More Dakka for Coronavirus: We need immediate human trials of many vaccine-candidates and simultaneous manufacturing of all of them
post by avturchin
Our best chance to fight CV is to create a vaccine as soon as possible. The irony is that we probably already have a vaccine but we can’t prove that it works, until animal safety test, 1 and 2 stage of the clinical trials, which will take 12-18 months at least. How we could accelerate the creation of the vaccine?
There are several ideas, which are mostly inspired by the research of anti-aging drugs, which suffer from the same problem: the need for very long clinical trials. See More Dakka post by Sara Constantin.
- Immediate human trials. If we have the vaccine in 3 months, not 18 months, we will save millions of lives. So, based on the trolley problem logic, we may risk the health of a few thousand people to achieve these goals, especially if they were volunteers. Thus we need to start a human test of the vaccine candidates immediately, even before the end of animal trials, which are still needed. here we get acceleration by performing in parallel the actions which are typically done sequentially.
- Test safety and efficiency simultaneously. We also should combine 1 stage and 2 stages oа tests, that is safety and efficiency, by giving the vaccine to people who are already under potential exposure to CV, like nurses, or old people in nurseries.
- Test on large groups. We should test a vaccine on a large group of people, like 10 000, so any finding will quickly get statistical significance. If the number of infection will decline relative to the control group, we could see it in one month.
- Test all vaccine candidates. All said above in 1-3 should be done with each of a dozen vaccine-candidates which are currently under developing. As a result, in one month we could know which vaccine candidate is the strongest and safest.
- Manufacturing in advance. Simultaneously, we should start large scale production of all vaccine-candidates, if it is possible. After the best (maybe 3 or 5) vaccine-candidates are validated, the stockpile of failed vaccine-candidates is destroyed, and the best vaccines are delivered to the population. This will help to fight the production delay.
- Give people different best vaccines. There is still could be long-term detrimental effects of some of the vaccines, so it may be better not to give everybody just one best vaccine - what if it makes everybody will become sterile in 1 year?
- Combine best vaccines. To increase protection, we could give each person a combination of several (but not all to ensure point 6) of the best vaccines. Here I assume that detrimental interaction between vaccines is typically unlikely, but more technical analysis is needed.
- Establish biomarkers of a good vaccine (e.g. antibodies). Biomarkers are important to check efficiency of a clinical trial before the final outcome is known.
- Try other approaches, like DRACO, distancing, coconut oil, a large dose of vitamin C etc and test them in the same accelerated way.
Several human trials already started: In China military volunteers are testing an experimental vaccine, and there are clinical trials of Moderna vaccine in the US.
Comments sorted by top scores.
comment by ChristianKl ·
2020-03-13T15:41:47.425Z · LW(p) · GW(p)
There are multiple players that could do this.
The obvious one is China. China can speed up clinical trials without bureaucratic red tape in a way that the US and Europe can't. Unfortunately, there's little that our community can do to affect Chinese decision making.
The less obvious is the UK. Politically pulling of the stunt of creating the first effective vaccine against the corona-virus would be very good to show the advantages that the UK has through Brexit that allow it to operate outside of EU red tape.
Dominic Cummings seems to be open to rationalist argument and also powerful enough to push through a policy like this.
comment by avturchin ·
2020-03-13T15:48:57.473Z · LW(p) · GW(p)
China can do it, but for effective testing they need to do it in a region with high level of new infections, but for now they almost stop local transmission.
comment by ChristianKl ·
2020-03-13T16:15:40.086Z · LW(p) · GW(p)
Yes, with especially with UK's chief scientific adviser Sir Patrick Vallance saying they want to not reduce spread and have 60% infected, that would make it a prime testbed for vaccines.
China does has prisons where they don't value the life of the inhabitants very much. You can even have a system where prisoners volunteer for the clinical trial and get released earlier as a reward.
In both cases it should be good for the world and there are a lot of political points to be scored. Further down the line it can also allow economic gain through drug development with less red tape.
comment by Pattern ·
2020-03-13T23:14:25.631Z · LW(p) · GW(p)
where prisoners volunteer
This sounds like something that could turn into a scandal where it later turns out prisoners were 'volunteered' against their will.
comment by ChristianKl ·
2020-03-14T18:42:48.022Z · LW(p) · GW(p)
You might have a situation where countries outside of China can decide whether or not to take a vaccine that was produced through in a process where prisoners were volunteered against their will and thus publicly affirm that they are fine that China does such things with their prisoners or let thousands of people die in their countries while public pressure builds up to accept the Chinese vaccine.
To me that seems like a good position for Xi to be in politically and not a problematic scandal.
comment by waveman ·
2020-03-14T00:04:49.261Z · LW(p) · GW(p)
So why won't this happen?
Part of the problem is the incentive structure faced by regulators. If they allow a vaccine out that kills 100 people they will be crucified. On the other hand if they delay a vaccine and 10,000 people die then nothing bad will happen to them. There are few incentives to make balanced assessments of risk/reward.
You have the same problem with the introduction of strong measures to control the Wuhan virus. It seems that in almost every country things have to get pretty bad before there is support to do anything serious. Taiwan is one of the very few exceptions:
Please note Taiwan's swift response. “42 confirmed cases & 1 death.”
Taiwan’s epidemic prevention policy (EPP) i. Travel limitations ii. Cancel big gatherings iii. Public health interventions iv. Behavioural changes v. Daily briefings vi. Compensation vii. Counter disinformation
I see in President Trump's announcement of a state of emergency he has cut some red tape inhibiting mass testing. So it is maybe not an entirely lost cause.
comment by RedMan ·
2020-03-19T07:38:56.778Z · LW(p) · GW(p)
From a strictly lolbertarian perspective, good vaccines are a shitty business to be in, shitty vaccines are a great business to be in.
Real vaccine: capital intensive, may or may not succeed despite best efforts, side effects will probably be present, requires that you produce insane amounts and successfully market to every potential customer or it doesn't work. In the best case where you actually achieve maximum distribution, the pathogen is gone, and you'll never sell another one, so if you didn't profit in the first rush, you'll never see your money again.
Alex jones colloidal silver: I tell you it works, if you're not dead in a year, you're obviously another satisfied customer, here buy another bullshit vaccine from me.
Second product is better for the seller than the first, capital investment is zero, marketing cost can find efficiencies in cost per customer, repeat business is probable.
If you can come up with a business model that makes good vaccines profitable in the current environment, absent aggressive government subsidies, you should start that business and shout your model from the rooftops, because most people in biotech would (angrily) agree with my summary.
Source: have thrown this at many biotech executives and government officers involved in vaccine procuremrnt. Have gotten head nodding.
comment by Yoav Ravid ·
2020-03-19T06:47:24.869Z · LW(p) · GW(p)
If anyone here is in or near Seattle -
This vaccine trial is recruiting volunteers in that area: https://corona.kpwashingtonresearch.org/
It's testing the safety of a SARS-CoV-2 vaccine that uses a new vaccine technology: mRNA in lipid nanoparticles; the idea is a few decades old, I think, but no vaccine using this tech has been approved for human use yet.
comment by AprilSR ·
2020-03-13T14:08:38.057Z · LW(p) · GW(p)
The way society works currently this can’t happen, but it’s a good insight into what an actually competent civilization would do.
Edit: After reading ChristianKI’s comment I’m realizing I was focusing overmuch on the US. Other countries might be able to manage it.
comment by avturchin ·
2020-03-13T14:52:54.756Z · LW(p) · GW(p)
But the interesting question is how can we reach this state of a more competent civilisation. I hope that the coronavirus crisis will be net positive as it will help preparedness and coordination for future disasters.
Maybe need some global coordination center in UN which will make decisions about such events.
comment by ErickBall ·
2020-03-14T23:56:32.897Z · LW(p) · GW(p)
Is the coconut oil thing for real? Are they suggesting a clinical trial where people just eat 3 tbsp/day of coconut oil and it's expected to have a significant antiviral effect? Or is it something more complicated?