Agreed—and I agree that “naive” is the right word for it.
I think the main thing I would change about the post (besides the info from Chi which greatly weakens one of the 4 main planks) is better emphasising that it sketches an ideal ceiling which we should expect to sink as details are added. A relatively realistic ideal, but not strong warrant for righteous rage.
Signing off now; thanks to everyone.
Thanks! That is good knowledge.
Not mostly happy, I think. China apparently needed a new factory, but other places didn’t (to the tune of 3bn wasteful doses or ~12bn real ones).
Also fast approval was only one prong of the fix, along with 2) an order of magnitude more investment, 3) invested much earlier, as pre-Phase I pre-purchases, 4) HCTs, and 5) pivoting away from 80%+ waste as soon as we realise we’re doing that.
(HCTs are still relevant here because some of the vaccines have a shelf life < 6 months, and HCTs could thus allow May-June 2020 production to dampen the second or third waves.)
Half a trillion dollars should really make some dent in the known and unknown bottlenecks. Not sure how to shrink my estimate to account for the immovable remainder.
Datum about process over speed in the civil service and civil society (and also about OWID being far more savvy about optics than Cummings):
“Someone please ensure that they have the 530k within 24 hours from now and report back to me it’s been sent,” Cummings wrote to the chief executive of NHSX. “No procurement, no lawyers, no meetings, no delay please – just send immediately,” he continued. The funding request had the backing of the health secretary, Matt Hancock, who was copied in on the email chain at this point...
After a flurry of communication between top civil servants, money for Our World in Data was approved within days and put on NHSX’s budget, the Guardian understands.
… the grant was not even wanted by the not-for-profit in the form being offered… The group chose to follow its own due process and later applied formally to DHSC and was awarded a grant.
“What a waste of time when we were at that position in the pandemic. I think it was unethical, immoral, and an abuse of power,”
August 28, 2020: “Production has started at a new plant in Beijing with an annual capacity of roughly 300 million doses. Sinovac has agreed to supply 40 million doses to Bio Farma, an Indonesian state-owned company, between November and March. Sinovac started building the factory in late March and finished the project in July.”
So this is in fact a little piece of the happy timeline.
One last guess:
My ideology-of-all-public-officials guess is pretty weak compared to an obvious alternative: simple public-choice herding at the executive level. (200 units instead of a million.)
If governments were each minimising their own reputation loss by (correctly) predicting that they wouldn’t be punished for doing what everyone was doing, this could be enough to prevent ~all innovation. As much as you want safety in numbers, you doubly don’t want to be the first to risk and lose. No entrainment needed, let alone intentional coordination.
(What could explain Israel’s contract being redacted? The dodgy data-sharing agreement? No, that came out. The reputational risk of being seen to have rushed something out in [Autumn 2020]? No: it worked, so why not unredact now?)
I am also very confused. The incentives for politicians to move as fast as they could were so vast.
Besides just vaguely accusing them of lacking courage: Another possibility is a profound entrainment of world elite opinion. One globalised and very narrow Overton window for public professionals. University is the obvious place for this to propagate, but I don’t really know. What is its content? “Don’t be hasty”? Could a philosophical accommodation really prevent every defection?
(There were some—Hungary vs EU on vaccines, Israel. I actually just tried to find out the date of Israel’s Pfizer contract—and it’s redacted!)
I think this is currently the strongest objection to the ideal timeline, even if it just points to the space where a concrete objection might well be.
You should go for a Connemara; so good natured, unlike some other breeds.
You seem to be mistaking this for a white paper, or a piece of legislation, or an itemized purchase order for one different timeline please. It is not that. It is instead a thing to measure our situation against, to short-circuit the useless shrugging described in the opening section.
It would be difficult for more seriousness, more money, more personal and institutional courage to not help. I struggle to understand why you are so sure it wouldn’t, or, if you do, why you’re pointing out that unexpected things happen, on occasion.
In fact the genome was released by one person, and the government didn’t say anything [against the genome]. He could have done it a week earlier still.
The estimate undersells long COVID because we don’t know how many years of 3.2m QALYs to add, but yes that’s roughly it. And yes, I only claim that it was a decent deal, particularly since the funding for it couldn’t really have gone on something else.
I freely admit that it could be off by a large factor (see my final paragraph). I would love for someone to come and do a proper Bayesian interval version, which would foreground the uncertainty.
I continue to challenge calling it “unrealistic”, on priors, just because it’s very uncertain. Last January, a historical baseline would have called it unrealistic to expect completion of vaccine R&D, trials, approvals, and distribution in 11 months. But here we are. I would have you be less sure about what’s not possible, or not realistic.
Human challenge trials are a very old idea. Not doing them is the aberration.
Lockdown uncertainty seems moot. I’m not arguing that any lockdown policy should have been different (except that we might have lifted it a few months early if vaccinations were successfully time-shifted). Did anyone think that (realistic, non-Chinese, non-remote-island) lockdowns were an alternative to vaccines—back when we thought vaccines were coming in 2022 or 2027? The UK government seriously thought they could only do lockdown for a month or two. It doesn’t add up.
But my real response is: of course the above dates aren’t exactly how it would go, of course the cost estimate isn’t exactly how much it would take; I’m not god. I’m not even Derek Lowe. But do you really think it would have been slower than what we did? Unless you do, it doesn’t seem wiser to me to refuse to estimate—even given that estimation is fallible.
Sure. Challenge trials polled well in the West, but you’re right that Wuhan could have been scarifying. Test of this: how did they poll in Lombardia?
My contention is that (in the US and UK at least) bioethicists and policymakers overestimated the controversy, possibly projecting their own misgivings.
Ah right! Yes, I misspoke; pardon.
Here’s my source, “based on dozens of interviews with diplomats, Commission officials, pharma industry representatives and national government aides”. Here’s another, and another.
The EU’s priorities are revealed in the result: 25% − 45% lower prices. They actually sort of brag about it:
It seems to have been a mix of understandable coordination, show of force, price haggling, and liability haggling (which is just a kind of price haggling with extra politics).
Gallina was soon called into the European Parliament, where she repeatedly promised that drugmakers would remain responsible for any problems, even though the issue was proving a sticking point.
I hadn’t seen those leaks, thanks. Note that they did plenty to fuel vaccine hesitancy elsewhere. No opinion about attribution to the EMA vs the Commission.
I don’t recognise my post in this description. I openly acknowledge that there are bottlenecks., including unknown bottlenecks. I put a 150% interval on the key uncertainty. (I am protected somewhat from Hofstadter’s law there by the reference point of the Braintree facility, with its almost known lead time.)
It’s not unrealistic to pay weekend overtime or make new weekend hires for regulators, in the biggest health crisis of the century. It’s not unrealistic for a single Chinese scientist to just decide on his own to release the genome he already sequenced, two weeks early. It’s not unrealistic to decide to stop wasting three-quarters of the precious vaccine, once you realise you are doing so and that the rules you set blindly a year ago were arbitrary choices. Approval sharing between rich countries is not unrealistic. It is not totally unrealistic to imagine that a suitably alarmed establishment might throw whole-number fractions of their wealth at solutions, rapidly; the Manhattan project had much worse odds than any COVID vaccine effort. Challenge trials didn’t happen, afaict, because a quite small number of people said so.
To the extent that any of the above were unrealistic, it’s for tractable social reasons, and tractable social reasons serve my point about institutional decision-making.
Moreover, while reference class forecasting is a powerful element in prediction, it often fails when equilibria are not efficient. Policy seems like a perfect example. Yudkowsky’s updated view is closer to my post than to one-step thought-terminating modesty.
It is important to realise how slow vaccines and all medical innovation is in general. That’s why I say it. But it is also important to investigate whether that is for hard-to-change reasons, or not.
If we had used your reference class in March 2020, you would (and we did) predict that the COVID vaccines were going to take 7 years. If this forecast was taken seriously by the wrong people—as it may well have been, given the sluggishness of the “Warp Speed” initiatives! - then a great deal of good would have been, and was, lost.
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.
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.
I will miss the Prize, it helps me identify which of the effortposts I should read.