Do you have any evidence WHATSOEVER to justify your "strong suspicion" that the FDA is deliberately slow rolling regulatory approval for political ends, or are you just making things up?
Citing Tyler Cowen's increasingly deranged FDA conspiracy theories does not count as evidence.
We vaccinate against chicken pox, or varicella. COVID appears to be much more fatal to children than chicken pox is.
Old COVID data from December, pre Delta:
“ More than 2 million children have been diagnosed with COVID-19, including more than 1 million since mid-November.
New data from the AAP and the Children’s Hospital Association show nearly 179,000 COVID-19 cases in children were reported last week alone, bringing the total to at least 2,000,681 as of Dec. 24. Children make up about 12.4% of the total cases in the U.S.
At least 172 children had died as of Dec. 17”
“ The fatality rate for varicella was approximately 1 per 100,000 cases among children age 1 through 14 years, 6 per 100,000 cases among persons age 15 through 19 years,”
Let’s say we took a rate of 2 per 100,000 deaths as a fair comparator for Varicella. That means for 172 children to have died of Varicella, there would have been 8.6 million cases, not 2 million.
I am curious about whether having the FDA inspect the factories in China would help because I'm genuinely not sure. I have a relative in a country that used a lot of Sinovac vaccines and have acquaintances with friend and family members in countries that depended on the Sinovac/Sinopharm vaccines. There isn't a lot of confidence in those vaccines. It's a combination of knowing that they aren't very effective compared to the mRNA , J&J and AZ vaccines, China having sold substandard PPE and Covid tests to many low income countries, and the way China has seemed to strong arm countries into buying their vaccines. On the other hand, even some protection is better than nothing.
Authorizing the NovaVax vaccine would also help. They should have data for the EU in October. It's about as effective as the mRNA vaccines and was specifically designed for use in low-income countries that don't have a lot of freezers. It's also a protein subunit vaccine, so some of the people who don't trust the mRNA vaccines or J&J might be willing to take it. And it seems to have fewer side effects. They're also working on formulating it along with a flu shot.
You ask in the subscription application: why did you subscribe. Today, finally, in order to call bullshit on your "shade" on "covid neurotics" who apparently are unmoved to prioritize stats over personal situations. You have no idea about people's reasons, and I hope you learn a lot from the comments below as so many people have already said what I need to say. Do you even have kids? If no, explains something, if yes, have you actually talked to their teachers? Or folks with underlying conditions are are really afraid of long haul covid, which you can get from post-vacc mild cases. Our own doc and dear friend says that the most recent OHSU studies have shown that now about 34% of people are carrying covid with no symptoms, post-vaacc. Well, I guess your "shade" was a great marketing technique.
Look, David and others, I see he has a child, but I don't know much more than that. How old? What is school like? What do the teachers there say? My sister and her husband re both elem sch teachers in a pretty progressive place, but are working under the worst conditions anyway. BC the vacc can carry it unbeknowns, their child is at risk. They are truly scared, have reason to be, have seen many kids and teachers get sick, afraid to bring it home. This is all anecdotal, but it is really hard to navigate through all the info and stat reading we get, what we see in our own lives, and in our case, what our own doc says. We met with him for long time to discuss the risks of holding a 100 person wedding outside at very end of August. I did cite his own research sources: Oregon Health Sciences Univ. for what it is worth. I find it super hard to understand the stats, or whether or not I should trust Matt, or people online here, or our own doctor (who is also a researcher) who advises great, great caution for someone like me, w underlying conditions.
As for why I claim to know 31 and counting w covid post-vacc, maybe my "social circle" is larger than you "loners," -- I think it may be bc two of my three kids got married in the last 4 weeks, my husband manages a firm so we also hear there, and there is a lot of info coming in. Maybe that is a larger social circle, maybe not. I just do know of them all by name. What I object to, and why I chose to subscribe today is for more than "yelling" at Matt; I tend to like him but I do not like being called "neurotic." I think we should save our anger and frustration for the truly anti-vacc, not for the grandma's who won't help you take your kids to school because they are afraid. I think I get to say to someone I respect, hey do not be calling me "neurotic." I say defensively.
Since we're talking about kids, one statistic that I had seen somewhere and I found interesting is that drowning kills more children than COVID. I googled a bit and found the following statistics:
This isn't a perfect comparison, because in one case you have reported deaths and in the other case estimates. Also, the age brackets are different and COVID has been going on for more than a year. However, I guess this gives a general estimate of how dangerous COVID is for children, and it doesn't seem terrible to me, given that we still allow the existence of pools.
PS: As a European, a rule of thumb is that you should never trust American doctors. :P
This seems like overly conspiratorial thinking. It seems much more plausible to me that the FDA's stated concerns around safety and efficacy of boosters and child vaccines are the real cause of slowness. Two high level people at the FDA recently published an opinion piece describing exactly why they're uncertain that boosters are needed (https://www.statnews.com/2021/09/13/international-review-argues-against-covid-19-vaccine-boosters/), and their paper only mentions equity concerns in passing at the end. For child vaccines, the risk of death from COVID is objectively low, and there is suggestive evidence that myocarditis side effects of the vaccines tend to inversely correlate with age. That was their stated reason for increasing the followup period and increasing the size of the trials. Maybe it's motivated reasoning, and really they're searching for excuses to delay to encourage global distribution of doses, but this is how the FDA has acted for decades: strictly following bureaucratic formulas around what kinds of evidence is necessary and how rigorously it was collected. I mean of course you can disagree about how reasonable this is under the circumstances (I disagree, for the very little that is worth), but there's no reason to think the FDA is not acting on the level.
But also the equity argument for child vaccines is just objectively much weaker than for adult boosters. The doses Pfizer is testing are 1/3rd of an adult dose for 5-12 years and 1/10th of an adult dose for 0.5-4 years. So if the Pfizer vaccine is approved for children at its current dosage, you could vaccinate 10 young children for the cost of vaccinating one adult (or five for the cost of boosting one adult). Children are less likely to spread the disease than adults, and they are more than 10x less likely to experience severe disease than adults. But still, it's not completely obvious that vaccinating 10 young children slows disease spread less than vaccinating one adult. It is fairly obvious that all else equal, a dose is more useful in an unvaccinated adult than boosting a vaccinated non-elderly/immunocompromised adult.
I haven't seen any post-delta numbers for how susceptible children are to delta, but it's reasonable to assume that it's much more than alpha or the ancestral strain, as with adults. Much higher pediatric ICU utilization than at previous points in the pandemic tends to support that.
Yup, I said that in my comment: "[children] are more than 10x less likely to experience severe disease than adults". Compared to elderly people it's several orders of magnitude.
My point is that vaccinating 10 children may reduce transmission enough to be better on strictly consequentialist grounds than vaccinating one adult. It's not *obvious* which wins, whereas it is obvious which wins for 3rd shots for vaccinated adults. Some epidemiological modeling would be able to answer which is better, but I haven't seen any analysis along those lines.
I think 'work to rule' might be too strong a phrase. If you work for the FDA, your comfort zone is slow and cautious. Utilitarian concerns about children dying while they wait for a vaccine might push you to go outside that comfort zone. If, however, the utilitarian position is we should vaccinate the world's adults before America's kids, then you no longer have a conflict between saving lives and following the process.
How quickly should we reasonably hope to get the world vaccinated? By tomorrow would be great, but may not be possible. MY's post hints at "next spring" (in terms of when supply will be a lot greater), but we can make a better estimate of that.
About a third of the globe is fully vaccinated now. Currently, global vaccinations are averaging ~35M/day. At just that rate of administration, we would hit 75% vaccinated in five months. But, as MY notes, global supply is increasing. That is, four months is a more reasonable estimate for hitting 75%, probably five months for 80-85% and so on.
Even faster would be better, but what are the chances that new interventions would speed the process up all that much, if not actually slow it down?
The real problem is hitting the laggards, and understanding why that is the case. As MY notes, Africa is way behind. That's especially the case for the biggest countries: Nigeria, Egypt, South Africa, not to mention DR Congo. Is it simply a matter of funding (something the advanced world can and should fix)? Or poor healthcare systems that simply can't administer the shots no matter the supply?
I think these are the more critical questions than figuring out how to give supplies a jolt.
" that it’s bad to authorize these uses of precious mRNA vaccines when there are much higher-value uses of them abroad. However urgent I may feel it is to get my kid vaccinated, objectively, the risks to him are very low, and the expected value of lives saved is much higher if those doses go to a middle-aged person in a poor country."
Bad take. The same group of policy geniuses that can't build public transit without dumping shed loads of money and just organized an Afghanistan pratfall are going to solve the global vaccine shortage?
And I've got a bridge in Florida to sell you.
Just take an easy win that we can actually accomplish rather than pie in the sky international utopianism.
Yes, saving a few pennies and getting out by September 11th so Biden could score all the political points while pissing off his European allies was sure worth it. Wouldn’t want to have waited until the winter or made contingency plans, nope, not gonna do it. Biden can now bask in the well deserved glow of a job well executed.
Also the liberati really need to stop with these straw man, false dichotomies.
Because you don’t dismiss the idea that COVID escaped from a lab doesn’t mean that you think the Chinese engineered the Wuflu to take out the globe.
Because you believe it was possible to leave Afghanistan without falling on your butt quite so badly doesn’t mean you think we need to stay there forever.
Considering that Biden was willing to slam 6000 troops in there when everything went to pieces, you should be able to see where problems with the withdrawal plans lie.
Biden’s willing to do it in response to something, but not preventing something from happening. I have to say it’s a very American management failure that appears to be universal.
Meanwhile, the number of Americans killed in one day in the withdrawal approaches the yearly totals for each of the past 5 years, where American troops somehow were holding out through campaign season without incurring significant casualties. There seems to be a myth that casualties dropped because of Trump’s deal, which is not the case.
The danger of Covid to children is so low that, for me at least, the importance of potential problems and side-effects becomes a bigger issue both mathematically and intuitively. I'd like to see the vaccine approved for kids, but only after it's gone through all the required safety testing so that we understand the risks well, particularly with myocarditis.
Secondly, more money in 2020 would not mean that there would be more vaccine factories in 2021. Things don't get built that fast, especially in today's regulatory environment.
It's the same with the current global chip shortage which isn't going away until 2023 because building capacity takes time regardless of how much money you throw at the problem.
I hate to be that guy but this ignores the risks of Long COVID which seems to also be lower in children but there's still some indications of a significant (low single digit) percentage of chronicle fatigue syndrome. The lack of good studies and data around this is one of the my biggest COVID frustrations (which is saying a lot) but I think it significantly affects the risk considerations.
There was a high quality study that looked at kids and long covid, which also found single digit rates of long covid (I think it was around 1.5%) and they found that most cases resolved within about 60 days, which is really encouraging. I have no doubt that there are going to be some cases of long covid that do fall into the chronic fatigue syndrome bucket, just like happens with other viral infections.
I share your frustration with our inability to study long covid and covid convalescence in a systematic manner. We'd be making much better decisions if we had good quality evidence one way or another.
That's very encouraging. I actually read that study but then skimmed Thomas Pueyo's adult focused chronice fatigue post yesterday and it may have moved up my memory of the numbers up too much (I haven't been doing a great job of taking notes on the various studies recently). Thanks for clarifying.
In terms of myocarditis risk I know that risk of that from COVID is higher for adults than from the vaccine and my sense is that this is also true for kids though I'm not 100% sure and it probably depends on vaccine dosing as well, but it's definitely not 0 for COVID.
"The FDA first granted Pfizer's request for an emergency use authorization for its COVID-19 vaccine in December. It got federal approval to include children as young as 12 in its vaccine trial in October."
So they at least started the next younger age group AFTER the adult safety data was in, and in fact BEFORE November 2020.
The Under 12 trials started right around then (they might have started earlier)
So it looks like they pretty consistently started each new (younger) cohort when the previous one was approved, without delays in between.
Maybe for a pandemic this could have overlapped more, maybe it didn't need to because the risk factors were lower, but it is consistent with "try it on younger patients after old" without apparent excessive delays.
How risky are children as vectors for transmission to unvaccinated adults?
Maybe I was reading in between the lines too much in this article but it read to me that there was an implicit assumption that all/sufficiently-enough adults are vaccinated. This is not true in most places and is definitely not true in the places where hospitals are already crowded.
Put another way, is vaccinating children a way to reach herd immunity given recalcitrant adults?
Here's my hot take: None of this matters because it's too late. The delta variant is so contagious that once it takes off in some area it causes a two-month pulse of cases and deaths after which it subsides due to acquired immunity. The variant is already everywhere and no plans we make now to produce more vaccines in the future will affect it. India had its wave a few months ago, South Africa is coming out of theirs, and we are in the middle of ours.
Maybe some new variant will emerge that evades acquired immunity but not immunity from vaccinations, in which case we will wish we had exerted ourselves more on vaccines at this moment, but that's speculation.
People are needlessly freaking out about their kids right now, but as our wave ends and the virus is less top of mind, people will naturally chill out. Approval for younger kids seems to be forthcoming notwithstanding any utilitarian concerns, so that will probably help set their minds at ease.
I don't think it's clear that acquired immunity is the deciding factor in when waves subside - it seems quite plausible that news alerts showing overflowing hospitals play a big role in getting ordinary people to cut their contacts a bit.
Evidence seems to suggest that acquired immunity from infection is comparable to that from vaccines in effectiveness (some seems to say a bit more, some seems to say a bit less). So it would be surprising to say that we can't vaccinate our way out, but then think that infection rates well below 50% allow us to infect our way out.
Okay, my big question: When did we all decide that, through this whole pandemic, we were going to use the term “normalcy” instead of “normality”? As someone who prefers the latter term, it’s been wild seeing it just completely discarded.
Yeah, but is everyone really going for the Harding reference? It feels like, after 9/11, more people used “return to normality” or referred to “normality” in general. Google Trends only shows back to 2004, but back then “normality” was definitely on top.
I think the Harding phrase is so ingrained that even when I was back in high school, I remember being surprised to learn that Harding coined "return to normalcy" (and I don't remember what he was saying it about).
I'm not sure if your anecdote about the FDA slow-playing boosters and child vaccination is true, but if the Biden Administration is actually trying to prioritize global vaccination then maybe they shouldn't actively humor these paranoid people.
Right now (fully vaccinated) Joe Biden is wearing a mask around his (fully vaccinated) cabinet and the admin has supported school mask mandates. Maybe the low hanging fruit to encourage Americans to prioritize global vaccination would be to act as though (a) the vaccines work and (b) children are at low risk without vaccination. Otherwise people will reasonably believe that the administration is not confidence in the efficacy of the current approach. Trying to backdoor policy through the FDA seems like a plan B.
> (a) the vaccines work and (b) children are at low risk without vaccination
I was talking to my parents the other day, about why my brother had canceled on a trip that they were still planning on going on, and they were saying that at least they have been vaccinated, while my brother has to worry about unvaccinated kids at home. In the circles I hang out in, it's been common knowledge that vaccinated people my parents age are at the same risk level as unvaccinated people my age, and that vaccinated people my age are still at higher risk than unvaccinated children, but a lot of people (including people with graduate degrees in mathematics, like my parents) haven't actually spent the time looking at the numbers to realize that age is a bigger factor than vaccination status for safety.
On the one hand, if the FDA thing is true then it makes me feel better about my children not having access to the vaccine yet - at least it's for a cause I support vs. "my children can't get it and we also wasted 12 million doses in June/July/August - can't we get some of those"?
But I also don't like being lied to about this - this smacks of the CDC mask requirement, which although I personally happened to have read the right things to understand it was about preserving supply rather than saying they were ineffective - came across (understandably) as(or was) a lie to many people which undermined trust.
My understanding is that we didn't waste 12 million doses. All vaccination drives have some number of doses that don't make it in arms due to equipment failures, human error, accidents, logistical issues, etc... Off the top of my head, I think it's usually in the 5-10% range and for COVID vaccines, it's around 3%. The only way to not "waste" these 12 million doses was to not vaccinate people.
Thank you very much for this post!
-Daniel in Kenya
Do you have any evidence WHATSOEVER to justify your "strong suspicion" that the FDA is deliberately slow rolling regulatory approval for political ends, or are you just making things up?
Citing Tyler Cowen's increasingly deranged FDA conspiracy theories does not count as evidence.
We vaccinate against chicken pox, or varicella. COVID appears to be much more fatal to children than chicken pox is.
Old COVID data from December, pre Delta:
“ More than 2 million children have been diagnosed with COVID-19, including more than 1 million since mid-November.
New data from the AAP and the Children’s Hospital Association show nearly 179,000 COVID-19 cases in children were reported last week alone, bringing the total to at least 2,000,681 as of Dec. 24. Children make up about 12.4% of the total cases in the U.S.
At least 172 children had died as of Dec. 17”
“ The fatality rate for varicella was approximately 1 per 100,000 cases among children age 1 through 14 years, 6 per 100,000 cases among persons age 15 through 19 years,”
Let’s say we took a rate of 2 per 100,000 deaths as a fair comparator for Varicella. That means for 172 children to have died of Varicella, there would have been 8.6 million cases, not 2 million.
And Delta is more infectious.
I am curious about whether having the FDA inspect the factories in China would help because I'm genuinely not sure. I have a relative in a country that used a lot of Sinovac vaccines and have acquaintances with friend and family members in countries that depended on the Sinovac/Sinopharm vaccines. There isn't a lot of confidence in those vaccines. It's a combination of knowing that they aren't very effective compared to the mRNA , J&J and AZ vaccines, China having sold substandard PPE and Covid tests to many low income countries, and the way China has seemed to strong arm countries into buying their vaccines. On the other hand, even some protection is better than nothing.
Authorizing the NovaVax vaccine would also help. They should have data for the EU in October. It's about as effective as the mRNA vaccines and was specifically designed for use in low-income countries that don't have a lot of freezers. It's also a protein subunit vaccine, so some of the people who don't trust the mRNA vaccines or J&J might be willing to take it. And it seems to have fewer side effects. They're also working on formulating it along with a flu shot.
You ask in the subscription application: why did you subscribe. Today, finally, in order to call bullshit on your "shade" on "covid neurotics" who apparently are unmoved to prioritize stats over personal situations. You have no idea about people's reasons, and I hope you learn a lot from the comments below as so many people have already said what I need to say. Do you even have kids? If no, explains something, if yes, have you actually talked to their teachers? Or folks with underlying conditions are are really afraid of long haul covid, which you can get from post-vacc mild cases. Our own doc and dear friend says that the most recent OHSU studies have shown that now about 34% of people are carrying covid with no symptoms, post-vaacc. Well, I guess your "shade" was a great marketing technique.
Look, David and others, I see he has a child, but I don't know much more than that. How old? What is school like? What do the teachers there say? My sister and her husband re both elem sch teachers in a pretty progressive place, but are working under the worst conditions anyway. BC the vacc can carry it unbeknowns, their child is at risk. They are truly scared, have reason to be, have seen many kids and teachers get sick, afraid to bring it home. This is all anecdotal, but it is really hard to navigate through all the info and stat reading we get, what we see in our own lives, and in our case, what our own doc says. We met with him for long time to discuss the risks of holding a 100 person wedding outside at very end of August. I did cite his own research sources: Oregon Health Sciences Univ. for what it is worth. I find it super hard to understand the stats, or whether or not I should trust Matt, or people online here, or our own doctor (who is also a researcher) who advises great, great caution for someone like me, w underlying conditions.
As for why I claim to know 31 and counting w covid post-vacc, maybe my "social circle" is larger than you "loners," -- I think it may be bc two of my three kids got married in the last 4 weeks, my husband manages a firm so we also hear there, and there is a lot of info coming in. Maybe that is a larger social circle, maybe not. I just do know of them all by name. What I object to, and why I chose to subscribe today is for more than "yelling" at Matt; I tend to like him but I do not like being called "neurotic." I think we should save our anger and frustration for the truly anti-vacc, not for the grandma's who won't help you take your kids to school because they are afraid. I think I get to say to someone I respect, hey do not be calling me "neurotic." I say defensively.
Since we're talking about kids, one statistic that I had seen somewhere and I found interesting is that drowning kills more children than COVID. I googled a bit and found the following statistics:
- Seems that there have been 415 deaths for ages 0-15 from the beginning of the pandemic: https://covid.cdc.gov/covid-data-tracker/#demographics
- Seems that there are approximately 830 deaths for ages 0-14 per year: https://www.stanfordchildrens.org/en/topic/default?id=water-safety--injury-statistics-and-incidence-rates-90-P03004
This isn't a perfect comparison, because in one case you have reported deaths and in the other case estimates. Also, the age brackets are different and COVID has been going on for more than a year. However, I guess this gives a general estimate of how dangerous COVID is for children, and it doesn't seem terrible to me, given that we still allow the existence of pools.
PS: As a European, a rule of thumb is that you should never trust American doctors. :P
This seems like overly conspiratorial thinking. It seems much more plausible to me that the FDA's stated concerns around safety and efficacy of boosters and child vaccines are the real cause of slowness. Two high level people at the FDA recently published an opinion piece describing exactly why they're uncertain that boosters are needed (https://www.statnews.com/2021/09/13/international-review-argues-against-covid-19-vaccine-boosters/), and their paper only mentions equity concerns in passing at the end. For child vaccines, the risk of death from COVID is objectively low, and there is suggestive evidence that myocarditis side effects of the vaccines tend to inversely correlate with age. That was their stated reason for increasing the followup period and increasing the size of the trials. Maybe it's motivated reasoning, and really they're searching for excuses to delay to encourage global distribution of doses, but this is how the FDA has acted for decades: strictly following bureaucratic formulas around what kinds of evidence is necessary and how rigorously it was collected. I mean of course you can disagree about how reasonable this is under the circumstances (I disagree, for the very little that is worth), but there's no reason to think the FDA is not acting on the level.
But also the equity argument for child vaccines is just objectively much weaker than for adult boosters. The doses Pfizer is testing are 1/3rd of an adult dose for 5-12 years and 1/10th of an adult dose for 0.5-4 years. So if the Pfizer vaccine is approved for children at its current dosage, you could vaccinate 10 young children for the cost of vaccinating one adult (or five for the cost of boosting one adult). Children are less likely to spread the disease than adults, and they are more than 10x less likely to experience severe disease than adults. But still, it's not completely obvious that vaccinating 10 young children slows disease spread less than vaccinating one adult. It is fairly obvious that all else equal, a dose is more useful in an unvaccinated adult than boosting a vaccinated non-elderly/immunocompromised adult.
What's your source for the "full order of magnitude" number? The numbers I'd seen were more like ~2x less likely to contract COVID and also had an R<1. (e.g. https://www.healthline.com/health-news/kids-are-half-as-likely-get-covid-19-as-adults-heres-what-we-know)
I haven't seen any post-delta numbers for how susceptible children are to delta, but it's reasonable to assume that it's much more than alpha or the ancestral strain, as with adults. Much higher pediatric ICU utilization than at previous points in the pandemic tends to support that.
Yup, I said that in my comment: "[children] are more than 10x less likely to experience severe disease than adults". Compared to elderly people it's several orders of magnitude.
My point is that vaccinating 10 children may reduce transmission enough to be better on strictly consequentialist grounds than vaccinating one adult. It's not *obvious* which wins, whereas it is obvious which wins for 3rd shots for vaccinated adults. Some epidemiological modeling would be able to answer which is better, but I haven't seen any analysis along those lines.
I think 'work to rule' might be too strong a phrase. If you work for the FDA, your comfort zone is slow and cautious. Utilitarian concerns about children dying while they wait for a vaccine might push you to go outside that comfort zone. If, however, the utilitarian position is we should vaccinate the world's adults before America's kids, then you no longer have a conflict between saving lives and following the process.
"Gentrifying Children of Logan Circle" is a terrible band name.
How quickly should we reasonably hope to get the world vaccinated? By tomorrow would be great, but may not be possible. MY's post hints at "next spring" (in terms of when supply will be a lot greater), but we can make a better estimate of that.
About a third of the globe is fully vaccinated now. Currently, global vaccinations are averaging ~35M/day. At just that rate of administration, we would hit 75% vaccinated in five months. But, as MY notes, global supply is increasing. That is, four months is a more reasonable estimate for hitting 75%, probably five months for 80-85% and so on.
See: https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/?sref=SvwPxqpB
Even faster would be better, but what are the chances that new interventions would speed the process up all that much, if not actually slow it down?
The real problem is hitting the laggards, and understanding why that is the case. As MY notes, Africa is way behind. That's especially the case for the biggest countries: Nigeria, Egypt, South Africa, not to mention DR Congo. Is it simply a matter of funding (something the advanced world can and should fix)? Or poor healthcare systems that simply can't administer the shots no matter the supply?
I think these are the more critical questions than figuring out how to give supplies a jolt.
It really sounds like the bottleneck is getting doses on-site and then into arms, more than getting doses to countries at this point.
" that it’s bad to authorize these uses of precious mRNA vaccines when there are much higher-value uses of them abroad. However urgent I may feel it is to get my kid vaccinated, objectively, the risks to him are very low, and the expected value of lives saved is much higher if those doses go to a middle-aged person in a poor country."
Bad take. The same group of policy geniuses that can't build public transit without dumping shed loads of money and just organized an Afghanistan pratfall are going to solve the global vaccine shortage?
And I've got a bridge in Florida to sell you.
Just take an easy win that we can actually accomplish rather than pie in the sky international utopianism.
Yes, saving a few pennies and getting out by September 11th so Biden could score all the political points while pissing off his European allies was sure worth it. Wouldn’t want to have waited until the winter or made contingency plans, nope, not gonna do it. Biden can now bask in the well deserved glow of a job well executed.
Also the liberati really need to stop with these straw man, false dichotomies.
Because you don’t dismiss the idea that COVID escaped from a lab doesn’t mean that you think the Chinese engineered the Wuflu to take out the globe.
Because you believe it was possible to leave Afghanistan without falling on your butt quite so badly doesn’t mean you think we need to stay there forever.
I am not a Trump supporter in least.
Considering that Biden was willing to slam 6000 troops in there when everything went to pieces, you should be able to see where problems with the withdrawal plans lie.
Biden’s willing to do it in response to something, but not preventing something from happening. I have to say it’s a very American management failure that appears to be universal.
Meanwhile, the number of Americans killed in one day in the withdrawal approaches the yearly totals for each of the past 5 years, where American troops somehow were holding out through campaign season without incurring significant casualties. There seems to be a myth that casualties dropped because of Trump’s deal, which is not the case.
The danger of Covid to children is so low that, for me at least, the importance of potential problems and side-effects becomes a bigger issue both mathematically and intuitively. I'd like to see the vaccine approved for kids, but only after it's gone through all the required safety testing so that we understand the risks well, particularly with myocarditis.
Secondly, more money in 2020 would not mean that there would be more vaccine factories in 2021. Things don't get built that fast, especially in today's regulatory environment.
It's the same with the current global chip shortage which isn't going away until 2023 because building capacity takes time regardless of how much money you throw at the problem.
I hate to be that guy but this ignores the risks of Long COVID which seems to also be lower in children but there's still some indications of a significant (low single digit) percentage of chronicle fatigue syndrome. The lack of good studies and data around this is one of the my biggest COVID frustrations (which is saying a lot) but I think it significantly affects the risk considerations.
Yeah, there are still a lot of unknowns which makes risk assessment more difficult.
There was a high quality study that looked at kids and long covid, which also found single digit rates of long covid (I think it was around 1.5%) and they found that most cases resolved within about 60 days, which is really encouraging. I have no doubt that there are going to be some cases of long covid that do fall into the chronic fatigue syndrome bucket, just like happens with other viral infections.
I share your frustration with our inability to study long covid and covid convalescence in a systematic manner. We'd be making much better decisions if we had good quality evidence one way or another.
That's very encouraging. I actually read that study but then skimmed Thomas Pueyo's adult focused chronice fatigue post yesterday and it may have moved up my memory of the numbers up too much (I haven't been doing a great job of taking notes on the various studies recently). Thanks for clarifying.
In terms of myocarditis risk I know that risk of that from COVID is higher for adults than from the vaccine and my sense is that this is also true for kids though I'm not 100% sure and it probably depends on vaccine dosing as well, but it's definitely not 0 for COVID.
And why were the studies on children not done in parallel with adults?
Because we do not experiment on children until we know a medication is safe and effective in adults.
And we knew that in November 2020, so ....
https://www.npr.org/sections/coronavirus-live-updates/2021/05/10/993591902/hold-fda-oks-pfizer-covid-19-vaccine-for-12-15-age-group
"The FDA first granted Pfizer's request for an emergency use authorization for its COVID-19 vaccine in December. It got federal approval to include children as young as 12 in its vaccine trial in October."
So they at least started the next younger age group AFTER the adult safety data was in, and in fact BEFORE November 2020.
The 12-16 was APPROVED on May 10.
https://med.stanford.edu/news/all-news/2021/05/covid-19-vaccine-trials-for-children-under-12.html
The Under 12 trials started right around then (they might have started earlier)
So it looks like they pretty consistently started each new (younger) cohort when the previous one was approved, without delays in between.
Maybe for a pandemic this could have overlapped more, maybe it didn't need to because the risk factors were lower, but it is consistent with "try it on younger patients after old" without apparent excessive delays.
The FDA wasn’t convinced.
The FDA's problem has become a problem for everyone else.
I don't know.
How risky are children as vectors for transmission to unvaccinated adults?
Maybe I was reading in between the lines too much in this article but it read to me that there was an implicit assumption that all/sufficiently-enough adults are vaccinated. This is not true in most places and is definitely not true in the places where hospitals are already crowded.
Put another way, is vaccinating children a way to reach herd immunity given recalcitrant adults?
Joining a new progressive synagogue??? Jew pride! Rock on bro!
I was curious about this too. Like, did he mean the synagogue is very reform, or did he mean that all the sermons are about land use regulations?
Hopefully both!
Here's my hot take: None of this matters because it's too late. The delta variant is so contagious that once it takes off in some area it causes a two-month pulse of cases and deaths after which it subsides due to acquired immunity. The variant is already everywhere and no plans we make now to produce more vaccines in the future will affect it. India had its wave a few months ago, South Africa is coming out of theirs, and we are in the middle of ours.
Maybe some new variant will emerge that evades acquired immunity but not immunity from vaccinations, in which case we will wish we had exerted ourselves more on vaccines at this moment, but that's speculation.
People are needlessly freaking out about their kids right now, but as our wave ends and the virus is less top of mind, people will naturally chill out. Approval for younger kids seems to be forthcoming notwithstanding any utilitarian concerns, so that will probably help set their minds at ease.
I don't think it's clear that acquired immunity is the deciding factor in when waves subside - it seems quite plausible that news alerts showing overflowing hospitals play a big role in getting ordinary people to cut their contacts a bit.
Evidence seems to suggest that acquired immunity from infection is comparable to that from vaccines in effectiveness (some seems to say a bit more, some seems to say a bit less). So it would be surprising to say that we can't vaccinate our way out, but then think that infection rates well below 50% allow us to infect our way out.
Okay, my big question: When did we all decide that, through this whole pandemic, we were going to use the term “normalcy” instead of “normality”? As someone who prefers the latter term, it’s been wild seeing it just completely discarded.
Warren Harding.
https://en.wikipedia.org/wiki/Return_to_normalcy
Yeah, but is everyone really going for the Harding reference? It feels like, after 9/11, more people used “return to normality” or referred to “normality” in general. Google Trends only shows back to 2004, but back then “normality” was definitely on top.
I think the Harding phrase is so ingrained that even when I was back in high school, I remember being surprised to learn that Harding coined "return to normalcy" (and I don't remember what he was saying it about).
You don’t want trends, you want the Ngram Viewer:
https://books.google.com/ngrams/graph?content=Normalcy%2C+normality&year_start=1800&year_end=2019&corpus=26&smoothing=3&direct_url=t1%3B%2CNormalcy%3B%2Cc0%3B.t1%3B%2Cnormality%3B%2Cc0
Ah, thanks for this. I'm very interested in what it will show once it has data from 2020/2021 in it.
I'm not sure if your anecdote about the FDA slow-playing boosters and child vaccination is true, but if the Biden Administration is actually trying to prioritize global vaccination then maybe they shouldn't actively humor these paranoid people.
Right now (fully vaccinated) Joe Biden is wearing a mask around his (fully vaccinated) cabinet and the admin has supported school mask mandates. Maybe the low hanging fruit to encourage Americans to prioritize global vaccination would be to act as though (a) the vaccines work and (b) children are at low risk without vaccination. Otherwise people will reasonably believe that the administration is not confidence in the efficacy of the current approach. Trying to backdoor policy through the FDA seems like a plan B.
> (a) the vaccines work and (b) children are at low risk without vaccination
I was talking to my parents the other day, about why my brother had canceled on a trip that they were still planning on going on, and they were saying that at least they have been vaccinated, while my brother has to worry about unvaccinated kids at home. In the circles I hang out in, it's been common knowledge that vaccinated people my parents age are at the same risk level as unvaccinated people my age, and that vaccinated people my age are still at higher risk than unvaccinated children, but a lot of people (including people with graduate degrees in mathematics, like my parents) haven't actually spent the time looking at the numbers to realize that age is a bigger factor than vaccination status for safety.
On the one hand, if the FDA thing is true then it makes me feel better about my children not having access to the vaccine yet - at least it's for a cause I support vs. "my children can't get it and we also wasted 12 million doses in June/July/August - can't we get some of those"?
But I also don't like being lied to about this - this smacks of the CDC mask requirement, which although I personally happened to have read the right things to understand it was about preserving supply rather than saying they were ineffective - came across (understandably) as(or was) a lie to many people which undermined trust.
My understanding is that we didn't waste 12 million doses. All vaccination drives have some number of doses that don't make it in arms due to equipment failures, human error, accidents, logistical issues, etc... Off the top of my head, I think it's usually in the 5-10% range and for COVID vaccines, it's around 3%. The only way to not "waste" these 12 million doses was to not vaccinate people.