Vaccine makers

 Vaxxers: The Inside Story of the Oxford AstraZeneca Vaccine and the Race Against the Virus

The inside story of the Oxford AstraZeneca vaccine, from two of the leading scientists who created it.

Beyond the vaccines:

It seems to me that there are three broad areas that limited our response to Covid-19, and that we need to improve in order to be in a better place the next time: infrastructure (including research and manufacturing), systems (including surveillance, stockpiling and travel bans) and global cooperation and collaboration. The solutions are not necessarily cheap or easy: but nor is dealing with a pandemic. We invest heavily in armed forces and intelligence and diplomacy to defend against wars. In the same way, we need to invest in pandemic preparedness to defend against pandemics.

 

The pandemic in US

 Uncontrolled Spread. Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic

New book by Scott Gottlieb , former FDA comissioner

COVID revealed dangerous gaps in the US public health preparedness, medical infrastructure, and healthcare system. We lacked the public health capacity and resiliency we thought we had. In the most advanced healthcare system in the world, we ran out of medical masks. We had to retrofit anesthesia machines and turn them into respirators. We didn’t have enough swabs to collect samples from patients’ noses.

Our system was set up well to handle singular, technology-intensive, and complex problems like developing a novel vaccine or antibody drugs. We do this better than anyone. But it faltered when we were faced with more mundane problems like manufacturing those vaccines in bulk, deploying testing centers, or making nose swabs to collect respiratory samples. When we finally developed safe and effective therapeutics and vaccines that could treat or prevent infection, we couldn’t manufacture enough of them in time to supply the nation for the winter surge. We had to set up elaborate rationing schemes. Then, we were unable to establish an efficient distribution plan. Antibody drugs went unused because we couldn’t deliver them. 

The virus made clear that we’ll need to fundamentally alter the way we approach all of these risks. If we don’t, our society will remain excessively vulnerable. For starters, we’ll have to lean much more on our intelligence agencies, and in a different fashion. International agreements alone haven’t provided us with the information we need about emerging threats. There’s little reason to believe they’ll perform much better in the future. The devastation caused by the pandemic proved that these risks, and our preparedness for them, is a matter of national security on par with other threats. We’re going to have to build the capacity to seek out the information we need to protect ourselves. Sometimes that will demand that we avail ourselves of the tools and tradecraft of our clandestine services. The challenge will be to maintain collaboration and multilateral efforts even as we turn more heavily toward intelligence services to guard against the risk of new contagions. 

 

Patents are Not the Problem (right now)!

 I agree absolutely with Alex Tabarrock and his post in Marginal revolution. He says:

Patents are not the problem. All of the vaccine manufacturers are trying to increase supply as quickly as possible. Billions of doses are being produced–more than ever before in the history of the world. Licenses are widely available. AstraZeneca have licensed their vaccine for production with manufactures around the world, including in India, Brazil, Mexico, Argentina, China and South Africa. J&J’s vaccine has been licensed for production by multiple firms in the United States as well as with firms in Spain, South Africa and France. Sputnik has been licensed for production by firms in India, China, South Korea, Brazil and pending EMA approval with firms in Germany and France. Sinopharm has been licensed in the UAE, Egypt and Bangladesh. Novavax has licensed its vaccine for production in South Korea, India, and Japan and it is desperate to find other licensees but technology transfer isn’t easy and there are limited supplies of raw materials:

Virtually overnight, [Novavax] set up a network of outside manufacturers more ambitious than one outside executive said he’s ever seen, but they struggled at times to transfer their technology there amid pandemic travel restrictions. They were kicked out of one factory by the same government that’s bankrolled their effort. Competing with larger competitors, they’ve found themselves short on raw materials as diverse as Chilean tree bark and bioreactor bags. They signed a deal with India’s Serum Institute to produce many of their COVAX doses but now face the realistic chance that even when Serum gets to full capacity — and they are behind — India’s government, dealing with the world’s worst active outbreak, won’t let the shots leave the country.

Plastic bags are a bigger bottleneck than patents. The US embargo on vaccine supplies to India was precisely that the Biden administration used the DPA to prioritize things like bioreactor bags and filters to US suppliers and that meant that India’s Serum Institute was having trouble getting its production lines ready for Novavax. CureVac, another potential mRNA vaccine, is also finding it difficult to find supplies due to US restrictions (which means supplies are short everywhere). As Derek Lowe said:

Abolishing patents will not provide more shaker bags or more Chilean tree bark, nor provide more of the key filtration materials needed for production. These processes have a lot of potential choke points and rate-limiting steps in them, and there is no wand that will wave that complexity away.

Technology transfer has been difficult for AstraZeneca–which is one reason they have had production difficulties–and their vaccine uses relatively well understood technology. The mRNA technology is new and has never before been used to produce at scale. Pfizer and Moderna had to build factories and distribution systems from scratch. There are no mRNA factories idling on the sidelines. If there were, Moderna or Pfizer would be happy to license since they are producing in their own factories 24 hours a day, seven days a week (monopolies restrict supply, remember?). Why do you think China hasn’t yet produced an mRNA vaccine? Hint: it isn’t fear about violating IP. Moreover, even Moderna and Pfizer don’t yet fully understand their production technology, they are learning by doing every single day. Moderna has said that they won’t enforce their patents during the pandemic but no one has stepped up to produce because no one else can.

 More information in his post.

Some weeks ago a journalist asked to me the same question, and I said more or less, the same!. There is no need to start discussions about patents in WCO, only the enforcement and implementation of mandatory licenses can be helpful.

¿Qué opina sobre las patentes de las vacunas de la covid-19? ¿Considera que, en este caso, deberían contemplarse excepciones al derecho de explotación exclusiva?

Antes de hablar de patentes, conviene considerar la inversión pública en investigación. Por ejemplo, en la medida que hay una vacuna cuyo coste de investigación ha sido sufragado en un 97% por el sector público, resulta lógico que se compre a un precio equivalente al coste de fabricación, tal como sucede.  Ahora bien, también sería deseable que se obligara a licenciar el proceso a otros fabricantes. En el caso de vacunas de RNA mensajero, el nivel de inversión pública en Estados Unidos es notable y sin embargo no ha sucedido lo mismo. Por consiguiente, los gobiernos deben gestionar las contrapartidas de la inversión pública en investigación.

•  ¿Considera que sería positiva una liberación de las patentes de las vacunas contra la covid? ¿Por qué? 

En mi opinión ya existen mecanismos que permiten conseguir que las vacunas sean asequibles y son las licencias obligatorias. Tal regulación que se configuró en la reunión de la OMC en Doha en el año 2003. Desafortunadamente no se ha desarrollado suficientemente por los países. Las condiciones por las que se deberían aplicar tales licencias quedan explícitas en la Declaración. Tales condiciones hacen referencia a la definición de emergencia y crisis de salud pública. En esta pandemia se daban las condiciones para su aplicación. Visto así, el debate necesita centrarse entre patentes y licencias obligatorias atendiendo a condiciones concretas. 

•  ¿Existen mecanismos ya reglados para que, en situaciones como ésta, más allá de la patente, se garantice la llegada de las vacunas a todos los países (incluyendo los de nivel económico más bajo)?

En realidad la Alianza Mundial para vacunas e inmunización (GAVI) nació para ello. En el caso de la COVID, la OMS a través de GAVI y otras instituciones ha impulsado la iniciativa COVAX que pretende ofrecer vacunas a países en desarrollo. Aún así sabemos que el esfuerzo es insuficiente a la vista de los resultados, el 87% de las vacunas ha ido a países ricos, y en los menos desarrollados tan solo ha llegado el 0,2%.

 

What you should know about the Covid-19 vaccines?

 The Covid-19 Vaccine Guide. The Quest for Implementation of Safe and Effective Vaccinations

A book that explains all the details of one of the greatest achievements in medical research,

In the United States, in just over 11 months, two mRNA vaccines were developed and manufactured in parallel, tested in phase 1, 2, and the phase 3 large clinical trials, found to be safe and efficacious, and distributed initially in December 2020 to healthcare workers and residents of long-term care facilities, followed by those over 65 and with underlying medical conditions in January 2021. The story of that remarkable scientific and manufacturing accomplishment is described later in this chapter.

Why do these vaccines work? What is an immune correlate of protection? Vaccines are designed to induce a human immune response that prevents individual disease and may prevent or shorten individual infections. Much of the background for SARS-CoV-2 vaccines was initially based on the research on SARS-CoV infections, which in 2003 caused a global outbreak in 26 countries, the work on another novel coronavirus MERS, the long-term studies of other coronaviruses, and the work on other respiratory viruses such as respiratory syncytial virus (RSV).

In addition to individual protection, vaccines may also induce community or “herd” protection by decreasing transmission of the virus from one individual to another. We know that the two initial mRNA vaccines prevent illness with 94–95% efficacy in individuals. However, we do not yet know if they prevent infection or transmission.

The narrative behind vaccine hesitancy

 VACCINE HESITANCY. Public Trust, Expertise, and the War on Science

The message:

The dominant framework that currently shapes scholarly and popular discourses on the problem of vaccine hesitancy employs a war metaphor to capture the intractability of the problem. The war metaphor also entrenches an “us” (science) versus “them” (publics) division that is not conducive to engagement and resolution. The “war on science” metaphor described a scientized (chapter 4) captured in three popular explanations for vaccine hesitancy: public misunderstanding of science (chapter 1), the influence of cognitive biases on the publics’ reasoning about vaccines (chapter 2), and antiexpertise and science denialism among the publics (chapter 3). All three narratives point to the publics as the problem (and even the enemy), with little attention to “us,” the courageous defenders of science. Yet, as I have shown, the scientizing force of “evidence-based everything” and the linear model of science-to-policy contribute to antagonizing science-publics relations

Take care... 

Vaccine equity

 From Vaccine Nationalism to Vaccine Equity — Finding a Path Forward

From NEJM: 

Vaccinating the world is not only a moral obligation to protect our neighbors, it also serves our self-interest by protecting our security, health, and economy. These goals will not be accomplished by making the world wait for wealthy countries to be vaccinated first. By investing in multilateral partnerships with a sense of shared commitment and employing a global allocation strategy that increases supply and manufacturing, we can meet the urgent challenge of Covid-19, while creating sustainable infrastructures and health systems for the future. Getting the world vaccinated may well be the critical test of our time.

 Anna Billing

Vaccine diplomacy

 PREVENTING THE NEXT PANDEMIC. Vaccine Diplomacy in a Time of Anti-science

Throughout modern history, vaccines have surpassed all other biotechnologies in terms of their impact on global public health. Because of vaccines, smallpox was eradicated, and polio has been driven to near global elimination, while measles deaths have declined more than 90%, and Haemophilus influenzae type b meningitis is now a disease of the past in the United States and elsewhere.

I define one part of vaccine diplomacy as a subset or specific aspect of global health diplomacy in which large-scale vaccine delivery is employed as a humanitarian intervention, often led by one or more of the UN agencies, most notably Gavi, UNICEF, and WHO, or potentially a nongovernmental development organization

 Do vaccines really deserve their own designation for a special type of diplomacy? Yes, I believe so, especially when we consider that between the past century and this one vaccines have saved hundreds of millions of lives [2]. In this sense, the technology of vaccines and their widespread delivery represent our most potent counterforce to war and political instability in modern times. Vaccines represent not only life-saving technologies and unparalleled instruments for reducing human suffering, but they also serve as potent vehicles for promoting international peace and prosperity. They are humankind’s single greatest invention.

The greater issue is that in each of these four cases—smallpox, polio, Ebola, and COVID-19—the global health community had to respond to a crisis and scramble to rapidly develop, test, license, and distribute these vaccines. Could we also implement an anticipatory system in which nations prioritize vaccine diplomacy and routinely employ it to improve international relations? The Global Health Security Agenda does not currently emphasize vaccine development, although new organizations like CEPI and start-up innovation funds from the Japanese and South Korean governments represent promising steps toward global vaccine diplomacy. I am an enthusiastic champion of their efforts. However, I also believe that an opportunity exists for a more comprehensive effort to tackle the world’s most prevalent poverty-related neglected diseases while simultaneously expanding international scientific cooperation as a core element.

The answer might be found somewhere in the G20...

 

Allocating vaccines

 Public Perspectives on COVID-19 Vaccine Prioritization

US adults broadly agreed with the National Academies of Science, Engineering, and Medicine’s prioritization framework. Respondents endorsed prioritizing racial/ethnic communities that are disproportionately affected by COVID-19, and older respondents were significantly less likely than younger respondents to endorse prioritizing healthy people older than 65 years. This provides reason for caution about COVID-19 vaccine distribution plans that prioritize healthy adults older than a cutoff age without including those younger than that age with preexisting conditions, that aim solely to prevent the most deaths, or that give no priority to frontline workers or disproportionately affected communities.

Beware.

 

Parov Stelar

The business of vaccines

 Covid-19 and the business of vaccines

The FT explains the business models behind vaccines and asks if the Covid-19 pandemic will fundamentally change the vaccine market. This short documentary features global experts including Bill Gates, the CEOs of Moderna and Gavi, and the lead scientist behind the Oxford/AstraZeneca vaccine

COVID epistemology

 Why Does the Pandemic Seem to Be Hitting Some Countries Harder Than Others?

And there lies an epidemiological mystery. The usual trend of death from infectious diseases—malaria, typhoid, diphtheria, H.I.V.—follows a dismal pattern. Lower-income countries are hardest hit, with high-income countries the least affected. But if you look at the pattern of covid-19 deaths reported per capita—deaths, not infections—Belgium, Italy, Spain, the United States, and the United Kingdom are among the worst off.

This is the unfixed conundrum explained by Siddhartha Mukherjee in The New Yorker, And no clear answer, you may read the whole article to confirm it.

 The covid-19 pandemic will teach us many lessons—about virological surveillance, immunology, vaccine development, and social policy, among other topics. One of the lessons concerns not just epidemiology but also epistemology: the theory of how we know what we know. Epidemiology isn’t physics. Human bodies are not Newtonian bodies. When it comes to a crisis that combines social and biological forces, we’ll do well to acknowledge the causal patchwork. What’s needed isn’t Ockham’s razor but Ockham’s quilt.

Above all, what’s needed is humility in the face of an intricately evolving body of evidence. The pandemic could well drift or shift into something that defies our best efforts to model and characterize it. 

 

Great documentary, on Knoedle gallery fake art

COVID-19 innovation response

 The COVID-19 Innovation System

EIT Community COVID-19 Response

 The COVID-19 innovation system represents a departure from business as usual. Considering the remarkable progress to date, especially on vaccine development, this raises the question of whether this model is useful only for crisis times, or whether biomedical innovation policy in “normal” times might productively incorporate some elements of the COVID-19 model as well.

The largest funding response has been from the US government. Roughly $14–$15 billion of the $4 trillion allocated to the COVID-19 response was for R&D for vaccines and treatments.8,9 Though this increased US federally funded biomedical R&D by about one-third (compared to previous NIH funding; see “NIH Data” in the online appendix),10 it is small compared with the potential value of these interventions for ameliorating or preventing the disease and securing a return to normalcy

 

 

 

Vaccine access, now!

 Global equitable access to vaccines, medicines and diagnostics for COVID-19: The role of patents as private governance 

A compulsory licence allows a third party to produce a patented technology without the patent holder’s permission. Article 31 of the TRIPS Agreement allows all WTO States to issue compulsory licences subject to certain criteria.19 First, all cases are considered on their individual merits. Thus, a blanket compulsory licence for certain technologies, for example, medicines, is not possible. Second, prior attempts to negotiate a licence for the invention on reasonable terms with the patent holder must be evident. This requirement can be waived in ‘a national emergency or other circumstances of extreme urgency or in cases of public non-commercial use’ which would likely apply for COVID-19. Third, the scope/duration of the licence must be for the limited purpose it was authorised for. Fourth, the licence is non-exclusive so the patent holder can still enter into licensing agreements with others. Fifth, use of the licence is generally permitted predominantly for the supply of the domestic market of the State where the compulsory licence is granted. Finally, the patent holder must be paid ‘adequate renumeration’ for the compulsory licence.

So, 

 Crucially, it is only by starting a deeper conversation around the role of patent holders within the health context for COVID-19 and of the role of the public interest within patent law more generally that we can address and pre-empt some of the current obstacles posed by patents to equitable global access to healthcare. Given the significant health implications at stake it is vital that this conversation is informed by a global health and bioethics perspective

 

Key success factors of COVID-19 vaccine development

 How New Models Of Vaccine Development For COVID-19 Have Helped Address An Epic Public Health Crisis

 This acceleration has largely been fueled by an influx of resources—both financial and human—that is likewise record-setting. Significant levels of cooperation and innovation, which enable more-efficient use of those resources, have also played a key role.

There may be additional opportunities for innovation that deserve exploration. For example, master protocols, in which multiple vaccine or drug candidates are tested against a single control arm, could further accelerate clinical trials without compromising safety. Innovations to overcome potential delivery impediments, including supply chain challenges and insufficient numbers of health care workers in some regions, would also be welcome.

If widespread COVID-19 vaccination is realized in the coming months and years, the approach undertaken to arrive at that point will offer lessons for how to optimize the development and accessibility of vaccines against other pathogens, under both outbreak and non-outbreak scenarios. Our experiences with COVID-19 may also offer knowledge spillovers to other areas of medicine and public health.

More details in this Health Affairs issue. 

FT on Why the three biggest vaccine makers failed on Covid-19. GlaxoSmithKline, Merck and Sanofi are left playing catch-up to upstarts with new technology

 

mRNA and Life Science research

How Moderna’s overnight vaccine success was 33 years in the making

Listen

 

Watch

How plagues end

Apollo's Arrow. The Profound and Enduring Impact of Coronavirus on the Way We Live

From the book:

After its dramatic initial appearance, SARS-2 will ultimately become endemic; it will regularly circulate among us at some low, steady level. This is connected to the second kind of end, which we have already considered: herd immunity. Here, the pathogen is still around, but it has a much more difficult time reestablishing itself. This resembles a well-vaccinated population for any infectious disease; there are only occasional, small outbreaks among nonimmune people.

By 2022 or so, we will reach this outcome naturally or via vaccination. Of course, if we do rapidly develop and distribute a safe and effective vaccine, we could reach herd immunity with fewer deaths. Based on the fundamental R0 of SARS-2, as we saw in chapter 2, up to an estimated 60 to 67 percent of the population could be affected (or roughly two hundred million people in the United States). The necessary percentage could be lower, closer to 40 to 50 percent, given that social network structure means that different people spread the virus to different extents (as we also saw in chapter 2); or it could be higher, if the epidemic moves extremely fast and we overshoot the level required for herd immunity. Whatever the exact percentage, as a pathogen spreads, some people will die and others will recover and become immune, so eventually the virus will run out of places to go. This is the ordinary, natural way that, biologically speaking, epidemics end.

This is what we mean when we say that a pathogen is under control. But sometimes, plagues are so devastating that a society never recovers. It’s very important to emphasize that, as bad as COVID-19 is, it’s not remotely as bad as epidemics of bubonic plague, cholera, or smallpox that have killed much larger fractions of the population and that have had much larger and longer-lasting effects. Those types of plagues are even associated with the iconography of the Four Horsemen of the Apocalypse, Pestilence riding side by side with War, Famine, and Death. Those epidemics vindicated the adage that “too few of the living were left to bury the dead.”

N. Christakis says at the begining of the book 

The god Apollo, for example, was both a healer and the bringer of disease. During the Trojan War, with his silver bow and quiver of arrows, he rained a plague down on the Greeks to punish them for kidnapping and enslaving Chryseis, the daughter of one of his favored priests.

I found myself thinking again about Apollo and his vengeance as I contemplated our own twenty-first-century barrage more than three thousand years after the events described in The Iliad. It seemed to me that the novel coronavirus was a threat that was both wholly new and deeply ancient. This catastrophe called on us to confront our adversary in a modern way while also relying on wisdom from the past.

Excerpts from the last chapter, How plagues end: 

The pathogens evolve to respond to us, but we, at a slower pace, also evolve to respond to them. Infectious diseases have been a part of our evolutionary history for so long that they have left a mark on our genes. For instance, humans have evolved genetic changes that have proven useful in coping with malaria beginning over one hundred thousand years ago, tuberculosis over nine thousand years ago, cholera and bubonic plague over six thousand years ago, and smallpox over three thousand years ago.36

Infectious pathogens (even if nonepidemic) have arguably been a crucial selective pressure throughout the evolution of our species.37 The primary killers of human beings across evolutionary time are other human beings. Humans do not have any natural predators that substantially affect survival.38 Except for our microscopic enemies.

The SARS-2 virus is a lot less lethal to people of reproductive age and can be combated with the lifesaving tools of modern medicine, so the impact on human evolution is surely going to be minimal. But, at least in theory, another way epidemics end is that hosts evolve to be resistant. And in fact, we may already have naturally occurring genetic variation in our species that affects the severity of COVID-19 in different populations, which would lay the groundwork for such evolution. Over generations, this can result in changes to the genetic makeup of the afflicted populations.

 This social construction of COVID-19 means that the end of the pandemic can also be socially defined. In other words, plagues can end when everyone believes they are over or when everyone is simply willing to tolerate more risk and live in a new way. If everyone willingly risks infection and resumes a semblance of normal life (or, implausibly, if everyone decides to employ physical distancing forever), then the epidemic can be said to have ended, even if the virus is still circulating. We got a glimpse of this phenomenon as well in the summer of 2020 as different states, tired of the lockdowns, acted as if the epidemic were over, even though, biologically speaking, it was not. It was wholly understandable that everyone was eager to leave the epidemic behind as quickly as possible. But the epidemiological reality did not submit to our desires. The pandemic was still claiming roughly a thousand lives per day, although Americans seemed inured to it. Many people, and not just self-interested politicians, seemed to believe the SARS-2 epidemic could end by fiat.

Last paragraph:

 Microbes have shaped our evolutionary trajectory since the origin of our species. Epidemics have done so for many thousands of years. Like the myth of Apollo’s arrows, they have been a part of our story all along. We have outlived them before, using the biological and social tools at our disposal. Life will return to normal. Plagues always end. And, like plagues, hope is an enduring part of the human condition.

A must read. This is my preferred book reference on current pandemic.

 

Figure 16: The mortality impact of COVID-19 in the United States can be quantitatively compared to that of other modern epidemics.

Atul Gawande on this pivotal moment

 Atul Gawande on Taming the Coronavirus

Can a vaccine be distributed fairly? What will be the impact of a large number of people not taking it—as they say they won’t? Atul Gawande, a New Yorker staff writer who was recently appointed to President-elect Joe Biden’s covid-19 task force, walks David Remnick through some of the challenges of this pivotal moment

 And in FT:  "I do think that the fundamental disaster of the United States is tying where you get your healthcare to where you work,"

Agree

 Podcast in The New Yorker radio:

The largest global public-health initiative

 The COVID-19 vaccines are here: What comes next?

From McKinsey:

As vaccine availability nears, communities and consumers will want answers to many questions, including:

• Is the vaccine effective and safe?
• Who will get vaccinated first?
• Which vaccine will we receive, especially if multiple vaccines are available?
• Where and when can we get vaccinated?
• Will we have to pay?
• Above all, what do we need to worry about?

Although the scale of the task may seem daunting, countries benefit by starting end-to-end planning immediately. Our 6A framework lays out a structured approach to ensure vaccines are available, administrable, accessible, acceptable, affordable, and accountable while taking into account strategic considerations associated with uncertainty (for example, vaccine clinical and technical profile) and building system capabilities (Exhibit 2). We have developed, in granular detail, the individual activities and considerations behind each component of the framework. Through the collective initial effort of the pharma industry, the scientific community, global health institutions, and governments, most elements of the “available” segment of the 6A journey are being addressed

 

Paul Strand

 

Prioritising the vaccine

 Framework for Equitable Allocation of COVID-19 Vaccine

Health equity is intertwined with the impact of COVID-19 and there are certain populations that are at increased risk of severe illness or death from COVID-19. In the United States and worldwide, the pandemic is having a disproportionate impact on people who are already disadvantaged by virtue of their race and ethnicity, age, health status, residence, occupation, socioeconomic condition, or other contributing factors.

Framework for Equitable Allocation of COVID-19 Vaccine offers an overarching framework for vaccine allocation to assist policy makers in the domestic and global health communities. Built on widely accepted foundational principles and recognizing the distinctive characteristics of COVID-19, this report's recommendations address the commitments needed to implement equitable allocation policies for COVID-19 vaccine.

If vaccines are coming in the next months and we all agree that supply will not fulfill demand, then we need to prioritise. This publication of the National Academy of Medicine provides some usegul insights. However, the most important is to have a concrete application in specific contexts.

Joana Biarnés

Diagnostic Testing for the COVID-19 Pandemic (again)

 Rapid Expert Consultation on Critical Issues in Diagnostic Testing for the COVID-19 Pandemic

Yesterday I was thinking about the implications of having spare structural capacity in hospitals for pandemics and disasters. With a larger capacity, the need for lockdown to preserve health system operations would be less important. However, how much capacity is needed is uncertain. Therefore, the cost and benefit of spare capacity of the health system is very difficult to estimate. And I would add, it is really much more difficult to manage such investment, because spare capacity in physical terms is not enough, you would need also spare capacity in human resources!. Maybe there is a technological innovation that I can foresee. Forget it. 

Right now the hotest issue are the tests and the vaccine. And NASEM has released a rapid consultation of interest about tests.

This rapid expert consultation draws attention to four critical areas in developing diagnostic testing and strategies to reduce the number of COVID-19 infections and deaths: (1) advantages and limitations of reverse transcription polymerase chain reaction (RT-PCR) testing for viral RNA; (2) the status of POC testing; (3) testing strategies, namely, considerations in the deployment of types and sequences of tests; and (4) next-generation testing that offers the prospect of highthroughput, rapid, and less expensive testing.

If you want to know the state of the art, this is the document to read. I can't see anywhere any cost-benefit approach of different options...We are still dealing with precision and accuracy, i.e. effectiveness.

PS. Quite surprising that today everybody is talking about a vaccine and its 90% effectiveness without any scientific paper being published. Can you accept that?. Information merchants looking for attention.

 

Covid vaccine landscape

 Evolution of the COVID-19 vaccine development landscape

Currently there are 321 vaccine candidates for COVID, however only 33 have entered clinical trials.

Although the leading COVID-19 vaccine candidates have progressed to advanced stages of clinical development at exceptional speed, many uncertainties remain given the lack of robust clinical data so far. Moreover, given the highly unusual circumstances associated with developing a vaccine during the evolution of a novel global pandemic, probability of success benchmarks for traditional vaccine development are likely to underrepresent the risks associated with delivering a licensed vaccine for COVID-19. The most advanced candidates are expected to begin reporting data from pivotal studies over the coming months, which if positive will be used to support accelerated licensure of the first COVID-19 vaccines.