Distribute the vaccines NOW!

My last post about covid vaccines felt like shouting uselessly into the void … at least until Patrick Collison, the cofounder of Stripe and a wonderful friend, massively signal-boosted the post by tweeting it. This business is of such life-and-death urgency right now, and a shift in attitude or a hardening of resolve by just a few people reading could have such an outsized effect, that with apologies to anyone wanting me to return to my math/CS/physics lane, I feel like a second post on the same topic is called for.

Here’s my main point for today (as you might have noticed, I’ve changed the tagline of this entire blog accordingly):

Reasonable people can disagree about whether vaccination could have, or should have, started much earlier. But now that we in the US have painstakingly approved two vaccines, we should all agree about the urgent need to get millions of doses into people’s arms before they spoil! Sure, better the elderly than the young, better essential than inessential workers—but much more importantly, better today than tomorrow, and better anyone than no one!

Israel, which didn’t do especially well in earlier stages of the pandemic, is now putting the rest of the planet to shame with vaccinations. What Dana and I hear from our friends and relatives there confirms what you can read here, here, and elsewhere. Rabin Square in Tel Aviv is now a huge vaccination field site. Vaccinations are now proceeding 24/7, even on Shabbat—something the ultra-Orthodox rabbis are grudgingly tolerating under the doctrine of “pikuach nefesh” (i.e., saving a life overrides almost every other religious obligation). Israelis are receiving texts at all hours telling them when it’s their turn and where to go. Apparently, after the nurses are finished with everyone who had appointments, rather than waste whatever already-thawed supply is left, they simply go into the street and offer the extra doses to anyone passing by.

Contrast that with the historic fiasco—yes, another historic fiasco—now unfolding in the US. The Trump administration had pledged to administer 20 million vaccines (well, Trump originally said 100 million) by the end of 2020. Instead, fewer than three million were administered, with the already-glacial pace slowing even further over the holidays. Unbelievably, millions of doses are on track to spoil this month, before they can be administered. The bottleneck is now not manufacturing, it’s not supply, it’s just pure bureaucratic dysfunction and chaos, lack of funding and staff, and a stone-faced unwillingness by governors to deviate from harebrained “plans” and “guidelines” even with their populations’ survival at stake.

Famously, the CDC urged that essential workers get vaccinated before the elderly, since even though their own modeling predicted that many more people from all ethnic groups would die that way, at least the deaths would be more equitably distributed. While there are some good arguments to prioritize essential workers, an outcry then led to the CDC partially backtracking, and to many states just making up their own guidelines. But we’re now, for real, headed for a scenario where none of these moral-philosophy debates turn out to matter, since the vaccines will simply spoil in freezers (!!!) while the medical system struggles to comply with the Byzantine rules about who gets them first.

While I’d obviously never advocate such a thing, one wonders whether there’s an idealistic medical worker, somewhere in the US, who’s willing to risk jail for vaccinating people without approval, using supply that would otherwise be wasted. If anything could galvanize this sad and declining nation to move faster, maybe it’s that.

In my last post, I invited people to explain to me where I went wrong in my naïve, simplistic, doofus belief that, were our civilization still capable of “WWII” levels of competence, flexibility, and calculated risk-tolerance, most of the world could have already been vaccinated by now. In the rest of this post, I’d like to list the eight most important counterarguments to that position that commenters offered (at least, those that I hadn’t already anticipated in the post itself), together with my brief responses to them.

1. Faster approval wouldn’t have helped, since the limiting factor was just the time needed to ramp up the supply. As the first part of this post discussed, ironically supply is not now the limiting factor, and approval even a month or two earlier could’ve provided precious time to iron out the massive problems in distribution. More broadly, though, what’s becoming obvious is that we needed faster everything: testing, approval, manufacturing, and distribution.
2. The real risk, with vaccines, is long-term side effects, ones that might manifest only after years. What I don’t get is, if people genuinely believe this, then why are they OK with having approved the vaccines last month? Why shouldn’t we have waited until 2024, or maybe 2040? By that point, those of us who were still alive could take the covid vaccine with real confidence, at least that the dreaded side effects would be unlikely to manifest before 2060.
3. Much like with Amdahl’s Law, there are limits to how much more money could’ve sped up vaccine manufacturing. My problem is that, while this is undoubtedly true, I see no indication that we were anywhere close to those limits—or indeed, that the paltry ~$9 billion the US spent on covid vaccines was the output of any rational cost/benefit calculation. It’s like: suppose an enemy army had invaded the US mainland, slaughtered 330,000 people, and shut down much of the economy. Can you imagine Congress responding by giving the Pentagon a 1.3% budget increase to fight back, reasoning that any more would run up against Amdahl’s Law? That’s how much$9 billion is.
4. The old, inactivated-virus vaccines often took years to develop, so spending years to test them as well made a lot more sense. This is undoubtedly true, but is not a counterargument. It’s time to rethink the whole vaccine approval process for the era of programmable mRNA, which is also the era of pandemics that can spread around the world in months.
5. Human challenge trials wouldn’t have provided much information, because you can’t do challenge trials with old or sick people, and because covid spread so widely that normal Phase III trials were perfectly informative. Actually, 1DaySooner had plenty of elderly volunteers and volunteers with preexisting conditions. It bothers me how the impossibility of using those volunteers is treated like a law of physics, rather than what it is: another non-obvious moral tradeoff. Also, compared to Phase III trials, it looks like challenge trials would’ve bought us at least a couple months and maybe a half-million lives.
6. Doctors can’t think like utilitarians—e.g., risking hundreds of lives in challenge trials in order to save millions of lives with a vaccine—because it’s a slippery slope from there to cutting up one person in order to save ten with their organs. Well, I think the informed consent of the challenge trial participants is a pretty important factor here! As is their >99% chance of survival. Look, anyone who works in public health makes utilitarian tradeoffs; the question is whether they’re good or bad ones. As someone who lost most of his extended family in the Holocaust, my rule of thumb is that, if you’re worrying every second about whether you might become Dr. Mengele, that’s a pretty good sign that you won’t become Dr. Mengele.
7. If a hastily-approved vaccine turned out to be ineffective or dangerous, it could diminish the public’s trust in all future vaccines. Yes, of course there’s such a tradeoff, but I want you to notice the immense irony: this argument effectively says we can condemn millions to die right now, out of concern for hypothetical other millions in the future. And yet some of the people making this argument will then turn around and call me a callous utilitarian!
8. I’m suffering from hindsight bias: it might be clear now that vaccine approval and distribution should’ve happened a lot faster, but experts had no way of knowing that in the spring. Here’s my post from May 1, entitled “Vaccine challenge trials NOW!” I was encouraged by the many others who said similar things still earlier. Was it just a lucky gamble? Had we been allowed to get vaccinated then, at least we could’ve put our bloodstreams where our mouths were, and profited from the gamble! More seriously, I sympathize with the decision-makers who’d be on the hook had an early vaccine rollout proved disastrous. But if we don’t learn a lesson from this, and ready ourselves for the next pandemic with an mRNA platform that can be customized, tested, and injected into people’s arms within at most 2-3 months, we’ll really have no excuse.

88 Responses to “Distribute the vaccines NOW!”

1. Alyssa Vance Says:

Over a week ago, it looks like the Texas government ordered everyone to vaccinate as fast as possible, and specifically ordered that lower-priority people (or even just the general public) should be vaccinated if higher-priority people weren’t around and more vaccines weren’t available. But they don’t seem to be going that much faster than other states, they currently rank 15th in % of doses administered and a bit lower in terms of % of people vaccinated. I’m not sure why.

2. Alyssa Vance Says:

I think it’s worth noting that even though Russia and China “approved” their own domestic vaccines months ago, the US is still ahead of them in terms of vaccine distribution – in fact, despite all of the US’s obvious screwups, the US is currently fourth in the world behind Israel, Bahrain and the UK (per the Bloomberg tracker as of the morning of January 2nd). Purely anecdotally, rapid approval seems to have backfired by causing the population to think of the vaccine as some kind of sinister government experiment that was being tested on them and would probably make them infertile or something.

3. Thomas R Says:

> The real risk, with vaccines, is long-term side effects, ones that might manifest only after years
I think the steelmanned version of this is that there’s a risk of rare delayed side-effects, which need a certain amount of vaccinated people x time to detect. So you have a trade-off between doing a longer Phase III trial with fewer people, or doing a shorter Phase III trial with more people (and so exposing more trial participants to possible side-effects).

I think this is a somewhat reasonable argument when vaccinating young people, who have a low personal risk from covid. Of course challenge trials would still have allowed us to avoid the risk from running Phase III trials of ineffective vaccines, and so we could have significantly scaled up the trials of those vaccines that did prove effective. It’s also harder to see how this argument can apply to the most at-risk groups, where vaccination is expected to save one life per tens to hundreds of people.

4. Andrew Says:

“whether there’s an idealistic medical worker, somewhere in the US, who’s willing to risk jail for vaccinating people without approval, using supply that would otherwise be wasted.”

“The pharmacist was arrested, and claimed they deliberately spoiled the vaccines then injected people with them hoping to convince everyone the vaccines are not effective.”

So, I guess this is where civilisation is.

5. Yanosh Says:

Israel can easily turn into the “cautionary tale” of why not to rush vaccines, if they discover serious adverse events after the second dose, after life virus exposure, in kids, or if it turns out vaccines aren’t as effective as promised (efficacy vs effectiveness). Already now, hundreds got infected within days of getting the vaccine, and nobody knows if their disease turns out to be worse. It’s interesting that Israel of all places is doing the world a favor by trying this Mengele-style human experiment first.

6. hwold Says:

Well, be happy you’re not French… We have ~100 vaccines inoculated per day (332 total as January 1st). This is NOT a typo. Modern bureaucracy in general is just incredible in its inefficiency.

7. Renato A. Laguna Says:

This shows the value of not being “edgy”. Scott can be quoted by high status people. Other bloggers, though they may have been saying similar things for a long time, canDon’t be edgy, don’t get cancelled, and you can inject some drops of rationality when they are needed.

8. Boaz Barak Says:

Hi Scott,
I completely agree with you this time.
I think complex rules are part of the reason for the slow pace, and part of it is also decentralization where vaccines are allocated per state, and then state allocates to hospitals and nursing homes, and then they need to administer it only to their population. Compare this to Israel where the vaccines are all part of a national effort and indeed every living breathing Israeli, young or old, is potentially part of the pool and can get it if the alternative is spoilage.

Probably the only thing that can impact this is a sense of urgency and outrage, so your post can help!

9. Alexandre Zani Says:

An argument I’ve heard from people who have worked on challenge trials in the past is that figuring out the challenge dose is really hard and that if we had gone the route of challenge trials, we would not have ended up with vaccines any sooner.

10. chorasimilarity Says:

This inept bureaucratic response is international. I saw the same kind of idiocy during the first quarantine, when we, as concerned parents, asked the school to do something to organize online learning (this was during the spring 2020). People well intended and otherwise intelligent and educated argued that in order to start online classes the school has to centralize all the kids contacts before the online classes to begin, otherwise it would not be fair.

Or, as experience showed later, the fast response and the logical one is different. Make the frame (in this case use available free tools which allow the students to enroll, just as easy as making a mail address), delegate to the professors the moderation of online classes and start the activity.

There were no online classes in our kids school during the spring.

Or, let’s apply the actual bureaucratic thinking to a big mail provider. You want an account? Then file a demand, we contact your country authorities and as soon as we shall have everybody’s data we shall activate your account.

It is a way of thinking, not a matter of intellectual capacity, or bad intentions.

11. James D. Miller Says:

We got lucky in that many of our early attempts at developing vaccines worked. But in an alternative reality where they didn’t, doing human challenge trials could have literally advanced by years when we would have ended up with an effective vaccine because these trials would have more quickly told us that our existing vaccines didn’t work.

12. Paul Topping Says:

It is no surprise that the Trump administration had no real plan to deliver the vaccines once approved. They just mouthed the words, including “military” and “states”, then left it to work itself out which it is now doing. I doubt they have ever thought hard about much of anything except perhaps how to get Trump reelected. Of course, we all knew this a long time ago so the rot goes much farther than the administration. When the Biden administration starts working on infrastructure, they need to go far beyond dealing with mere transportation.

13. Nick Nolan Says:

“2. The real risk, with vaccines, is long-term side effects, ones that might manifest only after years.”

This seems to be a response to my argument. I used type 1 diabetes as an extreme example of delay, not as a typical case. For the Oxford vaccine Phase II/III they do safety, tolerability and reactogenicity profile checkups 7 days, 28 days, 6 months and 12 months after vaccination.

What I don’t get is, if people genuinely believe this, then why are they OK with having approved the vaccines last month? Why

It was Emergency use authorization. Taking larger calculated risk in the face of pandemic.

Just for the record: Here is the current timeline for Oxford vaccine Phase II/III: ClinicalTrials.gov Identifier: NCT04400838

Official Title: A Phase 2/3 Study to Determine the Efficacy, Safety and Immunogenicity of the Candidate Coronavirus Disease (COVID-19) Vaccine ChAdOx1 nCoV-19

1. Actual Study Start Date: May 28, 2020 – The actual date on which the first participant was enrolled in a clinical study
2. Estimated Primary Completion Date :September 2021 – The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure.
3. Estimated Study Completion Date :September 2021 – The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant’s last visit).

Primary outcome measures:

1. Assess the efficacy of …..

2. Assess the safety of the candidate vaccine ChAdOx1 nCoV-19 in adults [ Time Frame: Study duration (12 months from last vaccination) ] Occurrence of serious adverse events (SAEs) throughout the study duration.

James D Miller #11,

We got “lucky” because the diseases is so widespread that it was easy to assess the effectiveness of the vaccines. It would take years to do in places that have the pandemic under control, like New Zealand.

I think people overestimate the usefulness of challenge trials. If the pandemic is under control, there is no urgency in doing human challenge trials, although it may be the only way to get efficacy numbers in a reasonable time frame. If it is wildly out of control, like it is here, challenge trials probably won’t tell you more than a regular, ole Phase III trial (my opinion).

Scott,

Given that the feds have basically dumped the responsibility for distribution to the states, I think you would get better results if you used your platform to get people to call/write/email their local, state, congressional and senate representatives to put pressure on your state government to do this. Shouting into the twitter wind is probably not effective, although it probably feels good

16. STEM Caveman Says:

Insane to push not just a new vaccine but a new type of vaccine on people young enough to reproduce when they are at very low risk from it. This is no polio or 1918 flu.

Israel leading the way shows that the comparative sanity resulting from their military situation and above-replacement fertility does not hold throughout the society, the medical sector (like their academic and judicial sectors) is apparently progged.

17. Matt Says:

While not exactly a stay in your lane criticism, I do question the method of gathering answers by asking these questions your blog. I get that this is probably largely your thinking-aloud place, but aren’t you likely to mostly get confirmation-bias responses from people who think similarly as you or speculation or second-hand answers. It is fine, but as a method to discover truth it seems pretty unreliable.

My point is mainly that if you get unsatisfactory answers, please don’t conclude that you’re justified in concluding that the guidelines should change or whatever, but rather that you have questions and perhaps you need to ask first-hand to people who may be able to answer you. And I’m not assuming that there are answers, just that the method you’re using doesn’t seem reliable to tell whether there are answers and what they are.

Like personally, I recognize I have not taken the steps to be informed sufficiently (i.e. did actual non-twitter based research) on pretty much all COVID based topics. Yes, I know the standard arguments, but I also know that I won’t take the blame if my conclusions are wrong so I haven’t bothered becoming an “scientific expert” on the topic, with everything required to get there. Which means my ultimate POV is I have questions, but I don’t know. But I have not concluded everyone is doing it wrong or that they are not learning from current experiences to do it better in the future!

As a thought experiment, if I’m a neuroscientist but had doubts about some of the quantum computing conclusions, what would I have to do before I’m justified concluding that you’ll got it wrong (and yeah, one is an experimental science, and one is a theory-based science, so the scientific skills are different)?

I think of this as the reverse Murray Gell-Mann Amnesia effect. You read in the newspaper about a topic you know little about such as how some car company is trying to make money with an obviously stupid strategy which will definitely fail, or how some new policy decisions that will certainly lead to catastrophe. Then you read about a scientific topic you’re an export in, about how dude #2 thinks all the experts got it wrong and they obviously overlooked some basic facts and perhaps even have different morals than you, but being an expert, you know they misunderstood some subtle concept or maybe they are mostly right, but still got the overall conclusion wrong.

The next day, you again read in the newspaper how some public health researcher has concluded something obviously wrong and that they are clearly not aware of facts X Y and Z and probably never even thought about all the objections you have. Forgetting that yesterday, on the topic you knew something about, the experts did indeed know all the subtleties, but it was the newspaper which was unable to convey that to you.

18. Deepa Says:

Also, we should have been stopping travel to and from UK. Hope they’ve been requiring negative tests from travelers from UK and following up with them for a couple of weeks to rest and isolate if infected.

19. James Cross Says:

I don’t think my objections in particular were ever about potential long-term effects, but you have to take into account at least effects on the several weeks timeline. The vaccines approved now require two doses 3 or 4 weeks apart with high immunity two weeks after the second dose. So we are already talking about 6-8 weeks to make sure there are no significant adverse effects and to determine that antibodies are at a high enough level to potentially protect the recipient.

Again the timeline

1- Phase 1 to gauge dosages, determine if antibodies actually develop, and make sure no major adverse events with a relatively small number of healthy volunteers.

2- Phase 2 with a larger group that incorporates people not so healthy.

3- Phase 3 for a really large group to make sure it really works.

That gives you a minimum of 6 months and probably more since you can’t vaccinate several thousand people in one day. It has to be spread across weeks and days simply because of logistics.

So with vaccines available in April, October to November would be the earliest to accumulate enough data for approval and that was pretty much what was achieved. I don’t think it rational to suggest not doing Phase 1. Even if Phase 2 was eliminated, possibly not that much time would be saved because there is still recruitment time for several thousand people for Phase 3.

So what seems to be suggested is that we should have just taken a bunch of random volunteers with possibly varying levels of natural resistance to the virus, injected them with the vaccine (what dose?) as soon as it became available, exposed them to the virus, if everything went well immediately seek approval, roll it out, and hope for the best while the probably half or more of the doctors and scientists will know the testing hasn’t been adequate and a half or more of them would likely be vocal about it.

20. Ratufa Says:

I think 6 is to a large degree consistent with the evidence. Public health officials and bio medical scientists are generally NOT utilitarians (or some other type of consequentialists). And so they are not doing things that seem obvious (and indeed morally required) to the modal reader of this blog. Take paying for kidney transplants for example. The issue is the objective function itself, not so much the solver.

You could argue that medical ethics is effectively some form of rule utilitarianism (which is the gist of point 7) since protecting medicine as an institution is a legitimately important goal. I think this might be true on an institutional level. But I don’t think the individuals who actually make decisions think like this.

I also wonder if there’s some proportion of people making these decisions who didn’t want to do something that would help Trump. And so in a sense are utilitarians. There are probably a non-trivial number of people who think that 200,000 extra covid deaths would be an acceptable tradeoff to retire Orange Man. Bill Maher has kind of gone off in this direction although not specifically about Covid. If that’s true, God help us.

21. pete Says:

Scott,

I agree with your comments on vaccination but I have not heard anything about vaccines spoiling (except for the heavily reported madman who took 500 out of a refrigerator on purpose). As I understand it, as long as they keep it refrigerated (very cold for Pfizer), it will not spoil. That certainly applies to the shipping hubs but not all hospitals have ultracold fridges. In that case, anything a hospital receives has to be used within 5 days. Is that 5-day limit what you mean?

In any case, I especially agree with being willing to bend the strict distribution order if you cannot move the vaccines fast enough.

22. Scott Says:

(Alas, for my own gerrymandered Texas rep, I fear the response would be: “we’ll look into your concerns about vaccine distribution, just as soon as we’ve overthrown Biden’s Satanic Communist pedophile canal and installed Trump as God-Emperor for Life.”)

23. Danijel Kecman Says:

It’s amazing to me that a genius can be blinded by urgency. Yes, solve the problem at hand, distribute vaccines by any means necessary. If you can keep it organized and you can keep track and record! But if you want to learn something, then learn that all of this wouldn’t be a problem, if the administration engaged the pandemic instead of waging a cultural war in order to hide it prefers old people to die to any harm to the economy caused by the lockdowns. If it did, everything would be already in place for vaccines. This panic just reflects haphazard way of leading the country of the going away administration (hopefully to prison for, among the other things, criminal negligence). This reminds me to democrats arguing it’s ok to just drop money from the airplanes during the 2008 crash. And you can’t compare Israel to most of the countries. Let alone the US. Israel is an on standby society, for any danger. Meaning a well organized society when it comes to the public safety.

24. Raoul Ohio Says:

In theory, theory and practice are the same.
In practice, theory and practice are not the same.

25. Gareth Says:

When an institution has to make decisions, the institution will choose to minimize costs to itself. In many cases this means offloading massive costs onto the consumer or general public, so that total cost is vastly greater.

That’s why we have lockdowns and border closures which have huge public costs, trillions in dollars, massive in human suffering, terrible inequities for the poor. Lockdowns are cheap to administer though, and they actually make politicians look good. Until the lockdown involves telling people they can’t protest racism, and then temporarily the policy is too costly for the institution and so it is revoked.

Challenge trials, while costing nothing to the general public, could cost public health authorities their reputations, and if successful damages the long term legitimacy of many of the regulators (what is it ya do here, at the FDA, exactly?). The medical ethics boards are not going to put themselves out of a job.

Number 7 I think is the most chicken**** rebuttal of all. (If a hastily-approved vaccine turned out to be ineffective or dangerous, it could diminish the public’s trust in all future vaccines.) All it requires is someone to put their hand up and say “This vaccine is experimental and could hurt you. It could even kill you. It hasn’t been through the normal trials (yet) because desperate times call for desperate measures, but if you want to take it, you would be doing your country and all of humanity a great service.” Tell the truth and people will trust you. I’m not sure if these politicians are capable of intentional honesty or have any faith in it.

26. philh Says:

> The old, inactivated-virus vaccines often took years to develop, so spending years to test them as well made a lot more sense. This is undoubtedly true

I disagree. The premise (“years to develop”) seems true, and the conclusion (“made a lot more sense”) I can buy, but the argument itself (“so”) doesn’t hold. The one doesn’t follow from the other. The development time is a sunk cost, it shouldn’t affect how long we spend testing them.

If it made sense to spend years testing previous vaccines, that’s true for reasons other than how long they took to develop. (Such as “there’s no global pandemic killing 10k people/day”.) If these vaccines took years to develop, and we were somehow still losing 10k people/day by the time they were finished, we shouldn’t then spend further years testing them.

There’s a bias where if a clock costs $5 in one store and$15 in another, and a TV costs $90 in the one and$100 in the other, and the second store is an hour out of your way, someone might say it makes sense to go to the second store for the clock (saving 67%) than for the TV (saving only 10%). But it’s $10 either way. 27. Scott Says: pete #21: Please read the Wallace-Wells piece. One issue, apparently, is that many vaccination sites don’t have the special freezers, so they’re storing the vaccines in ordinary freezers, with the theory being that they’ll just use them before they spoil—alas, it’s precisely that theory that the bureaucratic blank-facedness calls into question. A second issue is that once you thaw a given amount of vaccine you can’t refreeze it, so it’s either use it all or else throw it away—and if there’s no common sense or flexibility in the system, then the default will typically be the second. 28. Bill Says: It’s interesting to me that despite the common view in the west that China’s government doesn’t value human life, even they didn’t do challenge trials. I mean an authoritative government which puts the good of society ahead of individual rights seems like the perfect use case. It makes me think challenge trials are much harder to implement than one might think. 29. Scott Says: chorasimilarity #10: At Austin Independent School District, it was similar—the start of the school year was delayed by a month, because apparently the spring and summer hadn’t been enough time to make sure that all students had identical school-issued iPads, and for some students to have easier Internet access than others would’ve been unfair. I would’ve said that fairness is an excellent value, but one that needs to take its place alongside other excellent values like speed, competence, flexibility, and common sense, rather than (ironically enough) unfairly lording over all of them. But that just shows you how I’m so out of touch with the world of 2020, I might as well be a boomer! 🙂 30. Scott Says: Renato A. Laguna #7: Out of curiosity, which “edgy” bloggers do you have in mind, who were saying similar things for a long time? 31. Scott Says: Alyssa Vance #1: In Texas, the key thing to watch for right now is the start of what they’re calling “phase 1B,” when anyone over the age of 65, as well as anyone with diabetes or other high-risk conditions, will become eligible. Supposedly this should happen by mid-January, although I’ll believe it when I see it! 32. Scott Says: Matt #17: Look, I wish I could believe that, if only you talked to them, the public-health authorities would have deep, well-thought-out reasons for whatever they recommended, even when at first glance it looked stupid to an outsider like me. I.e., that there was really a wizard behind the curtain, crunching numbers in a way that with enough study I’d find perfectly intelligible. If you’d asked me in January 2020, I would’ve had a strong prior in that direction. But then came the year of “there’s no evidence that facemasks protect you,” “there’s no evidence that aerosols are an important transmission route,” “border closures are xenophobic,” “BLM protests should never be criticized on public-health grounds,” and “continue sanitizing surfaces even though there’s not a single known case of covid transmission that way.” When you look on Twitter, there are a few experts like Gottlieb and Lipsitch who seem to deeply understand what they’re talking about, and then there’s a long tail of “experts” with MDs and PhDs after their names who confidently say things like the above and have zero introspection or shame after events repeatedly prove them not only wrong, but wrong with deadly consequences. Alas, there’s no way to unlearn what we learned this terrible year. I did end 2020 with a different perspective than I began it with. 33. publicschoolgrad Says: Scott #32, I think that is an unfair characterization. There was little to no evidence that facemasks protected you significantly from covid in normal situations initially while there was a risk that a mask shortage would be dangerous for medical workers working in covid wards, where presumably the virus was in concentrated form. There was no significant evidence that aerosols were an issue until it was studied. Border closures can xenopobic exercises as they were here (shut down flights from china but leave Europe wide open, for example. The virus that crippled NY came mostly from Europe, if I recall). BLM protests were criticized on public health grounds but it was with a caveat that the issues they were protesting were as important as the pandemic itself. It also appears that there was not a significant bump in infections resulting from most of the protests since they were outside for the most part, but I could be wrong. The advice on sanitizing of surfaces initially began because it was thought that Covid was mostly passed through touch. I don’t have to tell you that in science that there are few eternal truths. As we learn more, we adjust our actions. Now, there are so called “experts” in every field who opine on matters which may be close to their field but not exactly in it. That happens in every field but the pandemic gave a platform to every wannabe. 34. daniel Says: Scott #32: First of all, I completely agree that we should prioritize the speed of the vaccination rollout even at the cost of a non optimal ordering. Regarding masks, aerosols and surfaces: I agree that the public messaging could have been much *much* better (and the political climate did us no favors in this regard…), but the actual scientific consensus on these topics seemed quite reasonable to me. First of all, from what I could tell from mainstream publications such as Nature, almost everyone agreed that washing your hands and wearing a facemask decreases your chances of getting sick and infecting others. Indeed, these common sense preventative measures have used to reduce the spread of disease long before covid 19. Since both these methods are cheap they are basically a no brainer. However, in March, it legitimately was not clear what the primary transmission routes were. This question did not have an obvious “a priori” answer since there exist similar viruses with different routes. It is hard / unethical to run controlled experiments to test this, so researchers relied on natural experiments and observational studies. By July / August, the accumulated evidence made it clear that the primary route of transmission is through the air. Furthermore, it showed that N95 masks provide excellent protection to both the wearer and others and that cloth masks provide high protection to others and also some level of protection to the wearer. I know I’m not saying anything new here – I just wanted to emphasize the (disappointing) gap in my opinion between the public communication on these matters and the incremental (and nuanced) process of studying the disease in an evidence based fashion. 35. Boaz Barak Says: Scott #32: In most of the examples you mention, it is true that official authorities such as CDC and WHO were wrong, or more accurately slow, but they were not that slow. In all cases such as asymptomatic transmission, mask efficacy, aerosol transmission, (lack of) surface transmission, etc, scientists were learning this on the fly. Official guidance naturally lags behind the latest finding, but you are right that in many cases the guidance still took 2-4 weeks slower than it should have. Still, the main problem in the US wasn’t bad advice from public health authorities but the fact that it was only advice and wasn’t translated to policy. For example what we called “lockdown” was really a recommendation, implemented differently in any locality. In any country which had successfully suppressed transmission there was actual lockdown where it is illegal to go further than few hundred yard or so from your home. Yes, the CDC should have recommended masks before April 3, but if we had a national mask mandate on April 3 we would have been in a completely different shape. This happened time and again – the problem was not so much that health experts were wrong on the science as much as that the US didn’t have a coherent national policy that is based on the science that is agreed upon. The countries that did better were not ones whose experts were smarter than ours or strayed from the “conventional wisdom “, but ones whose governments listened to their experts. 36. Josh B Says: Amdahl’s law is only true in a percentage sense. Quadrupling one resource is likely to lead to a bottleneck in a different one, while raising all resources 25% will likely lead to more gains. The same with the military budget, at least in the short term. There is the military and there are those in the penumbra of military related matters, like able-bodied young men (as long as there are enough qualified trainers), or not-so-abled veterans in their 40s. Arms exporters and those that sell to the private market (as long as there aref enough people to fire those weapons), police officers, and foreign militaries. Probably not fashion designers, bowling alleys and tik tok influencers. So it makes sense to give the military the budget to bring in those resources, but giving more will accomplish nothing. An institution can’t quadruple in size overnight. The same is true for any set of related institutions, regardless of their size. Attempting to quadruple the number of string theorists in one year by quadrupling the budget will fail, regardless of the fact that the budget involved is miniscule in absolute terms. There are only so many people who know enough about vaccines to be helpful, so adding$40 billion dollars, while small in absolute terms, is double the CDC budget and there is no where to put it.

37. bertgoz Says:

Israel is not an example to follow. It is refusing to provide any support in the vaccination efforts of the occupied Palestinian territories.
https://www.theguardian.com/world/2021/jan/03/palestinians-excluded-from-israeli-covid-vaccine-rollout-as-jabs-go-to-settlers

38. chorasimilarity Says:

Scott #29, something similar happened, that’s the gist
>the spring and summer hadn’t been enough time to make sure that all students had identical school-issued iPads

with the effect that nobody had school during the spring. The fairness argument worked against everybody in that school. Mind that other schools, typically in less advantaged neighborhoods, did manage to help their students. A cynical view is that they had something to prove, or they reacted faster because they knew that nobody else is going to help them.

But I don’t think that the desire for fairness or other ethical criteria is what drives the slow bureaucratic response. It’s like this because people think that in any organisation there has to be a bottleneck which can be controlled.

Going back to the vaccine, I have similar opinions as you have, but, funny: my first jerk reaction was “they [Pfizer] surely checked that there is no similar sequence in the human genome”. Or, it turns out, according to the excellent link you gave
https://berthub.eu/articles/posts/reverse-engineering-source-code-of-the-biontech-pfizer-vaccine/
that they use two existing sequences in the human genome, which they don’t know why they work.

39. Gerard Says:

Reports are now starting to come out that almost half of health care workers who are eligible for covid vaccination are refusing the vaccine:

https://www.forbes.com/sites/tommybeer/2021/01/02/large-numbers-of-health-care-and-frontline-workers-are-refusing-covid-19-vaccine/

If true this does not seem to bode well for achieving herd immunity through voluntary vaccination anytime soon.

40. Alex Says:

The real risk, with vaccines, is long-term side effects, ones that might manifest only after years. What I don’t get is, if people genuinely believe this, then why are they OK with having approved the vaccines last month? Why shouldn’t we have waited until 2024, or maybe 2040? By that point, those of us who were still alive could take the covid vaccine with real confidence, at least that the dreaded side effects would be unlikely to manifest before 2060.

There is no reason to see it as black and white (either start immediately or wait until 2060). With every day passing without the news of side-effects, it becomes less likely that they exist.

Also, I don’t think that you have engaged with the argument that severe side effects of a vaccine would make it much harder to convince people to vaccinate afterwards – even if the ones who experienced those side effects signed all the forms before.

Finally, the damage (real and potential) inflicted by covid is much less than that of WWII so why should it warrant the same level of mobilisation of resources and risk appetite?

41. Renato A. Laguna Says:

Scott #30, there was a finger malfunction that made me post before making sure I was right.

“Long time” is more like 3 days. Gray Mirror’s Dec. 28 post touches similar themes to your Dec. 31 post.

What edgy bloggers have been hammering on for years (and this led me to error) is the generic trope of “decline of the west, everything sucks now”, with references to Manhattan project, Apollo project, and WWII examples of a golden age when America could Get Things Done™.

42. Scott Says:

bertgoz #37: Israel has said that they are going to help the Palestinian territories with their vaccination effort—after all, it’s in Israel’s own interest to do so—but I’d prefer they start on it earlier. But this is clearly orthogonal to what we’re talking about. Like, Israel could be flawed in a thousand ways, and its speed of vaccinating its own population (including the Israeli Arabs) could still be worth other countries learning from and duplicating.

43. Scott Says:

publicschoolgrad #33, daniel #34, Boaz Barak #35: I completely agree that science is an error-correcting process, and that the point is not to be right from the very beginning but to update. At the start of the pandemic, I too was under the mistaken impression that hand-washing, disinfecting surfaces, and manufacturing more ventilators were going to be key, and I wasn’t sure about masks. I only updated my knowledge as the rest of the world did.

For me, the central issue is speed.

On question after question—including the role of superspreader events, the role of aerosols, the effectiveness of cloth and paper masks, the need for vitamin D supplements, the value of ventilators, …—what would happen would be that the smart people on Twitter (including smart epidemiologists and virologists but also, yes, Silicon Valley nerds and rationalists) would extremely quickly figure something out, via a combination of reading key research papers as they appeared and using their background knowledge and common sense. They would then change their own behavior to reflect the correct understanding and urge everyone around them to do the same.

Meanwhile, though, the CDC and the WHO would resist and downplay the conclusion, only to be dragged kicking and screaming to the exact same place 6-8 months and hundreds of thousands of corpses later.

In a war against a fast-moving pandemic, it’s not enough to eventually converge to the right answers … and maybe the public health authorities will eventually realize that! But this was not, to put it mildly, their finest hour.

44. Leo Says:

Although I agree which the principle than now and to anyone is better than later or to no one, in my view there three important and interrelated issues that justify the delays. This is the view from the UK and to put my cards on the table there’s nothing more I would like than getting vaccinated and be able to see my parents whom I haven’t seen for more than a year now:

1. Lockdown and masking measures do work. As much as they are painful they are saving lives. If one is using utilitarian arguments for the vaccine the same arguments should be applied for the lockdown and masks. In the UK at least lockdown measures have been haphazardly applied with leadership or support to say the list and as a result people don’t believe in them. The desperate need for the vaccine arose because of the pandemic being handle badly and seeing that is impossible to vaccinate 40 million people twice in a month lockdown seems like a low hanging fruit to save lives.

2. The experts still disagree (https://www.theguardian.com/world/2021/jan/02/dr-anthony-fauci-says-us-will-not-delay-second-doses-of-covid-vaccine). This just shows that the are shades of utilitarianism in whatever decisions/suggestions they are making. It also shows that the situation is evolving just like the knowledge regarding transition a few months ago.

3. This may apply to the UK more than the USA but since the AZ-Oxford vaccine was on its way how realistic is it to ask to solve all of Pfizer teething problems (especially the -70C one) if a much more convenient one is round the corner?

This is a hard problem and I think I’m tending to disagree with Scott with respect to rushing the vaccines. There exists bureaucracy to overcome but the situation is more complicated than something than can be solved with vast amounts of cash.

45. daniel Says:

Scott #43 Just to make sure we are on the same page, do we agree that the basic science as communicated by articles in preprint servers and leading scientific journals evolved relatively quickly given the circumstances, and that the delay we are discussing is in the public messaging?

In that case, rather than casting accusations I think it is worth having a serious discussion about the best way to communicate rapidly evolving potentially life saving knowledge to the public. Generally I agree with the approach of “telling it as it is” and not over simplifying things or worrying that people will misunderstand nuance.

But in practice, even the (perhaps over-)cautious approach that the WHO/CDC opted for *still* resulted in large numbers of people complaining about them updating their recommendations with comments like “First you tell us to focus on hand washing and now you tell us to wear masks, make up your minds!” or even sillier “If you are telling us that masks prevent covid, then why do we have to social distance or lock down?” or absurd gotchas like “Someone on twitter said that they got sick even though they wore a mask!” or more recently “Breaking news – a person got covid a few days after getting vaccinated.”

After seeing all this I do not think it is obvious which messaging is better from a purely “number of lives saved” perspective – Freely communicating updates as evidence comes in which carries the risk of people getting disillusioned and alienated, or a more cautious approach which is slower but has the unrealistic consistency that people seem to expect. The latter approach seems to have caused its own sort of disillusionment in the people who were actually following the scientific research, but those people don’t need the WHO to be well informed so perhaps this is less problematic than the former which ends up with people pivoting to weird conspiracy theories.

46. Timon Knigge Says:

> 2. The real risk, with vaccines, is long-term side effects, ones that might manifest only after years.

On a related note – guess what _definitely_ was not tested for long-term adverse effects? The f***ing bat virus.

47. Gareth Says:

The public messaging was not “slower” or “cautious” or “lagging” behind the scientific knowledge. The public messages were intentional lies. These people are happily burning the trust in these institutions for short term gains, and that is a very bad thing.

“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.”

48. Yiftach Says:

Just a comment. It seems that now Israel is running out of vaccinations. Also, there is a huge mess, lots of non-prioritized people were vaccinated, while older people weren’t. In addition, as Israelis do, many people just gathered together to get vaccinated not keeping social distance. So who knows what will be the implications. It is an unregulated experiment. Likely it would be okay, but the risks are large. To be clear, I am not suggesting that other places are better, I have no clue, but I suggest that the Israeli experience should be looked at with scepticism.

49. A B Says:

Historically, responsibility for public health in the United States has been split up in a reasonable way: The federal government supports the States which are in charge of actually handling things. That division was never going to change with this pandemic, nor is their any evidence that this should have other than the standard calls for the President to “Do Something,” which happens every few decades in this country (e.g., the calls for Franklin Roosevelt to enact a fascist takeover of the United States in the 30s).
One can critique the support or lack of it given by the Federal Government. But we really have to look at what the individual States are doing, or should have been doing leading up to this moment. And we will see which States did a good or bad job in the ensuing weeks.

Personally, I’m glad I’m going to be driving my Mom from New York to Florida in a few weeks.

50. Boaz Barak Says:

Scott #43: I almost agree with you except for the crucial difference that rather than being “dragged kicking and screaming 6-8 months later” the CDC and WHO were 2 weeks or so late

For example, on March 23 Scott Alexander wrote a blog post summarizing the evidence for masks and ending with a qualified recommendation for wearing them in high risk situations. To quote: “ Please don’t buy up masks while there is a shortage and healthcare workers don’t have enough. If the shortage ends, and wearing a mask is cost-free, I agree with the guidelines from China, Hong Kong, and Japan – consider wearing a mask in high-risk situations like subways or crowded buildings. Wearing masks will not make you invincible, and if you risk compensate even a little it might do more harm than good.”

11 days later – on April 3 – the CDC recommended Americans wear face masks.

The problem wasn’t as much that they were 11 days late but rather that even now – 9 months later – it’s still a recommendation and we don’t have a nation wide mask mandate.

I’m too lazy to research other examples (human transmission, asymptomatic transmission, airborne transmission) but I believe in these cases as well authorities were a couple of weeks or so behind the latest evidence but not more than that. Also the last time I looked, I didn’t really see that the contrarians and rationalists were so much ahead (if at all) of experts:

https://windowsontheory.org/2020/04/09/experts-shmexperts/

I still maintain that the problem in the US wasn’t that authorities listened to the official experts in the CDC rather than followed rationalist blogs. Rather the problem was that authorities didn’t make policies following those experts.

The WHO and CDC have made several mistakes and were too slow in some aspects, but if the US simply followed their recommendations or the “pandemic playbook” prepared in advance, we would be in immeasurably better shape now.

51. Simon Says:

I am not sure the vaccines stored at -80 will spoil unless defrosted for application. Minus 80 is basically how all long term biological samples are stored indefinitely. But maybe I am wrong in this case.

52. Robert Michaels Says:

If anyone has specific details regarding their interaction / scheduling with the medical community for the vaccine, please let us all know:

I for one signed up on the clipboard at HEB pharmacy for phase 1b, 66 yrs old, no health problems. They told me I was #133 on that list, they would call me ahead of time when to come over, they said likely this next week 1-4 through 1-8.

53. William Gasarch Says:

Excellent point: vaccinate people as soon as possible—trying to prioritize people will only slow the entire process down.

This also solves (or may solve) one of the problems I’ve read about: Line-cutters. If it just gets rolled out like in Israel there is no need to cut the line.

Here is hoping your blog helps this to happen! Or that it happens in any case!

54. Ari Timonen Says:

Dear Scott,

Thanks for the good blog post. I was actually surprised to see you defend such unorthodox position. I don’t think government has any right to stop people from taking medicine without massive negative consequences (which do not exist).

It took market two (or 3?) DAYS to make the vaccine but government spent around a year to approve it while people are dying. Just like the great Milton Friedman said FDA should stamp drugs, but not illegalize them. As back of the envelope CBA; imagine 85% vaccines which pass Phase2 are safe and effective (as in they pass phase 3 as well), then there’s 85% chance its OK, maybe 10% chance its useless and maybe 5% chance its harmful. Even in 5% cases, its not obvious its harmful to everyone, let alone kill them. I can’t imagine any vaccine killing 10k people per week. Given that these vaccines are voluntary, it’s not far form saying the gov is murdering people. In lesser terms, if you approve 15 vaccines after Ph2, it should still positive expected utility by a big margin even if some of turn out to be poison. Maybe Scott can get my stats and numbers right, and integrate the real PDF

Real CBA would take into account all kinds of tricks from economics like epidemiology of the virus (how fast it spreads will correlate with dmg), QALY, problems in microeconomic theory (expected utility), complete prob. distribution of outcomes, better probability calculus etc. I wonder if anyone has a link to one? Shouldn’t government do a CBA for these trials?

Did you know that a CERN physicist died to COVID? Maybe he would be alive without FDA rules.

https://home.cern/news/obituary/cern/danila-tlisov-1983-2020

p.s. I am not anti-gov, anti-left etc. Just like my idol Robin Hanson, I am not pro-anything, its just important to get the answers right. Too many lives are at stake.

55. fred Says:

My sources tell me that the US gov is about to use their top secret Chemtrail program to distribute very efficiently an aerosol form of the vaccine.

56. fred Says:

No expert dares say that the virus propagates efficiently through prepared food.
The virus can survive for days, if not weeks, on metal, cardboard, clothes, so what do you think happens when a covid positive cook is breathing for hours over dishes and beverages that are about to be ingested within minutes by dozens of people?

57. Boaz Barak Says:

I tried to calculate the costs in lives of delaying vaccine distribution here – https://twitter.com/boazbaraktcs/status/1346106342973591552?s=20 – it’s very rough but I estimate that if we delay 10M doses for a week, and then completely catch up, that still costs at least 6,500 unnecessary deaths.

This is a very conservative estimate in the sense that it assumes we delay immunization by a week for a random american, and doesn’t take into account that the people due to be vaccinated now are higher risk. It is also rather conservative in terms of estimating downstream cases from a single case today.

58. Steve Says:

On the challenge trial, I think the immorality of giving a healthy person a disease that would have a high probability of serious injury is fairly clear. But, you could have set up challenge trials in stages. First do a big group of healthy younger people with little chance of serious effects if they get Covid (and, of course, informed consent). If that goes well, then a bigger challenge trial with a broader group including those in older groups and people with comorbidities.

The biggest problem with your challenge trial argument is that what is almost as important in a vaccine trial as proving efficacy is proving safety. Vaccines need to be the safest class of medicines we use. First, we give vaccines to those who are not sick and may never become sick with the disease. So, the trade off on the individual level has to for a very low risk. Second, we mass vaccinate. So, we are going to expose millions to the risks of the vaccine. We need a regulartory structure that insures that vaccines have vanishingly few side effects. Because of this, we need to test with a very large group. I am just not sure if a challenge trial or my suggested two-tier challenge trial would get us the data we need for safety.

But, why couldn’t we make an exception in this case? We were in the middle of a pandemic. We could have accepted a little more risk for this vaccine. This brings me to my third point. Unfortunately, a bunch of idiouts have convinced a large number of Americans that vaccines, despite being the safest medicines we have are in fact the most risky. To change and speed up the regulatory approval would have required a public debate on accepting more risks from vaccines — a debate in which not only idiots but some very smart people would have probably concluded that these short cuts involved too much risks. The outcome of that debate would most likely have been a public even more skeptical about vaccines and Covid vaccines in particular. We would get less people taking the vaccine, and have ended up causing more deaths. There are a lot of things that the US did wrong in this pandemic. And, just about everything should have moved faster and should move faster now. But, I am not sure that the regulatory approval of the vaccines was one of them.

59. Robert Michaels Says:

America’s Vaccine Rollout Is Already a Disaster

https://nymag.com/intelligencer/article/americas-vaccine-rollout-disaster.html

60. fred Says:

Europe is struggling too, with France being the top loser in vaccination efficiency.

https://www.bbc.com/news/world-europe-55529240

61. Scott Says:

Boaz Barak #50:

I almost agree with you except for the crucial difference that rather than being “dragged kicking and screaming 6-8 months later” the CDC and WHO were 2 weeks or so late

It depends on which issue you look at. The WHO was out of the gate promising to re-review the evidence for aerosol transmission in … November (!!), after hundreds of scientists begged them to, and a full half-year after we were all perfectly well-aware of dozens of cases where the particles must have spread much, much further than 6 feet. Is that the behavior of an agency that I should trust about anything, if the smart people on Twitter are saying something different?

62. Boaz Barak Says:

The WHO updated their position on airborne transmission on July 9th (
https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions ). The article you mention says “Published July 7, 2020 Updated Nov. 19, 2020”

The open letter by scientists was published on July 4th:

https://www.ncbi.nlm.nih.gov/search/research-news/10551/

The main references cited by the letter the following manuscripts posted on June 2, June 18 , June 26, and April 22 (case study of a restaurant). As far as I can tell 3 of them were not peer reviewed at the time the open letter was written.

Again: I am not saying the WHO deserves a medal – it shouldn’t have come to an open letter- and probably they could have come to the same conclusion in June rather than early July.

But in this issue (and this may have been the one where they were slowest) they still probably weren’t more than a month later than they should have been based on a body that needs to act based on evidence

———————

7.Miller SL, Nazaroff WW, Jimenez JL, et al. Transmission of SARS-CoV-2 by inhalation of respiratory aerosol in the Skagit Valley Chorale superspreading event. medRxiv 2020; doi: 10.1101/2020.06.15.20132027. Accessed 23 June 2020.

8.Buonanno G, Morawska L, Stabile L. Quantitative assessment of the risk of airborne transmission of SARS-CoV-2 infection: perspective and retrospective applications. medRxiv 2020; doi: 10.1101/2020.06.01.20118984. Accessed 23 June 2020.

9.Cai J, Sun W, Huang J, Gamber M, Wu J, He G. Indirect virus transmission in cluster of COVID-19 cases, Wenzhou, China. 2020.

10.Li Y, Qian H, Hang J, et al. Evidence for probable aerosol transmission of SARS-CoV-2 in a poorly ventilated restaurant. medRxiv 2020; doi: 10.1101/2020.04.16.20067728v1. Accessed 05 June 2020.

If you’re still wondering why all the anti-vaccination groups and conspiracies spring up, the reason is extremely obvious. You media is propaganda and lies to you constantly. It’s so biased in a blatantly obvious ways that it’s not a coincidence any person with a brain and critical thinking just can’t trust it anymore. That lack of trust is not a coincidence, it’s a direct result of the way your media was weaponized into a propaganda tool against Trump.

When the sources that are supposed to be trustworthy are found to be full of obvious bias and foreign interests, people have to resort to other sources, and unfortunately, most people do not have the logical capability to discern truth from lies. It doesn’t help that many of those lies are intentionally manufactured to be caught and repeated by skeptics in order to discredit their reputation.

The damage to vaccination reputation is just ricochet from the damage to the credibility of the media. Unfortunately, people aren’t smart enough to understand the burden of proof in scientific research is much higher than the joke that you call journalism and press. The only people responsible for the incredible damage done by anti-vax and other anti-scientific movements are your media, which are actually unrelated but indistinguishable for a layperson. When people realize supposedly trusty sources are intentionally lying to them they become paranoid.

I’m in Israel and I already took the vaccine. Corona isn’t a flu it’s a real and serious disease. I still think your elections are fraudulent on a massive scale.

I knew coronavirus was dangerous as soon as the diamond princess numbers were known, before the media caught on the story, and predicted the 1%-0.5% mortality (not the inflated hype of 5% they were also pumping in your media).

It was uncomfortable thinking that there might be a dangerous disease but I still sought out that information and judged for myself. I was surprised when Trump said there was fraud but then I looked at all the research people were doing, looked at the numbers myself and came to the conclusion it’s fraudulent on a massive scale and these numbers do not happen in normal elections.

I challenge you, Scott, to actually try and see if Trump’s claims have merits, come from as unbiased point of view as possible, and honestly report your results here. Look at the numbers and statistical analyses and time-series data from nytimes yourself and come back and tell me it looks like a normal honest election.

64. Boaz Barak Says:

p.s. Once again, I think the WHO, CDC, etc. had multiple failures, and especially the WHO as a international body that makes all its decision by committees was often far too slow.

If you Scott ask personally where you can get the most up to date information about Covid, then yes, don’t go to the CDC and WHO websites but rather follow people like Marc Lipsitch, Ashish Jha, Florian Krammer etc. on Twitter.

However, the reason more than 350,000 Americans died is not that the government listended to the CDC instead of to Lipsitch etc. The reason is that the government didn’t translate facts that bodies such as CDC were well aware of and publicly saying, into policies, and didn’t execute on the policies that they did set.

65. Scott Says:

Gadi #63: The fact that you correctly rejected one unhinged conspiracy theory doesn’t give me much confidence that you’re right to accept a different unhinged conspiracy theory! 🙂 As I’ve said many times on this blog, I’m a militant atheist when it comes to conspiracy theories (an a-conspiracist?).

But no one should take my word for it! We all now have the opportunity to read the complete transcript of Trump’s threatening phone call with Brad Raffensperger, and to judge for ourselves whether Trump has succeeded in showing that the same ballots that reelected Republicans to Congress were fraudulently manipulated against him … or whether Trump even clears the lower bar of being more coherent than a typical asylum patient.

66. Ajith Says:

Apparently scientists are ready to adapt the vaccine to a virus mutation at short notice (6 weeks!) ..

UK scientists worry vaccines may not protect against S.African coronavirus variant

Quote: “The accumulation of more spike mutations in the South African variant are more of a concern and could lead to some escape from immune protection”… Scientists… have said they are testing the vaccines against the new variants and say they could make any required tweaks in around six weeks.

Scott #65: I don’t care what Trump says because I don’t take his word for it, especially not his word out of an edited phone call. I just looked at your governments published data, at the time series data of nytimes, at the research of Matt Braynard, at the testimonies of your poll watchers, at the videos, and it’s way too obvious your elections are rigged by design.

I’m a cyber security researcher and the way your elections look like is like a protocol designed with intentional backdoors all over the place. Like the Netscreen’s Dual_EC_DRBG NSA shenanigans. Most elections have some flaws because it’s impossible to be perfect, but there’s a huge difference between a centralized election with mail-in ballots and voting machines and a decentralized election with humans-only in-person counting like in Israel.

All I had to know in order to see it’s rigged by design is to see the videos of your election workers being entrusted with thousands of ballots, and those claims were never refuted – only unimportant facts like calling ballot boxes “suitcases”, as if that makes the essence of the claim any different.

All I had to know is that Dominion’s own CEO admits under oath (there’s video) that in the event the same ballot is fed twice to their machines, it will be counted twice, and then watch and see it being done on video.

And even the humans-only in-person only method of Israel which by-design minimizes the access of fraudulent actors to ballots has its flaws if the citizens are lulled into complacency of not guarding the polls, by the backwards and undemocratic notion that “stealing elections is conspiracy”.

Here is how it looks like in Israel: https://youtu.be/WvfSun0vz_Y
Several differences from US are immediately apparent. This is published by a well respected Israeli media company. Nobody it saying nonsense that they shouldn’t say that because “it reduces trust in the election process”. (It’s actually mind boggling that you can be say that increased scrutiny reduces trust, without implying you think that trust is misplaced).

In Israel, police at least try to investigate fraud, yet in the US, you had no police investigations at all. And even in Israel they fail to persecute election fraud perpetrators.

Even in Israel where the potential scope for this problem is orders of magnitudes smaller than the US (because polling places are much smaller and decentralized), unobserved polling locations are regularly abused, so it’s even more obvious that unobserved central counting locations are not just a disaster but intentional sabotage in the US.

At least in Israel they teach you the importance of volunteering to observe as a poll watcher in school. The US has reached a point where not only is it discouraged (who needs to do it if everything is so secure), it’s even looked upon as a conspiracy theory. Someone implanted a twisted idea of democratic elections in your hearts and you just can’t see the truth. If you really believe in liberal values you need to wake up and realize the corrupted idea of elections you were brainwashed to believe.

I think just like the body needs to be immunized against viruses, the mind needs immunization against propaganda.

And there are no better sources for reference for historical propaganda than Hitler. What was the secret of Hitler’s propaganda? He built his support around the most basic common denominator of people: their race. He then constructed a system and theory where the race alone is perceived as the most important factor to anything and hyped people up with racial politics. This is literally the recipe for how Hitler got elected.

Now your BLM and the politics of your democratic party are literally the same pattern. It’s literally out of Hitler’s playbook of propaganda. Any liberal person with any critical thinking watching anyone so much as to hint at trying Hitler’s propaganda recipe should immediately denounce and cut all ties with anyone trying it, because he’s exploiting a publicly known vulnerability in human behavior, a sign of absolute evil.

Note that with all of the bad things you can say about Trump, he never played race politics. He might have support of white supremacists but yet he never hyped race as the reason for all problems. That’s not something you can say about the other side which is publishing articles which push race as a factor for nearly everything.

69. Bruce Smith Says:

Regarding the potential danger of long-term harm: what I would like to know (serious question, not rhetorical), is whether there is a reason to be reassured about the implausibility of a dangerous ADE effect between a COVID19 vaccine and a hypothetical future “COVID23 virus” (another bat coronavirus which jumps to humans a few years from now).

Suppose the future virus is related to SARS-CoV-2 (the COVID19 virus), but less closely than current variants of SARS-CoV-2 are to each other — maybe like the different subtypes of Dengue fever (as described in that Wikipedia article). Then it might happen (based on that article’s description) that prior infection with SARS-CoV-2, *or* prior exposure to a COVID19 vaccine, would enhance the seriousness of subsequent infection by “COVID23” — and if the vaccine produces antibodies differently or more efficiently than the actual infection, maybe that effect from the vaccine would be worse. Is there any reason to believe this is implausible, other than “hoping COVID23 doesn’t happen”?

That Wikipedia article addresses a related question this way:

Coronavirus vaccines

Further information: Misinformation related to the COVID-19 pandemic

VADE might hamper vaccine development, as a vaccine may trigger the production of antibodies which, via ADE and other mechanisms, worsen the disease the vaccine is designed to protect against. This was a concern during late clinical stages of vaccine development against COVID-19.[25][26]

ADE has been observed in animal studies during the development of coronavirus vaccines, but as of 14 December 2020 there had been no observed incidences in human vaccine trials. Anti-vaccination activists falsely cite ADE as a reason to avoid vaccination against COVID-19.[27][28]

But skimming those four references (and the “misinformation” article), it looks to me like they are addressing the question of an ADE effect caused by the COVID19 vaccine, against the COVID19 virus (SARS-CoV-2) — *not* against a hypothetical less-closely-related future virus causing “COVID23”. And since nothing specific about the hypothetical virus can be known, we can’t very well test for this effect — at best there would be some theoretical reason to not worry about it. I *hope* there is one, but I didn’t see anything like that mentioned in those references! (Admittedly I didn’t read the denser ones as closely as possible.)

70. Annonymous post Says:

As an Israeli, I too was at first impressed and surprised by the vaccination efforts, but apparently over-romanticizing anything has its toll. For example, due to some political squabbles, the ministry of health have just (temporarily?) closed the vaccination center in Rabin square. This makes me furious, as I have an elderly relative who was supposed to get the second vaccine there.

It is a true shame, because the I have nothing but good words for the Rabin square compound. When I accompanied my relative the first time, we were immediately directed to a “fast lane” due to his age being over 80, and less than 10 minutes later he had already received the vaccine.

71. Gerard Says:

> If you’re still wondering why all the anti-vaccination groups and conspiracies spring up, the reason is extremely obvious. You media is propaganda and lies to you constantly. It’s so biased in a blatantly obvious ways that it’s not a coincidence any person with a brain and critical thinking just can’t trust it anymore. That lack of trust is not a coincidence, it’s a direct result of the way your media was weaponized into a propaganda tool against Trump.

Can you provide one specific example where a major US media outlet lied against Trump ?

72. Scott Says:

Gerard, Gadi: Sorry, but because I fear derailing a thread about an ongoing life-or-death crisis, I’m going to ban all further arguments around Trump and the alleged stealing of the election from him. Thanks!

73. G Says:

Israel certainly looks impressive until you consider the millions of Palestinians living under Israeli colonialist rule who will not be vaccinated.

74. Scott Says:

G #73: Except they will be! Reading more about it, apparently what happened was that the Palestinian Authority declined to ask Israel for any help with its vaccination effort (help that Israel was willing to provide), choosing instead to order vaccines from Russia, which are scheduled to arrive shortly, at the same time as many other countries in the Middle East. Meanwhile, Israeli Arabs are being vaccinated on the exact same schedule as Jews.

75. Ben H. Says:

Scott, thanks very much for the well-reasoned and important post.

I see the a combination of factors playing into the current wrenching situation:

1. Preparation for “last mile” difficulties in vaccine distribution has been insufficient. And there is an urgent need to communicate that to our political leaders and public health officials in the hopes of improving distribution in the near term future.

2. There are questions we can legitimately ask about how optimal the current priority lists are under real conditions, i.e., in clinical practice. This isn’t to fault public health officials over the current prioritization — the CDC thought a lot about this, and developed a reasoned position that gives first order status to the goals of reducing harm and maximizing benefit [1]. I’m just trying to say that there are hard questions about the implementation of priority lists that do not seem to be addressed. For example, what should we as a society do when health care workers are too busy working their shifts to get vaccinated, or when a significant percentage of nursing home staff or residents decline the vaccine? One important point here is there is a moment at which time pressure due to spoilage deadlines and lack of possible progress at a higher priority level is sufficient to warrant a switch to a lower priority level. And the larger question is, how well do the priority lists behave “in the wild”?

3. Lastly, spoilage — it’s a significant thing. As a layperson, this is a “20/20 hindsight” moment (bad pun not intended). But spoilage issues were clear to experts as planning was (or should have been) taking place [2]. Both expiry date and open vial spoilage are big deals. I hope it will become clear, going forward, that it’s OK to opportunistically vaccinate individuals with doses that would otherwise go unused, even if such “catch as catch can” vaccinations do not adhere to priority list requirements. Public health guidelines should encourage such vaccinations. There are recent indications that states are loosening their guidance on opportunistic vaccinations [3]. Meanwhile at least one hospital used vaccine that would otherwise have gone to waste [4]; here is to hoping that such resourceful behavior graduates from anecdote to norm.

76. Gprime Says:

Just want to point out that I have commented in the past under the name “G” (about stuff like being a single-issue voter on climate change), but I’m a different person from G above. Maybe this name will be more unique 🙂

77. Gerard Says:

Scott and Gprime #76:

> Just want to point out that I have commented in the past under the name “G” (about stuff like being a single-issue voter on climate change), but I’m a different person from G above. Maybe this name will be more unique.

I don’t want to detract from the more important discussion going on here (Scott, feel free to not publish this comment if you want), but I’ve often wondered about this point and I think Scott should do something to clarify it (like adding a note to the comment policy).

The question is are usernames here unique across blog posts or not ? In other words can one assume that user X making comment C1 on post Y is the same person (or at least is using the same email address) as user X making comment C2 on post Z (or for that matter Y) ?

78. OhMyGoodness Says:

My last attempted post was of course meant to apply to comments and not original posts. 🙂

79. OhMyGoodness Says:

Early vaccines have often been withdrawn from the market. A contaminated batch of the Salk polio vaccine resulted in 40,000 out of 200,000 vaccinated children falling ill with polio. The predominant polio vaccine for many years was found contaminated with a simian virus associated with cancer. A vaccine used in the UK for swine flue resulted in an antibody that damaged hypocretin receptors thus resulting in narcolepsy. A swine flu vaccine in the US was associated with Guillain Barre. The issues with the early SARS vaccines are well known.

No one in my family of four is high risk and none of us will willingly be vaccinated. The risk of complications for any of us from Covid infection is extremely low so why willingly be vaccinated. I hope this new vaccine platform works as advertised but advertisements do sometimes overstate their case. In this case I have every confidence in our natural immune systems, tuned by hundreds of thousands of years of evolution and in the disease cauldron of Europe for some of that time, to be up to the task.

80. Ajith Says:

There are therapeutic options too.. vaccines are not the only solution. However, the early response on those (HCQ) was botched. Even the obvious(?) plasma treatment was not approved by the FDA until August! Furthermore, the supposedly ‘well studied + FDA approved’ Remdesivir is completely ineffective, so much that WHO has withdrawn its use.

There was some hope that monoclonal antibodies may be the best therapeutic option (POTUS got the Regeneron one), but it seems medical professionals are not even using them because every dose takes several hours to administer, so more than 80% is lying unused.

81. Eitan Bachmat Says:

The Israeli vaccination effort is amazing. The main source of efficiency is the rather unique structure of the public health system in Israel that has 4 integrated service providers-insurers. All service providers have many clinics scattered all over the country
and that is where the bulk of the vaccination activity is happening. As service providers-insurers they also have complete unparalleled data that allows great efficiency, control and automation and the process can be quickly analyzed, which is a huge plus for the drug companies, which is why Israel received a disproportional portion of early vaccine shipments, it serves in a sense as the world’s clinical trial in massive vaccination. The problem is that the British mutation which is very contagious is now rampant so its a race between the virus spread and the vaccination effort. We will know in a few weeks if the fact that about 60 percent of the over 60 population has already been vaccinated will have the effect that everyone is hoping for in reducing mortality.
But, my main point is that the success is just a manifestation of a very efficient public health system that predates the state. One more example of how to encourage efficiency. In Israel, the service providers are prepaid by the government annually for their patients, which means that they actually have the incentive to keep you healthy! So preventive medicine is important and there are other efficiencies and innovations that result from this basic setup.

82. John Says:

Something I didn’t see above is that Israel is using one vaccine. It doesn’t need to track who got what vaccine for the 2nd shot. That’s a huge help.

83. Eitan Bachmat Says:

Indeed Israel is using rather exclusively the Pfizer vaccine and itvwas announced yestetday that Israel will get another large shipment next week and should be able to vaccinate everyone who wants by the end of March, it was noted that the ability to track the efficiency of the vaccinations and serving as a model of a vaccinated country were the main motivators for pfizer. Israel will also get large shipments of the Moderna vaccine, it is a logistically simpler vaccine and will be administered to people who are not mobile at their homes or nursing homes.
The main difficulty is certain populations, especially Arab Israelis who are not enthusiastic about
vaccines, but the situation has been improving.
I should note that a good number of computer scientists, physicists, mathematicians and biologists have volunteered to actively help the ministry of health and other public institutions, I think this should be done in other countries, in the US, just go to the ministry of health in your state and say you are a wel respected genius who wants to help. They will probably be suspicious, but insist.

84. Max Chaplin Says:

Another example of Israeli organized chaos: when the health minister stopped the supply of vaccines to Ichilov because it had vaccinated teachers against directions, the municipality of Ramat Gan started secretly vaccinating teachers, 3 days before Bibi and Gantz agreed to give teachers priority.

https://www.ynet.co.il/news/article/H1UDhhH0v

85. Deepa Says:

Interesting article on how California residents are crowdsourcing information on finding the vaccine. I see the same sort of a thing happening in Texas. I have been doing my very best to help everyone I know get a vaccine if they seem interested.

Maybe this should be a template for such an effort in every county in the U.S :
https://www.vox.com/future-perfect/2021/1/15/22231241/california-coronavirus-vaccine-availability-moderna-pfizer

86. TheMoneyIllusion » Anti-ostrich Says:

[…] Mowshowitz is a good place to go for the latest estimates of how the disease is progressing.Scott Aaronson provides an excellent defense of challenge studies and other proposals to speed up the process.And […]

87. IJK Says:

Amdahl’s law for vaccine research funding. Interesting idea. So what is the rate limiting process that cannot be sped up with money?

1) Is it the number of labs which can work on a problem of this kind? There are a lot of labs working with viruses; very few with coronaviruses. Working on a virus as dangerous as SARS-COV-2 will presumably require extra safety precautions (level 4?). But conversion of labs should not be a rate limiter if enough money is av available. I guess there might be a latency problem here, but no major throughput bound.

2) Is it the supply of trained people? Given the ratio of biology undergrads trained to work in labs and the number of faculty and (long-term) industry positions, I would doubt that the rate of producing trained manpower is the limiting factor at present; one could assume an unbounded resource here. If there are multiple contending emergencies, one might have to reconsider.

3) Are there limiting rates in the testing of vaccines? I suppose each vaccine has to go through a sufficiently slow process of testing to check that it is safe and efficient. But this is a serial problem. When multiple vaccines are being tested (parallel development) this will probably cause a latency issue, but not a throughput slowdown.

3a) Is the number of available test subjects a constraint? My guess is that in a pandemic this would not be. But this is a quantity that will already have been “measured”, so guesses can be replaced by measured numbers with a little work.

4) Is there a limit on the number of different possible vaccines? I guess it requires a real domain expert to answer this, but having talked to experts for a few months now, my guess is that we have not hit it. One could try to stimulate the immune system to respond to many different parts of the molecules that make up a virus. Many possibilities would be eliminated at pre-clinical stages, and the more things that can be tried in parallel, the better. So I guess this is what could be sped up by more funding.

Although, given that the first press release for a working vaccine (Pfizer, November 18, 2020) came less than 10 months after the WHO PHEIC notice (of Jan 30, 2020), my guess is that funding was not a major constraint. This is not to say that we should not think harder about this, since even a month would have saved many lives.

88. OhMyGoodness Says:

My ancestors struggles for survival in the disease-ridden urban cesspools of Europe for hundreds of years resulted in the immune system that I inherited. I will not disrespect their success in procreating by using an artificial aid such as a vaccine to reduce some low probability of complications from this virus. I am unable to consider my immune system genetics with other than a Confucianist reverence.