Alex Tabarrok notes today that the Omicron variant is so different from the original Wuhan variant of COVID-19 that there was no guarantee that existing vaccines would work against it. But they did:
We got lucky. But for how long will our luck last? Do we really have to wait for a more transmissible, more deadly, more vaccine escaping variant before we act?
Where are the variant-specific boosters? The FDA has said they would approve them quickly, without new efficacy trials so I don’t think the problem is primarily regulatory. Why not catch-up to the virus and maybe even get a jump ahead with pan-coronavirus vaccines?
....Why the failure to invest more broadly? Mostly I blame American lethargy.
I don't understand this kind of reasoning. Both Moderna and Pfizer announced in November that they planned to produce an Omicron-specific vaccine within 100 days if turned out to be needed. About a week later, testing showed that current vaccines weren't very effective against Omicron and both companies announced that they had immediately started work on new boosters. Yesterday, Pfizer's CEO said that “we hope to have 50-100 million doses of the omicron specific vaccine available by late March/early April.” They are also acquiring new technology that should cut future development of new vaccines from 100 days to 60 days.
As for pan-coronavirus vaccines, there are a dozen labs and companies working on that. The version being developed at the Walter Reed Army Institute of Research recently completed its Phase 1 human trial.
So I don't really see the case for American lethargy. And that's before even mentioning the fact that Europe also has labs and pharmaceutical companies. Do we suffer from a pan-European lethargy too?
I think the real answer here is the sadly most boring one: Development of Omicron vaccines began nearly instantly after testing was finished on the current vaccine, but it takes a while to move into production. A pan-coronavirus vaccine has also been in the works for quite a while, but it's a really hard scientific problem. There's no getting around that.
Yeah, but it's a significant weakening of the original virus so it can spread. Sounds like OC43's evolution. If you have not had a treatment, too late.
It's not 'so it can spread.' It seems primarily evolved to escape current immunity but that has nothing to do with lethality because there is no evolutionary pressure to become less deadly. It's lessened severity may be just dumb luck.
Tabarrok says "After 9/11 the country was angry and united and we had troops in Afghanistan within a matter of weeks". Yes, but we spend $770 billion a year (this is fairly constant in real terms) on keeping the war machine ready to go at a moment's notice. As I keep saying, in order to be able to react immediately to pandemics and produce massive amounts of vaccine and other materials the government will have to spend a lot of money to keep the production facilities ready. In case of war we don't wait for the private sector to see the chance for windfall profits and ramp up from scratch.
Well considering the U.S. was attacked by a rogue group singular, what did he expect??? There is no vaccine for this that is 100% proof and never will be. Making a "vaccine" for omicron is a waste of time. It's really the end of the pandemic phase as natural immunity provided by it kills older more lethal strains. I see 60% of the U.S. having it by April.
To Spades- That immunity is reported to look pretty transient. But Hey there's always someone reporting something.
Trying out commenting. Please ignore...
Why is it a waste of time to evolve our vaccines as the SARS-CoV-2 virus has genetic drift?
Since immunity appear transient and the virus keeps mutating, it appears we are going to need vaccine boosters for the long term, and it would seem that they would work best if they match the present virus strains.
Sadly, true.
We have to keep the war machine ready to go because otherwise if the public had several weeks/months notice they wouldn't be caught so wrong-footed.
I'm still puzzling over the public's acceptance at face value of Bush II's evidence of 'weapons of mass destruction', if that's what you're thinking. Though I'm a lot less puzzled than I used to be 🙁
> So I don't really see the case for American lethargy.
Tabarrok has a narrative, a shoe horn, and plenty of time to think, he'll find a way.
My favorite Tabarrok column was the one that complained that there are more firemen now than there used to be, despite there being fewer fires. He had thought so little about this that he failed to grasp that 1) response time is critical in fighting fires; 2) response time is a function of distance; and 3) duh, urban sprawl. Any number of commenters pointed out the need to build and staff more fire stations where people choose to live: suburbs, exurbs, fringe …
Plenty of time to think, but no will.
I will remember that phrase .
But maybe revise it to
Plenty of time and ability to think, but no will.
Just describes so many problems today where it is not stupidity itself but unwillingness to think.
I like that turn of phrase myself. I may appropriate for my own use in future.
And have not firemen generally been taking more and more time serving as paramedics? Is that not what firemen really do nowadays with most of their time ?
So expanded role , more personnel needed. Even if original role requires less.
I was a volunteer firefighter over thirty years ago, in a small town in the California desert. We typically went a two or three calls a day. Virtually none were for fires. Most were purely medical aid, down to and including helping a disabled person who had fallen to stand up. An actual fire was a rare treat.
Or, perhaps, there are fewer fires because there are more firefighters.
One of my all-time favorite television moments was the Tom Green Show installment where he had on a gay porn actor to reenact a firehouse movie scene with sideman Glenn Humplik.
"Where's the fire?" the actor re-read from the script.
"In my pants", answered Glenn.
Unlikely. If we limit the discussion to structure fires, there are fewer of them because we have better building codes. More firefighters partially explains why fewer structure fires spread.
I'm going to go out on a limb here and, without reading his reply (if any), guess that he refused to concede any sort of error on his part.
There's a reason I belittle that tiny, tiny man every time his name comes up. And it doesn't have much in the way to do with ideological differences.
I agree that things are going pretty fast. I was hoping to hear more about oral vaccines by now, but it looks like we'll have to wait longer for those.
While I might agree with part of what spades says ( the part that is comprehensible as I have no idea what he is talking about in part - rougue group singular ?), I think that saying a new omicron specific vaccine is worthless is wrong.
I think he is correct that, if this comes out in April, it is way too late to help much for this wave as it will be over by then, we will be at herd immunity with low case numbers. Almost everyone who could have been helped by it will have already had omicron by then. I think we will be at 60% THIS month.
But what if our natural immunity does decline over time, even from an omicron infection . It would be very surprising if it does not. So maybe you need a booster next year and perhaps this will help better then than getting the old booster.
But maybe not. Original antigenic sin might mean that anyone who was vaccinated before, or was infected first by a prior variant, has their immunity focus locked in to original or delta and any omicron specific vaccine will do nothing more than existing vaccine. I doubt it is that extreme and expect that an omicron specific vaccine booster should at least tweak it a little. But say that was the case .
There are still those who really did get omicron and were never vaccinated or infected before. Even if only 2% , that is still over 6 million in usa and this booster is for them if they need immunity boost next year . And what about, over time , newborns? If original and delta gone by then , and omicron only left , you want a better vaccine for them at least .
I do expect that , in the end, omicron will turn out weak enough and long term immunity good enough ( without boosters ) that no vaccine is a good idea anymore once you had it or been vaccinated once . But newborns still might need that first vaccine.
And we cannot still have confidence in anything yet. What if it turns out that omicron bad effects turn up months later and it is deadlier than now appears so any little booster improvement is a big benefit.
I am happy spending money developing a vaccine that ends up being a waste 4 out of 5 times if it turns out that it has a huge benefit one of five times. And that means you do not wait to see evidence that it is needed. You develop it just in case it is.
Our new "lifelong liberal Democrat" GQP troll admits agreement with our legacy (multiple Drum blog iterations) drunk Lindberghian conservative troll Shooter.
Perfect.
It's almost as if they have twice the crediblity for the price of one.
Not a single coronavirus variant so gar confers strong long last immunity after infection. They all need at least 1 vaccine.
Why wasn't a generic vaccine developed after SARS or MERS?
I wouldn't call it lethargy, but there definitely was a lack a investment in vaccine development. Look at the history of the mRNA vaccine development.
That's not the only area that needs more investment.
By the same token, this pandemic shed light on a lot of the work they has been done. The mRNA vaccine, the carrier virus vaccine (J&J and Oxford), even the protein fragment/nanoparticle vaccine (NovaVax and the Walter Reed) though none of the latter have been approved (problems with protein purity in production). Even how to optimize the sequence used to help with production and efficacy played a key role too.
The pandemic also gave us a chance to test a bunch of different vaccines--and not all worked.
Small molecule antivirals--they require knowing the specifics of a given lifecycle of a viral infection. Hard to know what may work until that is done. AIDS gave us great insight into how our immune system works, and spurred a lot of vaccine research.
The anti-vaxxers are convinced the whole Covid thing is a plot by Pfizer, Moderna, J&J, Biden, Fauci, Gates, Soros et al to make billions hawking vaccine. The sad truth is vaccine development has always been the neglected child, ignored until we really needed them. Why? Because vaccines don't cost all that much and patients only need a small number of doses over a full lifetime (in other words they don't make all that much money).
Companies want high ROI, and will focus resources accordingly.
Which causes all sorts of issues. We do need to rethink how we develop and deploy health care resources.
SARS was bad, but regionally contained & burnt out relatively quickly.
MERS never really got started... & by the time there was a vaxxx to trial for it, there was no MERS left to experiment against.
It's not exactly a plot by the pharmaceutical industry, but they have made huge profits. But the lesson can't be to take government out of the process, as conservatives would argue, it's to get things lined up in advance, as we do for making war. The industries would not be shut out of making money as most of the production would be done by government contract.
We do that in a very ad hoc manner. The "War on Cancer" kept a number of academic labs alive, even with work only tangently related to cancer, which meant a number could pivot to new diseases, e.g. HIV. Funding for HIV gave us new insights into our immune system.
The human genome project also was a lot of money, and also lead to a lot of breakthroughs in sequencing. The promise of treatments tailored to your DNA hasn't really materialized, but that sequencing power now means we could sequence the new virus and do so quickly.
And with this outbreak, a lot of academic labs pivoted to help. Universities have set up in house testing (PCR). Others tried modeling, search for small molecule therapies, do their own tests on vaccinations, model disease spread, etc. You had some of this with MERS and SARS--but funding dried up quickly when the threat went away. The corona virus field had all but dissipated by the time COVID emerged.
That said, the response in terms of vaccine development and disease treatment has been remarkably fast.
Research is -- and should be -- driven by demand. Also, without a certain amount of domain expertise and a willingness to continually keep your ear to the ground for this sort of news (almost impossible if you're not doing so for pay or working in a closely related field), it's very hard to assess just how much or how little progress is being made on a given topic. IMHO, of course.
It's also been my experience just how much of this progress is progress in tools to make the tools to make the tools, so to speak, and that the lay public, of which I myself am a member don't realize how difficult this is. As opposed to, say, weighing something or taking it's temperature, the way you would do when engaging in your generic physical science research.
And how do you establish "research demand" for research to solve problems we do not know we have yet?
Indeed mRNA was such research, and it was only luck that it was pursued despite "the lack of research demand" that we have the best vaccines that are available for covid-19.
I'm less concerned about his reasoning then his premises. People in the know (virologists/clinicians) were joking early on when the vaccines came out that they had a "superpower", which was preventing infections. To pass the clinical trials, the only requirement was to prevent serious disease and death, like most vaccines.
Frame of reference is important here. The vaccines are working fantastically well at their primary assignment. Yet most of the world is in a frantic panic because lots of vaccinated folks are still getting (mostly) asymptomatic or mild illness (aka infections).
Begin your reasoning from there, and make reference to the dominant reasoning about infections, since you've got to get through and make clear the differences in premises, while ultimately ignoring it.
Disease is our foremost concern, specifically serious to severe to fatal disease, not infections (cases).
Because DTAP and MMR are life long. Tetanus needs a refresher but if its updated you don't get it. HPV is the newest major vaccine IIRC and it too is life long. The main experience is immunity from infection, or as close as makes no difference.
Flu is the only major vaccine that becomes useless over time.
Tetanus requires periodic boosters. With the flu vaccine, it's not so much that immunity wears off as that last year's flu strain is different enough from this year's that last year's vaccine doesn't work on this year's flu strain.
There are a number of vaccines for tropical diseases that require periodic boosters, for instance yellow fever and cholera. Cholera requires a booster every six months.
Most vaccines are not one-and-done/lifelong, and most do not prevent infections either, do your homework. Regardless, the standard for passing clinical trials for this set of vaccines was preventing serious illness and death.
The concern from the beginning was that the medical apparatus would be overwhelmed, thereby increasing death rate from all causes, and this fear is returning with omicron. The main idea was originally to flatten the curve, not prevent the pandemic totally. With the development of the more effective mRNA vaccines, it did begin to look possible to control pandemics without the kind of drastic isolation measures that China and others have resorted to. But production and distribution facilities have been inadequate. With more rapid vaccine approval and adequate production facilities the next pandemic could be much less serious.
Overwhelming emergency medical care and hospitals is a primary concern, no doubt, but we are not really looking at that happening because of Omicron, maybe in pockets for a week or two there will be significant strain, but most of those requiring hospitalization and more importantly ICU are the unvaccinated, whose numbers are dwindling and who with a symptomatic infection will boost their immune systems for some time going forward.
The cynical but true line on R&D in the pharmcuetical industry has always been:
Palliative treatments for diseases, especially chronic ones, should have the highest priority as they are the most profitable. One could make the utilitarian argument that it is the greater good since it helps the greater number.
Curatives are second. The disease likely continues, but over time the cash flow declines as the total "market" diminish - although that can be a toss-up for communicable diseases; the number of people cured is offset by new sufferers.-
Vaccines are at the bottom of the profit list. Good income as mass inoculation starts, then a steep decline as the bulk of the target population becomes vaccine
Now, mutating diseases, are quite appealing from an investment perspective - a constant demand for new pharmcueticals...
The radical question is why are Pharmacutical companies set up as for profit entities?
Worth thinking about, save that we won't.
The hard line most extreme anti vaccine activists do NOT think the vaccines are about making profit for phizer et al.
They think the vaccines are either developed as a secret device to control people by some microchip, and honestly any group who had that sort of technology and ability to keep such a huge conspiracy could control the world in easier ways..
Or that the vaccines are designed to kill a lot of people with some delay as a plot to depopulate the earth to some extent.
Of course both of those require that the elites have to all be " in on it" to know to not get that vaccine themselves and get a fake placebo or the " real vaccine " .
Your idea that they think it is all part of a scheme for profit motive is actually somewhat a more reasonable belief . It is not hard to believe that phizer would have a profit motive to try to cover up any study results that might show that their vaccine does not work as well as expected after all.
Your theory is more like what an extreme anti vaccine activist coming from a left wing perspective might think, playing to their biases. Not what an anti vaccine activist coming from a more conservative position might think. But, as with many things, you go way far enough to the extreme right and extreme left, you might end up same place and then they can agree to believe both at the same time..
It's a conspiracy to kill off half the human race AND make money at the same time.
Bioweapons to kill off republicans! That would be worth it!
Maybe we can make a Covid nasal spray combined with ivermectin, hydroxychloroquine, and human urine. That way you can get immunity from the infection and not need the vaccine.
"It is not hard to believe that phizer would have a profit motive to try to cover up any study results that might show that their vaccine does not work as well as expected after all."
It is very hard to believe.
Oh Justin, you've got to stick around more. Just not cynical enough. Yet.
WHY ARE THEY TRYING TO KILL THE SHEEPLE? I never figured that one out
They thought about it and screwed it up.
https://www.nytimes.com/2021/12/23/us/covid-vaccine-biden-trump.html
The government’s partnership with Emergent, which cost taxpayers hundreds of millions of dollars over the past decade, was supposed to be a pillar of the nation’s pandemic preparedness. Instead, it proved to be the culmination of 30 years of frustrations.
Here is the money shot from Kevin's post:
"I think the real answer here is the sadly most boring one: Development of Omicron vaccines began nearly instantly after testing was finished on the current vaccine, but it takes a while to move into production. A pan-coronavirus vaccine has also been in the works for quite a while, but it's a really hard scientific problem. There's no getting around that."
Money and "drive" are not the same as time. We are dealing with very complex issues on the science side, the risk management/public health side, the healthcare delivery side, and the manufacturing/supply-chain side.
I was in the US when the pandemic began, and have been in Spain since last June. Neither the US or Europe have been lethargic. The US - quite frankly - is a hellhole consumed by propaganda from the "Republicans" and a cult of "exceptionalism" propogated by all parties which created the current "shithole" situation with Covid to develop there.
I actually believe the "exceptionalism" cult is the root of the problem - I didn't realize how pervasive it was in my own thinking until recently. As Americans we have are so deeply involved in this cult that we believe we are exceptional, that our "will" can suspend complexity and warp time. It allows us to believe that our ideas are at least as good as any professional - if we are conservatives, because they are stupid; if we are liberals, because we are giving them perspective. Honestly, we are sick, sick victims of a cult that ruined us long before the pandemic.
Here is Spain, people generally don't pretend to be professionals or know more than them. I haven't had anyone suggest crazy cures, and my Spanish FB is not full of conspiracies. People are scared, admit it, and believe it when the professionals say it is difficult. They do this because they admitted that life was difficult already, that things take time, that they are not exceptional - nor is their country.
Here, Covid is a buzz in the background - it will pass. Our more pressing issue is how cold it feels and getting a good tostada and beer for breakfast and talking with our neighbors.
I doubt belief in conspiracies is much more widespread in Seattle, DC or Boston than it is in most of Europe. Nor is conspiracy-mongering unknown on the Continent.
The difference between countries like Spain and the US on this score is that belief in nutty conspiracies is (apparently) considerably more widespread and powerful in America than in the former. Why is that?
I'd suggest in general it's due to a greater erosion in trust of and confidence in public authorities in the US—largely concentrated in the parts of the country that are being left behind. People who feel life is getting more difficult, and that they're powerless to do anything about (and certainly they don't expect the government to help them) have to turn somewhere. Conspiracy theories offer an explanation that to such people makes the world a bit more comprehensible, and therefore less frightening, because a world they understand is a world over which they have a modicum of control (and therefore perhaps some small degree of hope they can better their circumstances).
Vox doesn't spread conspiracies?
Exceptionalism built by foreign debt. Doesn't sound patriotic at all. Maybe you should rethink this post. Yes, I was in Spain during November. I don't agree with that take. Covid is indeed a background buzz everywhere.
Even if it were approved today, the scale up to provide billions of doses will take months. Make an appointment for July or October. At the most these plants are putting out 20 or 30 million doses a week in the US and the supply chain is full of the current vaccine. They will want to administer all those before shipping the new one.
Now this is a wonderful development!
Jan 12 (Reuters) - As COVID-19 cases surge in the United States, businesses say they fear a California court ruling has increased the likelihood that companies will be sued for infections, even by people who are not employees or customers.
The Dec. 21 ruling allowed a wrongful death lawsuit to proceed against See's Candies Inc, owned by Berkshire Hathaway (BRKa.N), by the family of Arturo Ek of Los Angeles who died in April 2020 at 72 from COVID-19.
See's employed his wife, Matilde Ek, who said she was infected by the coronavirus while working inches apart from sick coworkers, and then her husband caught it from her at home.
The ruling is the first by an appeals court to allow a novel "take-home" COVID-19 lawsuit, which seek damages from a business over allegations of violating safety protocols and setting off a chain of infections beyond the company's premises.
https://www.reuters.com/world/us/us-business-fears-never-ending-liability-take-home-covid-19-lawsuits-2022-01-12/
Good for her! Sadly, this seems to be an exception that proves the rule, to use a bit mangled cantrip.
Kevin's right with respect to this piece by Tabarrok.
Also, the administration had put together a compelling, long-term package to deal with the grave threat of pandemics. The current one, needless to say, won't be the last. There was lots of good stuff in there. All very sensible. And a bargain at $65 billion or so over ten years. And naturally Republicans wouldn't even consider it.
https://www.whitehouse.gov/wp-content/uploads/2021/09/American-Pandemic-Preparedness-Transforming-Our-Capabilities-Final-For-Web.pdf
About a week later, testing showed that current vaccines weren't very effective against Omicron and both companies announced that they had immediately started work on new boosters.
That turned out not to be the case, actually. Full vaccination (2 shots) of either was pretty darned effective at preventing serious illness or death from omicron and 2 shots and the standard booster were *amazingly* effective. As we're seeing in NYC and elsewhere, breakthrough infections occur, but virtually no-one with the full course of shots, including the booster, is in the hospital right now. Some older patients and those with comorbidities who were long past the six month mark on their first course of vaccines and hadn't gotten a booster yet have been getting sick, but that's a minuscule proportion of the overall hospitalized population.
Working on a virus-specific booster seems to be a poor strategy -- by the time you develop it, get it approved, and ship it, and start getting it into arms, the wave will have been long over.
And all of them will be patent protected including the ones developed entirely on public money and thus so expensive that 75% of the people in the world won't get any vaccine insuring that COVID in some form stays endemic. I swear to god that humans are in fact no smarter than yeast.
The lethargy is endemic among the USAmerican politicians and public which won't do the simple things that a herd* species has to do in order to deal with a new infectious disease. The medical community has done a remarkable and heroic job in providing vaccines and treatments ASAP but a significant portion of the general population does not believe in science, medicine, or simple common sense.
* Homo sap sap (that sap!) is a herd species. By acknowledging that biological fact I am in no way advocating the "let's get everybody infected FAST" idea of herd immunity.
Emergency medical workers should get some serious consideration from Congress about big bonuses and/or no taxes the past two years.
Nice article Kevin.
We are lucky that scientists pursued mRNA technology even as it was poorly funded and under appreciated.
We need to be more strategic in realizing that the technologies we will need in the future are not necessarily obvious at the present. In short, more support for science and in particular basic science.
But this has been a problem since the 70s and despite the covid-19 experience, our society does not seem ready to learn this fundamental lesson.