My vaccine crackpottery: a confession
Thursday, December 31st, 2020I hope everyone is enjoying a New Years’ as festive as the circumstances allow!
I’ve heard from a bunch of you awaiting my next post on the continuum hypothesis, and it’s a-comin’, but I confess the new, faster-spreading covid variant is giving me the same sinking feeling that Covid 1.0 gave me in late February, making it really hard to think about the eternal. (For perspectives on Covid 2.0 from individuals who acquitted themselves well with their early warnings about Covid 1.0, see for example this by Jacob Falkovich, or this by Zvi Mowshowitz.)
So on that note: do you hold any opinions, on factual matters of practical importance, that most everyone around you sharply disagrees with? Opinions that those who you respect consider ignorant, naïve, imprudent, and well outside your sphere of expertise? Opinions that, nevertheless, you simply continue to hold, because you’ve learned that, unless and until someone shows you the light, you can no more will yourself to change what you think about the matter than change your blood type?
I try to have as few such opinions as possible. Having run Shtetl-Optimized for fifteen years, I’m acutely aware of the success rate of those autodidacts who think they’ve solved P versus NP or quantum gravity or whatever. It’s basically zero out of hundreds—and why wouldn’t it be?
And yet there’s one issue where I feel myself in the unhappy epistemic situation of those amateurs, spamming the professors in all-caps. So, OK, here it is:
I think that, in a well-run civilization, the first covid vaccines would’ve been tested and approved by around March or April 2020, while mass-manufacturing simultaneously ramped up with trillions of dollars’ investment. I think almost everyone on earth could have, and should have, already been vaccinated by now. I think a faster, “WWII-style” approach would’ve saved millions of lives, prevented economic destruction, and carried negligible risks compared to its benefits. I think this will be clear to future generations, who’ll write PhD theses exploring how it was possible that we invented multiple effective covid vaccines in mere days or weeks, but then simply sat on those vaccines for a year, ticking off boxes called “Phase I,” “Phase II,” etc. while civilization hung in the balance.
I’ve said similar things, on this blog and elsewhere, since the beginning of the pandemic, but part of me kept expecting events to teach me why I was wrong. Instead events—including the staggering cost of delay, the spectacular failures of institutional authorities to adapt to the scientific realities of covid, and the long-awaited finding that all the major vaccines safely work (some better than others), just like the experts predicted back in February—all this only made me more confident of my original, stupid and naïve position.
I’m saying all this—clearly enough that no one will misunderstand—but I’m also scared to say it. I’m scared because it sounds too much like colossal ingratitude, like Monday-morning quarterbacking of one of the great heroic achievements of our era by someone who played no part in it.
Let’s be clear: the ~11 months that it took to get from sequencing the novel coronavirus, to approving and mass-manufacturing vaccines, is a world record, soundly beating the previous record of 4 years. Nobel Prizes and billions of dollars are the least that those who made it happen deserve. Eternal praise is especially due to those like Katalin Karikó, who risked their careers in the decades before covid to do the basic research on mRNA delivery that made the development of these mRNA vaccines so blindingly fast.
Furthermore, I could easily believe that there’s no one agent—neither Pfizer nor BioNTech nor Moderna, neither the CDC nor FDA nor other health or regulatory agencies, neither Bill Gates nor Moncef Slaoui—who could’ve unilaterally sped things up very much. If one of them tried, they would’ve simply been ostracized by the other parts of the system, and they probably all understood that. It might have taken a whole different civilization, with different attitudes about utility and risk.
And yet the fact remains that, historic though it was, a one-to-two-year turnaround time wasn’t nearly good enough. Especially once we factor in the faster-spreading variant, by the time we’ve vaccinated everyone, we’ll already be a large fraction of the way to herd immunity and to the vaccine losing its purpose. For all the advances in civilization, from believing in demonic spirits all the way to understanding mRNA at a machine-code level of detail, covid is running wild much like it would have back in the Middle Ages—partly, yes, because modern transportation helps it spread, but partly also because our political and regulatory and public-health tools have lagged so breathtakingly behind our knowledge of molecular biology.
What could’ve been done faster? For starters, as I said back in March, we could’ve had human challenge trials with willing volunteers, of whom there were tens of thousands. We could’ve started mass-manufacturing months earlier, with funding commensurate with the problem’s scale (think trillions, not billions). Today, we could give as many people as possible the first doses (which apparently already provide something like ~80% protection) before circling back to give the second doses (which boost the protection as high as ~95%). We could distribute the vaccines that are now sitting in warehouses, spoiling, while people in the distribution chain take off for the holidays—but that’s such low-hanging fruit that it feels unsporting even to mention it.
Let me now respond to three counterarguments that would surely come up in the comments if I didn’t address them.
- The Argument from Actual Risk. Every time this subject arises, someone patiently explains to me that, since a vaccine gets administered to billions of healthy people, the standards for its safety and efficacy need to be even higher than they are for ordinary medicines. Of course that’s true, and it strikes me as an excellent reason not to inject people with a completely untested vaccine! All I ask is that the people who are, or could be, harmed by a faulty vaccine, be weighed on the same moral scale as the people harmed by covid itself. As an example, we know that the Phase III clinical trials were repeatedly halted for days or weeks because of a single participant developing strange symptoms—often a participant who’d received the placebo rather than the actual vaccine! That person matters. Any future vaccine recipient who might develop similar symptoms matters. But the 10,000 people who die of covid every single day we delay, along with the hundreds of millions more impoverished, kept out of school, etc., matter equally. If we threw them all onto the same utilitarian scale, would we be making the same tradeoffs that we are now? I feel like the question answers itself.
- The Argument from Perceived Risk. Even with all the testing that’s been done, somewhere between 16% and 40% of Americans (depending on which poll you believe) say that they’ll refuse to get a covid vaccine, often because of anti-vaxx conspiracy theories. How much higher would the percentage be had the vaccines been rushed out in a month or two? And of course, if not enough people get vaccinated, then R0 remains above 1 and the public-health campaign is a failure. In this way of thinking, we need three phases of clinical trials the same way we need everyone to take off their shoes at airport security: it might not prevent a single terrorist, but the masses will be too scared to get on the planes if we don’t. To me, this (if true) only underscores my broader point, that the year-long delay in getting vaccines out represents a failure of our entire civilization, rather than a failure of any one agent. But also: people’s membership in the pro- or anti-vaxx camps is not static. The percentage saying they’ll get a covid vaccine seems to have already gone up, as a formerly abstract question becomes a stark choice between wallowing in delusions and getting a deadly disease, or accepting reality and not getting it. So while the Phase III trials were still underway—when the vaccines were already known to be safe, and experts thought it much more likely than not that they’d work—would it have been such a disaster to let Pfizer and Moderna sell the vaccines, for a hefty profit, to those who wanted them? With the hope that, just like with the iPhone or any other successful consumer product, satisfied early adopters would inspire the more reticent to get in line too?
- The Argument from Trump. Now for the most awkward counterargument, which I’d like to address head-on rather than dodge. If the vaccines had been approved faster in the US, it would’ve looked to many like Trump deserved credit for it, and he might well have been reelected. And devastating though covid has been, Trump is plausibly worse! Here’s my response: Trump has the mentality of a toddler, albeit with curiosity swapped out for cruelty and vindictiveness. His and his cronies’ impulsivity, self-centeredness, and incompetence are likely responsible for at least ~200,000 of the 330,000 Americans now dead from covid. But, yes, reversing his previous anti-vaxx stance, Trump did say that he wanted to see a covid vaccine in months, just like I’ve said. Does it make me uncomfortable to have America’s worst president in my “camp”? Only a little, because I have no problem admitting that sometimes toddlers are right and experts are wrong. The solution, I’d say, is not to put toddlers in charge of the government! As should be obvious by now—indeed, as should’ve been obvious back in 2016—that solution has some exceedingly severe downsides. The solution, rather, is to work for a world where experts are unafraid to speak bluntly, so that it never falls to a mental toddler to say what the experts can’t say without jeopardizing their careers.
Anyway, despite everything I’ve written, considerations of Aumann’s Agreement Theorem still lead me to believe there’s an excellent chance that I’m wrong, and the vaccines couldn’t realistically have been rolled out any faster. The trouble is, I don’t understand why. And I don’t understand why compressing this process, from a year or two to at most a month or two, shouldn’t be civilization’s most urgent priority ahead of the next pandemic. So go ahead, explain it to me! I’ll be eternally grateful to whoever makes me retract this post in shame.
Update (Jan. 1, 2021): If you want a sense of the on-the-ground realities of administering the vaccine in the US, check out this long post by Zvi Mowshowitz. Briefly, it looks like in my post, I gave those in charge way too much benefit of the doubt (!!). The Trump administration pledged to administer 20 million vaccines by the end of 2020; instead it administered fewer than 3 million. Crucially, this is not because of any problem with manufacturing or supply, but just because of pure bureaucratic blank-facedness. Incredibly, even as the pandemic rages, most of the vaccines are sitting in storage, at severe risk of spoiling … and officials’ primary concern is not to administer the precious doses, but just to make sure no one gets a dose “out of turn.” In contrast to Israel, where they’re now administering vaccines 24/7, including on Shabbat, with the goal being to get through the entire population as quickly as possible, in the US they’re moving at a snail’s pace and took off for the holidays. In Wisconsin, a pharmacist intentionally spoiled hundreds of doses; in West Virginia, they mistakenly gave antibody treatments instead of vaccines. There are no longer any terms to understand what’s happening other than those of black comedy.