LET ‘ER RIP!!! Vaccines, that is. They’re our best defence against thousands of inevitable COVID-19 mutations.

Speed does not kill.
Speed saves.
It saves life by saving time,
which amounts to the same thing.
~LJK Setright

That is seems relevant and necessary to begin two articles within a year with the same opening quote reveals either that i) I’m really that unimaginative, ii) I’m getting tired of playing the waiting game, iii) the best quotes have several interpretations and applications, iv) repetition is the father of learnin’, or v) the speed premium really is that under-rated, under-appreciated, and under-discussed.

And it’s not just autobahns where speed matters. Recall from your intro to genetics/immunology courses, we’re not just fighting “a new strain” right now, we’re fighting thousands of new strains of COVID-19. And time is of the essence.

nextstrain-org january 1 2021

Alex Tabarrok, of course, has it. The vaccine safety/efficacy “debate” focuses way too much on commission and maliciously denies omission:i

Notice that giving less than one hundred volunteers the virus (commission) is ethically fraught and takes months of debate before one can get approval [by UK government]. But running a large randomized controlled trial in which tens of thousands of people are exposed to the virus is A-ok even though more people may be infected in the latter case than the former and even though faster clinical trials could save many lives. Ethical madness.

But what’s the big deal? What’s the big rush? Don’t we have nowhere to go and all day to get there? Not really! New variants of COVID-19 are Darwinianly selected to become more virulent (and elusive) over time, and possibly less lethal but we can’t guarantee that, and nor is that actually as important as virulence. As Adam Kucharski of London School of Hygiene & Tropical Medicine notes, speed of transmission matters hugely:

Why a SARS-CoV-2 variant that’s 50% more transmissible would in general be a much bigger problem than a variant that’s 50% more deadly. A short thread… As an example, suppose current R=1.1, infection fatality risk is 0.8%, generation time is 6 days, and 10k people infected (plausible for many European cities recently). So we’d expect 10000 x 1.1^5 x 0.8% = 129 eventual new fatalities after a month of spread… What happens if fatality risk increases by 50%? By above, we’d expect 10000 x 1.1^5 x (0.8% x 1.5) = 193 new fatalities. Now suppose transmissibility increases by 50%. By above, we’d expect 10000 x (1.1 x 1.5)^5 x 0.8% = 978 eventual new fatalities after a month of spread. The above is just an illustrative example, but the key message: an increase in something that grows exponentially (i.e. transmission) can have far more effect than the same proportional increase in something that just scales an outcome (i.e. severity).

The parry to this microbiological blow? Not more stupid fucking lockdowns! That lockdowns “usually work” is perhaps overly generous of Jeffrey Barrett, but we see that B.1.1.7 (and newer variants of COVID-19) don’t give a fuck about the dumb fucking protestantism of the west. Why? Because no western country can do 100% lockdowns once the virus is loose in the population, which it is. As such, there’s always political kingmaking deeming specific industries “essential” and others “non-essential.” The result of this is (obviously) a frustrating clusterfuck of insanity and short-termism, not because there shouldn’t be “essential” services, but because the list of “non-essential” services is so indistinguishable from the “essential” ones in terms of public health and public safety.

if we look across all English regions, in the overwhelming majority B.1.1.7 expands during lockdown while other lineages contract. We almost never see the reverse. Conditions during lockdown were usually enough to suppress older variants, but not B.1.1.7.

A better, and the only serious parry against COVID-19 is vaccination! While vaccines aren’t guaranteed to be effective against all future variants, they appear to be effective against most variants today – and that matters a lot – because the sooner we roll-out vaccines, the more mutations we prevent, which also means we’ll save more lives and prevent unnecessary damage to our economies (and fiat currencies). Pushing for natural herd immunity is what is usually meant by “let ‘er rip” but that’s an unnecessarily costly approach in a world where vaccines exist and the only thing standing between us and accelerated herd immunity.

So we have three prongs of vaccine implementation to contend with: i) Research & Development, ii) Manufacturing, iii) Distribution & Administration.

1. Research & Development

Both Pfizer and Moderna had the vaccine basically completed within 6 weeks of obtaining the genomic sequence. This, based on a novel mRNA-based vaccine approach (compared to v1 vaccines that used damaged or “killed” whole virus particles to incite a healthy and protective immune response). That’s damned impressive! The rest of the waiting game has mostly been for regulatory approvals, though Trump‘s Operation Warp Speed deserves credit for parallel processing of manufacturing as an insurance policy against wasted production. China’s and Russia’s vaccines also deserve mention and credit for rapid R&D. Speed of research really doesn’t seem to be an issue in this category, which is a very positive sign for the future of vaccines, but speed of regulatory approvals seems to be stuck in the stone age. For shame!

2. Manufacturing

Basic manufacturing is one thing but scaling up production to the level of billions of doses is another kettle of fish. So it is that early production schedules are already being back pushed further and further. We were supposed to have 100 million Pfizer vaccine doses by last week but we only had 50 million. We’re supposed to have 1.3 billion doses from Pfizer by the end of 2021, 500 million doses from Moderna within the same timeframe, and 700 million doses by Q2 2021 from AstraZeneca, but we’ll see! The clock is definitely ticking. Meanwhile, the virus continues to mutate and mutate (because that’s what viruses do folks!) Tabarrok brings a positive spin to the manufacturing side of the equation:

One of the big virtues of mRNA vaccines is that much like switching a bottling plant from Sprite to 7-Up we could tweak the formula and produce a new vaccine using exactly the same manufacturing plants. [...] Thus, if we needed it, we could modify mRNA vaccines (not other types) for a new variant in say 8-12 weeks.

That’s pretty quick! Of course, manufacturing isn’t the whole of the solution. We also need to scale-up the last mile – distribution and administration – which is another bottleneck.

3. Distribution & Administration

The “last mile” is no small matter! Of course, leave it to the “politically dysfunctional” (yet functionally competent) Eretz Israel to make the restii of the western world look like the slow-on-the-uptake schmucks we are in this regard:iii

Health Minister Yuli Edelstein called Thursday to keep the vaccine operation going 24 hours a day, 7 days a week, including on Shabbat. Regarding the push to carry out vaccinations on Shabbat, Edelstein, who is Orthodox, cited the Jewish legal principle of saving a life, or “pikuah nefesh,” which trumps nearly all other religious requirements.

Israel’s cutting of red tape, leveraging of its military-industrial capital,iv and intelligent use of incentives is utterly admirable and foreshadows the world to come:v

The [Israeli] Health Ministry is planning to issue those who are vaccinated against the coronavirus a “green passport” that will grant a waiver of restrictions applied to curb the virus outbreak, top officials told media in a round of interviews on Sunday.

Among the rights for holders will be access to cultural events and eating at restaurants, and the right to not quarantine after exposure to a diagnosed virus-carrier, they said.

Incentives matter! A lot! The speed premium on COVID vaccines is soaring like BTC-USD at the moment.vi As our old friend Tyler Cowen notes:

Note also it is very likely the new mutation already has spread well beyond the UK. And with compounding, an R increase of 0.4 is really bad as time passes.

If this all is true, what are the policy implications? First, a lockdown with no pending vaccine will only postpone problems, a’ la the herd immunity theorists.

Second, we do have vaccines and so in any plausible model faster viral spread implies a faster timetable for vaccine approval and distribution. And it implies we should have been faster to begin with. [...]

If Godzilla is faster than you had thought, you need to start running away sooner.  And you needed to have started running away sooner.  In any plausible model.

In any plausible model.

So waddya say we LET ‘ER RIP on vaccines? Get rid of the bullshit bureaucratic box-ticking from “normal times” and spend a few (tens of) billions of dollars where they’ll actually do good, lest we spend goodness knows how many more years wringing out hands and wondering why the sky is falling when it was in fact our navel-gazing political correctness that led us down the road to perdition. Vaccine deployment (no matter how close to “ideal” efficaciousness) can and must be made widely available now.

In the same way and for the same reasons that it was completely embarrassing that we had a shortage of masks and hand sanitizer in western countries in April/May of last year, we need to be fucking embarrassed about the lack of broadly available vaccines (and testing) today!

Let’s get going people! LET ‘ER RIP!!!
___ ___ ___

  1. Meanwhile trillions are spent on economic stimulus while barely a few billion are begrudgingly scraped together to fight the root cause: the virus itself. Because logic! Or maybe I just don’t understand the logic of socialism very intuitively?
  2. Is Israel really a western country? It’s arguably a middle eastern country / eastern mediterranean country but it has so many characteristics of a western country that we’re going to use it here anyways. There’s no time for semantics, I have a point to make!
  3. I said the following back in April:

    It’s useless to compare statistics from country-to-country, or even over time. No one is measuring the same way, nor keeping methodologies consistent as the pandemic progresses.

    I know I know! Does that make me a hypocrite? Or merely weak in the face of epidemiological temptation? Well, neither. Because I was talking about “case numbers” back then and now I’m talking about vaccinations (and testing). While Israel has the advantage of relatively small population, higher population density, well-educated and militarily experienced population, and the Jewish X-Factor (that the PC world is too squeamish to notice), it also does without the ossified incentive structures plaguing the US on the distribution side of the vaccine roll-out equation, as a reader of MR volunteers:

    I am a physician in private practice in [redacted]. We have just been approved to order and administer the vaccine to tier-appropriate patients. Medicare has approved a payment of 18$ for the first shot and 28$ for the second. As far as we can determine we will not be allowed to bill for an office visit so that is the entire amount we will receive for registering the patients, screening then for covid outside of the office, taking their vital signs, taking a history to see if there are any contraindications to the vaccine, administering the vaccine, observing them in the clinic for a minimum of 15 minutes up to 30 minutes depending on their history, and recalling them in 28 days and going through most of the same procedure again, minus the registration and history. There is also an extensive regime of recording and reporting all vaccination data daily to the state government. We had anticipated hiring someone to manage this new service due to the amount of new work that is required. At this rate we might be able to give 10 shots an hour in each of our 3 clinics if we see no other patients for illness, injury, or covid testing.

    Do I need to say that we cannot possibly afford to do this for the reimbursement offered. The alternative is for patients to receive the vaccine in some state funded site or clinic. That may take a very long time to roll out.

  4. Not that Israel is perfect. It’s apparently dumb enough that it’s now halting domestic research of its own vaccine, apparently figuring that the planned roll-out of the Pfizer vaccine makes this war against our invisible enemy a fait accompli. Either that or they’ve made a deal with the devil that is Pfizer/USistan to shut down Israeli R&D in exchange for millions of vaccine doses. There are several possible readings!
  5. Or have you forgotten that Chamath predicted immunity passports in March/April back when it was a “crazy idea”?
  6. 1 BTC = USD$ 29,395 31,274 32,596 as of this draft.