Second, the assumption that we can develop, produce and admin boosters fast enough to combat a resistant variant seems highly unlikely. After large part of the pop is vaccinated, NPIs like distancing are gonna be relaxed (this is already happening), so the spread will be fast.
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We saw this in Manaus in January. ~76% of the pop had immunity due to natural infection. <1 month after the detection of P1 variant, spread increased explosively, overwhelming hospitals. And on that timescale, we can’t vaccinate our way out of this.https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00183-5/fulltext …
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Even our faster production technology, mRNA vaccines, take around 6 weeks for the commercial production process to switch to a new antigen sequence. And that ignores the time needed to run immunogenicity trials etc.
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Tl’dr I don’t think it is wrong to think that, absent rapid global vaccination, even places like the US will experience devastating new outbreaks that will cause death and very significant disruption.
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Finally, I think you are misremembering your AIDS history. No one ever made the argument that absent treatment expansion, transmitted drug resistance will threaten rich folks, because that makes no sense.
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ART drug resistance only evolves in ppl exposed to treatment drugs, drug resistance mutations don’t get selected absent this.
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In fact the *opposite* argument was made by pharma, that because Africans can’t tell time and other racist bullshit, they will poorly adhere to their meds, so that increased treatment access would increase drug resistance, threatening rich folks.
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Replying to @jbkrell
I think I wrote enough long-form on this to explain my concern, especially with how the intended target (purely selfish, rational, informed person) could reasonably draw other conclusions. But this may move policy people regardless, so if that works, guess that works.
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On HIV history: I do know there were arguments like that by drug companies, and I may well be misremembering public-facing ones as I wasn’t around or here for most of it. But I do know what worked was a mix of activism plus “legacy”—not a rational calculation by selfish masses.
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Replying to @zeynep
Two things. There wasn’t a rational self interest argument for HIV tx expansion made, because there was none, unlike for COVID. And, I think we need to be careful saying that it “worked” , considering it took years and millions of unnecessary deaths to get access.
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Of course on how it “worked”. The whole point is not to repeat that delay, clearly. On the former, again, the discussion is what is the level of evidence that would move this imagined purely selfish person, and what are their selfish options? We may disagree what that looks like.
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