Thread by @luigi_warren

@EnjoyTheDecline 1/ My concern would be that the approval process has been rushed in order to field the vaccine in time to be relevant -- and then, likely only slightly relevant in the big picture -- for a disease that mostly represents a way of slightly accelerating death from old age, and for

@EnjoyTheDecline 2/ which hundreds of millions will have to be vaccinated. I would personally take a wait-and-see approach -- let's see what the real-world incidence of side effects is after this has been given to a few million human guinea pigs, and how serious an issue C19 remains after it

@EnjoyTheDecline 3/ has fallen into an endemic equilibrium -- i.e., is there much resurgence in the late fall of next year. Also, I'd like to have better ways of evaluating whether I likely have had the disease and developed significant immunity -- a number of papers have demonstrated that

@EnjoyTheDecline 4/ existing antibody tests only capture a fraction of infected&recovered, and the technology to find the rest is still to inconvenient, labor-intensive and expensive for general use. Being able to tell whether you've been infected already and therefore are unlikely to get any

@EnjoyTheDecline 5/ benefit from a vaccine shot strikes me as critical to evaluating the personal risk-benefit before deciding on whether to take a vaccine, at least until it's been out there in the field for a few years and we have solid safety data.

@EnjoyTheDecline 6/ I don't see any obvious reason to be more concerned about a vaccine based on mRNA than any other, beyond the generic concern that it is a relatively new technology. Obviously, new technologies can have unrecognized problems (remember the Comet), but worries that mRNA will

@EnjoyTheDecline 7/ "reprogram your" DNA strike me as hysteria. Here is a good, non-hysterical article on why we should be cautious about the safety of new vaccines generally and a rushed C19 vaccine in particular:
mainichi.jp/english/articl…

@EnjoyTheDecline 8/ These concerns are heightened by the fact the relaxation of normal safeguards has been done at the behest of private interests, promoted by a known bad-faith actor (Tony Fauci) and a scientific ignoramus (President Trump), all in the context of an elaborate info op to mislead

@EnjoyTheDecline 9/ the public about the character of COVID-19 and the role of natural immunity in bringing a spontaneous end to the attendant public health crisis.

@EnjoyTheDecline 10/ None of this is to deny that the new mRNA vaccines, and other C19 vaccines in the pipe, may ultimately prove useful & have acceptable risk profiles, or that it's a very good thing we have technology and infrastructure to turn out new vaccines more quickly than ever before.

@EnjoyTheDecline 11/ A bit more nuance on my suggestion above that vaccination will likely play a relatively minor role in vanquishing C19 as a major public health crisis...

@EnjoyTheDecline 12/ It's pretty obvious the waning of C19 in the US & in most major European countries (including, now, Eastern Europe) will be driven by herd immunity & occur spontaneously by the end of this flu season (say, February) before a major fraction of the population is vaccinated.

@EnjoyTheDecline 13/ Looks like in South America, where flu is mostly non-seasonal, the same will be true -- only there's just one big wave rather than a first wave when the virus first hits an immunologically-naïve population followed by a seasonal 2nd wave when R0s spike in the Temperate Zone.

@EnjoyTheDecline 14/ In Africa, with it's youthful population, C19 (as opposed to the disastrous effects of lockdown) isn't that big of a problem anyway. The situation is quite different in Asia -- for example, Japan. There, they haven't had much mortality and are potentially on a precipice

@EnjoyTheDecline 15/ (*especially* Japan, with its massive aged population) if they have simply been protected by containment. Thus, they might have a lot to gain from a vaccine. OTOH, there's a real unresolved question about whether their population has really been shielded and is therefore wide

@EnjoyTheDecline 16/ open for a public health catastrophe when the virus eventually breaks out, or whether they were never really that vulnerable in the first place because of (for example) widespread cross-immunity to antigenically similar circulating coronaviruses.

@EnjoyTheDecline 17/ There are also various mostly minor countries which probably don't have much pre-existing immunity but might yet survive the winter wave without a general breakout owing to containment & natural isolation (NZ, Norway, etc.) For them, a vaccine is a godsend -- but with risks.

@EnjoyTheDecline 18/ So, when I say I don't expect vaccines to play a big role in the resolution of the C19 public health crisis, I am speaking largely of the US, South America, Europe and Africa. Things might be quite different in some other places...

@EnjoyTheDecline 19/ I fully expect the powers that be to pretend otherwise -- we know that's coming, of course.