Thanks so much for the excellent feedback. I’ve updated a bit, but I don’t think we disagree as much as it seems at first glance, or I’m not understanding your position. In general, I think you’re responding about antivirals in general, and I was talking about antivirals specifically as a response option for during a nascent pandemic. But I do see a few points of clear disagreement.
1) Biological diversity & over-updating from one disease
Antivirals work poorly everywhere. The “best” antivirals we have for flu, like tamiflu, don’t have any significant clinical impact, according to all of the studies not run by the company making it. And yes, antivirals are relatively more important for diseases that don’t have vaccines, but as I noted, HIV antiretrovirals are weak and only work slowly and in combinations, and “highly successful” seems like a weird claim given how long it took and how complex it is.
And I agree that vaccines aren’t always practical for all diseases, at least yet. But that doesn’t lead me to think that we might be successful with antivirals.
[Edit to add: “The success of COVID vaccines… does not, in my view, imply that they will be a sufficient defense against most or all possible threats.”
No, but finding vaccines not working says nothing about the success of other approaches—nothing guarantees that anything works, so pessimism on one front doesn’t justify optimism on another, even if it causes us to invest differently.]
2) Future promise of antivirals vs current performance
I think I agree with all of this, which is why I think antiviral work should continue to be funded. But none of this makes me think it’s a valuable target for emergency response.
3) Portfolio theory and scientific innovation
Agreed on our inability to pick winners, and the difficulty of exactly choosing relative investment amounts—but again, I’m not talking about foundational research, where a diversity of approaches are really important, I’m talking about last-ditch emergency response. We need more and faster COMPARE-like trials for extant treatments, but new drugs seem like a dumb place to put money if we need results this year.
Thanks so much for the excellent feedback. I’ve updated a bit, but I don’t think we disagree as much as it seems at first glance, or I’m not understanding your position. In general, I think you’re responding about antivirals in general, and I was talking about antivirals specifically as a response option for during a nascent pandemic. But I do see a few points of clear disagreement.
1) Biological diversity & over-updating from one disease
Antivirals work poorly everywhere. The “best” antivirals we have for flu, like tamiflu, don’t have any significant clinical impact, according to all of the studies not run by the company making it. And yes, antivirals are relatively more important for diseases that don’t have vaccines, but as I noted, HIV antiretrovirals are weak and only work slowly and in combinations, and “highly successful” seems like a weird claim given how long it took and how complex it is.
And I agree that vaccines aren’t always practical for all diseases, at least yet. But that doesn’t lead me to think that we might be successful with antivirals.
[Edit to add: “The success of COVID vaccines… does not, in my view, imply that they will be a sufficient defense against most or all possible threats.”
No, but finding vaccines not working says nothing about the success of other approaches—nothing guarantees that anything works, so pessimism on one front doesn’t justify optimism on another, even if it causes us to invest differently.]
2) Future promise of antivirals vs current performance
I think I agree with all of this, which is why I think antiviral work should continue to be funded. But none of this makes me think it’s a valuable target for emergency response.
3) Portfolio theory and scientific innovation
Agreed on our inability to pick winners, and the difficulty of exactly choosing relative investment amounts—but again, I’m not talking about foundational research, where a diversity of approaches are really important, I’m talking about last-ditch emergency response. We need more and faster COMPARE-like trials for extant treatments, but new drugs seem like a dumb place to put money if we need results this year.