The scale of thinking here is amazingly constricted.
Imagine if we had approached this like we did WWII.
We would have nationalized the effort to produce vaccines, building entire production chains and staffing them with anyone in need of work.
We would have built infrastructure to produce n95 masks and shipped them to every address.
What would this mean? We would have saved hundreds of thousands of lives, employed millions of people, strengthened our economy, and would now be wrapping up vaccinating everyone.
Our response to the crisis should be noted as a failure of monumental proportions. The lack of leadership at all levels of government continues to be astounding.
I agree. He insists there's an uncopyable bottleneck that couldn't be overcome by opening things up, BUT then also admits his knowledge of the purported microfluidics device (which isn't uncommon in pharma manufacture... and big pharma has capacity to manufacture bespoke microfluidics devices if they know the specs) is fuzzy because...
...well, because it's NOT open. The very bottleneck he's talking about is something he has to wave his hands about because it's bespoke, proprietary, and not well-published or open. This inadvertently validates the original tweet!
I can assure you, under most meanings of the words "uncommon" and "common", microfluidic devices for manufacturing these nanoscale encapsulated mRNAs are definitely "uncommon." In fact, I would wager that there are probably a handful in the world at most. Moreover, it's a fair bet that no two are alike.
Additionally, until this brand new mRNA vaccine technology actually demonstrated efficacy it was not quite so clear cut that we should put a huge proportion of our resources into making more of these devices, rather than explore different vaccine platforms.
They demonstrated high efficacy in primate models only like a month or two after first developed and earlier than that in vitro.
But we're not really limited in resources, here. We have TONS of money, people are unemployed, and this is essentially the biggest problem facing the world right now. We can AND OUGHT TO be "wasting" money by throwing large resources at a wide range of potential vaccines (some of which wouldn't work).
The whole "we don't have resources" thing is absurd. We've been spending literally trillions of dollars on COVID-19 relief (and monetary easing, etc) which is a poor substitute for actually solving the COVID-19 problem.
We did "waste" billions of dollars on a number of possible vaccine candidates that didn't actually pan out. See, Merck and Sanofi and GSK. Primate models are great (best we have), but we didn't "know" these things worked until end of December. It's beginning of Feb. I know the world is on fire, but things are moving fairly quickly. 1.34 million vaccinations a day in the U.S., from zero at beginning of Dec. That's pretty good. With much luck, the plateau in the vaccination rate this week gets resolved and we manage to hit 2M/day by end of Feb.
Economists clearly articulated last year that governments should buy capacity, not doses directly. Because that just pushes prices up (and we see the conflicts about fulfilling orders).
Furthermore. Since the process of vaccine development and manufacturing is closed, done in the shadows, no one had any idea where the bottleneck will be. (Yes, some companies bet on their vaccine and started expansion while the development was ongoing. And Derek speculates that the supply chain is at full capacity, but ... we don't know, and again, we could have been expanding that too exactly since a year ago.)
The mRNA LPN packaging might be new, but manufacturing plasmids that churn out Adeno Associated Virus particles with the correct payload is so old tech random youtube dude did it in 2018 February.
For example Trump simply went with ordering only 100 million doses of the Pfizer vaccine and said meh when asked about whether maybe in a country of 300+ million people they might happen to ... need a few extra ones.
The EU negotiated so hard that even though it ordered 400M from AstraZeneca, somehow they find it more important to fulfill other orders first.
It's too little too late. I understand that Bill Gates [0] can be so blasé easily, as for him it's just more of the same. Plus he has predicted it, he was directly trying to do something against these global health problems for at least a decade now. But this "inefficiency" - that thousands of people die of each day - is mind boggingly infuriating.
> Additionally, until this brand new mRNA vaccine technology actually demonstrated efficacy it was not quite so clear cut that we should put a huge proportion of our resources into making more of these devices, rather than explore different vaccine platforms.
I can't believe this is true.
The Pfizer and Modern vaccines were clearly in the top 10 last March and April. How could you argue that given 10 months and a billion dollars each we couldn't double our microfluidic device capacity for these two vaccines.
You are citing phase I data to support an implication that "clearly" phase 3 data was going to be positive. That is not how it works in real life. Many many many drug candidates look great after phase 1 and fail to become approved drugs.
Also, we did double our microfluidic device capacity. We more than doubled it. We increased our capacity by something like a million fold. Before these vaccines (first of their kind), there was no commercial scale capacity. This has all been invented in the last year. There was even a chance that achieving such capacity would not be possible. It is fairly common that drug candidates that look promising in phase 1 or 2 simply cannot be manufactured at scale with the quality required to ensure consistent safety and efficacy.
That’s true about many drug candidates but not these. Moderna (and Pfizer) had EXTREMELY promising results from in vitro, primate, Phase I, and Phase II results. Success by Phase III was very, very likely.
I agree that the new drug candidates had promising results. Yet as a new technology, there was still a risk. For example, the first Pfizer drug candidate BNT162b1 gave fever to 75% of the participants in some cases [0]. Some countries decided not to buy from them at first for that reason.
To add to that, except for Pfizer, all the other 5 vaccine contenders chosen by the Operation Warp Speed (Moderna, J&J, Oxford-AZ, Merk, Sanofi-GSK) received money to expedite their manufacturing regardless of the vaccine being successful of not. Together they received $11 BN. What can they show for that? Excuses about microfluidics? And vials ? (did you hear the one that Moderna will start putting 15 doses in vials intended for 10, because it turn out that vials are a bottleneck too after all). They couldn't figure out the vial thing in 10 months?
You don't think the government already thought of that? (for patents in general, that is).
From wikipedia:
Section 1498 gives the federal government of the United States the "right to use patented inventions without permission, while paying the patent holder 'reasonable and entire compensation' which is usually "set at ten percent of sales or less"
I think that in general patents, copyrights, trade secrets etc. have a negative impact on innovation by hindering potential innovators from building on the works of others. The question is, is that negative impact offset by the positive impact of the incentives to innovate granted by exclusive rights to IP?
The US response to WW2 took years. We’re still in the months range. You can’t parallel use the early sequential phases; you can’t fabricate this equipment — nor the expertise to manufacture it from nothing in just a few months.
Yes, actually, you can. (A well-endowed manufacturer can produce this equipment.) But it takes coordination, leadership, unlimited funding, and federal authority to step across red tape and corporate veils and IP to get things done. I was involved with some of this stuff. I know first hand how uncoordinated and un-led much of it was. We needed technocrats on private jets flying around the country tooling up production and solving every supply chain bottleneck like they were Elon trying to squeeze out luxury car production at the end of a quarter.
And vaccine production ABSOLUTELY could've been parallelized with approval. In fact, it was. They were stockpiling doses before approval. But the effort was at least an order of magnitude smaller than it ought to have been.
We constantly make excuses for this lack of effort. We shouldn't. We know what is possible. We can read history books.
That's a tough one. Could go either way (he's unstable... but resourceful). Tesla has been helping CureVac, though, which is one of the other mRNA vaccine providers (and could perhaps help scale out Moderna and Pfizer's vaccine, if they were given access to all their IP?).
This is true, and it will stay that way for a while. The US (at federal level) failed at nearly everything regarding containment of the virus, but got one single thing right in this pandemic: ordering vaccines. Ordering enough from the most promising manufacturers, at high-enough prices, and early. The EU failed at all of these three things in the most historic way possible.
4 months before the Pearl Harbour, FDR instated the Supply Priorities and Allocation Board by executive order. The purpose of the Supply Priorities and Allocation Board was to coordinate the distribution of materials and commodities related to national defense and to assist the Office of Production Management (OPM) in carrying out their overlapping duties.
On january 1942, merely 4 weeks after Pearl Harbour, FDR dissolved the SPAB and instated the War Production Board by executive order.
The WPB directed conversion of industries from peacetime work to war needs, allocated scarce materials, established priorities in the distribution of materials and services, and prohibited nonessential production. It rationed such commodities as gasoline, heating oil, metals, rubber, paper and plastics.
Moreover, the U.S. economy was already radically shifting before 1941. Between 1939 and 1941, unemployment feel from 17.2% to 9.9% and by 1942 it feel to 4.2%.
There's also an implicit assumption in your statement: the U.S. not actively joining the War until june 1944. That's incorrect as well.
The U.S. already actively engaged in the North African Campaign on 11 May 1942. Barely 6 months after Pearl Harbour.
Pearl Harbour kicked off the Pacific Theatre right off the bat. In June of 1942 - 7 months after Pearl - the Japanese Navy was soundly defeated in the Battle of Midway by Admiral Nimitz. August 1942 - 8 months after Pearl - the U.S. took the offensive at Guadalcanal.
Admiral Yamamoto, who led the Pearl attack, never believed Japan would be able to win from the United States in the first place. He believed it was a massive strategical mistake. He has conveyed his feelings:
> "I can run wild for six months ... after that, I have no expectation of success".
Which is exactly what happened.
So, no, the involvement of the United States in World War II is anything but an example of a nation state being forced to wait until it has ramped it's economic output before it can act.
We would have nationalized the effort to produce vaccines, building entire production chains and staffing them with anyone in need of work.
But that's not what happened in WW2. Businesses were not nationalized and they weren't staffed by anyone in need of work.
The War Productions board simply directed companies on what to produce. They could run their business as they see fit with some controls like wage caps, raw material quota, production quotas.
And it works better for war - switching from making planes to airplanes versus having companies switch from making microchips to making vaccines.
The only conclusion one can make is that it isn't as bad as we're claiming it is. If it were as bad as we claimed, we would be rushing RNs into ICU training, going full Taiwan on mask construction etc instead of saying "Don't wear masks" because we're scared we'll run out of masks.
Imagine if we had approached this like we did WWII.
We would have nationalized the effort to produce vaccines, building entire production chains and staffing them with anyone in need of work.
We would have built infrastructure to produce n95 masks and shipped them to every address.
What would this mean? We would have saved hundreds of thousands of lives, employed millions of people, strengthened our economy, and would now be wrapping up vaccinating everyone.
Our response to the crisis should be noted as a failure of monumental proportions. The lack of leadership at all levels of government continues to be astounding.