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Why a coronavirus vaccine could take way longer than a year (nationalgeographic.com)
82 points by pseudolus on April 10, 2020 | hide | past | favorite | 94 comments



I also wonder about deployment of said vaccine.

A couple thoughts spring to mind including both your standard, “it takes a while to get everyone in to get one of these,” coupled with a growing distrust of expert medical advice.

A member of my own extended family is still convinced this is a giant conspiracy by [insert flavor of the week here] to [insert flavor of the week here]. I doubt that they get the vaccine no matter how fast it’s available.

I know the goal of vaccines isn’t realistically 100% deployment, but it feels there is going to be some lag here too.

My hunch is a return to normalcy looks more like everyone wearing masks in public for the next few years, with increased distancing in confined spaces (more sweeping WFH policies!) while we wait for adoption of the vaccine.


A big factor is going to be how effective the vaccine is and what R0 will end up being. One of the key factors in determining the percentage of the population which needs to be vaccination is how quickly it spreads and this is definitely not on the favorable side of that range.


The hope is that a yearly vaccine will Protect enough to reduce mortality like we do with flu shots. Both R0 and milder symptoms of you are infected. Both of these fees into each other. I do think that mask culture is in our Kong term future.


Ditto: this spreads well enough that I’m not expecting a vaccine to be enough at first, although there will be a huge number of very motivated people working to improve effectiveness over time just as with previous diseases which are now almost forgotten.


"I doubt that they get the vaccine no matter how fast it’s available."

A lot of anti-vaxxers may start begging for or even insisting on getting the vaccine once they see enough unvaccinated people around them dropping like flies.


I wish that was true but the flare-up of conspiracist nonsense on my neighborhood mailing list today makes that pretty hard to believe. Maybe if Facebook shutdown.


People are not going to be 'dropping like flies'. I doubt anti vaxxers jump for the COVID-19 vaccine.


i hadn't thought about anti-vaxxers. it's true that their perspective might change with this pandemic and if we are able to make a vaccine.

the world is indeed not going to be the same.


However, it's critically important that we don't enable the anti-vaxxers by rushing an unsafe vaccine.


True. Don't want to give anyone monkey virus or anything.


Never gonna happen. I could be a good sport for another month, since they’re asking nicely. Beyond that, the risk from creeping fascism quickly outpaces the risk from any disease that fits these observations, and I don’t care if you believe it or not. Probably half of the country won’t put up with a shutdown for even that long.


I don’t think we’d stay locked down for so long. Even with the world on lockdown, the virus still spreads. Eventually I’d think we’d reach the 60–70% infected figure which is said to be enough for herd immunity. At that point and even without a vaccine it’s probably be safe to lift most or all restrictions while we’re looking for a vaccine. As I understand it the lockdowns are to avoid an unmanageable peak in hospital use, not to avoid most people getting the virus.

I wonder if China will strictly prohibit the hunting and eating of wild animals as a result from this outbreak and the considerable international pressure, or if it’ll keep going.


immunization is not something your body obtains forever - might only be a few months. If the spread is too slow we'll never reach immunization. Instead the virus will take its rounds repeatedly infecting people.

Also the 60/70% figure assumes an R0 of about 3. It seems though that it is >5. Then you would need a herd immunization of >80%.


Well at 60%-70% infected you also reach the million dead figure.


Ok, but gradually. If everyone gets it at the same time, people who would have normally made it would die because contention over the medical resources.


马牛羊 鸡犬豕

此六畜 人所饲

Horse, ox, sheep, fowl, dog, pig

These six animals are those which men keep


Isolation of the elderly and at-risk groups until either vaccine or herd immunity whilst increasing the stockpiles of PPE and ventilators seem like the only real strategy at the moment.


Yes, to be fair that seems to be the likely plan. It’s only crackpots like Bill Gates who are suggesting we go for the vaccine instead. Which, in his defense, might make sense to keep working on as a hedge.


I still wish they would recommend old and immunocompromised to stay locked up and let the young and fit out. It’s the only way out of the situation.


The UK was going to that but the numbers of dead / ICU treated looked too high.


Closing schools before the summer break might end up actually leading to more deaths, because young folks would develop immunity (relatively) safely while among their peers. Although this probably applies more to colleges and boarding schools. And if anything the less healthy teachers could have been sent home.


Young folks in schools are in constant contact with old folks. Whatever is spreading in school does not stay contained there.

The thing about schools is that thy are super effective at spreading everything.


I'm alarmed at the glee with which Americans are giving up their constitutional rights and calling for more restrictions. America is not Asia, or Europe. This is a frontier nation, and we must keep it that way.

"Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety."


Which frontier would that be?


Forgive my slight exaggeration for dramatic effect. But the point still stands.


Spot on. I’m happy that so many folks are using the First Amendment to demand liberty in (often) civil discussions online, but to quote the immortal Dave Chappelle, “The Second Amendment is just in case the First one doesn’t work out.”


What rights do Americans have, which you don't think Europeans have exactly?

You're implying America is more free than other parts of the world, but it just isn't.


It’s not so much that we enjoy more rights, it’s that the government is powerless to take away those rights which we prefer to keep. You can believe whatever you want, but that’s very true here, and not at all true in many other places.


Do you realise most of Europe has the same freedoms as America, including constitutional rights? America isn't the only place with freedom.


Most of Europe has constitutional rights... Unless those rights are icky. For instance, freedom of speech - unless it disparages a religion, or denies the Holocaust, or...


Europe still incarcerated significantly less people. And you won't get arrested for loitering which in practical terms is freedom of movement - current situation excepted.


Funny thing it, the Benjamin Franklin quote in the context did not meant what you think it meant at all. It was said when a family was trying to one-time-payment their way out of taxation and was pro-goverment got to rule.


There are still frontier nations out there. Russia, Greenland, Outback Australia, the Canadian Territories. Perhaps Alaska.

But the continental US is a developed land with dense cities. Your idea of what your liberties should be don't justify the drastic externalities you will inflict on your neighbors.


There's damn few places in the US with population density akin to Europe or Asia.

The last big city I lived in, Fresno, is low density sprawl. The culture there is like half a million cowboys decided to move to the suburbs. They put on their cowboy crap to go to concerts at their major park. It's bizarre.

We also generally have shit public transit.

You cannot tell me that lock down is the only possible way to handle the pandemic in the incredibly low average population density of most of the US. Give me a break.


Fresno, CA has population density of 1,761.69/km2. That's not too far from Daegu, South Korea (2,818/km2), where 6,807 were infected so far and 142 people died. They stopped it only through really aggressive testing and contact tracing.

I'm so tired of this America-is-so-special argument. Freaking Mississippi has 2,260 patients now. Now what?


Mississippi is one of the poorest places in the US. It's got problems akin to a third world country.

Now what? I'm sure you think that's a rhetorical question, but today is your unlucky day because I've spent the last 19 years getting healthier while the world says it cannot be done and generally acts like a butt to me.

Now we actively create a world where public bathrooms aren't health hazards to use at all. I propose we get Walmart to write that handbook. Their bathrooms are generally pretty damn good and there are lots of establishments where I don't want to set foot in their restroom.

Now we create a world where it's normal to call ahead or order online and pick-up instead of dining out or milling about waiting for our order because we all just showed up and then ordered.

Now we create cultural norms where you don't blow your nose at the god-damned conference table or restaurant table, jebus.

Now we create cultural norms like bowing instead of shaking hands.

Now we create architectural standards like using copper for stair rails because it's antimicrobial.

Making people a prisoner of their homes while our economy gets flushed down the toilet isn't our only option. That assumption is ignorant on the face of it. There's always more than one way to solve a problem.


I genuinely agree that each of them is a noble cause that will make America a better place, but unfortunately, none of them are an answer to "We have a pandemic going on here, now what?"

First you make a absurd assertion that most of the US has much lower population density than Europe or Asia - that's true only if you measure by land area, not people, but then it's irrelevant: land doesn't contact COVID19, people do. In any case, it stopped being relevant about two weeks ago when the US overtook Italy - America's lower population density clearly didn't stop the disease.

There's a crisis going on, and I'm sorry that you will likely be affected much more by it than I will, and I agree that it's a social injustice that should be addressed in the long term, but that doesn't mean you can just wave away the crisis because you have a moral high ground. Coronavirus doesn't care.


My understanding is that it's really bad in New York, one of the few places with population density similar to Europe.

I have no idea why you assume I will be impacted more than you. Although dirt poor, I already do remote work from home and hardly go out. My life has hardly been impacted at all. A few meetings I attend were cancelled (and now people are answering my emails for a change).

The pandemic has mostly had a positive impact on my life because the rest of the world is practicing germ control for a change and pollution levels have dropped dramatically.

I mean feel free to support my Patreon or otherwise kick a few bucks my way. I can always use more cash. But my kids sit around gleefully announcing "Coronavirus is the best thing that's ever happened to our lives" and giggling about all the free games they are downloading.


"Now what ?" - Now we practice common sense social distancing and wait for the virus to take its course. No need to overreact and go full China style authoritarian lockdown. And yes, America is exceptional even if it annoys you.


America is not going to adopt common sense social distancing enough to be able to let virus run its course. That would requires massive cooperation in good faith from both parties and most states. Looking how things go on, it won't happen.

You are more likely to see epidemic being used to disadvantage other side, to make voting harder for this or that group and massive amount of lies then cooperation in good faith.

Which would had negative implications for democracies in rest of world too.


You'd be surprised. There's vast land west of the Mississippi that is still rugged and relatively undeveloped. I speak more in terms of the frontier mindset, but I digress.


> Your idea of what your liberties should be don't justify the drastic externalities you will inflict on your neighbors.

With respect, that’s up to my neighbors, not the government.


We don't need a vaccine specifically. We need a treatment of one form or another that drops severity / mortality to acceptable levels. A vaccine is one option, but far from the only.


Exactly this , vaccination is a long term solution, right now we just need to turn a deadly disease into a manageable one.


Why coronavirus vaccine public availability in the US could take way longer than a year.

Not everybody cares about formal clinical trials, especially when it affects their bottom line. The global regulatory perspective is not even mentioned in the article.


In 1976 we rushed a vaccine without adequate safety tests (formal clinical trials) and more people were hurt by the unsafe vaccine than would have been sick without the vaccine.

https://en.wikipedia.org/wiki/1976_swine_flu_outbreak


You know, what would be cool is if we'd managed to make some progress on immunology and pharmacology in the past 40+ years, such that we could avoid mistakes like that.


It'd be cool if you could always deliver a bug free software program without thorough testing, on-time, on-scope, 100% of the time too... that'd be really nice. It's just not likely.

In software there's things your overlook, etc... I'm guessing biological 'hacking' is the same, I'd imagine making a vaccine is similar in a lot of ways to coding - lots of trial/error, except errors = dead people.


This is always a risk, but it can be a calculated risk.


No it can't be a calculated risk because we don't know the probability distribution without the proper clinical trials.


It would be a total disaster if the vaccine made things worse; it'd destroy trust in governments and vaccinations and our lock-downs would have been potentially worthless. It has to either work or we have to accept it'll take longer and deal accordingly. The risks of getting it wrong and implementing vaccination programs regardless are literally horrifying.


A death of a vaccine or a death of COVID-19 is still a death. We should act according to reduce the total number of deaths, taking into the probability we could be wrong (and if you say that probability can ever be zero, then I don’t believe you). A 0.01% chance we could kill more with the vaccine than without is not an excuse to not deploy it IF the alternative means more likely much higher deaths.

But luckily we don’t have a binary choice. A dead vaccine is usually much safer. We can start the vaccine to high risk groups early and watch carefully, expanding access as results come in. We’ve already started clinical human trials a month ago.


The 'calculated risk' you talk of is such a bad way to evaluate the risk of a vaccine making things worse that I shudder to think of the consequences should such an attitude be adopted. Please, just stop, and read about the consequences of getting a vaccine wrong.

https://www.pnas.org/content/early/2020/03/27/2005456117


I am aware.


Then you must be 'aware' that we can't simply calculate a probability of whether the vaccine will be worse or not. You either take a real gamble that it won't be, or you do the sane thing and actually observe long term effects in trials. There's no possible way you can assign probabilities like you can a coin flip - each vaccine and disease is far too unique and unpredictable.


Actually, you are taking a giant gamble with not vaccinating as well. You can, in fact, assign probabilities based on historical data. Epidemiologists do this all the time. To pretend probabilities don’t work in epidemiology means you don’t understand either probability or epidemiology.

There is no safe option. Every option will kill some people. Your goal is to minimize the expected number of deaths as best you can. That’s just the way it is. That may mean doing nothing OR it may mean finding a way to accelerate a vaccine program OR some combination of expanded early access with careful monitoring to stepped expansion of the treatment access.


This conversation has stuck with me for several days, and I'd like to recap my thoughts on it.

I think this highlights the difference between risk and uncertainty. Risk is something calculable. Uncertainty is either incalculable or the error bars are so wide that it is practically incalculable.

I, for example, am willing to take a calculated risk and ride a motorcycle. It's a fun, economical way of traveling. I am not willing to ride a motorcycle I am unfamiliar with without a close inspection. Maybe an unfamiliar bike is in complete operational order. Maybe it has a crack in a frame wield and the frame may snap during normal operations. The error bars for what can go wrong on an uninspected motorcycle are too wide and it introduces a level of uncertainty I am not comfortable with.

The downsides of a bad vaccine have been shown multiple times in multiple places. It's _very_ bad. I'm unwilling to accept uncertainty when the downside is so large.


>more people were hurt by the unsafe vaccine than would have been sick without the vaccine.

It would be naive to think that a majority of governments are primarily concerned with not hurting people, especially when stakes are high.


HN hive mind: At what point are there sufficient numbers of survivors to establish herd immunity and get some semblance of normalcy?


I think we need to shoot for "a new normal" where better cultural germ control practices are a more normal part of the world.

In which case, we don't need to shoot for herd immunity. We just need to shoot for "Hey, stupid, don't do stuff like blow your nose at the restaurant table or conference table, good god."


Or: “Don’t show up at the office sick, you’re not ‘dedicated’, you’re just an asshole.”


I always wondered about this. For COVID, the recommendation is that you have to be symptom free for 14 days before you are considered not contagious. Adding another 7-10 days of actual disease, you will be asking people to take 21-24 days off for a disease ? That is simply not accepted in American corporate culture, where many mothers return to work 2 weeks after giving birth


Then we need to start accepting it. Those that don't will be the assholes who kill their employees and co-workers. Legislating sick time off, like every other developed country in the world and many that aren't, is what we really need to do. Along with healthcare for everyone. But it all starts by not accepting the assholes at the office trying to kill you as normal.


Realistically, I mean symptomatic (coughing and sneezing). It’s not perfect but people are typically most contagious while they have symptoms.

Plus, when you don’t need bed rest, you can still do any work that can reasonably be done from a remote location. Most companies haven’t done much to push that boundary in the past, and that’s a good idea, but it’s not a complete solution by any means.


Are there any studies that prove that asymptomatic people are less contagious ?


Filed under "People I would like to slap, except it involves touching them."

Yeah.

But in order to enforce that, we need different sick leave and health care policies and ...stuff.

And that's very much a world I would like to see born of this mess, like a Phoenix rising from the ashes.


That’s really the only hope I’m clinging to at this point, that over the next hundred-plus years the cultural changes might be worth all the damage.


Let's shoot for a five year time frame for some major cultural changes and I'm in.

Let's start on fostering them today. If we jump on it, we could flatten the curve with less economic pain this very year.


That ship may have sailed, unfortunately.


Let's build another.


The threshold is 1 - 1 / R_0 [1]. Using the commonly quoted R_0 ~ 2.5, that's 60%. The highest estimate I've seen is R_0 ~ 5.7 [2], in which case more than 80% of the population would need to be immune.

[1] https://en.wikipedia.org/wiki/Herd_immunity#Mechanics

[2] https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article


At about 60-80% immunity you gain herd immunity and the expected infection chain length is less than 2.


The people talking about herd immunity are talking about 60% to 70% of the population having had, and survived, covid-19.

The trouble is how to achieve that without killing 10% of everyone over 50, or anyone with comorbidities.


I remember reading 70%.


Even if the vaccine is available now, it took more than a year to mass-produce it and distribute to everyone in the world.


English does have a subjunctive mood for counterfactuals like this, to keep people from thinking that you mean the vaccine actually is available or was mass-produced in the past. The sentence would be more grammatical like this:

"Even if the vaccine were available now, it would take more than a year to mass-produce it..."


Thanks. as you clearly see, English is not my native language.


I think the OP may have just made a mistake. As a native speaker, his sentence is wrong. "It took" is perfect paste tense. I think their intent was to say "It will have taken, (future perfect), or "it will take" (simple future).


"It will take" would work fine if he had said "Once the vaccine is available, it will take...", because that doesn't imply the vaccine is available now.

"Even if the vaccine is available, it will take" is wrong because the vaccine is not available. That means you need "would" instead of "will", and ideally a past subjunctive verb in the if-clause. "If it were available, it would take time to distribute."

https://en.wikipedia.org/wiki/English_conditional_sentences#...


It would be a good start if we vaccinated high risk groups. They account for almost all the severe cases.


[flagged]


That was one surreal thread, if you're talking about the recent AMA with Gates. Why he decided to throw a steak into a room full of rabid pit bulls, I can't imagine.


Hadn't seen or heard of that, for others:

https://www.reddit.com/r/Coronavirus/comments/fksnbf/im_bill...


This was talked about and explained in January.

What we need to be discussing is why we are still discussing it.

There may never be a vaccine. Anyone who says 'until a vaccine' or 'when a vaccine' is not worth talking to.


Basically every country in the world is waiting for it, you can't realistically expect the virus to die down itself now that it's reached every country.


That's all well and good, but you can't realistically expect a vaccine to be created. It MIGHT be created, or it might not. There are many viruses for which we've tried and failed to produce effective vaccines.


To be fair, the blend of incentive structure and technology is a little different now.


Given that people survive it and then have large amount of antibodies, it seems likely that we can create a vaccine. While some viruses are incredibly challenging to make a vaccine for, like HIV and the flu due to the mutation rate. The coronavirus has a slower mutation rate than the flu. It may be the case that we end up needing yearly or every two year booster shots. But, the most frequent stumbling block for vaccine development is funding, which won’t be a problem for coronavirus. MERS and SARS both had promising vaccine research that were shelved because the infections died out.


I don't have numbers, but it's mentioned that many recovered patients have low amounts of antibodies and immunity could be more a temporary affair.


> There are many viruses for which we've tried and failed to produce effective vaccines.

This is the first time in modern history where every developed country in the world has top researchers expediting work on a vaccine. A virus has never been the world's top economic and political issue until now. Comparing it to vaccine research on other viruses is irrelevant.


Not true at all. There are issues with making vaccines for some viruses that are well-understood and seemingly quite intractable. And what about HIV? We've spent far more resources trying to find a cure for that, and although some good treatments exist, there is no vaccine.


People don’t survive HIV and it mutates incredibly quickly.


Is it the mutation rate that makes it challenging? Or something else, line how it defeats the immune system?


Yeah HIV mutates extremely quickly. Over time people develope multiple strains circulating. Directly targets immune cells. Also I believe it tends to stitch itself into cells DNA and remain latent indeterminate amounts of time.


Mutation rate combined with the fact that no one has ever recovered from aids. Vaccines typically “teach” the body how to fend off a virus, but we’ve never seen someone do that once infected.




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