The comparison to the HIV treatment is even more tragic when you consider the vaccine is simply a one-time cost, whereas HIV treatments are for the rest of the patient's life. The US's hoarding of vaccines for people who have to be bribed to get them is shameful.
If Biden announced that Americans only had 2 more weeks to get their first dose, then the rest of the supply would be directed overseas, I think there'd be a spike in interest in getting vaccinated!
Perhaps. One key problem is the supply is constrained, and we are not acting like it is the emergency that it really is. So I hope we do both: redirect excess but, crucially, figure out a way so that it is not some sort of scramble like this with supply constraints causing all these problems.
"every single vaccine out there does a very very good job against preventing severe disease and death"
Would that include the Chinese vaccine? Wondering because China offered it to Taiwan, and Taiwan refusing it. How effective would that vaccine have been in stopping the current spike?
So Taiwan part is a bit complicated for obvious reasons but... In terms of preventing severity and deaths, as far as I can tell from real life data and lab studies and trials (where we have less clear data) the two vaccines from China do work fairly well, though they seem to need the booster (unlike the mRNA vaccines for example that do help both symptomatic breakthroughs and deaths even after a single dose, but more so after the booster). The problem with not being as good in preventing breakthrough cases (seems about 50% compared to 75-80-95% for the others depending on where someone is on the process with the boosters/timing) is that transmission chains are probably not cut off as effectively (though scant data on transmission in breakthrough cases from any vaccine so it may well be that they do a good job there as well). Still, though, if my loved ones were in a country with nothing but the either Chinese vaccine, I would not hesitate to recommend that they get both shots. It's possible they would eventually need boosters, but that would greatly diminish the chances of death and severe disease.
I did see a couple articles about a Chinese vaccine working well in Indonesia and Brazil, after scrolling down a bunch of articles questioning their effectiveness.
To me the Taiwan situation seems totally self inflicted. If they had accepted the Chinese vaccines instead of playing politics, they would have been in a much better situation. Instead i hear they are pinning their hopes on their own vaccine. Which is still in phase 2 trials.
To be fair, would you accept vaccine from someone who is constantly pointing a gun to your head? Taiwan has ordered vaccines from Moderna and AZ and also participated in COVAX. Those vaccines should be enough to cover at least the front line medical workers and also the elderly and high-risk groups. Of course due to the global shortage, vaccines have been slow to arrive. Developing home-grown vaccines is also a necessity, considering the fact that Taiwan has always been isolated in the world due to pressure from China. Taiwan tried very hard to prevent a domestic outbreak via border control, in the hope that virus can be block out until there are vaccines available. I guess the goal is partially achieved since there are several vaccines on the market now, just not enough doses for everyone. I still consider this to be extremely lucky, comparing to the alternative which is experiencing outbreaks last year and having to wait for more than a year to have access to vaccines.
As zeynep said, Taiwan’s situation is complicated. Saying Taiwan is playing politics and the situation is self-inflicted is really quite unfair. For someone whose country is not under constant existential threat from their authoritarian neighbor, it might be hard to understand why accepting the so call “help” from China is not as simple as it seems. I sincerely hope you could try to understand the nuances better before jumping into conclusions.
If the health of the people I'm responsible for is on the line, then yes, I'd swallow my pride and accept any help i could get.
So in the end it's really not that complicated, it's (green) party politics. Not that I'd know what the kmt would have done of course. Maybe they'd pick ideology over the wellbeing of their people too.
Your argument is based on the assumption that any promise CCP made is actually credible, which is quite naive if not cynical coming from a person claiming to know the nuance of the situation. It is also sad that you live in a reality where begging an authoritarian state who commits genocide of its own people is the only option. Thankfully Taiwan has friends like Japan who understand the difficulty Taiwan is facing and sent help promptly. Taiwanese people will forever be grateful for this.
To quote from the thread above, “It is also crucial to remember the PRC offering vaccines to Taiwan is akin to mocking someone while bullying them; the PRC is solely responsible for blocking Taiwan's access to the WHO and is interfering with their vaccine supply deals.” If anyone is to be blamed for playing politics at the expense of people’s health, it would be China.
I wasn’t going to reply to your post again originally, because trying to convince someone who believes in China’s narrative regarding Taiwan is often an effort in vain. However, today is June 4th, a date that China is trying to erase from history. If people in Hong Kong can hold a vigil for Tiananmen Massacre under the threat of jail time, then maybe I should try harder.
This is a much more "practical" essay than the NYT version because it focus the solution on producing more vaccines instead of redistributing existing doses. As a species we are real good at science, engineering and industrial production but not so much at equitable distribution. We should go with our strengths and not our weaknesses.
Vaccine production is a complicated thing, and it really requires leadership and money and industry cooperation/compulsion and a lot of things. We're letting it not happen simply because we are not trying hard enough.
If this site is correct, we will manufacture 12 billion doses in 2021. There is no reason why at least the amount won't be produced in 2022. I haven't seen evidence that it is possible to produce more vaccines. Since there is about 8 billion people this should be enough vaccines. Getting them into arms will be the problem.
Agreed that we *must* spread vaccine access as widely as possible. Even if only considering self-interest, not doing so is like fire-proofing your house but ignoring the flammability of the row house that shares a wall with yours.
Agreed that much of the inadequacy of the response comes from thinking of one's nation as an island, US government policies forbidding the government from negotiating prices with pharmaceutical companies, etc.
But a piece of it is that some nations' leaders are just not confronting the situation at all. From Bloomberg Prognosis Coronavirus Daily of May 27, 2021:
"Some nations such as Burkina Faso and Chad have yet to vaccinate any of their citizens, and other countries including Turkmenistan and North Korea have been slow to do so. But at least they have accepted the need for inoculations. Tanzania, Burundi and Eritrea so far haven’t even done that.
"That’s not just a threat to the 75 million people who live in those countries. It’s also a threat to the world. If the virus is allowed to continue to circulate in pockets of population anywhere, it’s likely to mutate. When people travel, they carry it with them, and those mutations can sometimes evade antibodies produced in reaction to vaccines more easily than earlier versions of the virus.
"Already, tests on travelers from Tanzania who arrived in Angola have found what South African genome-sequencing institute Krisp described as the most mutated variant yet."
(I have no way to fact-check this, and certainly don't want to diss other nations whose challenges I don't understand. But we have certainly seen-- & experienced first hand-- national leaders just refusing to acknowledge epidemics. And it does seem like willful refusal is the royal road to mutations that could be beyond our vaccines' efficacy.)
That is part of the picture, though I think the moral case is strong enough and I don't feel like the vaccinated in wealthy countries face an immediate threat, and I worry that emphasizing the threat part may not be enough or even wise partly because what if it turns out not to be threat?
I'm frustrated as hell with the variant threat. Just when we thought we were seeing a light at the end of the tunnel, along comes threat #2. All I hope is that as you say, full vaccination (which we are racing towards as fast as we can) will confer enough protection to render even the variants into nothing more than a few miserable days in bed. As far as vaccinating the world, I have so many conflicting thoughts that range from selfish to selfless. I find myself enraged with incompetent/corrupt governments who predictably need a bailout to save their own citizens. I don't have any confidence that rescue will come from China or Russia, unless strings are attached. And feeling guilty once again for having the luck to have been born in the west, and feeling we should sacrifice something to ensure poorer countries are saved.
I'm frustrated, too. I think the variants are not as big a threat to those of us who have been vaccinated in wealthier countries, but of course, one cannot rule out unwelcome surprises. Still, the moral case for rushing as much as we can to vaccinate the world is so strong that it's immensely frustrating not to see the effort.
1) To my mind, there's a serious case for postponing vaccination of members of lower-risk populations (say, age ≤24, to pick an arbitrary number) in countries where the incidence is already plummeting, presuming (how realistically?) that supplies could be diverted to protect persons at high risk in global hotspots. Thoughts?
2) What is currently thought about the relationship between overdispersion in COVID-19 transmission and the threshold for herd immunity?
I just look at the Democratic Republic of the Congo in the upper left quadrant and shudder: some 90 million persons, of whom 99.98% haven't received even a single dose, and hardly any cases have been reported. Sitting ducks indeed. (Yes, they have other problems there too.)
I had a very sobering discussion recently with a virologist who thinks that the new variant may potentially create problems in Africa (long technical reasons, and I hope it does not happen) but you are exactly right. If this tips into a threat for places like that, there is just nothing stopping it from burning through very rapidly, and if there is also increased severity, the age structure that has been favorable to lower and middle income countries may not be that protective either.
Patents may not be the only issue, but it is a big issue. And the reason patents have not been suspended is continuous with why rich countries have done very little to help poorer ones develop vaccines and get them into the population. The pandemic has shown us that public health and capitalism dont mix well. For rich countries and their pharma industries the pandemic is a terrific economic opportunity. And to milk this opportunity to the max does not obviously include stopping the pandemic cold. It means follow the money and make sure the money keeps flowing. This is not so e kind of thoughtless mistake. It is the result of well considered policy. Words to the contrary are occasionally uttered for PR (think the inadequate covaxx program), but the aim is to keep supply tight and send it first to those who can pay top dollar and make sure it does not become cheaply available.
as with climate change, my own belief is that with their vaccine inaction, political leaders in the dominant countries are committing crimes against humanity, and should be tried in the Hague.
It is so very hard to keep people as a group focused on something, particularly when the threat feels like it is abating. Thank you for this, we have to keep our eyes on the spiky ball!
What does this mean for figuring out if or when those who have been vaccinated need boosters? What is the likelihood that highly transmissible variants get a leg up on vaccinated immune systems?
My guess is that in most Western countries, that if that becomes an issue, it will be a question and problem for 2022, and once the emergency part is over, we should be able to deal with it with updated boosters. The constraint at the moment isn't in our ability to vaccinate against any new variant, but just lack of vaccines.
After reading your post I asked my friends in China, Japan and Singapore when they can get vaccines, and they replied October, next year, and June. The higher transmissibility is evoking anxiety in me similar to that at the start of the pandemic. Ahhhh why are we always one step behind? (Just venting, you don't have to answer that question)
I agree with the posts of Keith Danner and Norbert. And have the additional thought- Some people see monopoly capitalism as amoral, but, doesn't a situation like this pandemic and our failure to speed production and distribution to the world's population (along with the ultimately even more important issue of climate change) suggest that the extreme capitalism with which we live today is immoral? As a matter of international law and order, what steps can be taken to grab hold of this problem?
It seems like using binary terms (success vs failure or moral vs immoral) just isn't going to work for something as complex as the worldwide response to the pandemic? There are many successes, many failures, and people behaving in moral and immoral ways, all at the same time.
How is it even possible to sum it all up in a meaningful way? You might as well say the answer is 42.
I think we can point to 1.8 billion doses given of COVID-19 vaccines so far as showing some of the strengths of the current systems as a partnership of many companies and governments working together (sometimes).
And beyond that, point to the many missed opportunities to do more.
Politics during evolution of this (and a future) pandemic will have to measure up responses that include an entitlement to live out the last 30 years of life in blissful comfort. Such entitlement, challenged by a mortality rate of *only* 1 percent, may respond along the lines of "Well, there were too many of them anyway". If that theme is probed too deeply, in respect of , say, impoverished & unstable African nations, how will the vaccinated of the West respond to a mortality of 10%?
I do not think we have any idea of the kinds of authoritarian attitude that enliven the "specialness" that defines nations of the Anglosphere and the EU, as well as Japan, China & Israel.
The comparison to the HIV treatment is even more tragic when you consider the vaccine is simply a one-time cost, whereas HIV treatments are for the rest of the patient's life. The US's hoarding of vaccines for people who have to be bribed to get them is shameful.
If Biden announced that Americans only had 2 more weeks to get their first dose, then the rest of the supply would be directed overseas, I think there'd be a spike in interest in getting vaccinated!
Perhaps. One key problem is the supply is constrained, and we are not acting like it is the emergency that it really is. So I hope we do both: redirect excess but, crucially, figure out a way so that it is not some sort of scramble like this with supply constraints causing all these problems.
"every single vaccine out there does a very very good job against preventing severe disease and death"
Would that include the Chinese vaccine? Wondering because China offered it to Taiwan, and Taiwan refusing it. How effective would that vaccine have been in stopping the current spike?
So Taiwan part is a bit complicated for obvious reasons but... In terms of preventing severity and deaths, as far as I can tell from real life data and lab studies and trials (where we have less clear data) the two vaccines from China do work fairly well, though they seem to need the booster (unlike the mRNA vaccines for example that do help both symptomatic breakthroughs and deaths even after a single dose, but more so after the booster). The problem with not being as good in preventing breakthrough cases (seems about 50% compared to 75-80-95% for the others depending on where someone is on the process with the boosters/timing) is that transmission chains are probably not cut off as effectively (though scant data on transmission in breakthrough cases from any vaccine so it may well be that they do a good job there as well). Still, though, if my loved ones were in a country with nothing but the either Chinese vaccine, I would not hesitate to recommend that they get both shots. It's possible they would eventually need boosters, but that would greatly diminish the chances of death and severe disease.
Thank you!
I did see a couple articles about a Chinese vaccine working well in Indonesia and Brazil, after scrolling down a bunch of articles questioning their effectiveness.
To me the Taiwan situation seems totally self inflicted. If they had accepted the Chinese vaccines instead of playing politics, they would have been in a much better situation. Instead i hear they are pinning their hopes on their own vaccine. Which is still in phase 2 trials.
To be fair, would you accept vaccine from someone who is constantly pointing a gun to your head? Taiwan has ordered vaccines from Moderna and AZ and also participated in COVAX. Those vaccines should be enough to cover at least the front line medical workers and also the elderly and high-risk groups. Of course due to the global shortage, vaccines have been slow to arrive. Developing home-grown vaccines is also a necessity, considering the fact that Taiwan has always been isolated in the world due to pressure from China. Taiwan tried very hard to prevent a domestic outbreak via border control, in the hope that virus can be block out until there are vaccines available. I guess the goal is partially achieved since there are several vaccines on the market now, just not enough doses for everyone. I still consider this to be extremely lucky, comparing to the alternative which is experiencing outbreaks last year and having to wait for more than a year to have access to vaccines.
As zeynep said, Taiwan’s situation is complicated. Saying Taiwan is playing politics and the situation is self-inflicted is really quite unfair. For someone whose country is not under constant existential threat from their authoritarian neighbor, it might be hard to understand why accepting the so call “help” from China is not as simple as it seems. I sincerely hope you could try to understand the nuances better before jumping into conclusions.
If the health of the people I'm responsible for is on the line, then yes, I'd swallow my pride and accept any help i could get.
So in the end it's really not that complicated, it's (green) party politics. Not that I'd know what the kmt would have done of course. Maybe they'd pick ideology over the wellbeing of their people too.
Your argument is based on the assumption that any promise CCP made is actually credible, which is quite naive if not cynical coming from a person claiming to know the nuance of the situation. It is also sad that you live in a reality where begging an authoritarian state who commits genocide of its own people is the only option. Thankfully Taiwan has friends like Japan who understand the difficulty Taiwan is facing and sent help promptly. Taiwanese people will forever be grateful for this.
Regarding the politics behind whom Taiwan would accepts help from, it is explained by someone much more eloquent than me in this thread: https://twitter.com/lnachman32/status/1400414046197731328
To quote from the thread above, “It is also crucial to remember the PRC offering vaccines to Taiwan is akin to mocking someone while bullying them; the PRC is solely responsible for blocking Taiwan's access to the WHO and is interfering with their vaccine supply deals.” If anyone is to be blamed for playing politics at the expense of people’s health, it would be China.
I wasn’t going to reply to your post again originally, because trying to convince someone who believes in China’s narrative regarding Taiwan is often an effort in vain. However, today is June 4th, a date that China is trying to erase from history. If people in Hong Kong can hold a vigil for Tiananmen Massacre under the threat of jail time, then maybe I should try harder.
#勿忘六四
Interesting thread from Lev Nachman, thanks. It affirms to me what i mentioned, it's (green) party politics.
Btw, where did I claim to know the nuance of the situation?
This is a much more "practical" essay than the NYT version because it focus the solution on producing more vaccines instead of redistributing existing doses. As a species we are real good at science, engineering and industrial production but not so much at equitable distribution. We should go with our strengths and not our weaknesses.
Vaccine production is a complicated thing, and it really requires leadership and money and industry cooperation/compulsion and a lot of things. We're letting it not happen simply because we are not trying hard enough.
If this site is correct, we will manufacture 12 billion doses in 2021. There is no reason why at least the amount won't be produced in 2022. I haven't seen evidence that it is possible to produce more vaccines. Since there is about 8 billion people this should be enough vaccines. Getting them into arms will be the problem.
https://launchandscalefaster.org/covid-19/vaccinemanufacturing
Agreed that we *must* spread vaccine access as widely as possible. Even if only considering self-interest, not doing so is like fire-proofing your house but ignoring the flammability of the row house that shares a wall with yours.
Agreed that much of the inadequacy of the response comes from thinking of one's nation as an island, US government policies forbidding the government from negotiating prices with pharmaceutical companies, etc.
But a piece of it is that some nations' leaders are just not confronting the situation at all. From Bloomberg Prognosis Coronavirus Daily of May 27, 2021:
"Some nations such as Burkina Faso and Chad have yet to vaccinate any of their citizens, and other countries including Turkmenistan and North Korea have been slow to do so. But at least they have accepted the need for inoculations. Tanzania, Burundi and Eritrea so far haven’t even done that.
"That’s not just a threat to the 75 million people who live in those countries. It’s also a threat to the world. If the virus is allowed to continue to circulate in pockets of population anywhere, it’s likely to mutate. When people travel, they carry it with them, and those mutations can sometimes evade antibodies produced in reaction to vaccines more easily than earlier versions of the virus.
"Already, tests on travelers from Tanzania who arrived in Angola have found what South African genome-sequencing institute Krisp described as the most mutated variant yet."
(I have no way to fact-check this, and certainly don't want to diss other nations whose challenges I don't understand. But we have certainly seen-- & experienced first hand-- national leaders just refusing to acknowledge epidemics. And it does seem like willful refusal is the royal road to mutations that could be beyond our vaccines' efficacy.)
That is part of the picture, though I think the moral case is strong enough and I don't feel like the vaccinated in wealthy countries face an immediate threat, and I worry that emphasizing the threat part may not be enough or even wise partly because what if it turns out not to be threat?
Tanzania may now be coming around on the need for vaccinations.
https://www.bbc.com/news/world-africa-56944399
I'm frustrated as hell with the variant threat. Just when we thought we were seeing a light at the end of the tunnel, along comes threat #2. All I hope is that as you say, full vaccination (which we are racing towards as fast as we can) will confer enough protection to render even the variants into nothing more than a few miserable days in bed. As far as vaccinating the world, I have so many conflicting thoughts that range from selfish to selfless. I find myself enraged with incompetent/corrupt governments who predictably need a bailout to save their own citizens. I don't have any confidence that rescue will come from China or Russia, unless strings are attached. And feeling guilty once again for having the luck to have been born in the west, and feeling we should sacrifice something to ensure poorer countries are saved.
I'm frustrated, too. I think the variants are not as big a threat to those of us who have been vaccinated in wealthier countries, but of course, one cannot rule out unwelcome surprises. Still, the moral case for rushing as much as we can to vaccinate the world is so strong that it's immensely frustrating not to see the effort.
Sobering, thank you.
1) To my mind, there's a serious case for postponing vaccination of members of lower-risk populations (say, age ≤24, to pick an arbitrary number) in countries where the incidence is already plummeting, presuming (how realistically?) that supplies could be diverted to protect persons at high risk in global hotspots. Thoughts?
2) What is currently thought about the relationship between overdispersion in COVID-19 transmission and the threshold for herd immunity?
I just look at the Democratic Republic of the Congo in the upper left quadrant and shudder: some 90 million persons, of whom 99.98% haven't received even a single dose, and hardly any cases have been reported. Sitting ducks indeed. (Yes, they have other problems there too.)
https://www.facebook.com/alan.yoshioka/posts/10159263119015516
I had a very sobering discussion recently with a virologist who thinks that the new variant may potentially create problems in Africa (long technical reasons, and I hope it does not happen) but you are exactly right. If this tips into a threat for places like that, there is just nothing stopping it from burning through very rapidly, and if there is also increased severity, the age structure that has been favorable to lower and middle income countries may not be that protective either.
Patents may not be the only issue, but it is a big issue. And the reason patents have not been suspended is continuous with why rich countries have done very little to help poorer ones develop vaccines and get them into the population. The pandemic has shown us that public health and capitalism dont mix well. For rich countries and their pharma industries the pandemic is a terrific economic opportunity. And to milk this opportunity to the max does not obviously include stopping the pandemic cold. It means follow the money and make sure the money keeps flowing. This is not so e kind of thoughtless mistake. It is the result of well considered policy. Words to the contrary are occasionally uttered for PR (think the inadequate covaxx program), but the aim is to keep supply tight and send it first to those who can pay top dollar and make sure it does not become cheaply available.
as with climate change, my own belief is that with their vaccine inaction, political leaders in the dominant countries are committing crimes against humanity, and should be tried in the Hague.
It is so very hard to keep people as a group focused on something, particularly when the threat feels like it is abating. Thank you for this, we have to keep our eyes on the spiky ball!
That was an especially sober read. Don't see any fault in your reasoning, but a gloomy outlook indeed.
It is gloomy. One can hope that we get lucky, but as they say, hope is not a plan.
What does this mean for figuring out if or when those who have been vaccinated need boosters? What is the likelihood that highly transmissible variants get a leg up on vaccinated immune systems?
My guess is that in most Western countries, that if that becomes an issue, it will be a question and problem for 2022, and once the emergency part is over, we should be able to deal with it with updated boosters. The constraint at the moment isn't in our ability to vaccinate against any new variant, but just lack of vaccines.
After reading your post I asked my friends in China, Japan and Singapore when they can get vaccines, and they replied October, next year, and June. The higher transmissibility is evoking anxiety in me similar to that at the start of the pandemic. Ahhhh why are we always one step behind? (Just venting, you don't have to answer that question)
I agree with the posts of Keith Danner and Norbert. And have the additional thought- Some people see monopoly capitalism as amoral, but, doesn't a situation like this pandemic and our failure to speed production and distribution to the world's population (along with the ultimately even more important issue of climate change) suggest that the extreme capitalism with which we live today is immoral? As a matter of international law and order, what steps can be taken to grab hold of this problem?
It seems like using binary terms (success vs failure or moral vs immoral) just isn't going to work for something as complex as the worldwide response to the pandemic? There are many successes, many failures, and people behaving in moral and immoral ways, all at the same time.
How is it even possible to sum it all up in a meaningful way? You might as well say the answer is 42.
I think we can point to 1.8 billion doses given of COVID-19 vaccines so far as showing some of the strengths of the current systems as a partnership of many companies and governments working together (sometimes).
And beyond that, point to the many missed opportunities to do more.
perhaps so.
Politics during evolution of this (and a future) pandemic will have to measure up responses that include an entitlement to live out the last 30 years of life in blissful comfort. Such entitlement, challenged by a mortality rate of *only* 1 percent, may respond along the lines of "Well, there were too many of them anyway". If that theme is probed too deeply, in respect of , say, impoverished & unstable African nations, how will the vaccinated of the West respond to a mortality of 10%?
I do not think we have any idea of the kinds of authoritarian attitude that enliven the "specialness" that defines nations of the Anglosphere and the EU, as well as Japan, China & Israel.