The Vaccine

Lots of people all the world are hoping (praying?) that there will soon be a vaccine for the coronavirus. I’ve always felt that optimism for a vaccine as solution is misplaced. Here’s why.

Origin matters: Let’s face it: if China or India developed a vaccine, would most of the world trust it? Obviously not, so any vaccine has to come from the West for people to trust it. And therein lies the rub.

Clinical trials take, like, forever: Any new medicine or vaccine needs to be tested first. Obviously. For side-effects. To check if it actually works. And Western systems have unfortunately demonstrated an “inability to start and run clinical trials faster”, writes Matthew Herper. Siddhartha Mukherjee had described this exact problem in the context of possible AIDS medicines in The Emperor of All Maladies:

“(Clinical trials) were all well and good in the cool ivory towers of medicine, but patients affected by a deadly illness needed drugs now.”

Ethics of RCT (Randomized Control Trials): How are clinical trials done? You pick a representative set of people with the illness, give the medicine that you are testing to some of them, and placebos (pills that look like medicines but are nothing medicinal really) to the rest, then compare the results. This is to eliminate the placebo effect (There are additional checks, but I’ll skip those since they are not relevant to the point here). Now consider the case of the hypothetical coronavirus vaccine. If you were in the test group for such a vaccine, would you want to be in the placebo group? Hell, no! Everyone would want a shot of the vaccine that may work, not some placebo. Again, Siddhartha Mukherjee had described just this scenario in the context of AIDS:

“(In an editorial, advocate for AIDS patients, Larry Kramer wrote): Double-blind studies were not created with terminal illnesses in mind. AIDS sufferers who have nothing to lose, are more than willing to be guinea pigs.”

But what if there are many who are volunteering to be on such trials, as is happening for the coronavirus trials? Does that solve the problem? Not really, writes Tyler Cowen:

“Many members of the biomedical establishment do not wish to have bad feelings about any “sins of commission” and to see their status lowered as a result of “dirty hands”.

Precedents and slippery slope: The West cringes at the prospect of making an exception to the system of clinical trials for any reason. After all, they never made such exceptions for terminal AIDS and cancer patients in the past. Many researchers would probably agree with this line that Mukherjee quoted, in the context of possible cancer cures:

“(Researcher Debu Tripathy said,) If you start making exceptions and deviate from your protocol, then you get a lot of patients whose results are not going to help you understand whether a drug works or not.”

And if you make an exception for coronavirus now, would that set a dangerous precedent for all future medical trials? The West, in general, is paranoid of the slippery slope argument: they fear that if  they make an exception once, it will only open the floodgates later for every other medicine or vaccine. Why can’t the same exception be made for the next medication, would be the court-case argument of some Big Pharma company.

Manufacturing: Ok, let’s say the West did come up with a vaccine. How long would it take to build enough manufacturing capacity? Bill Gates has proactively tried to address this problem when he announced:

“(Gates) was picking the top seven vaccine candidates and building manufacturing capacity for them. “Even though we’ll end up picking at most two of them, we’re going to fund factories for all seven, just so that we don’t waste time in serially saying, ‘OK, which vaccine works?’ and then building the factory,” he said. Gates said that simultaneously testing and building manufacturing capacity is essential.”

Yes, this improves the situation, but it is still possible that none of the seven candidates works out. In which case, the manufacturing capability would have to be built from scratch only after the vaccine is found. Not an attractive proposition.

Global Reach: It doesn’t help if only a few countries have the vaccine. Sure, they’d be out of the woods, but the global economy is tightly integrated. We need (almost) every country to come out of the woods before things can truly get back to normal. How long would it take to build that much manufacturing capacity? And how long after that for it to be rolled out in most countries?

All of the above is why I believe that a return to normalcy is far more likely to happen not via any vaccine, but when our collective mindset of fear and paranoia changes. This will sound heartless, but here’s one such scenario: say, the death rate and hospitalization eventually starts falling because the virus has run out of people it can strike so devastatingly. In other words, those struck it by it from that point onwards, have negligible symptoms or just fall sick for a few days/a week, but rarely get hospitalized or die. If/when we reach that stage, the fear and paranoia will inevitably diminish. But how long will that take to happen? Who can tell, but I doubt that will happen anytime soon…