1) unlike challenge trials, which had surprising popular appeal, this looks terrifying. 2) unlike challenge trials, you need to isolate billions of live cultures. Given real world biosecurity this is a nightmare. 3) I don’t get the impression that the Indian government could move so fast, even though there are amazing private actors like the Serum Institute.
I don’t want to shift the goalposts; my post also relies on a few things being viewed differently. But mine just requires a few hundred elites to get out the way.
Re 1: could it work as opt in? The brave go first?
Re 2: Wait why do you need to do that? Maybe you can have a sick person sneeze into a napkin and immediately rub it on the next person or whatever, so there is no intermediate storage step? Wrt biosecurity, a high percentage of the population was going to get covid / it’s an available everywhere already anyway ?
Re 3: Have a private actor do it on govt contract? Competing firms ranked by effectiveness and safety etc
Re goalposts: What are you viewing as the goal post? I think I misunderstood you somewhere. What things are you viewing differently?
Yeah this might be getting out of scope for the discussion but a good variolation technique have no manufacturing, no patents, no buying / selling negotiation. Random people in poor countries with almost no govt could variolate each other. If world order or the science machine breaks down (new pandemic kills all the world leaders or something) then the technique can still be used.
And to get more out of scope, what’s the harm reduction of a vaccine? Let’s generously say the cost and side effects of getting vaccinated are 1% that of getting the disease itself. (Ignore spread reduction benefits for now.) At what percent would you consider variolation worthwhile as an option: 30%, 10%, 5%, 1%?
1. The UK began 2020 with an unspoken, dubiously voluntary version of this strategy. As the IFR firmed up, the backlash against this was so large that they were forced to deny that they ever intended any such thing.
The goalposts of this post are: “what is the best we could actually do, just changing the opinion of say a few hundred elites?” Challenge trials were popular; I strongly predict variolation is different, and that popularity matters even if 5% of the youngest and maddest volunteer.
2. You missed the absolutely critical, sign-flipping bit: you have to isolate the variolated! Variolation without enforced isolation is harbouring and abetting a lethal pathogen.
Again, this idea goes way past what our current institutions could possibly consider. They would want validation of the pathogen first, and who can blame em. COVID is indeed abundant, but you’re massively multiplying the number of intentional virus touchpoints, and when every lab slipup can kill a few hundred people…
3. Can’t imagine any private actor touching it with a bargepole.
The nearest possible version of a variolation policy is Hanson’s clinics. They look nothing like decentralised napkin passing, and that’s a feature.
Mm good points. If I were dictator, I would still have a variolation process at least tested and developed for each new pathogen, which could be deployed as an emergency backup.
If by threshold you mean the percentage thing, I would say that at 25% conterfactual harm, variolation is a reasonable option for countries that couldn’t manage vaccines, if nobody else was going to give it to them.
Sounds undoable.
1) unlike challenge trials, which had surprising popular appeal, this looks terrifying.
2) unlike challenge trials, you need to isolate billions of live cultures. Given real world biosecurity this is a nightmare.
3) I don’t get the impression that the Indian government could move so fast, even though there are amazing private actors like the Serum Institute.
I don’t want to shift the goalposts; my post also relies on a few things being viewed differently. But mine just requires a few hundred elites to get out the way.
Re 1: could it work as opt in? The brave go first?
Re 2: Wait why do you need to do that? Maybe you can have a sick person sneeze into a napkin and immediately rub it on the next person or whatever, so there is no intermediate storage step? Wrt biosecurity, a high percentage of the population was going to get covid / it’s an available everywhere already anyway ?
Re 3: Have a private actor do it on govt contract? Competing firms ranked by effectiveness and safety etc
Re goalposts: What are you viewing as the goal post? I think I misunderstood you somewhere. What things are you viewing differently?
Yeah this might be getting out of scope for the discussion but a good variolation technique have no manufacturing, no patents, no buying / selling negotiation. Random people in poor countries with almost no govt could variolate each other. If world order or the science machine breaks down (new pandemic kills all the world leaders or something) then the technique can still be used.
And to get more out of scope, what’s the harm reduction of a vaccine? Let’s generously say the cost and side effects of getting vaccinated are 1% that of getting the disease itself. (Ignore spread reduction benefits for now.) At what percent would you consider variolation worthwhile as an option: 30%, 10%, 5%, 1%?
1. The UK began 2020 with an unspoken, dubiously voluntary version of this strategy. As the IFR firmed up, the backlash against this was so large that they were forced to deny that they ever intended any such thing.
The goalposts of this post are: “what is the best we could actually do, just changing the opinion of say a few hundred elites?” Challenge trials were popular; I strongly predict variolation is different, and that popularity matters even if 5% of the youngest and maddest volunteer.
2. You missed the absolutely critical, sign-flipping bit: you have to isolate the variolated! Variolation without enforced isolation is harbouring and abetting a lethal pathogen.
Again, this idea goes way past what our current institutions could possibly consider. They would want validation of the pathogen first, and who can blame em. COVID is indeed abundant, but you’re massively multiplying the number of intentional virus touchpoints, and when every lab slipup can kill a few hundred people…
3. Can’t imagine any private actor touching it with a bargepole.
The nearest possible version of a variolation policy is Hanson’s clinics. They look nothing like decentralised napkin passing, and that’s a feature.
No clue on threshold, gimme some numbers.
Mm good points. If I were dictator, I would still have a variolation process at least tested and developed for each new pathogen, which could be deployed as an emergency backup.
If by threshold you mean the percentage thing, I would say that at 25% conterfactual harm, variolation is a reasonable option for countries that couldn’t manage vaccines, if nobody else was going to give it to them.