Challenge trial for Covid in England reveals airborne superspreaders

 Nature has a news story about a Lancet Microbe paper reporting the challenge trial. See links to and excerpts from both below.

Here's the Nature story:

What makes a COVID superspreader? Scientists learn more after deliberately infecting volunteers. A rigorous study identifies ‘supershedders’ who spew huge amounts of virus into the air — despite having only mild symptoms. by Saima Sidik

"A study of people who were intentionally infected with SARS-CoV-2 has provided a wealth of insights into viral transmission — showing, for example, that a select group of people are ‘supershedders’ who spew vastly more virus into the air than do others1.

"The publication describes data from a controversial ‘challenge study’, in which scientists deliberately infected volunteers with the virus that causes COVID-192. Although the approach drew opposition, the work has now yielded data on questions central to public health, such as whether the severity of symptoms correlates with how contagious people are and whether home COVID-19 tests can play a part in reducing viral spread.

...

"Challenge studies are “very bold”, says Gandhi. Some people argue that it’s unethical to give people an infection that can cause severe illness, but the research design comes with benefits. Challenge studies can substantially speed up vaccine testing, and they’re the only way to understand certain aspects of COVID-19, such as the stage before people test positive or develop symptoms.

"Researchers inoculated 34 healthy young participants by squirting a known quantity of viral particles up their noses. Eighteen developed infections and spent at least 14 days confined to hospital rooms. Each day, researchers measured viral levels in the participants’ noses and throats, in the air, and on the participants’ hands and various surfaces in the rooms.

...

"Of the 18 participants who developed infections, 2 shed 86% of the airborne virus detected over the course of the entire study — even though both had only mild symptoms. Previous research3 has provided evidence for the existence of superspreaders who infect large numbers of people. But whether such people are also ‘supershedders’ who emit copious amounts of virus, or simply have many social contacts, was up for debate

..

"None of the participants emitted a detectable level of virus into the air before testing positive, and only a small proportion of them left detectable virus on their hands, on surfaces or on masks that they donned temporarily.

"By the time they tested positive, most participants had already experienced mild symptoms, such as tiredness or muscle aches. That means that if people test as soon as they detect symptoms, rapid tests “can be a powerful tool” for controlling viral spread, says infectious-disease researcher Christopher Brooke at the University of Illinois at Urbana-Champaign.

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And here's the original paper:

Jie Zhou, Anika Singanayagam, Niluka Goonawardane, Maya Moshe, Fiachra P Sweeney, Ksenia Sukhova, Ben Killingley, Mariya Kalinova, Alex J Mann, Andrew P Catchpole, Michael R Barer, Neil M Ferguson, Christopher Chiu, Wendy S Barclay, Viral emissions into the air and environment after SARS-CoV-2 human challenge: a phase 1, open label, first-in-human study, The Lancet Microbe, 2023, ISSN 2666-5247, https://doi.org/10.1016/S2666-5247(23)00101-5. (https://www.sciencedirect.com/science/article/pii/S2666524723001015)

"After controlled experimental inoculation, the timing, extent, and routes of viral emissions was heterogeneous. We observed that a minority of participants were high airborne virus emitters, giving support to the notion of superspreading individuals or events. Our data implicates the nose as the most important source of emissions. Frequent self-testing coupled with isolation upon awareness of first symptoms could reduce onward transmissions."

Reconsideration of covid convalescent plasma

Recently Statnews reported that Covid convalescent plasma (CCP) may in fact be useful in preventing severe illness, despite the fact that earlier clinical trials did not show success in reversing severe illness:

Covid convalescent plasma: the ‘little engine that could’  By Michael J. Joyner, Nigel Paneth and Arturo Casadevall

"Unlike monoclonal antibodies, which can be defeated by new SARS-CoV-2 variants, CCP collected from vaccinated donors after recent breakthrough infections (VaxCCP) evolves with the variants and retains the ability to neutralize them. What makes CCP an even more promising therapy is that there are now many potential donors available in the U.S. who have been vaccinated and had recent breakthrough infections.

...

"An array of data, including randomized controlled trials and careful retrospective studies, show a clear survival benefit when CCP is given to immunocompromised individuals who test positive for SARS-CoV-2. There are also impressive case reports and case series showing that Covid convalescent plasma, especially VaxCCP, is effective in patients with smoldering Covid-19.

...

"the early “major” RCTs that tested the efficacy of CCP on survival in hospitalized patients tested the wrong use case. These studies treated patients who were too sick for too long to benefit from antibody therapy. But the major “negative” trials all showed evidence of effectiveness among people who received CCP earlier, who were not already desperately ill, who were immunocompromised, or who received the most antibodies. Unfortunately, these positive signals, which were consistent with impressive real-world data on Covid-19 and CCP, were buried under the top-line results."

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Earlier posts on convalescent plasma

The return of convalescent plasma as a treatment for Covid

 As evidence accumulates, it appears that convalescent plasma helps some patients with Covid.  Here's an article from Medpage

COVID Convalescent Plasma Finds a Therapeutic Role. — Growing evidence shows benefits in the immunocompromised

by Arturo Casadevall, MD, PhD, Jeffrey P. Henderson MD, PhD, Brenda J. Grossman, MD, MPH, Michael J. Joyner, MD, Shmuel Shoham, MD, Nigel Paneth, MD, MPH, and Liise-anne Pirofski, MD June 19, 2022

"In the dark days of the early COVID-19 pandemic, when there was no known therapy, COVID-19 convalescent plasma (CCP) brought a ray of hope. COVID-19 survivors, community organizers, clinicians, regulators, and blood bankers collaborated to quickly bring CCP to patients. First used at the end of March 2020 in the U.S., 40% of all hospitalized patients were being treated with CCP by October 2020, considerable progress for a treatment without pharmaceutical industry support.

"Since those early days, CCP use has largely fallen off based on insufficient evidence of efficacy in hospitalized patients and the availability of other therapies. But growing evidence has shown benefits of CCP in a population with diminished treatment options and vaccine responses: the immunocompromised. This population encompasses about 3% of the population and their needs have been relatively neglected in treatment guidelines during the COVID-19 pandemic.

...

"As the pandemic progressed, further evidence showing that CCP was effective when used early and with high antibody content emerged, strengthening support for the FDA EUA in specific groups. However, with evidence of widespread benefit being considered insufficient in the broader patient population, CCP was largely branded as ineffective, collections dropped, and little or no CCP was available when Omicron surged in early 2022.

...

"The continued needs of immunocompromised patients and the discovery that CCP obtained from vaccinated convalescent donors possess extremely high levels of antibodies that neutralize all known variants to date, including Omicron, have promoted a CCP comeback. CCP use is now recommended for immunocompromised patients by multiple major professional organizations, including the Infectious Diseases Society of America (IDSA) and the Association for the Advancement of Blood and Biotherapies (AABB).

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Earlier:

Sunday, April 25, 2021

The rise and fall of convalescent plasma as a treatment for Covid

 

Wednesday, May 20, 2020

Convalescent plasma collection and distribution

The demise of bourbon-scented hand sanitizer

The Covid pandemic isn't over, but the emergency shortage of hand sanitizer is.

Some Companies Will Stop Making Alcohol-Based Hand Sanitizer, by Rebecca Voelker, JAMA. 2021;326(19):1899. doi:10.1001/jama.2021.19919

"Nearly 2 years after the COVID-19 pandemic struck the US, the FDA will withdraw its guidance on manufacturing hand sanitizer. The withdrawal applies to nonpharmaceutical companies that followed temporary policies to produce both alcohol-based hand sanitizer and the alcohol used in them during the public health emergency.

"“In recent months, the supply of alcohol-based hand sanitizer from traditional suppliers has increased, and now, most consumers and healthcare personnel are no longer having difficulty obtaining these products,” Patrizia Cavazzoni, MD, director of the FDA’s Center for Drug Evaluation and Research, explained in a statement.

"The agency’s announcement stated that companies making alcohol-based hand sanitizer under the temporary policies must stop production by December 31. Those that plan to continue making the product will have to comply with requirements for over-the-counter topical antiseptics as well as the FDA’s Current Good Manufacturing Practice regulations."

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Earlier:

Thursday, June 11, 2020

The pandemic market for disinfectants (including Bourbon scented hand sanitizer)

Challenge trials in Britain and (not) in the U.S.

 The NY Times has an excellent piece on Covid vaccine challenge trials, and the different traditions (and repugnance) in Britain and the U.S.

Britain Infected Volunteers With Covid. Why Won’t the U.S.? By Kate Murphy

"In an age of masking, compulsive hand sanitizing and plexiglass dividers, it seems inconceivable that for more than 40 years people enthusiastically signed up — and were often put on a waiting list — to have respiratory viruses, including coronaviruses, dripped into their noses.

"They were volunteers at the Common Cold Unit, set up in 1946 by the British government’s Medical Research Council.

...

"the Common Cold Unit established and refined a model for so-called human challenge studies that paved the way for the first Covid-19 human challenge study just completed in Britain, where young, healthy and unvaccinated volunteers were infected while researchers carefully monitored how their bodies responded.

"Then, as now, there were those who decried deliberately infecting or “challenging” healthy volunteers with disease-causing pathogens. It violates the medical principle of “do no harm.” The trade-off is a unique opportunity to discover the causes, transmission and progression of an illness, as well as the ability to more rapidly test the effectiveness of proposed treatments.

...

"“The key benefit of human challenge studies is that they are controlled — everyone gets the same virus, the same amount and they are in the same environment,” said Dr. Christopher Chiu, professor of infectious diseases at Imperial College London and chief investigator in Britain’s Covid challenge study.

...

"In the United States, the regulatory hurdles to conduct challenge studies mean there are precious few, mostly for finding better treatments for malaria, cholera and influenza. Ethicists and regulators are more comfortable approving clinical trials where subjects are given a treatment, say a drug or vaccine, to see if it helps improve a condition volunteers already have, or could prevent them from developing later.

...

"Dr. Fauci’s office said the institute has no plans to fund Covid-19 human challenge trials in the future. Many bioethicists support that decision. “We don’t ask people to sacrifice themselves for the good of society,” said Jeffrey Kahn, director of the Johns Hopkins Berman Institute of Bioethics. “In the U.S., we are very much about protecting individual rights and individual life and health and liberty, while in more communal societies it’s about the greater good.”

"But Josh Morrison, a co-founder of 1Day Sooner, which advocates on behalf of more than 40,000 would-be human challenge volunteers, argues it should be his and other people’s right to take risks for the greater good. “Most people aren’t going to want to be in a Covid challenge study, and that’s totally fine, but they shouldn’t project their own choices on other people,” he said."

HT: Axel Ockenfels

Challenge trials for Covid-19 Delta variant

 Before the development of the first Covid vaccines, there was a good deal of discussion about the appropriateness of testing vaccines with human challenge trials, i.e. with tests in which volunteers were deliberately exposed to Covid so that the vaccine effectiveness could be more readily assessed.  Now, with the Delta variant spreading, those issues are once again live.

Only England has authorized challenge trials. Here's a story from the WSJ:

Researchers Ready Lab-Grown Covid-19 Delta Variant for Human Trials. U.K. company is growing the highly contagious variant under tight lab controls for use in challenge studies  By Jenny Strasburg

"While the rest of the world is trying to stamp out the Covid-19 Delta variant, British researchers are making progress growing a carefully controlled batch in a lab that they hope to use to infect volunteers in studies.

"The effort marks a new phase in the U.K.’s human challenge trials, the only Covid-19 studies in the world intentionally exposing participants to the virus with the goal of developing new vaccines and treatments. 

...

"Two Covid challenge trials sponsored by Imperial College London and the University of Oxford started earlier this year in the U.K. They so far have exposed more than 40 healthy, young volunteers under isolated medical supervision to the original Wuhan strain that circulated widely in 2020.

"Since then, the highly transmissible Delta variant has come to dominate infections globally, rendering vaccines less effective and boosting case numbers across the U.K., U.S. and elsewhere. Delta’s fast rise led researchers and U.K. challenge-trial partner hVivo Services Ltd. to focus on trying to grow the variant in the lab.

...

"It took U.K. researchers and government advisers almost a year to plan and gain approval from a U.K. ethics committee and medicines regulators to start the controversial challenge trials for which the Delta strain could eventually be used. The government provided funding; so did the London-based Wellcome Trust, a large healthcare-focused charitable foundation.

...

"The challenge trials faced pushback from some U.K. academics and foreign researchers, as well as from some government officials, who considered them unsafe or otherwise unethical, people involved in the process say. Delays have caused friction among partners. hVivo, part of London-listed pharma-services company Open Orphan ORPH 3.08% PLC, had hoped to use the Covid-19 challenge-trial model by now to test antivirals and other products for drug companies, executives have told industry peers. A U.K. government spokesman said the pace of the challenge studies has reflected appropriate caution, and the trials have been safe.

"Challenge trials have been used for decades to study viruses and other pathogens by deliberately exposing volunteers and studying the body’s response. While scientists in the U.S. and Europe also pushed to do Covid-19 challenge studies, only the U.K. has moved forward."

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Other posts about challenge trials.

Are incentives for vaccination coercive, exploitative, or otherwise unethical? Persad and Emanuel think not, in JAMA

 Many jurisdictions and venues are now offering incentives for people to be vaccinated against Covid-19.  It will not surprise the readers of this blog to learn that some people have found incentives for vaccination to be repugnant, and perhaps to be immoral and unethical coercion or exploitation.  Here's an article rebutting those concerns, in JAMA

Ethical Considerations of Offering Benefits to COVID-19 Vaccine Recipients  by Govind Persad, JD, PhD1; Ezekiel J. Emanuel, MD, PhD, JAMA. Published online July 1, 2021. doi:10.1001/jama.2021.11045

"Entry into a million-dollar lottery for getting vaccinated against COVID-19 is Ohio’s offer to adults. Teens who get vaccinated receive a lottery ticket for state college tuition, room, board, and more. Other states are offering gift cards. Now many employers are offering rewards for COVID-19 vaccination. Businesses ranging from Krispy Kreme and Sam Adams beer to the Cincinnati Reds have announced discounts or prizes for vaccinated individuals. Are these benefit programs ethical? Are they useful? Are they better than mandates?

...

"The ethical case for instituting vaccine benefit programs is justified by 2 widely recognized values: (1) reducing overall harm from COVID-19 and (2) protecting disadvantaged individuals.1 If benefit programs increase vaccine uptake, they directly protect recipients. By reducing transmission, increased uptake also protects the population, including ineligible children and adults, unvaccinated adults, and individuals with conditions reducing vaccine efficacy (Table). Because transmission has been higher and outcomes worse in less-advantaged communities, stemming transmission especially protects those in disadvantaged communities. In addition, costs, such as time off work for getting a vaccine or dealing with vaccine-related adverse effects, finding daycare for children, and transportation to a vaccine site, hamper access for poorer and marginalized people. Benefit programs, especially in the form of guaranteed cash payments, could improve access and increase uptake by offsetting these costs."

The Economics of Covid: The 31st Jerusalem Advanced School in Economic Theory (June 28-30)

This year's event doesn't involve travel. (Next year in Jerusalem!)

The 31st Jerusalem Advanced School in Economic Theory: The Economics of COVID-19 (Online event)

Mon, 28/06/2021 to Wed, 30/06/2021

 

General Director: Eric Maskin (Harvard University)

Co-director: Elchanan Ben-Porath (The Hebrew University)

 

List of lecturers and topics:

Glenn Ellison, MIT: Epidemiological models
Ben Golub, Northwestern University: Supply Chains
Michael Kremer, University of Chicago: Vaccines
Eric Maskin, Harvard University: Mechanism Design for Pandemics
Emily Oster, Brown University: Schools

Parag Pathak, MIT: Priority Schemes 

Covid vaccine congestion in France looks familiar

France is some weeks behind the U.S. in delivering vaccines, but the script will look familiar to Americans.

The  Financial Times has the story:

France finally gets its Covid vaccination act together. The country’s inoculation drive has picked up speed after a slow start. by David Keohane 

"All it took to get my first dose of the Covid-19 vaccine in France was a five-hour round trip and two days and eight hours of incessant refreshing at my computer. 

...

""Until May 12, younger people in France weren’t allowed to book a vaccination unless they suffered from an underlying health condition which pushed them up the queue. 

"Since then anyone can book as long as the dose is set to go begging in the following 24 hours."

Vaccinating the whole world quickly turns out to be hard

 As Covid vaccines became available, rich countries that had made early, advanced purchases at high prices had contracts that delivered available doses early, while countries and organizations that had made later purchases at lower prices had "best effort" contracts that allowed delivery dates to slip as supply chain problems developed.  The consequences were greatest for the poorest countries, despite efforts to speed vaccination worldwide.

The WSJ has the story:

Why a Grand Plan to Vaccinate the World Against Covid Unraveled. The multibillion-dollar Covax program was supposed to be a model for vaccinating humanity, but has hit problem after problem By Gabriele Steinhauser, Drew Hinshaw and Betsy McKay

"The Covax program, conceived in early 2020 as a kind of Operation Warp Speed for the globe, was supposed to be a model for how to vaccinate humanity, starting with those who needed it the most. The plan was scheduled to have the developing world’s entire healthcare workforce immunized by now.

"Instead, the idealistic undertaking to inoculate nearly a billion people collided with reality, foiled by a basic instinct for nations to put their own populations first, and a shortage of manufacturing capacity around the world.

"Dr. Berkley and a small crew of global health experts spent months trying to recruit much of the world into buying their vaccines from one common pool, rich and poor countries alike. While they were hammering out the details and raising money, nations that could afford it rushed to secure their own shots first.

...

"Most of the world’s poorest nations were left highly dependent on a single vaccine, produced by a single manufacturer in a single country. In a cruel twist, that supplier—the Serum Institute of India—ended up engulfed by the world’s worst Covid-19 outbreak.

...

"Dr. Berkley, the chief executive of Gavi, the Vaccine Alliance, a public-private partnership that secures childhood immunizations for the world’s poorest countries and is the central organization behind Covax, said the facility did its best to navigate a hypercompetitive vaccine market. “We hear a lot of criticism, and the truth is, we’ve tried to do something that we think is the right thing,” he said. “Hindsight’s 2020. Should we have not invested in India? Well, that was the fastest way to get there.”

...

"Covax started shipping Covid-19 vaccines within three months of the world’s richest countries administering their first shots—lightning speed, compared with the five to 10 years it often takes for new immunizations to reach the developing world.

"Yet now it is running out of vaccines just when Covid-19 cases are escalating across countries it was meant to protect: the low- and middle-income states of Latin America and South Asia. The program has shipped 72 million shots, far short of the 238 million it had targeted by the end of May. That’s 4% of the total 1.7 billion vaccines shipped world-wide.

"Some 20 million of Covax’s shots have come from India, which was due to ship 140 million by the end of the month but stopped exporting them as it works to inoculate the country’s 1.3 billion citizens

...

"Wealthy countries, including ones that had promised to fund Covax, were buying their own doses first. In late May, the U.K. had sealed its own agreement with AstraZeneca, for 100 million doses. The U.S., without a commitment to Covax, had signed up for 300 million from AstraZeneca, pledging up to $1.2 billion.

"In June, the European Union, worried that its own countries would start competing for limited supply, stepped in to buy shots for its 450 million citizens. As part of its deal with member states, the EU blocked governments from joining any parallel vaccine purchasing programs. That meant France and Germany were now effectively barred from buying doses from the pool they had championed.

...

"By late December, after months of haggling over prices, Covax had 2 billion doses lined up, enough to vaccinate some 20% of the population in over 100 countries. Yet most were soft agreements with no clear delivery dates or involved drugmakers whose shots hadn’t yet panned out. As Europe and the U.S. began to vaccinate, Covax’s only completed purchases were with AstraZeneca and the Serum Institute.

...

"On Feb. 15, the WHO approved the AstraZeneca shot for emergency use, six weeks after it was cleared in the U.K. That allowed Covax to make its first shipment to a developing country, Ghana, weeks after Serum began exporting shots to other countries.

"Three days later, the U.S., now under President Biden, announced a $2 billion contribution to Covax, with another $2 billion planned through 2022. The EU upped its commitment to 1 billion euro.

"By then, there were scant vaccines available to buy. This month, Covax reached a deal with Moderna for 500 million doses, of which 466 million won’t be delivered until 2022."

Payments for Covid vaccine

 The NY Times has the story:

Pakistan’s Private Vaccine Sales Highlight Rich-Poor Divide.  An inoculation push, plagued with limited supplies and red tape, makes doses available to those who can pay for them. In a country with a struggling economy, most can’t.  By Salman Masood

"Access to the coronavirus vaccine has thrown a stark light on global inequality. The United States and other rich countries have bought up most of the world’s vaccine supplies to protect their own people, leaving millions of doses stockpiled and in some places unused. Less developed countries scramble over what’s left.

"To speed up vaccinations, some countries have allowed doses to be sold privately. But those campaigns have been troubled by supply issues and by complaints that they simply reflect the global disparities.

...

"“The Pakistani example is a microcosm of what has gone wrong with the global response — where wealth alone has primarily shaped who gets access,” Zain Rizvi, an expert on medicine access at Public Citizen, a Washington, D.C., advocacy group, said in an email.

...

India sells vaccines to private hospitals, though they are scrambling to find supplies now that the pandemic there is so serious. Kenya authorized private sales, then blocked them over fears that counterfeit vaccines would be sold. In the United States, some well-connected companies, like Bloomberg, have secured doses for employees.

...

"Pakistan says the private program could make more free shots available to low-income people. By purchasing doses of the Russian-made Sputnik 5 vaccine, the country’s wealthy wouldn’t need to get the free doses, which are made by Sinopharm of China. Some people would prefer to get inoculated at a private hospital because they are widely believed to be comparatively better organized and more efficient than overwhelmed government facilities.

Vaccine shortages are more about congested supply chains than about patent protection: Alex Tabarrok at MR

 Alex Tabarrok has a nice post at Marginal Revolution about the actual problems in worldwide vaccine supply, involving congested supply chains much more than protected intellectual property.

Patents are Not the Problem! by  Alex Tabarrok May 6, 2021 

The rise and fall of convalescent plasma as a treatment for Covid

 The NY Times follows the story:

The Covid-19 Plasma Boom Is Over. What Did We Learn From It?  The U.S. government invested $800 million in plasma when the country was desperate for Covid-19 treatments. A year later, the program has fizzled.  By Katie Thomas and Noah Weiland

"In those terrifying early months of the pandemic, the idea that antibody-rich plasma could save lives took on a life of its own before there was evidence that it worked. The Trump administration, buoyed by proponents at elite medical institutions, seized on plasma as a good-news story at a time when there weren’t many others. It awarded more than $800 million to entities involved in its collection and administration, and put Dr. Anthony S. Fauci’s face on billboards promoting the treatment.

"A coalition of companies and nonprofit groups, including the Mayo Clinic, Red Cross and Microsoft, mobilized to urge donations from people who had recovered from Covid-19, enlisting celebrities like Samuel L. Jackson and Dwayne Johnson, the actor known as the Rock. Volunteers, some dressed in superhero capes, showed up to blood banks in droves.

...

"But by the end of the year, good evidence for convalescent plasma had not materialized, prompting many prestigious medical centers to quietly abandon it. By February, with cases and hospitalizations dropping, demand dipped below what blood banks had stockpiled.

...

"All told, more than 722,000 units of plasma were distributed to hospitals thanks to the federal program, which ends this month."

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There were also parallel private efforts that mobilized convalescent plasma donation through social media, and via faith based organizations.  I followed some of the science in a series of posts on plasma and plasma donation more generally.  I should note that, although convalescent plasma hasn't emerged as a treatment for Covid-19, it continues to have many very well documented life-saving uses.

Challenge trial for Covid-19 reinfection, in Britain.

A second round of (controvesial) challenge trials is being conducted in England, this one designed to assess how susceptible are people to reinfection with Covid-19, after recovering from it once.

The WSJ has the story 

Covid-19 ‘Challenge Trial’ Will Purposely Reinfect Adults. Dozens of quarantined volunteers in U.K. to receive coronavirus in study focused on reinfection  By Jenny Strasburg

"University of Oxford scientists plan to reinfect dozens of adult volunteers with the coronavirus in the second U.K. clinical trial to study deliberate Covid-19 infection in quarantine—this time among people who have already recovered from the virus.

"Such “human challenge” trials are controversial because they involve intentionally infecting healthy humans, and the U.K. is the only country so far conducting them with Covid-19, researchers said.

...

"The first Covid-19 challenge study, led by Imperial College London infectious-disease researchers, started in March with a handful of volunteers isolated inside London’s Royal Free Hospital, part of the state-funded National Health Service. That study received a pledge of more than $45 million from the U.K. government.

...

"the U.S. and other countries have steered clear of purposely infecting healthy people with the coronavirus. Critics argue the risks aren’t justified, given the broad presence of naturally circulating virus and the success of vaccines already available.

...

"Challenge-trial proponents argue there is no substitute for the precision of controlled studies. They have been used for decades to study diseases including typhoid, malaria and tuberculosis and to develop vaccines. With Covid-19, Prof. McShane told journalists in a briefing last week, “We don’t know whether someone has not been infected because they haven’t been exposed or [because] they have protective immunity.” Controlling exposure will help with those questions, she said.

...

"Volunteers will be tracked for a year. They will be paid around £5,000, equivalent to $6,917, for their time in quarantine and for follow-ups, Prof. McShane said."

*************

Related posts here:  https://marketdesigner.blogspot.com/search/label/challenge 

Congestion in vaccine delivery: uncancelled extra appointments

 In school choice, the reason universal enrollment systems that give each child one assignment are so desirable is that if children are accepted by multiple schools, it often takes time (e.g. the first week of the school term) to sort out which children are going where, and to free up the unclaimed spaces.

The same thing is happening with decentralized appointments for Covid vaccines. The WSJ has the story:

Got Your Covid-19 Vaccine? Now Cancel Your Extra Appointments.  Pharmacies and community clinics say uncanceled appointments lead to no-shows, adding to their already heavy workload   By Jaewon Kang and Sharon Terlep

"Pharmacies and health officials are making a plea to Americans who received their Covid-19 vaccines: Cancel the other shots you booked.

"As vaccine eligibility expands and more places offer shots, many people are signing up for multiple appointments and not backing out of the ones they don’t need. The resulting influx of no-shows is forcing vaccine providers, from pharmacies to community clinics, to find last-minute replacements so doses aren’t wasted.

...

"Appointments remain tough to score in many parts of the country even though the overall supply of vaccines and the pace of inoculation are improving. Some people are making multiple bookings in hopes of getting vaccinated sooner or sometimes because they don’t receive or see confirmation emails, according to pharmacies and community vaccination sites. Others receive shots at pop-up vaccination events before scheduled appointments and don’t notify providers.

"The U.S. lacks a concrete system of tracking wasted doses. Generally, local and state officials say that demand is high enough that no-shows aren’t leading to tossed vaccines, though vaccine providers say they sometimes fail to find takers for all the doses they have thawed in time to use them all safely."

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Previous post:

Monday, February 15, 2021

Multiple queues for Covid vaccines, as pharmacies join the supply chain

Allocating leftover vaccine before it spoils

 The NY Times has the story:

Hunting for a Leftover Vaccine? This Site Will Match You With a Clinic.  More than half a million people have signed up for Dr. B, a service that promises to match them with clinics struggling to equitably dole out extra doses before they expire.   By Katie Thomas

"a New York-based start-up is aiming to add some order to the rush for leftover doses. Dr. B, as the company is known, is matching vaccine providers who find themselves with extra vaccines to people who are willing to get one at a moment’s notice.

"Since the service began last month, more than 500,000 people have submitted a host of personal information to sign up for the service, which is free to join and is also free to providers. Two vaccine sites have begun testing the program, and the company said about 200 other providers had applied to participate.

...

"The company’s database sorts people by local rules about vaccine priority, giving providers better odds of administering their leftover shots to those in the greatest need.

"For many providers, that orderly procedure would be a welcome change from the haphazard systems they are using now. At some pharmacies and supermarket chains, workers have resorted to combing the shopping aisles to find people willing to get a last-minute vaccine. At other locations, vaccine hopefuls wait in line at the end of every shift, which could pose an infection risk, particularly to the most vulnerable."

Coordinating vaccine delivery is hard (California/Blue Cross version)

 The Mercury News has the story:

Santa Clara County will not participate in state’s Blue Shield-run vaccine program  by Maggie Angst

"Santa Clara County said late Monday it won’t take part in the state’s new centralized vaccine distribution system run by Blue Shield — a potentially huge blow to Gov. Gavin Newsom’s highly-touted plan.

"County Executive Jeff Smith said the county would not sign a contract with Blue Shield allowing the health insurance company to take over vaccine distribution in the county, claiming the new oversight wouldn’t do anything to improve vaccination speed or efficiency.

...

"According to officials from Blue Shield and the state, only one county of 58 in the entire state — Kern County — has signed a contract with Blue Shield.

“I think everyone sees it as a solution looking for a problem,” Smith said. “We’re talking about adding bureaucracies rather than vaccinating people.”

Vaccine supply and delivery in Germany: I'm interviewed in Zeit

 Here's an interview in the German newspaper Zeit, in which I was asked in early February about the vaccine rollout here and there. (Google translate is pretty readable, although some of the Q&A is a bit garbled by the translation from English to German and re-translation back into English...)

"Die Welt kann es sich leisten, einiges zu bezahlen" Alvin Roth weiß, wie man begehrte Güter effizient verteilt. Er hat den Nobelpreis dafür bekommen. Ein Gespräch über knappen Impfstoff und wie er vermehrt werden kann.  Interview: Lisa Nienhaus

Google Translate: "The world can afford to pay a lot" Alvin Roth knows how to efficiently distribute desirable goods. He got the Nobel Prize for it. A conversation about scarce vaccine and how it can be propagated. Interview: Lisa Nienhaus February 15, 2021,

The interview starts off talking about congestion, and line jumping, and the tradeoffs between speed and fairness (and how it's really costly to allow some vaccine to expire unused in the name of fairness).  It then turns to shortages of vaccine in the near term:

ZEIT ONLINE: Attempts are being made to build new production facilities. But in Germany we are - to be honest - pretty late.

Roth: But now is not the time to give up. Everything we build now may help us in August. Even if Germany is running late, there is still time to expand production facilities. Especially since these systems would certainly not have to be destroyed after Covid. Being able to produce mRNA vaccines oneself is also a good thing in the future. Vaccine production is not that complicated. You can build production facilities anywhere. And you should too.

ZEIT ONLINE: It's not happening on a large scale yet. What to do?

Roth: Laws are really useful for that. Pfizer / BioNTech and Moderna could be forced to license the production technology to other German pharmaceutical companies.

ZEIT ONLINE: That sounds radical.

Roth: I only think it's logical. If you had a pharmaceutical company, you'd think, "I'm paid by the dose. I've got enough capacity to ship to the whole world in the next year and a half. Why should I hurry?" There is no need to set up production facilities just to supply the world in six months instead of 18. It doesn't make any difference from a business perspective. But for the German or American government, these two options are by no means equivalent. It is important that we vaccinate quickly. We need a lot more production capacity than the pharmaceutical companies think it makes sense.

ZEIT ONLINE: Economists rarely suggest such a strong market intervention. And that also applies to companies that we must first be grateful to because they show us a way out of lockdown.

Roth: It's a global pandemic. It is economically necessary to think about how to avert the damage to the economy. But of course you have to pay the manufacturers. Many forget that.

ZEIT ONLINE: How fair the companies think that probably depends on how much you pay them.

Roth: Yes. But the world can afford to pay a lot. Because the world economy is currently largely at a standstill. We have a multi-trillion dollar economy. Paying a billion to save a trillion is good business.

ZEIT ONLINE: Why is that not happening so far?

Roth: The pharmaceutical companies themselves don't think that way at the moment. But we need the vaccine now. And it's very expensive for the world to shut down its economy like that. If you lose a few percentage points of GDP growth in Germany, that's a huge number. And there is almost no amount to pay to license the vaccine that is not worth it.

Anger at vaccine line jumping

 There is some tension between getting populations vaccinated quickly and ensuring that priorities for who gets vaccinated first are carefully followed.  In some places we have seen the costs of adhering too strictly to priorities when enough high priority people are hard to find quickly.  In other places we see the costs of ignoring priorities.

Here's a NY Times story on corruption in South America (followed by a Guardian story about the difficulty of stopping tech-savvy Californians from grabbing appointments meant for underserved minorities):

‘V.I.P. Immunization’ for the Powerful and Their Cronies Rattles South America. A wave of corruption scandals is exposing how the powerful and well-connected in South America jumped the line to get vaccines early. Public dismay is turning into anger.   By Mitra Taj, Anatoly Kurmanaev, Manuela Andreoni and Daniel Politi

"The hope brought by the arrival of the first vaccines in South America is hardening into anger as inoculation campaigns have spiraled into scandal, cronyism and corruption, rocking national governments and sapping trust in the political establishment.

"Four ministers in Peru, Argentina and Ecuador have resigned this month or are being investigated on suspicion of receiving or providing preferential access to scarce coronavirus shots. Prosecutors in those countries, and in Brazil, are examining thousands more accusations of irregularities in inoculation drives, most of them involving local politicians and their families cutting in line.

...

“People find it much more difficult to tolerate corruption when health is at stake,” said Mariel Fornoni, a pollster in Buenos Aires.

The brazen nature of some of the scandals — which mirror similar affairs in Lebanon, Spain and the Philippines — has outraged the region.

...

"Earlier this month, the doctor conducting Peru’s first vaccine trial acknowledged inoculating nearly 250 politicians, notables and their relatives, as well as university administrators, interns and others, with undeclared extra doses. Some had received three doses, according to the trial’s director, Dr. Germán Málaga, in an attempt to maximize their immunity."

***************

And here's the Guardian, on California:

California vaccine sites see misuse of codes meant to prioritize Black and Latino residents  by Vivian Ho

"Access codes meant to give Californians of color priority access to Covid-19 vaccine slots have been getting passed around among other residents in the state, allowing some to cut the line and get appointments meant for underserved Black and Latino residents.

Misuse of these codes was reported at vaccine sites in Los Angeles and the Bay Area, said Brian Ferguson, spokesperson for the California office of emergency services, to the Guardian.

"The codes were one of the tools devised by California leaders to address inequities in vaccine distribution in the state. They were given out to leaders and non-profits in the Black and Latino communities in LA and the Bay Area to administer to eligible individuals...

"Instead, the codes ended up passed on by text message and email, oftentimes with misinformation. “My daughter says that the Oakland Coliseum needs to fill up appointment slots in the next few days to prevent spoilage of excess vaccines!” read an email that Oakland resident Jhumpa Bhattacharya received from a friend on Monday. “If you are interested in getting a vaccine before this Wednesday, the link and access code are pasted below."

...

"State officials thought that by handing out vaccine access codes through community leaders, they would bridge any cultural or language barriers while also addressing the issue of the digital divide by giving these eligible individuals special access to the website, Ferguson said. “We don’t want people to be able to get appointments based on who has the fastest internet connection,” he said.

"Since learning of the misuse, the state will begin issuing individualized codes rather than group codes next week. In addition to these codes, the state has been setting up mobile vaccination clinics in these specific communities in hopes of reaching these underserved residents."

Vaccine delivery improving, with congestion

 A statewide vaccine appointment list is a good idea, but it can crash:

Massachusetts Vaccination Website Crash: What Went Wrong?  The state thinks the high volume of traffic may have been the cause, but they still aren't 100% certain

"Massachusetts’ COVID-19 vaccine appointment portal temporarily crashed Thursday morning as more than 1 million additional state residents became eligible to schedule a shot.

"Gov. Charlie Baker said the administration had run through different scenarios to try to avoid problems with the vaccine portal. He said people in the administration are in the process are trying to determine what happened.

"The state on Thursday for the first time began allowing those age 65 and older, people with two or more certain medical conditions, and residents and staff of low income and affordable senior housing so sign up for a vaccine shot. But it came with a warning that it could take up to a month to book an appointment.

...

"As of Friday morning, the issues appeared to have been resolved and the website seemed to be working properly. But vaccination appointments remained hard to find.

"People who went to vaxfinder.mass.gov on Friday to book an appointment were told none were available. A statement from state health officials said “a small number of appointments for other locations,” including pharmacies and regional collaboratives, would be posted over the next few days."