Rolling Out the Vaccine
Rolling Out the Vaccine
This morning’s (Dec. 25) New York Times offers a panel discussion on the question of who should get vaccinated against Covid first. Broadly speaking, they take a utilitarian position: it’s interesting that none disagreed with the positions taken by panelist Peter Singer, the world’s most prominent utilitarian philosopher. And I wouldn’t either, except for one thing.
The vaccines approved by the FDA, along with those approved by other countries like China and Russia, have gone through the fastest possible testing. Tens of thousands of individuals have been placed in control and treatment groups in order to determine two things: to what extent do the vaccines reduce the likelihood of getting infected (efficiency) and how common and severe are the side effects (safety)? Meeting both criteria is sufficient for approval, which is how it should be.
But there is another crucial question, to what extent do the vaccines reduce transmission of the virus to others? The answer does not affect whether these vaccines should be employed, but they do have large consequences for other policies during this phase of the pandemic, such as rules for separation and masking, restrictions on activities and events, resumption of in-person schooling, and how much should be spent on interventions like ventilation overhauls. To the extent that vaccination reduces transmission, other restrictions and investments can be modified as the vaccinated portion of the population increases. Unfortunately, our knowledge of this issue is minimal. We don’t have any published lab results at all, and we are at least months away from meaningful epidemiological data.
A rollout that prioritizes crucial learning could change this. Some substantial portion of the early vaccines could be reserved for community trials. A number of communities could be given treatments in which a designated proportion of the population is vaccinated as soon as possible; this portion could be varied (30%, 50%, 70%) so that a variety of treatments could be tested. Others matched to them by relevant demographic, economic, and other variables would be controls and would not receive any vaccines during the trial period. (Note that the lack of blinding at the community level should not be a serious problem as long as unvaccinated individuals in treatment communities are given a convincing placebo.) Everyone living in these communities would be tested regularly. We could then observe differences between community infection rates corresponding to treatment and infer transmission probabilities under real world conditions. It might also be possible to learn how transmission varies across the different viral strains that have emerged. The entire operation could be accomplished within the space of a month or less.
What is disheartening is that not a single expert on the Times panel broached this possibility. They are entirely preoccupied with the health significance of vaccination at the individual level and consider communities only in social and economic terms. To the extent they consider the need for learning at all it is in the context of individual response to vaccines, such as comorbidities and interactions with other drugs people may be taking.
Where’s the public health?
Lost in trump’s “China VIrus” attacks are the simple facts that China’s actions did no one in the world a favor. Impossible to tell how many people this killed.
” At a time when digital media is deepening social divides in Western
democracies, China is manipulating online discourse to enforce the
Communist Party’s consensus. To stage-manage what appeared on the
Chinese internet early this year, the authorities issued strict commands on the content and tone of news coverage, directed paid trolls to inundate social media with party-line blather and deployed security forces to muzzle unsanctioned voices.
Though China makes no secret of its belief in rigid internet controls, the
documents convey just how much behind-the-scenes effort is involved in
maintaining a tight grip. It takes an enormous bureaucracy, armies of people, specialized technology made by private contractors, the constant monitoring of digital news outlets and social media platforms — and, presumably, lots of money.
It is much more than simply flipping a switch to block certain unwelcome ideas, images or pieces of news. China’s curbs on information about the outbreak started in early January, before the novel coronavirus had even been identified definitively, the documents show. When infections started spreading rapidly a few weeks later, the authorities clamped down on anything that cast China’s response in too “negative” a light.”
https://www.propublica.org/…
EM:
Not sure why you were spammed.
Seems to me that the thing about spreading is a gros canard: The numbers lie in infections; less infections, less spreading.
Given the newness of the science, the unknowns, …, there are all sorts of possible consequences. But, given the alternative? C’est une grande expérience.
It is rare for an effective vaccine not to greatly diminish the chances that a vaccinated individual will spread the disease. I think you would err on the presumption that it does curtail their participation in transmission cycles. Multiple trials of different strategies would be inefficient as you would tie up resources trying to assess their benefits in the exact same timeframe that the goal is to reach as many Americans as possible. By sometime in March you want to be doing everyone who wants it and not thinking that in April you can have some trial results that indicate an optimum distribution as if it were still December. I do think I would like to hear more about the different vaccines. Maybe they have properties apart from availability that make a specific plan around that valuable
The issue of whether vaccinated people can still transmit the virus is real. I got the Moderna booster in September, but my wife still hasn’t been vaccinated. I still mask and social distance as much as before, importantly to protect her. Also to protect others. Until everyone who chooses to is vaccinated, all vaccinated people should behave as though they aren’t.The problem will be the vaccine refuseniks. They are vulnerable not only from other refuseniks but also perhaps from asymptomatic vaccinated people.
@Ken.
“less infections”
FEWER
Data or no, I think you can expect that people will change their behaviors once they have taken the vaccine.
some people, many people, most people?