The vaccine acceleration has some nuance as well. It’s definitely not as simple as “people could have produced enough vaccines to end malaria if the silly people slowing things down didn’t get in the way”. RTS’S, whilst moderately effective at reducing deaths in infants until the effects wear off never had the potential to get remotely close to ending malaria, and has been estimated to be less cost-effective at saving lives than plain old bednets.[1] Ideally, of course, kids in the most affected areas would have both and probably seasonal chemoprevention too, but we haven’t even funded comprehensive enough bednet distribution yet.
Also these particular decisions don’t get taken by people who are sceptical of the potential of science or who lack skill in number crunching—quite the opposite. The Phase III trials had a further followup very large trial rather than instant mass distribution as soon as it was declared efficacious and probably safe because spending large fractions of developing countries’ healthcare budget on a promising intervention that appeared to work well in some groups but not others is a difficult thing to do.[2] It’s not like adopting the opposite approach doesn’t have its drawbacks: the COVID vaccines were about as effective and safe as could be possibly have been hoped for in the accelerated timescale they were released on, but still ended up with the indirect result of US medicine being coopted by radical antivaxxers[3] which seems bad, as does more parents withdrawing their kids from once routine vaccination schedules. Could have been a lot worse if those rare myocarditis side effects people spotted late on weren’t rarer than myocarditis side effects from the COVID everyone was getting anyway. It’s easier to say more, bigger, faster without considering second order effects.
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see for example https://www.1daysooner.org/how-cost-effective-is-the-new-r21-vaccine-compared-to-existing-malaria-interventions/ and note that these have wide error bars due to the differences in costs of vaccination programs between countries and uncertainty about how consistently bednets are used, and that R21 which got faster regulatory approval is more cost effective because it appears more potent and is cheaper to manufacture and distribute.
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it wasn’t just the overlapping but probably completely coincidental meningitis, there were quirks in the Phase III trial data probably related to the relatively small sample size like the rare but most-likely-to-be-fatal cerebral malaria actually showing up more in vaccinated older kids which brought recommendations for a very large trial rather than universal incorporation into everyone’s vaccine schedule.
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Trump moves in mysterious ways, but his decision to appoint RFK Jr to attack vaccine science surely isn’t unlinked to how the fact the one Trump achievement he can get booed by his own supporters for mentioning is vaccine rollout, after the narrative everyone was being injected before the scientists even knew what the side effects were took hold.
On paper the absolute perfect people to do this are the diaspora: people who are both sufficiently familiar with local languages and cultural norms and challenges and sufficiently Westernized to be good at dealing with Western consumers and importers and funders.
Obviously some are doing this, just wondering if there’s much [Western] support infrastructure to help people trying to get into it?