Thread by @atatimelikethis

A little knowledge is a dangerous thing...is wrong.

Dunning Kruger is far worse.

Donald Trump has declared a plan sure to worsen #Covid_19. This time though he affects the world as well as the US.

Sadly the topic is obscure; few know it's even a problem.

Settle in. Long one

1. A thread on shooting feet.

Must we always divide between self interest and progress? Choose the labels your system gives them.

It looks like that but in viral science we'd found peace—a place where politics was finally beaten by mutual interest.

Want to know how, why?

2. I wouldn't try this story usually but all of a sudden virology is fashionable. Not sure why 🙃

Let me take you back to the 1980s and a different Virus - HIV.
Some of you may know that it took almost 20 years for treatments to become available in developing markets.

3. For those of you who did know, did you think that allowing generic manufacture of anti-HIV (and other) viral treatments was an act of human kindness?

Of course not! We in the west went to great lengths to try to stop it, including suing India, South Africa and others.

4. But even if you knew that bit, did you realise those court action stopped. Unusual - we never stop. Did you know why?

Good work was done in politics, and a breakthrough was a Doha WTO meeting.

But I need to explain why this was nothing short of a miracle caused by death.

5. The reason Donald Trump has been eager to undermine and dismantle the WTO is his inability to get it to do his bidding. GATT, its forebear, was signed in 1948 pushed through by WW2 powers.

The WTO replaced GATT in 1995. Trump's anger isn't unusual. The WTO doesn't "do" things

6. There used to be a myth, or was it real? Googling "French military victories" used to return "did you mean defeats".

Googling "Major WTO agreements" doesn't entirely return an analogous result, but if you dig into the 60 that exist, you'll find they were around 1948 or 1995

7. In other words, it agreed treaties at foundational points and did bugger all else.

Apologies for taking you down a WTO rabbit hole in a virus thread but you needed to know it is Agreement Tar.

It's impossible to get anything done, so Doha must have been extraordinary!
WHY?

8. Someone once said the only way to get everybody to agree something at the WTO is if the world is about to end and they can see it from the room.

They were right.

How much do you want to know about viral resistance?

Probably less than I want to tell you even with #Covid_19

9. The summary version is that it's NOT the same as the more commonly understood bacterial resistance. You can't badly mishandle vaccines to create resistance like you can with antibiotics.

BUT (virologists forgive my simplifications) you can fail to suppress natural replication

10. Imagine bacteria are clever, over generations of copies they learn to avoid antibiotics.

Now imagine viruses are stupid. They don't know to survive a vaccine and mess up copying all the time. By accident that might result in resistance...except vaccines stop them copying.

11. Bacteria copy away from antibiotics.
Viruses can't copy away from vaccines (which prevent copying).

It's almost the opposite. Antibiotics create resistant bacteria.

It's a failure to vaccinate that allows viruses to copy and then become resistant

Does Doha make more sense?

12. HIV is a particularly stupid virus. Scientists realised by preventing the developing world from treating it, the chances to produce a "bad copy" increased. If that copy found its way to the west it could undermine all the profitable HiV treatments.

Greed was bad for profits!

13. Resulting in maybe the only significan agreement at the WTO. They saw -ve $$

Well that's a nice story. The great divide of politics solved by a communist virus which became a bigger threat the more selfish we were.

I and many virologists thought that was the end. How naive

14. Guess which virus is even more stupid than HiV?

👋 #coronavirus
Except
with training wheels.

It makes worse copy mistakes but it has a little trick that rejects mistakes that aren't viable.

So it changes rapidly and when it changes the outcomes are more successful.

15. That's a simplified reason why we have never managed to produce a #coronavirus vaccine.

It's also a very undisclosed reason why the Trump (and UK?) strategy is so dangerous. Lockdown stops spread but reduce spread, also stop copying.

You now know why we don't want copying.

16. Ironically the most critical reason we now need a vaccine is a badly informed President has created the ideal circumstances where any vaccine could find itself immediately ineffective because he let it copy.

I said we were naive. No one expected Trump.
But then he got worse.

17. Trump's ability to kill is limited by the US population. And while 350 million Americans are a lot, there are more people in developing markets where #Covid_19 is also copying.

Eventually that will be the greater risk. It should be already, under any normal President.

18. But we had hope.
After Doha, we knew at least the world would never again make the mistake of NOT treating developing markets for a virus.

Greed is bad for profits.

But for the worst of Trump, and our naivety
Today the US declared any #COVID19 vaccine would not be generic

PostScript 1.

1. Viruses aren't stupid, bacteria aren't clever. An analogy for clever humans to help the stupid.

2. Antivirals are not vaccines. For the purposes of this thread the distinction wasn't needed.

3. Find ways to remove stupid politicians before they kill us all.

Postscript 2.

The idea of having an Inquiry after an event makes sense. Who wants to create more disruption in a crisis?

That works with something that is over and done.

But if you let people who made bad decisions continue to make them?

Bad decisions compound, as do deaths