I used to be going to put in writing a protracted weblog put up on the brand new pressure however Zeynep Tufekci has written an excellent piece for The Atlantic. I’ll quote from it and add just a few factors.
One of many large virtues of mRNA vaccines is that very like switching a bottling plant from Sprite to 7-Up we might tweak the formulation and produce a brand new vaccine utilizing precisely the identical manufacturing crops. Furthermore, Marks and Hahn on the FDA have mentioned that the FDA would not require new clinical trials for security and efficacy simply smaller, shorter trials for immune response (equally we don’t do new large-scale medical trials for each iteration of the flu vaccine.) Thus, if we wanted it, we might modify mRNA vaccines (not different varieties) for a brand new variant in say 8-12 weeks. As Zeynep notes, nonetheless, the vaccines are very prone to work properly for the brand new variant. It’s good to know, nonetheless, that we do have some flexibility.
The actual fear will not be that the vaccines gained’t work however that we gained’t get them into arms quick sufficient. We had been already going too gradual however in a race in opposition to the brand new extra transmissible variant we’re wanting like tortoises.
A extra transmissible variant of COVID-19 is a possible disaster in and of itself. If something, given the stage within the pandemic we’re at, a extra transmissible variant is in some methods rather more harmful than a extra extreme variant. That’s as a result of larger transmissibility topics us to a extra contagious virus spreading with exponential progress, whereas the danger from elevated severity would have elevated in a linear method, affecting solely these contaminated.
Right here’s a key example from epidemiologist Adam Kucharski:
For example, suppose present R=1.1, an infection fatality danger is 0.8%, technology time is 6 days, and 10k folks contaminated (believable for a lot of European cities just lately). So we’d anticipate 10000 x 1.1^5 x 0.8% = 129 eventual new fatalities after a month of unfold. What occurs if fatality danger will increase by 50%? By above, we’d anticipate 10000 x 1.1^5 x (0.8% x 1.5) = 193 new fatalities.
Now suppose transmissibility will increase by 50%. By above, we’d anticipate 10000 x (1.1 x 1.5)^5 x 0.8% = 978 eventual new fatalities after a month of unfold.
…the important thing message: a rise in one thing that grows exponentially (i.e. transmission) can have way more impact than the identical proportional improve in one thing that simply scales an end result (i.e. severity).
I argued that the FDA ought to have accredited the Pfizer vaccine, on a revocable foundation, as quickly because the knowledge on the protection of its vaccine had been made obtainable round Nov. 20. However the FDA scheduled it’s assembly of specialists for weeks later and didn’t approve till Dec. 11, whilst 1000’s of individuals had been dying every day. We might have been weeks forward of the place we’re as we speak. Now the epidemiologists are telling us that weeks are essential. As Zeynep notes holding back second doses appears like a transparent mistake and the stability of the proof additionally suggests we must always transfer to first doses first:
All which means the pace of the vaccine rollout is of huge significance.
…In the meantime, america was reportedly planning to hold back half the vaccine it has in freezers as a hedge in opposition to supply-chain points, and a few states could also be slowed down by murky prioritization plans. Scott Gottlieb—the previous FDA chief and a present board member of Pfizer—has argued that the U.S. must also go forward with vaccinating as many individuals as doable proper now and belief that the availability chain shall be there for the booster. Researchers in Canada—the place some provinces determined to vaccinate now as a lot as doable with out holding half in reserve, and can administer the booster with future provides—estimate that this kind of front-loading may help “avert between 34 and 42 per cent extra symptomatic coronavirus infections, in contrast with a method of maintaining half the shipments in reserve.” (Word that this technique, which is completely different from the one the UK just announced it should undertake in prioritizing the primary dose, doesn’t even essentially contain explicitly altering booster timing protocols with a view to maximize vaccination now; it simply means not ready to get photographs into arms when the vaccines are at present obtainable.) These had been already vital conversations to have, however given the menace posed by this new variant, they are even more urgent.
Maybe most critically, the FDA ought to approve the AstraZeneca vaccine if not as a part of Operation Warp Velocity then on a proper to strive foundation. We’d like each weapon within the arsenal. What number of instances should we be taught to not play with exponential matches?
Addendum: See additionally this wonderful Miles Kimball put up, How Perfectionism Has Made the Pandemic Worse.