Guarded Optimism

The editors of the Washington Post are guardedly optimistic about Pfizer’s announcement I mentioned yesterday:

The companies have a large Phase 3 clinical trial underway with 43,538 volunteers, and the announcement was based only on preliminary results. But should it hold up, the significance is that one of the most promising and new technologies does work at preventing infection. That may well mean that other vaccines will also work, that we can banish from our thoughts the worst-case scenario of “no vaccine,” and that the world will find a way out of a disease that has already taken 1.2 million lives.

but they caution:

Mr. Biden has properly addressed the persistent shortages in diagnostic testing, personal protective equipment and other issues, and on Monday he implored Americans to wear a mask, one of the most vital mitigations. But these are not going to be enough. The nation faces a massive, surging wave of infection into a population dangerously fatigued and complacent. Until the vaccine arrives, the pandemic demands a far more vigorous response. We hope Mr. Biden continues to work on it as he waits to take the reins.

I think they’re getting a bit ahead of themselves and they’re making the same mistake I have cautioned against with respect to Pfizer’s announcement. A few speeches, policy statements, and appointing a blue ribbon panel do not of themselves increase the amount diagnostic testing, PPE, and so on.

I thought for one brief glorious moment that Megan McArdle was actually going to commit journalism in her latest WaPo column. I was disappointed but she does point out some of the limitations in Pfizer’s announcement:

Keep in mind, however, that mass inoculation will be a massive headache. Earlier vaccination programs against childhood illnesses could rely on widespread immunity among adults and focus somewhat narrowly on kids, or adults who hadn’t had the disease. Once we have an effective vaccine, we’d ideally want to inoculate most of the population in short order. That will be particularly challenging with this vaccine, which needs to be stored at minus 94 degrees Fahrenheit. You can’t just pop this one in the fridge.

IMO mass innoculation will be a greater headache than anyone envisions at this point. I question whether your local Walgreens will install the necessary refrigeration capacity for keeping the vaccine or whether they have the follow-up capability that the two phased dose strategy requires.

I don’t want to be a crepe hanger and I recognize the sense of urgency that people feel but I question whether hurrying a completely novel method (mRNA) is prudent. Thhere is no experience with them. Quite literally no one really knows what their longitudinal effects might be—the trial has only gone on for a couple of months. It might take years for unforeseen adverse effects to appear.

There’s one more point I’d like to make. When you start doing back-of-the-envelope calculations about the scale of the plan, keep in mind that COVID-19 is a worldwide phenomenon. We aren’t just talking about innoculating 330 million Americans but 7.5 billion people in the world. In many places the refrigeration requirements of Pfizer’s solution would be as insurmountable a problem as putting it on the moon would be. I’ve also heard a lot of people making blithe assertions of priorities, e.g. healthcare workers and the elderly. I think that in the real world first priority will be given to all “essential workers” which, as we have learned is half of the population. Don’t be surprised if in some countries the military comes first.