may have by July would vaccinate at least 200 million people.

A chart in the article notes that the US has procured enough vaccine to cover almost 1.5 billion people after fully vaccinating its entire population.

Let’s Clear This Up: What Does 95% Covid-19 Vaccine Efficacy Actually Mean?

posted by Jason Kottke   Feb 18, 2021

In popular press and social media, there’s been a misunderstanding of what is actually meant when scientists say that the Pfizer and Moderna Covid-19 vaccines have an efficacy of 94-95%. It does not mean that 95% of vaccinated people are protected from infection — these vaccines are better than that. Dr. Piero Olliaro explains in a letter to The Lancet:

The mRNA-based Pfizer and Moderna vaccines were shown to have 94-95% efficacy in preventing symptomatic COVID-19, calculated as 100 x (1 minus the attack rate with vaccine divided by the attack rate with placebo). It means that in a population such as the one enrolled in the trials, with a cumulated COVID-19 attack rate over a period of 3 months of about 1% without a vaccine, we would expect roughly 0.05% of vaccinated people would get diseased.

Another way to put it: you’re 20 times less likely to get Covid-19 with a vaccine than without. (And again, data indicates these are safe vaccines.) Olliaro explains with some simple math:

If we vaccinated a population of 100,000 and protected 95% of them, that would leave 5000 individuals diseased over 3 months, which is almost the current overall COVID-19 case rate in the UK. Rather, a 95% vaccine efficacy means that instead of 1000 COVID-19 cases in a population of 100,000 without vaccine (from the placebo arm of the abovementioned trials, approximately 1% would be ill with COVID-19 and 99% would not) we would expect 50 cases (99.95% of the population is disease-free, at least for 3 months).

And of course if you vaccinate widely, it becomes a compounding situation because the virus just runs out of people to infect.

“Can We Do Twice as Many Vaccinations as We Thought?”

posted by Jason Kottke   Dec 18, 2020

In an opinion piece for the NY Times, Zeynep Tufekci and epidemiologist Michael Mina are urging for new trials of the Moderna and Pfizer/BioNTech Covid-19 vaccines to begin immediately to see how effective a single dose might be in preventing new infections. If the trials do indicate that a single dose works, that would effectively double the number of people we could vaccinate within a certain time period, saving countless lives in the US and worldwide.

Both vaccines are supposed to be administered in two doses, a prime and a booster, 21 days apart for Pfizer and 28 days for Moderna. However, in data provided to the F.D.A., there are clues for a tantalizing possibility: that even a single dose may provide significant levels of protection against the disease.

If that’s shown to be the case, this would be a game changer, allowing us to vaccinate up to twice the number of people and greatly alleviating the suffering not just in the United States, but also in countries where vaccine shortages may take years to resolve.

But to get there — to test this possibility — we must act fast and must quickly acquire more data.

For both vaccines, the sharp drop in disease in the vaccinated group started about 10 to 14 days after the first dose, before receiving the second. Moderna reported the initial dose to be 92.1 percent efficacious in preventing Covid-19 starting two weeks after the initial shot, when the immune system effects from the vaccine kick in, before the second injection on the 28th day

That raises the question of whether we should already be administrating only a single dose. But while the data is suggestive, it is also limited; important questions remain, and approval would require high standards and more trials.

The piece concludes: “The possibility of adding hundreds of millions to those who can be vaccinated immediately in the coming year is not something to be dismissed.”

A Portrait of the Covid-19 mRNA Vaccine

posted by Jason Kottke   Dec 07, 2020

portrait of the Covid-19 mRNA vaccine

Artist and biologist David Goodsell has done a painting of the Covid-19 mRNA vaccine.

The vaccine structure is highly idealized, with spike mRNA in magenta, lipids in blue, and PEG-lipid in green. The background is blood serum or lymph.

Both the Pfizer/BioNTech and the Moderna Covid-19 vaccines are based on mRNA — you can brush up on how they work at Stat or the CDC.

mRNA vaccines are a new type of vaccine to protect against infectious diseases. To trigger an immune response, many vaccines put a weakened or inactivated germ into our bodies. Not mRNA vaccines. Instead, they teach our cells how to make a protein — or even just a piece of a protein — that triggers an immune response inside our bodies. That immune response, which produces antibodies, is what protects us from getting infected if the real virus enters our bodies.

See also Goodsell’s painting of a SARS coronavirus from back in February.

How Children Took the Smallpox Vaccine Around the World

posted by Jason Kottke   Dec 03, 2020

With the first approved Covid-19 vaccines set to roll out in the US soon, some of the focus has shifted to how the vaccine will be distributed and its equitable allocation. Part of the distribution logistics puzzle is making sure there are enough glass vials to hold and transport the vaccine around the nation to those waiting to be vaccinated. For the New Yorker, Christopher Payne took some photos of two Corning factories that are manufacturing vials as fast as they can.

But back in the early 19th century, for a colonial empire dealing with overseas smallpox epidemics, glass vials were not an option. Smallpox vaccination at that time was most reliably accomplished by transferring material from cowpox blisters on one person (or cow) to another person. The freshly inoculated person got a little sick but later proved to be immune to the much deadlier smallpox. So when Spain’s Royal Philanthropic Vaccine Expedition set sail in 1803 to inoculate the inhabitants of their overseas colonies for smallpox, they used the bodies of human beings to transport the vaccine. To be more specific, they used “twenty-two orphan boys, ages three to nine”.1

And so it was that, “in the era before refrigeration, freeze-dried vaccines, and jet aircraft,” writes medical historian John Bowers, “the successful circumnavigation of the globe with the vaccine…rested on a single medium — little boys.” During the long crossing, approximately twenty-two orphans who had not previously contracted smallpox or cowpox were “vaccinated in pairs every ninth or tenth day,” via arm-to-arm inoculation (taking lymph from an unbroken pustule on a recently vaccinated boy and introducing it under the skin of another). This created a vaccine chain — the vaccine remained active and viable for the entire journey.

The three-year expedition was success and an early & effective example of philanthropic healthcare, but you also have to note here that the reason the Americas were ravaged by smallpox was because Spain brought it there in the first place.

Update: In The Atlantic, Sam Kean provides some more detail on the vaccination effort.

Given the era, it’s likely that no one asked the orphans whether they wanted to participate — and some seemed too young to consent anyway. They’d been abandoned by their parents, were living in institutions, and had no power to resist. But the Spanish king, Carlos IV, decided to make them a few promises: They would be stuffed with food on the voyage over to make sure they looked hearty and hale upon arrival. After all, no one would want lymph from the arm of a sickly child. Appearance mattered. And they’d get a free education in the colonies, plus the chance at a new life there with an adoptive family. It was a far better shake than they’d get in Spain.

  1. The article describes these children as “orphaned” but I wonder if it’s not more accurate to describe them as “enslaved”. Surely these kids didn’t have a real choice in whether they wanted to be infected with cowpox and carried overseas in a cramped ship.

Science Gave us a Vaccine. Now to Turn That Into Vaccinations…

posted by Jason Kottke   Dec 02, 2020

In an incredible effort, science has provided the world with what looks like an incredibly effective vaccine for Covid-19. For Stat, Helen Braswell writes about the challenges of turning that vaccine into vaccinations. In the US, despite heroic work from individuals and individual groups, our public health system has proved unequal to the challenge of addressing the pandemic, and we’re now turning, in part, to that system to distribute and administer the vaccines, as well as to educate the public and drum up support for vaccination. The people that we’re counting on are public officials and healthcare workers worn out from what is essentially one 9-month-long wave of illness, hospitalizations, and death across the country. Misinformation and skepticism of science and government has sowed “justified distrust” about vaccines in many people:

Concern about the vaccines, however, cuts across ethnic and socioeconomic groups. President Trump’s overt efforts to pressure the FDA to issue EUAs before the Nov. 3 election — before the vaccine trials were finished — has deepened the sense of unease. The CDC’s early pandemic testing fiasco, coupled with its sidelining by the Trump administration, has eroded its standing as a trusted source of information.

Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania, refers to the current situation as a perfect storm of “justified distrust.”

“People who don’t think twice about vaccinating their kids totally on time, who get their flu shot every year, are in the sort of, ‘Hmmm. Might wait six months on this one,’” Buttenheim, who works on vaccine acceptance, told STAT. “I’ve heard people say, ‘I’ll get the European one,’” she said, adding other people have said they would get vaccinated after Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, gets vaccinated.

And it’s not just the general public. A recent survey of 2,000 doctors and nurses in New Jersey found that 60% of doctors planned to take a Covid vaccine, but only 40% of nurses intended to, Health Commissioner Judith Persichilli said in a recent “60 Minutes” segment about Operation Warp Speed.

Fauci, along with other respected public health officials and workers, should get vaccinated live on CNN. Stream it on YouTube and Twitch. It won’t convert the anti-vax, anti-mask, QAnon wingnuts (nothing will) but if you can at least get healthcare workers and at-risk folks on board, it would be time well spent.

But that’s only one small piece of the puzzle. Braswell’s piece is long and comprehensive look at the challenges regarding the Covid-19 vaccines and is worth reading all the way through.

A Framework for the Equitable Allocation of a COVID-19 Vaccine

posted by Jason Kottke   Nov 24, 2020

Now that the preliminary results of various Covid-19 vaccine trials are coming out (and looking promising), attention is turning to the eventual distribution of the vaccines. The logistics of getting the doses out to hospitals, clinics, and doctor’s offices is one concern but so is the question of who should get vaccinated first. Supplies of the vaccines will be limited at first, so we’ll need to decide as a society what distribution method is most fair and is of the most benefit to the greatest number of people.

To this end, and in response to a request by the CDC and NIH, the National Academies of Sciences, Engineering, and Medicine formed a committee to produce a report called Framework for Equitable Allocation of COVID-19 Vaccine. The 252-page report is available to the public for free to read online or download.

In addition several recommendations — including that the vaccine be distributed to everyone free of charge — a central feature of the report is a four-phase system of vaccine distribution, summarized in this graphic:

Four-phase framework for the equitable allocation of a COVID-19 vaccine

I’d like to stress that this graphic does not show all groups of people included in each phase — please consult the text of the report for that before you go sharing that graphic on social media without context. For example, here’s the full description for “high-risk health workers” in Phase 1a:

This group includes frontline health care workers (who are in hospitals, nursing homes, or providing home care) who either (1) work in situations where the risk of SARS-CoV-2 transmission is higher, or (2) are at an elevated risk of transmitting the infection to patients at higher risk of mortality and severe morbidity. These individuals — who are themselves unable to avoid exposure to the virus — play a critical role in ensuring that the health system can care for COVID-19 patients.

These groups include not only clinicians (e.g., nurses, physicians, respiratory technicians, dentists and hygienists) but also other workers in health care settings who meet the Phase 1a risk criteria (e.g., nursing assistants, environmental services staff, assisted living facility staff, long-term care facility staff, group home staff, and home caregivers). The health care settings employing these workers who are at increased risk of exposure to the virus may also include ambulatory and urgent care clinics; dialysis centers; blood, organ, and tissue donation facilities; and other non-hospital health care facilities. Finally, there are community and family settings where care for infected patients occurs. Not all the workers in these settings are paid for their labor, but, while they are caring for infected people, they all need to be protected from the virus.

Situations associated with higher risk of transmission include caring for COVID-19 patients, cleaning areas where COVID-19 patients are admitted, treated, and housed, and performing procedures with higher risk of aerosolization such as endotracheal intubation, bronchoscopy, suctioning, turning the patient to the prone position, disconnecting the patient from the ventilator, invasive dental procedures and exams, invasive specimen collection, and cardiopulmonary resuscitation. In addition, there are other frontline health care workers who, if they have uncontrolled exposure to the patients or the public in the course of their work, should be in this initial phase. This group includes those individuals distributing or administering the vaccine — especially in areas of higher community transmission — such as pharmacists, plasma and blood donation workers, public health nurses, and other public health and emergency preparedness workers. The committee also includes morticians, funeral home workers, and other death care professionals involved in handling bodies as part of this high-risk group.

The report declines to list specific industries which would be covered in Phase 2’s “critical workers in high-risk settings” but generally says:

The industries in which these critical workers are employed are essential to keeping society and the economy functioning. Since the beginning of the pandemic, millions of people have been going to work and risking exposure to the virus to ensure that markets have food; drug stores have pharmaceutical products; public safety and order are maintained; mail and packages are delivered; and buses, trains, and planes are operating.

Note also the text at the bottom of the graphic: they recommend that within each phase, priority be given to geographic areas where folks are more socially vulnerable in situations like these (e.g. as represented in the CDC’s Social Vulnerability Index).

In developing this phased approach, the committee focused on those who are at the most risk of exposure, severe illness or death, and passing along the virus to others as well as critical workers:

Risk of acquiring infection: Individuals have higher priority to the extent that they have a greater probability of being in settings where SARS-CoV-2 is circulating and of being exposed to a sufficient dose of the virus.

Risk of severe morbidity and mortality: Individuals have higher priority to the extent that they have a greater probability of severe disease or death if they acquire infection.

Risk of negative societal impact: Individuals have higher priority to the extent that societal function and other individuals’ lives and livelihood depend on them directly and would be imperiled if they fell ill.

Risk of transmitting infection to others: Individuals have higher priority to the extent that there is a higher probability of their transmitting the infection to others.

You should read (or at least skim) the full report for more information about the plan and the rationale behind it.

On a personal parting note, as someone who is squarely in the 5-15% of Americans covered in Phase 4 — more specifically: as a 40-something straight white man who non-essentially works from home, isn’t low-income, doesn’t socialize widely even under normal circumstances, and should probably be the very last person on this whole Earth scheduled to be vaccinated under an equitable framework — I am content to wait my turn should the US adopt this framework or something like it.1 Distributing vaccines to those who need them most is absolutely the right thing to do, both ethically and from the standpoint of getting society “back to normal” as quickly as possible and with as little additional death and suffering as possible.

  1. Being that equity often isn’t America’s thing, especially during the pandemic, I could see this going either way. And even if this framework is adopted, those who can afford it will undoubtably be able to procure themselves a dose right alongside those medical workers in Phase 1a.

Oxford-AstraZeneca’s Covid-19 Vaccine Up to 90% Effective

posted by Jason Kottke   Nov 23, 2020

Preliminary results from the trials of the Covid-19 vaccine jointly developed by the University of Oxford and AstraZeneca indicate that the vaccine’s overall efficacy is 70% but that a regimen that calls for a lower first dose is 90% effective.

The preliminary results on the AstraZeneca vaccine were based on a total of 131 Covid-19 cases in a study involving 11,363 participants. The findings were perplexing. Two full doses of the vaccine appeared to be only 62% effective at preventing disease, while a half dose, followed by a full dose, was about 90% effective. That latter analysis was conducted on a small subset of the study participants, only 2,741.

Hopefully more study will be done on that dosage question. From the AP:

“The report that an initial half-dose is better than a full dose seems counterintuitive for those of us thinking of vaccines as normal drugs: With drugs, we expect that higher doses have bigger effects, and more side-effects,” he said. “But the immune system does not work like that.”

The seemingly lower efficacy comes with some perhaps significant benefits: this vaccine is cheaper to produce and doesn’t require any special refrigeration.

The vaccine can be transported under “normal refrigerated conditions” of 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit), AstraZeneca said. By comparison, Pfizer plans to distribute its vaccine using specially designed “thermal shippers” that use dry ice to maintain temperatures of minus-70 degrees Celsius (minus-94 degrees Fahrenheit).

The Pfizer and Moderna vaccines were pretty similar in many respects and this one seems quite different. These results were just released a few hours ago, so it will be interesting to follow the debate and expert commentary on this. Stay tuned…

Update: This is amazing: the seemingly more effective 1/2 dose + full dose regimen was a mistake.

Around the time when Astra was initiating its partnership with Oxford at the end of April, university researchers were administering doses to trial participants in Britain.

They soon noticed expected side effects such as fatigue, headaches or arm aches were milder than expected, he said.

“So we went back and checked … and we found out that they had underpredicted the dose of the vaccine by half,” said Pangalos.

A far smaller number of participants was given the initial half-dose, so more research will need to be done to determine if this mistake will be added to the long list of scientific discoveries made because of errors. There’s a good piece in Nature that talks about what we know and don’t know about the vaccine results so far along with some informed speculation.

But, if the differences are bona fide, researchers are eager to understand why. “I don’t think it’s an anomaly,” says Katie Ewer, an immunologist at Oxford’s Jenner Institute who is working on the vaccine. “I’m keen to get into the lab and start thinking about how we address that question.” She has two leading theories for why a lower first dose might have led to better protection against COVID. It’s possible that lower doses of vaccine do a better job at stimulating the subset of immune cells called T cells that support the production of antibodies, she says.

Another potential explanation is the immune system’s response against the chimpanzee virus. The vaccine triggers an immune response not only to the SARS-CoV-2 spike protein, but also to components of the viral vector. It’s possible that the full first dose blunted this reaction, says Ewer. She plans to look at antibody responses against the chimpanzee virus to help address this question.

Update: A short thread by Dr. Natalie Dean, which leads with “AstraZeneca/Oxford get a poor grade for transparency and rigor when it comes to the vaccine trial results they have reported”.

Preliminary Results: Moderna Covid-19 Vaccine Is 94.5% Effective

posted by Jason Kottke   Nov 16, 2020

Last Monday the world got some good news: an early review of the data showed that Pfizer’s Covid-19 vaccine was “more than 90% effective” in preventing the disease. The results pointed to other vaccines also being highly effective against the virus and this morning comes this news: Early Data Show Moderna’s Coronavirus Vaccine Is 94.5% Effective.

The drugmaker Moderna announced on Monday that its coronavirus vaccine was 94.5 percent effective, based on an early look at the results from its large, continuing study.

Researchers said the results were better than they had dared to imagine. But the vaccine will not be widely available for months, probably not until spring.

Despite the delivery timeline, this is such good news.

The companies’ products open the door to an entirely new way of creating vaccines — and creating them fast. Both use a synthetic version of coronavirus genetic material, called messenger RNA or mRNA, to program a person’s cells to churn out many copies of a fragment of the virus. That fragment sets off alarms in the immune system and stimulates it to attack, should the real virus try to invade. Although a number of vaccines using this technology are in development for other infections and cancers, none have yet been approved or marketed.

“The fact that two different vaccines made by two different companies with two different kinds of structures, in a new messenger RNA concept, both worked so effectively confirms the concept once and for all that this is a viable strategy not only for Covid but for future infectious disease threats,” said Dr. Barry R. Bloom, a professor of public health at Harvard.

Natalie E. Dean, a biostatistician at the University of Florida, said an important finding was that the vaccine appeared to prevent severe disease. Pfizer did not release information about disease severity when reporting its results.

Researchers say the positive results from Pfizer and Moderna bode well for other vaccines, because all of the candidates being tested aim at the same target - the so-called spike protein on the coronavirus that it uses to invade human cells.

It’s only a few more months — please please do what you can to stay safe and keep others safe (especially medical workers) until these vaccines can be rolled out.

Initial Data Shows Covid-19 Vaccine Is More than 90% Effective

posted by Jason Kottke   Nov 09, 2020

In a press release (and not a paper in a peer-reviewed journal) based on a preliminary outside review of data from its phase 3 trial, Pfizer says its Covid-19 vaccine was more than 90% effective in preventing the disease.

The company said that the analysis found that the vaccine was more than 90 percent effective in preventing the disease among trial volunteers who had no evidence of prior coronavirus infection. If the results hold up, that level of protection would put it on par with highly effective childhood vaccines for diseases such as measles. No serious safety concerns have been observed, the company said.

I really hope this analysis holds up when more data from the study is released:

The data released by Pfizer Monday was delivered in a news release, not a peer-reviewed medical journal. It is not conclusive evidence that the vaccine is safe and effective, and the initial finding of more than 90 percent efficacy could change as the trial goes on.

The world, and the United States, could really really use some good news like this about the pandemic.

Update: Here’s Pfizer’s press release. And a thread from Dr. Natalie Dean on how she is interpreting this news (“Celebrate, but let the process play out over time as intended.”)

Pfizer’s first analysis was planned for 32 events, which they pushed back after discussions with FDA. But by the time they analyzed the data, 94 had accrued. This shows how quickly trials can generate results when placed in hotspots (and how much transmission is ongoing!).

These vaccines are tested until a certain number of infections happen. So you have this interesting paradoxical situation where if a potential vaccine is more successful at curbing infection, the longer it takes for the study to conclude. You get a better vaccine but wait longer for it. Countering that are the rising transmission counts in the US — more community transmission will get you to the target number of infections more quickly.

Update: From virologist Dr. Florian Krammer, a thread about what Pfizer and other companies will be looking for in terms of the efficacy of vaccines in a number of different situations. Overall, he is optimistic about these preliminary results. And here’s a FAQ about the vaccine from the NY Times.

Another open question is whether children will get protection from the vaccine. The trial run by Pfizer and BioNTech initially was open to people 18 or older, but in September they began including teenagers as young as 16. Last month, they launched a new trial on children as young as 12 and plan to work their way to younger ages.

Update: A very simplified explanation of Pfizer’s RNA-based vaccine.

Vaccines May Help End the Pandemic. But Realistically, It’s Not Even Halftime Yet.

posted by Jason Kottke   Oct 13, 2020

We’re all so goddamned tired of this fucking pandemic and so people are looking at the development and distribution of a vaccine as the thing that’s going to get us out of this (and quick). But realistically, that’s not what’s going to happen. Carl Zimmer wrote about some of the challenges with Covid-19 vaccines.

The first vaccines may provide only moderate protection, low enough to make it prudent to keep wearing a mask. By next spring or summer, there may be several of these so-so vaccines, without a clear sense of how to choose from among them. Because of this array of options, makers of a superior vaccine in early stages of development may struggle to finish clinical testing. And some vaccines may be abruptly withdrawn from the market because they turn out not to be safe.

“It has not yet dawned on hardly anybody the amount of complexity and chaos and confusion that will happen in a few short months,” said Dr. Gregory Poland, the director of the Vaccine Research Group at the Mayo Clinic.

See also Dr. Fauci’s belief that our best case scenario for returning to something close to normal life in the US is late 2021.

On Twitter, Zimmer also commented on something that I hadn’t really thought about: that all of these vaccines in development in the US are only for adults:

I wrote last month that no trials for kids had started. Update: still no US trials for kids. The goal of having shots ready for them by fall 2021 may be slipping further away.

From Zimmer’s article on the development of a kids’ vaccine:

Only if researchers discovered no serious side effects would they start testing them in children, often beginning with teenagers, then working their way down to younger ages. Vaccine developers are keenly aware that children are not simply miniature adults. Their biology is different in ways that may affect the way vaccines work. Because their airways are smaller, for example, they can be vulnerable to low levels of inflammation that might be harmless to an adult.

These trials allow vaccine developers to adjust the dose to achieve the best immune protection with the lowest risk of side effects. The doses that adults and children need are sometimes different — children get smaller doses of hepatitis B vaccines, for example, but bigger doses for pertussis.

You probably hate reading these kinds of articles; I know I do. But facing up to the reality of our situation, particularly here in the US where our political leadership has utterly failed in protecting us from this virus, is much better than burying our heads in the sand — that’s just not mentally healthy.

Dr. Fauci: Earliest We’ll Be “Back to Normal” Is the End of 2021

posted by Jason Kottke   Oct 08, 2020

A few weeks ago during the Q&A session after his lecture for MIT’s online biology class about the pandemic, Dr. Anthony Fauci shared his expert opinion on when things might return to “normal” in the US. Here was my paraphrased tweet about it:

With a very effective vaccine ready in Nov/Dec, distributed widely, and if lots of people take it (i.e. the best case scenario), the earliest we could return to “normal life” in the world is the end of 2021.

At the New Yorker Festival earlier in the week, Michael Specter asked him about a return to normalcy and Fauci elaborated a bit more on this timeline (starts ~10:22 in the video).

When are we gonna get back to something that closely resembles, or is in fact, normal as we knew it?

We’re already making doses, tens and hundreds of millions of doses to be ready, first at least, in graded numbers at the end of the year in November/December. By the time we get to April, we likely will have doses to be able to vaccinate anybody who needs to be vaccinated. But logistically by the time you get everybody vaccinated, it likely will not be until the third or even the beginning of the fourth quarter of 2021.

So let’s say we get a 70% effective vaccine, which I hope we will get, but only 60% of the people get vaccinated. There are going to be a lot of vulnerable people out there, which means that the vaccine will greatly help us to pull back a bit on the restrictions that we have now to maintain good public health, but it’s not going to eliminate things like mask wearing and avoiding crowds and things like that.

So I think we can approach normality, but I don’t think we’re going to be back to normal until the end of 2021. We may do better than that; I hope so but I don’t think so.

Leaving aside what “normal” might mean and who it actually applies to,1 there’s some good news and bad news in there. The good news is, they’re already producing doses of the vaccine to be ready if and when the phase 3 trials are successful. Ramping up production before the trials conclude isn’t usually done because it’s a waste of money if the trials fail, but these vaccines are so critical to saving lives that they’re spending that money to save time. That’s great news.

The bad news is that we’re not even halfway through the pandemic in the best case scenario. We’re going to be wearing masks in public for at least another year (and probably longer than that). Large gatherings of people (especially indoors) will continue to be problematic — you know: movie theaters, concerts, clubs, bars, restaurants, schools, and churches — and folks staying within small pods of trusted folks will likely be the safest course of action.

A change in national leadership in both the executive branch and Senate could change the outlook for the better. We could get some normalcy back even without a vaccine through measures like a national mask mandate/distribution, a real national testing & tracing effort, taking aerosol transmission seriously, and easing the economic pressure to “open back up” prematurely. We’re never going to do as well as Vietnam or Taiwan, but I’d settle for Greece or Norway.

Update: In an interview posted yesterday, Johns Hopkins epidemiologist Dr. Caitlin Rivers gives her best guess at a return to normalcy:

Topol: When do you think we’ll see pre-COVID life restored?

Rivers: I wish I knew. I’m thinking toward the end of 2021. It’s really hard to say with any certainty. We should all be mentally prepared to have quite a bit ahead of us.

  1. It’s America. If we know anything by now about this country, it’s that access to healthcare and economic opportunity is going to apply unevenly to the people who live here. For instance, it’s likely that Black & brown communities, which have been disproportionately affected by the pandemic, may face difficulty in getting access to vaccines compared to wealthier, predominantly white communities.

A Covid-19 Vaccine Is “Only the Beginning of the End”

posted by Jason Kottke   Jul 24, 2020

The Atlantic’s Sarah Zhang has A Vaccine Reality Check for us.

Biologically, a vaccine against the COVID-19 virus is unlikely to offer complete protection. Logistically, manufacturers will have to make hundreds of millions of doses while relying, perhaps, on technology never before used in vaccines and competing for basic supplies such as glass vials. Then the federal government will have to allocate doses, perhaps through a patchwork of state and local health departments with no existing infrastructure for vaccinating adults at scale. The Centers for Disease Control and Prevention, which has led vaccine distribution efforts in the past, has been strikingly absent in discussions so far — a worrying sign that the leadership failures that have characterized the American pandemic could also hamper this process. To complicate it all, 20 percent of Americans already say they will refuse to get a COVID-19 vaccine, and with another 31 percent unsure, reaching herd immunity could be that much more difficult.

I am the least anti-vaxxer person in the world, but I have to say that getting a vaccine for Covid-19 that was rushed through trials in time for the election (October surprise!) and signed off by a Trump administration that has completely politicized science does not sound like something I want to go near. Which, for me personally, is a really really depressing thing to even think.

Update: I got a lot of flack for suggesting that I’d be skeptical of a Trump-approved vaccine rushed to market in time for the election (a very specific set of circumstances). But his buddy Putin is attempting something similar in Russia (skipping phase 3 trials), so if you don’t think Trump can try to bully the FDA and CDC into signing off on a vaccine that hasn’t been fully tested — perhaps made by a company whose CEO has donated millions to a Trump SuperPAC? — in order to salvage his reelection chances, I suggest that you haven’t paying proper attention over the past 4 years.

Update: A poll suggests that many Americans across the political spectrum are worried about a politicized FDA being forced to approve a Covid-19 vaccine before it’s adequately tested.

Seventy-eight percent of Americans worry the Covid-19 vaccine approval process is being driven more by politics than science, according to a new survey from STAT and the Harris Poll, a reflection of concern that the Trump administration may give the green light to a vaccine prematurely.

The response was largely bipartisan, with 72% of Republicans and 82% of Democrats expressing such worries, according to the poll, which was conducted last week and surveyed 2,067 American adults.

The sentiment underscores rising speculation that President Trump may pressure the Food and Drug Administration to approve or authorize emergency use of at least one Covid-19 vaccine prior to the Nov. 3 election, but before testing has been fully completed.

How Flu Vaccines Are Made

posted by Jason Kottke   Oct 10, 2019

Ten years ago, in the midst of the 2009 swine flu pandemic, I wrote about the manufacturing process for the H1N1 flu vaccine. It involves billions of chicken eggs.

The most striking feature of the H1N1 flu vaccine manufacturing process is the 1,200,000,000 chicken eggs required to make the 3 billion doses of vaccine that may be required worldwide. There are entire chicken farms in the US and around the world dedicated to producing eggs for the purpose of incubating influenza viruses for use in vaccines. No wonder it takes six months from start to finish.

The post holds up pretty well because, according to the CDC, this is still the way most flu vaccines in America are manufactured. Here’s a look at pharmaceutical company GSK’s egg-based process:

Two other techniques for making flu vaccines were approved for use in the US in 2012 and 2013 respectively, cell-based flu vaccines:

‘Cell-based’ refers to how the flu vaccine is made. Most inactivated influenza vaccines are produced by growing influenza viruses in eggs. The influenza viruses used in the cell-based vaccine are grown in cultured cells of mammalian origin instead of in hens’ eggs.

A cell-based flu vaccine was developed as an alternative to the egg-based manufacturing process. Cell culture technology is potentially more flexible than the traditional technology, which relies upon adequate supply of eggs. In addition, the cell-based flu vaccine that uses cell-based candidate vaccine viruses (CVVs) has the potential to offer better protection than traditional, egg-based flu vaccines as a result of being more similar to flu viruses in circulation.

And recombinant flu vaccines:

NIAID and its industry partners have made progress in moving from both the egg-based and cell-based flu vaccine production methods toward recombinant DNA manufacturing for flu vaccines. This method does not require an egg-grown vaccine virus and does not use chicken eggs at all in the production process. Instead, manufacturers isolate a certain protein from a naturally occurring (“wild type”) recommended flu vaccine virus. These proteins are then combined with portions of another virus that grows well in insect cells. The resulting “recombinant” vaccine virus is then mixed with insect cells and allowed to replicate. The flu surface protein called hemagglutinin is then harvested from these cells and purified.

Both of these new techniques make production quicker, thereby resulting in more effective vaccines because they are more likely to match the strains of whatever’s “going around”.

As a reminder, you should get a flu shot every year in the fall. The CDC recommends that “everyone 6 months of age and older should get a flu vaccine every season with rare exception”, especially those “who are at high risk of serious complications from influenza”. Flu vaccines are covered by your health insurance without copay (thanks, Obama!) and are often available at drug stores without an appointment or a long wait. So go get one!

Fighting the Measles and Dangerous Ideas

posted by Jason Kottke   Aug 26, 2019

For the New Yorker, Nick Paumgarten writes about this year’s measles outbreak in the US, the largest such outbreak in decades. The outbreak is solely due to a growing number of people who decline to vaccinate their children, so the fight has become one not against a disease, as it was decades ago, but against dangerous ideas.

But, if we have to pick a Patient Zero, Andrew Wakefield will do. Wakefield is the British gastroenterologist who produced the notorious article, published in The Lancet in 1998, linking the M.M.R. vaccine to autism. The study, which featured just twelve subjects, was debunked, the article was pulled, and Wakefield lost his license to practice medicine — as well as his reputation, in scientific circles anyway. But, owing to his persistence in the years since, his discredited allegations have spread like mold. In the anti-vaxxer pantheon, he is martyr and saint. There are also the movement’s celebrities, such as Jenny McCarthy and Robert F. Kennedy, Jr., stubborn in the face of ridicule, and the lesser-known but perhaps no less pernicious YouTube evangelists, such as Toni Bark, a purveyor of homeopathic products, and the Long Island pediatrician Lawrence Palevsky. If your general practitioner is Dr. Google, you can find a universe of phony expertise. The movement seems to sniff out susceptibility. Not surprisingly, there is money there, though the financial incentives behind this strand of advocacy are less clear than, say, what has led the Koch brothers to champion fossil fuels. This spring, the Washington Post reported that the New York hedge-fund manager Bernard Selz and his wife, Lisa, have given more than three million dollars to anti-vaccination causes and helped finance “Vaxxed,” Wakefield’s 2016 documentary, which purports to reveal a C.D.C. conspiracy to cover up the connection between vaccines and autism. Needless to say, the anti-vaccination ethos is by no means exclusive to the New York tristate-area Orthodox community. It thrives in certain pockets — affluent boho-yoga moms, evangelical Christians, Area 51 insurgents. The vaccination rates are about the same in Monsey and in Malibu. Before New Square, the three most recent big outbreaks of measles occurred among Somali immigrants, in Minnesota; Amish farmers, in Ohio; and a hodgepodge of visitors to Disneyland.

“It’s shocking how strong the anti-vax movement is,” Zucker said. “What surprises me is the really educated people who are passionately against vaccinations. I see this as part of a larger war against science-based reality. We need to study vaccine hesitancy as a disease.” He gave a TEDX talk recently about the crippling disconnect between the speed at which information, good or bad, spreads now and the slow, grinding pace of public-health work. He managed, by way of the general theory of relativity, to establish the equivalence of H1N1, Chewbacca Mask Lady, and Pizzagate: “How do we immunize and protect ourselves from the damaging effects of virality?”

The internet is such an efficient way to spread ideas (regardless of their validity) that you begin to wonder if instant global individual-to-individual and individual-to-everyone communication is an insurmountable Great Filter for societies.

On the Safety of Vaccines and the Low Risk of Side Effects

posted by Jason Kottke   May 13, 2019

The development of vaccines against infectious diseases is among the greatest of human accomplishments and has saved ten of millions of people from dying. And yet some are still hung up on their side effects (and also the widely disproved and debunked fraudulent claim that vaccines cause autism). In this video, Kurzgesagt looks at how vaccines work and compares the impact of their side effects (minuscule) to the potential effect of the diseases they protect against (children dying).

The extensive list of sources they used for the video can be found here.

The title of this video is “The Side Effects of Vaccines - How High is the Risk?”, which seems like it’s maximized for clicks and to spread amongst anti-vaxxers on social media. I wish it had a more accurate title — something like “The Absurdly Low Risk of Vaccine Side Effects” or maybe “Vaccines. And Now My Kids Don’t Die.” — but perhaps positioning it this way is a good strategy to get folks who may not be quite so radicalized to watch it.

Tetanus Has Nothing To Do With Rust

posted by Tim Carmody   Mar 15, 2019

Tetanus, popularly called “lockjaw,” is a serious illness, fatal in 10 percent of cases in North America and a larger percentage elsewhere. But despite the popular perception of its association with cutting oneself on a rusty nail, the disease has nothing to do with iron oxide, or rust:

Rather, tetanus is a product of the bacteria Clostridium tetani, which is in dirt, dust, and feces—in other words, everywhere. It can enter your body through puncture wounds, yes, but also through superficial cuts, bug bites, surgical procedures, and any other rupture to your skin. It can come from stepping on a rusty nail, or tending the soil in your garden. That’s why it’s so essential to track your booster shots: You need one every decade, not just when you rip your palm open on a rusty chain link fence. Waiting for a classic tetanus injury won’t work when anything could, in theory, be a tetanus injury.

If the bacteria enter your body and you aren’t up-to-date on your vaccinations, the tiny invaders begin to multiply rapidly. This incubation period, which lasts between three and 21 days, according to the CDC, is symptom free. But as the bacteria begin to die inside you, they form a neurotoxin that attacks the nervous system. Specifically, it inhibits the chemical GABA, which regulates muscle contractions. The result is a body-wide state of tension, from lockjaw in your face to uncontrollable arching spasms in your back to permanently-curled toes.

Luckily, here as elsewhere, tetanus vaccines (a series of three shots and a booster every ten years) work. Get those shots up to date and mind those cuts, no matter where they came from.

Roald Dahl: Not Vaccinating Your Kids Is “Almost a Crime”

posted by Jason Kottke   Jan 25, 2019

Roald Dahl’s oldest daughter Olivia died from the measles when she was seven years old. She died because there wasn’t a reliable measles vaccine then, and in this heartfelt letter he wrote years later, Dahl wants everyone to know that there is such a vaccine now.

Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

‘Are you feeling all right?’ I asked her.

‘I feel all sleepy,’ she said.

In an hour, she was unconscious. In twelve hours she was dead.

The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her. That was twenty-four years ago in 1962, but even now, if a child with measles happens to develop the same deadly reaction from measles as Olivia did, there would still be nothing the doctors could do to help her.

On the other hand, there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunised against measles. I was unable to do that for Olivia in 1962 because in those days a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family and all you have to do is to ask your doctor to administer it.

I feel so tired when I think about parents not vaccinating their children against easily preventable fatal diseases. It’s child abuse and the kids know better! Here’s a tweet from Erin Faulk sharing some screenshots of teens asking how they can get vaccinated over their parents’ objections.

Teen Vaccine Legal

“Vaccines. And now my kids don’t die.”

In 90 seconds, Penn & Teller show why vaccination is great

posted by Jason Kottke   Dec 07, 2017

In only 90 seconds with the use of a few props (and some profanity), entertainers Penn & Teller offer a succinct and compelling argument of the benefits of vaccinating our children.

So even if vaccination did cause autism, WHICH IT FUCKING DOESN’T, anti-vaccination would still be bullshit.

Along with “Vaccines. And now my kids don’t die.”, this might be my favorite anti-vaxxers broadside ever.