> We also could have invested single digit billions early on to build capacity for all of these different potential vaccines
As of the end of October, the U.S. had invested $18 billion to "build capacity," mainly by making advance purchases of vaccines that had yet to be produced (and had yet to pass clinical trials). See [1]. But maybe you're thinking of building capacity in a different way.
> We refused to risk any individual life in order to potentially save hundreds of thousands or more.
This is such an important point. In particular, human challenge trials, in which healthy, low-risk volunteers are infected with a low dose of the virus, could have saved tens of thousands of lives -- at a minimum -- in the U.S. alone. The case for HCTs, including the ethical case, is taken up in [2].
In a comment below, someone likens HCTs to the infamous Tuskegee syphilis study. The comparison isn't apt. In the Tuskegee study, people infected with syphilis were promised medical care that they were later denied. When they were diagnosed with syphilis, they weren't even told of the diagnosis. Those conditions are a world apart from the HCTs that Eyal et al. propose in [2].
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I don't think challenge trials would have really helped much. The issue is that obtaining an accurate estimate of vaccine efficacy in the real world is a crucial piece of information. There is a very large difference between a 95% effective and a 70% effective vaccine in terms of the roll out and who/how many need to be vaccinated. Additionally, challenge trials are fundamentally contrived in terms of the innoculum size and mode of transmission. There is no substitute for a proper randomised trial under native transmission conditions. Challenge trials would lead us into a long night of uncertainty about efficacy.
That's not evident at all. The vaccines appear to be effective enough against the existing 'notable' mutations, and we don't really have much information about what rate of concerning mutations to expect.
And then on the other side of it, Moderna has a vaccine against the South African mutation in a trial. And production capacity on the mRNA vaccines is pretty clearly not maxed out in any long term sense (and then the other vaccines apparently have a better path to volume; J&J still sounds like they will make 1 billion vaccines this year. The viral vector vaccines aren't as immediately adjustable as the mRNA vaccines, but they are similarly targeted, choosing a protein to be expressed).
There's talk in the press about the vaccines being less effective on the mutations.
In any case, the more people who are vaccinated, the more likely a strain will arise that is not affected by the vaccine. This will reset all the vaccination efforts back to zero.
They have reduced but sufficient effectiveness against the mutations that are in the news.
I guess there's lots of room for arguing about definitions, but I think we don't go back to zero if there is a vaccine escape. The production capacity that has been built in the last year is a big step forward (and we can expand it), and we are building out the administrative capacity to get the vaccine in people's arms (capacity that won't just vanish).
As of the end of October, the U.S. had invested $18 billion to "build capacity," mainly by making advance purchases of vaccines that had yet to be produced (and had yet to pass clinical trials). See [1]. But maybe you're thinking of building capacity in a different way.
> We refused to risk any individual life in order to potentially save hundreds of thousands or more.
This is such an important point. In particular, human challenge trials, in which healthy, low-risk volunteers are infected with a low dose of the virus, could have saved tens of thousands of lives -- at a minimum -- in the U.S. alone. The case for HCTs, including the ethical case, is taken up in [2].
In a comment below, someone likens HCTs to the infamous Tuskegee syphilis study. The comparison isn't apt. In the Tuskegee study, people infected with syphilis were promised medical care that they were later denied. When they were diagnosed with syphilis, they weren't even told of the diagnosis. Those conditions are a world apart from the HCTs that Eyal et al. propose in [2]. - - - - -
[1] https://www.bloomberg.com/news/features/2020-10-29/inside-op...
[2] https://academic.oup.com/jid/article/221/11/1752/5814216