So I think that you’re right to point out the bias that many experts have in overprioritizing wanting to avoid harm from a vaccine at the cost of ongoing deaths from the pandemic. That’s likely a very strong consideration playing into their judgments here, and one that should be fought against.
That being said, I think another concern that is underappreciated in these debates is lack of efficacy, rather than lack of safety. What if—and this is probably more likely—a vaccine doesn’t result in any harm, but also just doesn’t do anything to prevent disease? How much time have you spent getting pharma to invest time and resources into developing a manufacturing process for a particular vaccine, and getting the vaccine distributed to people, only to find out it doesn’t work? How many people will have lost trust in the vaccine development process such that they won’t take a subsequent vaccine, even if it works much better? Do you really have the option to “start over”? Maybe moreso now than ever the answer is “yes” given the relative agility with which you can move from design to manufacturing process with mRNA vaccines, but with anything cell culture-based you’ve probably lost months, at which point you might be in a worse situation than if you’d started with trials. This scenario doesn’t have to play out with literally zero efficacy, the same considerations apply if you have, say, 30% efficacy. You could blow your shot at developing a 90% efficacy vaccine b/c you’ve spent down all your resources on the 30% efficacy one.
The implicit theory behind this concern is that you have a limited bank of public trust + resources to work with, such that if you spend it all on the first try and it doesn’t work out, then there’s no going back. So best to make sure your one try definitely goes well, e.g. by setting up trials first.
I think it’s unclear exactly to what extent this theory holds up, but I think it warrants serious consideration. Too often I think these debates stop at “well the expected risk of harm to any given individual from even an untested vaccine is much less than the expected risk of harm from being unvaccinated, so we should give untested vaccines as early as possible” rather than considering the true counterfactual at a society-wide level.
Potential counterargument against the above: Well, yes, any individual pharma company might only have one shot, but as a society we could have many different untested vaccine candidates going out to people all at once. We already have a risk diversification mechanism by having many different vaccine candidate options, so we don’t need to further avoid risk by doing trials on all of them. And we also don’t have to give untested vaccines to literally everybody, just small populations at first.
Response to the counterargument: If the proposal is to give a bunch of untested vaccine candidates to people early on in the pandemic before knowing for sure how they work, haven’t you just reinvented clinical trials? Maybe a conception of them that is faster and to a larger population, but still fundamentally the same thing?
So I think that you’re right to point out the bias that many experts have in overprioritizing wanting to avoid harm from a vaccine at the cost of ongoing deaths from the pandemic. That’s likely a very strong consideration playing into their judgments here, and one that should be fought against.
That being said, I think another concern that is underappreciated in these debates is lack of efficacy, rather than lack of safety. What if—and this is probably more likely—a vaccine doesn’t result in any harm, but also just doesn’t do anything to prevent disease? How much time have you spent getting pharma to invest time and resources into developing a manufacturing process for a particular vaccine, and getting the vaccine distributed to people, only to find out it doesn’t work? How many people will have lost trust in the vaccine development process such that they won’t take a subsequent vaccine, even if it works much better? Do you really have the option to “start over”? Maybe moreso now than ever the answer is “yes” given the relative agility with which you can move from design to manufacturing process with mRNA vaccines, but with anything cell culture-based you’ve probably lost months, at which point you might be in a worse situation than if you’d started with trials. This scenario doesn’t have to play out with literally zero efficacy, the same considerations apply if you have, say, 30% efficacy. You could blow your shot at developing a 90% efficacy vaccine b/c you’ve spent down all your resources on the 30% efficacy one.
The implicit theory behind this concern is that you have a limited bank of public trust + resources to work with, such that if you spend it all on the first try and it doesn’t work out, then there’s no going back. So best to make sure your one try definitely goes well, e.g. by setting up trials first.
I think it’s unclear exactly to what extent this theory holds up, but I think it warrants serious consideration. Too often I think these debates stop at “well the expected risk of harm to any given individual from even an untested vaccine is much less than the expected risk of harm from being unvaccinated, so we should give untested vaccines as early as possible” rather than considering the true counterfactual at a society-wide level.
Potential counterargument against the above: Well, yes, any individual pharma company might only have one shot, but as a society we could have many different untested vaccine candidates going out to people all at once. We already have a risk diversification mechanism by having many different vaccine candidate options, so we don’t need to further avoid risk by doing trials on all of them. And we also don’t have to give untested vaccines to literally everybody, just small populations at first.
Response to the counterargument: If the proposal is to give a bunch of untested vaccine candidates to people early on in the pandemic before knowing for sure how they work, haven’t you just reinvented clinical trials? Maybe a conception of them that is faster and to a larger population, but still fundamentally the same thing?