I similarly spent a few years working in this space (TfL, digitising their data and website etc). It always struck me just how nuts the weekly meetings between different station operators and TOCS within the GLA would be, essentially a shouting match to determine who would have to keep their station open that weekend. Resultant timetable changes on the fly were always fun content to keep updated.
Timetabling (at that point) remained very much a manual process, I think they had to bring a poor chap out of retirement who wrote them by hand.
Yeah, the fact that this doesn't even need a freezer is great news.
The fact that we have three highly effective vaccines in such a short period is amazing and between them we might stand a chance of making and distributing them at the scale necessary to get things under some kind of control by August.
The safety concerns cannot be resolved yet. Effective - yes. Safe? We won’t know for a while.
Pandemrix, a flu vaccine, caused a notable uptick in narcolepsy in Sweden, Finland and likely the UK. This was not (and could not) be seen in smaller trial populations.
It is not a given that any of the covid vaccines is safe enough. Historically, two cases of rushed vaccines (cutter polio and Gullah barre) were worse than the disease - and these were for diseases worse than covid. Those were 50-60 years ago. Pandemrix was 10-20. I’m not sure we’re that much better on safety now to rush vaccines.
If the association between Pandemrix and narcolepsy is because it caused narcolepsy (as with Guillain-Barré it's also plausible the problem is that this is an auto-immune problem and so the vaccine wasn't actually the problem it just highlighted a problem you already had) then the incidence rate was estimated at like 18k patients per case.
So if you give the entire US population a vaccine like that, less than twenty thousand of them develop narcolepsy. As a reminder a quarter million of them already died from COVID-19 and more are dying every day - not to mention the tens of thousands whose cause of death isn't listed as COVID-19 but would not be dead if not for an ongoing pandemic.
Cutter screwed up. No amount of prior safety testing can fix that. Their Polio vaccine had Polio virus in it (to be clear: The traditional Oral Polio Vaccine is supposed to have a "live" virus in it, but the injected vaccine Cutter were selling is not). Obviously nobody is going to test "What happens if we inject children with the Polio virus" because the answer is "Some of them get Polio. Duh" and so no test could have prevented Cutter from screwing up.
I have no idea what you meant by "Gullah barre" the Google results I get are all about Guillain-Barré syndrome, which I mentioned above. Guillain-Barré is not a vaccine, it's a weird auto-immune disorder, and arguably even where it's listed as very rare side effect of a vaccine, that's misleading because it's also a side effect from getting viral infection, so if you avoid vaccination but do get the virus you may get GBS as a result anyway. The human immune system is pretty inscrutable.
> less than twenty thousand of them develop narcolepsy. As a reminder a quarter million of them already died from COVID-19 and more are dying every day
I assume the concern is that an unknown unknown means it could cause/trigger/amplify some other disease/condition that may be comparable/worse than the problem it solves.
Cause/effect and morals are hard. Add to the mix a general statistical innumeracy, and some general suspicion about authorities, and it makes it really hard for the general populace to actually weigh the two different options.
I don't think we should dismiss these concerns as just stuff for nutjobs. I've seen otherwise reasonable people having trouble making up their minds about that.
The association in Sweden is strong enough to say “it does”.
And yes, the mechanism is likely that Pandemrix activated a predisposition. But it was not activated in statistically equivalent kids who did not get Pandemrix.
Why is it so hard to acknowledge that not all vaccines are perfect, and that there’s a risk involved? I am not avtivax. I am pro vaccination. I am anti religious “a vaccine can never be bad” thinking which seem to be prevalent among otherwise rational scientific people.
covid risk varies wildly depending on socioeconomic factors. Educated, WFH, small family, stable or low IRL social interaction: pretty low risk. Low-education, multiple in-person jobs, lots of casual social interaction, large family: very high risk. We've seen it very starkly in England. When entire communities are being ravaged by exponentially-growing transmission, it's hard to argue that a vaccine might be worse, because the chances are really minimal.
> Historically, two cases of rushed vaccines (cutter polio and Gullah barre) were worse than the disease - and these were for diseases worse than covid.
This is just patently untrue.
The Cutter Incidence gave patients Polio due to an improperly activated virus. While this is bad, it could not be worse than the disease itself - since it is the disease itself, no worse, no less.
Regarding risk of Gullain-Barre syndrome due to vaccination, Wikipedia has this to say: "In fact, natural influenza infection is a stronger risk factor for the development of GBS than is influenza vaccination and getting the vaccination does reduce the risk of GBS overall by lowering the risk of catching influenza." So here I also find it hard to believe the vaccine would be worse than the disease,
I'm also sceptical of the claim that Polio or the 1976 Swine Flu would unambiguously be worse than Covid19. 70% of Polio case have no symptoms, and less than 0.5% cause permanent injury, according to Wikipedia. The 1976 Swine Flu outbreak seems to have caused a few hundred cases and only one death.
No, the cutter incidence was worse than the disease, because the activated virus was injected into a population, whereas naturally only a tiny part would be exposed at the same level, and the rest would be exposed at a much lower level - that would give them immunity but not disease.
Cutter was, most definitely, much worse than the disease if you look at it from a population perspective.
The 1976 Guilian barre was at least comparable to the flu it was supposed to stop, if not worse. According to https://en.m.wikipedia.org/wiki/1976_swine_flu_outbreak, the disease caused one death and 13 hospitalizations, and an uptick of Giullan barre reports - a disease that more often than not requires hospitalization and sometimes death. I can assure you it caused more than 13 hospitalizations, and - having known two GBS people who made a full recovery - a very long and painful months long process. So, at 50,000,000 immunized - a 1 in 1,000,000 would still be worse than the flu.
I am not anti vax even if HN constantly seems to interpret my comments as such.
I am vaccinated, so are my kids. But whenever I mention that immunizations have risks, I’m treated like a heretic.
Everyone is assuming something like cutter cannot happen again. This is a religious assumption, not a scientific one.
> No, the cutter incidence was worse than the disease, because the activated virus was injected into a population, whereas naturally only a tiny part would be exposed at the same level, and the rest would be exposed at a much lower level - that would give them immunity but not disease.
This is a more reasonable assessment, but it is still patently false. According to Wikipedia, 0.04% vaccinations resulted in paralysis in the Cutter Incident, compared to 0.1-0.5% of wild type polio. So the vaccine was 2-10x safer than wild polio. Without vaccinations, virtually all children were infected with polio virus early in life [1], so being administered the defective vaccine was still a lot better than taking a chance with the real disease.
Of course, you are correct regarding the 1976 flu outbreak. If you administer something to a large segment of the healthy population, even a small risk of side-effects will add upp to a large number of cases. If the disease itself turns out to be very rare, as was the case with the flu outbreak, the vaccine itself could cause more damage than the disease even if the disease is much worse.
However, this is clearly not applicable Covid-19, which we already know is spreading very fast and will need to infect a large number of the population before herd immunity is achieved. The situations are simply not comparable at all – even the vaccine from the 1976 flu outbreak would be less risky than the odds of being infected with a serious case of Covid 19 (of which the long term effects are also unknown, to be clear).
> But whenever I mention that immunizations have risks, I’m treated like a heretic.
Mainstream media, healthcare professionals and social media are all worried about the risks of a rushed vaccine. I literally see articles and hear conversations about this several times a month. Nobody is denying that large scale vaccinations have risks.
I'm not criticizing you because I'm against being cautious of vaccination risks. The criticism is that you are spreading false facts and misleading analysis that grossly mischaracterise what the risks of vaccinations really are, both presently and historically.
"Some vaccines can have rare but serious side effects" is a perfectly alright statement. But "Historically, two cases of rushed vaccines (cutter polio and Gullah barre) were worse than the disease - and these were for diseases worse than covid" is just not. Some of it is false and the comparison to Covid19 is misleading.
> According to Wikipedia, 0.04% vaccinations resulted in paralysis in the Cutter Incident, compared to 0.1-0.5% of wild type polio.
From https://en.wikipedia.org/wiki/Polio_vaccine#1950%E2%80%93195... : "The Cutter vaccine had been used in vaccinating 200,000 children in the western and midwestern United States.[76] Later investigations showed that the Cutter vaccine had caused 40,000 cases of polio, killing 10.[76]". So, 20% incidence; mentions 250 "paralytic illness", so 0.125% paralysis (no idea where you took the 0.04% - it does not appear in the Wikipedia text).
From https://en.wikipedia.org/wiki/Polio#Paralytic_polio : "In children, nonparalytic meningitis is the most likely consequence of CNS involvement, and paralysis occurs in only one in 1000 cases." ; So, for children, the incidence of paralysis is 0.1%
Who got the cutter vaccine? Mostly children. See e.g. from https://www.washingtonpost.com/history/2020/04/14/cutter-pol... "By April 30, within forty-eight hours of the recall,” Offit wrote. “Cutter’s vaccine had paralyzed or killed twenty-five children: fourteen in California, seven in Idaho, two in Washington, one in Illinois, and one in Colorado."
So, I just tried to check your numbers, and I couldn't; Could you post references?
But I also wanted to check my memory, and Wikpedia seems to agree with me, Go on, please do check my quotes.
still patently false. pfft. Perhaps false under some assumptions, definitely not "patently false".
You are almost certainly using the wrong numbers. According to https://en.wikipedia.org/wiki/Cutter_Laboratories#Cutter_inc... and https://www.nejm.org/doi/full/10.1056/NEJMp048180, the faulty production applied to 120.000 doses of vaccine, which lead to 56 cases of paralysis (0.046%) among vaccinated children. These sources further mention "the exposures led to an epidemic of polio in the families and communities of the affected children, resulting in a further 113 people paralyzed and 5 deaths", which tells me that your number of 250 probably includes cases caused by such transmission. This is of course reasonable when discussing the total damage caused by the vaccine, but this number can not be compared to the incidence of paralysis for a single infection, as you do.
You would also have to include further transmissions caused by wild polio if you would like to make such a comparison.
> still patently false. pfft. Perhaps false under some assumptions, definitely not "patently false".
Even with your own calculation, which is inflated by also including transmission within the community for the vaccine but not for wild polio, the vaccine was very much comparable to wild polio (0.125% versus approx. 0.1%). Without vaccination, polio would usually infect virtually all children. So even with your own inflated assumptions it's false that the vaccine was worse than polio.
> You are almost certainly using the wrong numbers
Take them with wikipedia, not me. I will note, that Wikipedia talks about both Cutter and Wyeth having problems, so it is possible the numbers are a sum of wyeth+cutter which would be compatible with your numbers being cutter only, but in the context of safety vs. polio wouldn't matter.
> You would also have to include further transmissions caused by wild polio if you would like to make such a comparison.
All wild polio numbers include those numbers by default - there actually is no way to get them otherwise, I guess you are saying "you should probably debase by more than 200,000 because of secondary infections". I don't know how to do that, exactly, but it will likely still be similar.
> Even with your own calculation, which is inflated by also including transmission within the community for the vaccine but not for wild polio, the vaccine was very much comparable to wild polio (0.125% versus approx. 0.1%).
With this calculation, the vaccine was 25% worse than the wild type. No error bars, but, that's easily worse, even much worse.
> So under which assumptions would it not be false?
How kind of you to drop "patently". If you didn't mean "patently" false earlier, why did you use that word? twice?
From[0]: "Patently: in a way that is so obvious that no one could disagree.". It's nice of you to finally bring sources, but even these sources don't make it "patently" false, given that they disagree with the sources I gave (which, I concede, reference more than just the safety of the Cutter incident which I originally mentioned, but which are definitely the subject matter under discussion)
> Take them with wikipedia, not me. I will note, that Wikipedia talks about both Cutter and Wyeth having problems, so it is possible the numbers are a sum of wyeth+cutter which would be compatible with your numbers being cutter only, but in the context of safety vs. polio wouldn't matter.
Wikipedia is not wrong, but you are using their numbers wrong. Your source is talking about the total number paralysis cases that occurred as a result of the vaccine ("250 cases of paralytic illness had occurred"). This includes secondary infections. If you follow the sources listed on Wikipedia page you reference, you will find two sources: my source [1], and [2] (via [3]), both which declare around 60 cases of paralysis in vaccinated persons, and then a larger number (in the order of 200) of total cases. The numbers you reference are referring to only the Cutter polio vaccine, by the way.
And you cannot use the total number of cases in the comparison that you did.
> All wild polio numbers include those numbers by default - there actually is no way to get them otherwise, I guess you are saying "you should probably debase by more than 200,000 because of secondary infections". I don't know how to do that, exactly, but it will likely still be similar.
If by debase you mean divide, then yes: you would need to divide by more than 200,000.
Your number is {how likely am I to get paralysed by the vaccine polio + how likely am I to cause further paralysis via secondary infection chain}, and you are comparing it to simply {how likely am I to get paralysed by the wild polio}. The first number is inflated a lot by the addition of secondary infections.
The numbers are not at all likely to be similar. As you can see in my (and your) sources, secondary infections accounted for more than double the number of paralysis cases, and therefore there it is likely a lot more people got sick via the secondary infections than the number people who was vaccinated. This causes the big discrepancy between our numbers.
Wild polio causes secondary infections as well, but this is not included in the number you are using for comparison, since it only includes the individual risk.
> With this calculation, the vaccine was 25% worse than the wild type. No error bars, but, that's easily worse, even much worse.
But the lack of error bars means that the calculation is meaningless.
You are assuming that "one in 1000 cases" means exactly one case per 1000 cases, and translate this to 0.100% with three decimals of accuracy.
It is clear from context that "one in 1000" is a rounded number for convenience, and they could very well have runded up from 0.8 or down from 1.4. You simply cannot conclude that the vaccine was 25% worse from your data. But we can conclude that they were in some way similar under your false assumptions, as they both would round to 1.
If you want to conclude anything else except "they are both around 0.1%", you would have to find a source that specifies at least 1 decimal of accuracy in the number incidents per 1000 cases.
Of course, this does not really matter, since you would still be comparing the wrong numbers.
Your argument here is "It's ambiguous and inconclusive when using clearly wrong assumptions that inflate the difference". Taking that argument into consideration, I'm still willing to confidently call it patently false.
Although I agree that I should not have said "Even with your own inflated assumptions it's false that the vaccine was worse than polio." What I meant was "Even your own inflated assumptions does not support that the vaccine was worse than polio", but I clearly worded it badly.
> How kind of you to drop "patently". If you didn't mean "patently" false earlier, why did you use that word? twice?
I meant it when I used it, and my question had a purpose. If you cannot give any reasonable assumptions where it wouldn't be false (which you haven't been able to do), then it would be patently false to me. The reason it does not seem patently false to you is because you have several misunderstandings in your reasoning and your reading of the sources. But I'm not really interested in discussing this terminology further.
> given that they disagree with the sources I gave
They don't. As I said, you are simply misreading your sources.
But seriously, even if you would manage to find some source which would refute my sources and back up your original claims, I have a bigger point to make now:
During this discussion, you have made numerous mistakes in many posts, beyond my criticism of your faulty reasoning:
(1) Mathematical mistakes
(2) Misreadings of the sources
(3) Inability to clear up ambiguities by looking at the referenced source or secondary sources
Even if by some happenstance you would happen to be right (even a broken clock, etc), you clearly are not confident enough doing this kind of analysis to be lecturing people about the specifics of vaccination risks. You are just as likely to mislead yourself and others as you are to educate.
Of course, this probably won't stop you, since you are not likely to respect my opinion. But hopefully it will still be in the back of your mind next time you approach this topic.
Thank you for your thoughtful answer. I pointed the lack of error bars myself, as well as mentioned that I don’t know what other number to divide by, as you noted. I am not trying to be intellectually dishonest.
And I may agree with your analysis - on phone now, can’t really do the reading.
However, we have two sources you claim are only for the cutter incident, whee one quotes 200,000 doses and another 120,000; as you note, the 1/1000 might well be 0.8 or 1.3 in 1000; it may be false but it is definitely bot “patently false”.
On the same note, it’s the internet, and for all you know I am a dog, but I have saved a family members from years of
agony and wrong treatments due to wrong diagnosis after being told “it is patently obvious” that my analysis was wrong. And I have apology letters from department heads at two of the world’s highest ranked hospitals after it turned out I was right and they were wrong.
And you know what? I’m quite sure I probably had a few mathematical errors along the way back then as well. But what they thought was two orders of magnitude more probable evidence towards one direction, turned out to be higher probability in the other (by less than an order of magnitude) and turned out to be what the thought was improbable beyond consideration. (And, I found a few mathematical errors in a three peer reviewed papers they were relying on)
I take issue with people who claim “patently obvious” about things which have about factor of 2 or so (if I take your numbers) without error bars (120000-200000 is a large difference) and without supplying sources, which you didn’t bother until I did.
(And I may not have time to delve into this further - this is merely of historical interest to me, not life and death like that other event).
Also, you may notice this sub thread is basically the only one that actually discusses numbers, others use arbitrary determinations like “most people’s living memory” to discard concerns. Despite advocating vaccines myself, I have a problem with religious zealotry around vaccines, which is what most pro-vaccine people practice - I have a child who could not get vaccines for medical reasons for many years, and I have to explain that, no, vaccines are not perfectly safe on an individual basis, and have not historically been perfectly safe on a population basis (Swedish Pandemrix), even though on a net population basis they are a net positive.
On the one hand I tend to agree, and all my expectations for this vaccine are positive. The medical industry tends to be paranoid to a level that exceeds rationality and even if they dropped their standards for this that should only get them down to "conservative and rather safe" levels of caution.
On the other, a cursory search says the current record for fastest developed vaccine was mumps at 4 years. So this is a vaccine setting new milestones, and there is a risk that not all of them will be positive. I'd rather be a little late to be vaccinated than a little early, especially being in a lower risk demographic.
I'm not an expert by any means, but I do know that a lot of the speed comes from moving along the CHEAP-FAST side of the CHEAP-FAST-SAFE triangle, without necessarily changing anything on the FAST-SAFE axis. In particular, governments paid for the companies to start producing enough vaccines for phase 3 trials before phase 1 was complete, while normally drug companies would wait for phase 1 to be completed before preparing for phase 2 for economic reasons.
BiondVax recently finished their phase 3 trial of a universal flu vaccine. It was 15 years in the making. Science was (still is solid). Phase 3 took two years to account for ADE and other safety issues.
At the 1-year mark, everything looked perfect. At the towo years mark (original endpoint) the conclusion was that while it was safe, it offered statistically insignificant protection.
Properly designed tests need those 2 years, at the very least. The “SAFE” confidence axis was compromised. Whether or nit it is justified is what we’re discussing here.
I'm very pro-vaccine, and not disagreeing with your conclusions, but your logic leaves out the consideration that the natural risk also depends on catching the disease, whereas the vaccine is administered systematically.
I have had Guillain-Barre Syndrome (not due to a vaccine). No matter what, I still always get my vaccines and make sure that I am up to date and never late on any of them.
Sure, having Guillain-Barre is scary, but it is something that you can make a full recovery from.
It is never an excuse NOT to get a vaccine, unless you actually know that you got Guillain-Barre Syndrome from a vaccine. That is a discussion between that particular patient and their neuromuscular neurologist. In that case, you do not get the flu vaccine any longer because it can cause you to experience Guillain-Barre Syndrome again.
But, this really is an isolated situation that can be categorized as very rare and the general public should always get their vaccines.
If you catch the flu, it can absolutely trigger Guillain-Barre Syndrome, and would be far more likely to trigger Guillain-Barre Syndrome than the flu vaccine itself. If you get the flu and had the flu vaccination, it typically makes the flu illness less worse, making you less likely to get something like Guillain-Barre Syndrome.
There are lots of infectious agents that can trigger Guillain-Barre Syndrome, so it is wise to get your vaccines to prevent them as much as possible. They prevent serious infections, at minimum, which would help prevent Guillain-Barre Syndrome.
I also have the long term variant of Guillain-Barre Syndrome, known as Chronic Inflammatory Demyelinating Polyneuropathy, which is in pharmaceutical remission due to me taking subcutaneous immunoglobulin twice a week for 3 hours each time.
What I am saying is that while all of this sounds rare and devastating, it’s treatable. Not only that, you’re more likely to get Guillain-Barre Syndrome from a bad case of the flu than from a flu shot.
“Even at this stage, it does not appear that narcolepsy following vaccination against pandemic influenza is a general worldwide phenomenon, as no excess of narcolepsy has been reported from several other European states where Pandemrix was used, or from Canada where a pandemic vaccine similar to pandemrix was used. This complicates interpretation of the findings in Finland and Sweden. It seems likely that some as yet unidentified additional factor was operating in Sweden and Finland. The findings from the VAESCO project and further investigations in Finland and Sweden, may help clarify the determinants of any increased risk of narcolepsy, which currently appears to be restricted to the months following vaccination and by age group and country.”
What’s certainly true that for some effects to be observable, millions have to be vaccinated first.
“In total, the GSK shot was given to more than 30 million people in 47 countries during the 2009-2010 H1N1 swine flu pandemic.”
“Independent teams of scientists have published peer-reviewed studies from Sweden, Finland and Ireland showing the risk of developing narcolepsy after the 2009-2010 immunization campaign was between seven and 13 times higher for children who had Pandemrix than for their unvaccinated peers.”
“Europe’s drugs regulator has ruled Pandemrix should no longer be used in people aged under 20.”
> Pandemrix, a flu vaccine, caused a notable uptick in narcolepsy in Sweden, Finland and likely the UK.
"The increased risk of narcolepsy due to vaccination was 1 in 18400 or 0.005%."[1] Considering the fatality and long term disability rate of Covid, and the way testing and safety protocols are done for vaccines, I don't really see how there could be an unknown and unseen risk that would outweigh the risk of contracting Covid.
The risk of death in kids without underlying diseases is is approximately 0. It is not clear that giving (e.g. in the US) 30,000 of these kids narcolepsy is reasonable.
As far as I know, none of the COVID19 vaccines have been tested on children under 12 or are currently planned on being given to children.
Additionally, it's not as if the average vaccine has a 0.005% chance of giving you narcolepsy. That figure was for the one vaccine in one country which appears to be the only example in most people's living memory of a vaccine possibly causing long-term side effects (it's not even proven the vaccine was the cause). There have been tens of billions of vaccines given during this time period and this is the only example where there may have been long term side effects.
I've also mentioned the cutter polio vaccine and the 1976 swine flu vaccine which seems to have caused an uptick of GBS.
> There have been tens of billions of vaccines given during this time period and this is the only example where there may have been long term side effects.
No, there are other examples, the other two I just mentioned are from memory, I suspect if I go research I will find more (I don't have the time). You know what else is common to those other two cases? They were rushed (pandemrix wasn't AFAIK).
SARS-Cov-2 vaccines were all rushed, and the safety protocols used to confidently ascertain those billions of vaccines were NOT followed - The standard is to wait 2-4 years to see that there's no ADE or other issues.
I am pro-vaccination. I don't understand why it is hard to acknowledge and discuss the risk profile of vaccines - they re not risk free. Excuse me if I don't automatically think a rushed vaccine is perfectly safe.
> I've also mentioned the cutter polio vaccine and the 1976 swine flu vaccine which seems to have caused an uptick of GBS.
That Polio vaccine wasn't a side effect of the vaccine though, it was an issue with people accidently getting injected with a live virus. Since no live virus is even remotely involved in any COVID19 vaccines it has zero relevance here. Even if they were, we have 60+ years of history with no similar incidents since then.
> I suspect if I go research I will find more
You really won't. I've been reading about this extensively during this period and those are the only examples where there may have been long term effects that anyone can point to.
I qualified my original comment with "in most people's living memory" and didn't include the '76 swine flu vaccine because, frankly, I don't think pointing to an issue that happened 44 years ago in a field that has seen pretty significant technological advancement in knowledge, methods, and manufacturing processes really makes sense.
> why it is hard to acknowledge and discuss the risk profile of vaccines
My issue is not that there's isn't some theoretical risk, it's that it just isn't put in context of how minute it is. In all likelihood your risk of facing long term effects from a car accident happening on your way to get vaccinated are higher than anything that could happen from the vaccine. And both those risks are, of course, many orders of magnitude less than your chance of suffering long-term effects from catching COVID19.
> Since no live virus is even remotely involved in any COVID19 vaccines it has zero relevance here.
Your omnipotent knowledge is inspiring. We have absolutely zero years of experience with RNA based vaccines. We had incidents with vaccines, not of the same kind. Ergo, there's a non zero probability we will have incidents in the future, by any reasonable inference.
> I qualified my original comment with "in most people's living memory" and didn't include the '76 swine flu vaccine because, frankly, I don't think pointing to an issue that happened 44 years ago in a field that has seen pretty significant technological advancement in knowledge, methods, and manufacturing processes really makes sense.
That's really painting a target where your arrow landed. Most people's living memory does not include e.g. the 1918 pandemic or the bubonic plague, or atomic bombs, or thousands of other things we're proactively defending against and of which we have better understanding but are still an issue. If "living memory" is your criterion ... well, I wouldn't describe it as anything but completely arbitrary.
Within living memory you have totally understandable and preventable things like Fukushima, the nestle mother milk fiasco in Africa, and others. We had enough understanding to stop all of them, and yet they happened. Every single SARS-COV-2 vaccine manufacturer has gotten government immunity from future claims, which aligns their incentive differently compared to vaccines they have produced in the past. They have become too big/important to sue - much like e.g. the fukushima reactor operator. Given this distinctly different incentive structure, rushed schedule, novel RNA delivery system - your belief that the past is a good predictor of the future is unscientific (at the very least, unbayesian without a ton of nontrivial priors you don't bother stating).
> And both those risks are, of course, many orders of magnitude less than your chance of suffering long-term effects from catching COVID19.
Ah, about that. Do you have any actual data about that? Because the best summary of "long covid" evidence I found was written by an MD, is summarized here[0], and can further be summarized by the word "lacking". I spent a lot of time looking for actual data about long covid (not anecdotes), and this summary is better than what I was able to find myself (but I do urge you to read it - do introduce it to your "living memory").
I wonder if because the Oxford vaccine has taken an already tested and approved vaccine approach it has a higher chance of safety than the other 2 which use a new approach that has never been approved by regulators before.
FTA: "The Oxford vaccine (ChAdOx1 nCoV-19) is made from a virus, which is a weakened version of a common cold virus (adenovirus), that has been genetically changed so that it is impossible for it to grow in humans. Adenovirus vaccines have been researched and used extensively for decades"
I think the cold storage issues are a bit overblown.
Apparently the pfizer and Moderna vaccines will keep for 30 days at refrigerator temps after thawing out. You can ship in dry ice and then I can't imagine the vaccine sitting around in any doctors office or pharmacy for longer than 30 days.
Another huge differentiator is price. At $3 to $4, many countries will jump on board ASAP and stay away from the expensive vaccines from Pfizer and Moderna.
>At $3 to $4, many countries will jump on board ASAP and stay away from the expensive vaccines from Pfizer and Moderna.
The price difference will likely remain substantial, but in case anyone is unaware, the difference is currently greater due to AstraZeneca pledging to the sell the vaccine at cost "during the pandemic", while Pfizer and Moderna have indicated that they fully intend to profit. [1]
Once AstraZeneca deem the pandemic to be over, the price will likely rise.
It was reported a few months ago that internal AstraZeneca documents showed them projecting the "Pandemic Period" to end on 1 July 2021. [2]
To be fair, Johnson & Johnson (a US company) also made a similar pledge to AstraZeneca.
These two companies have collectively received more than $1.5 billion from the US government [1]. As I understand it, Pfizer have not taken any federal funding. They do have government purchase agreements, but they are dependent on Pfizer delivering a viable vaccine. Their partner BioNTech received German government funding:
Berlin gave the German company $445 million in an agreement in September to help accelerate the vaccine by building out manufacturing and development capacity in its home market. [2]
I don’t think the data bears this out exactly. US healthcare tends to optimize for access and quality to the detriment to cost. As the saying goes: access, quality, or cost... you only get to choose two.
The US tends to measure better than any comparable country of its size on those two metrics (and quite poorly on cost...but some of that is because the US funds about 50% of worldwide medical R&D)
The US healthcare is good only when considering those who can pay to access it. But since large swathes of the US population cannot afford to have access (expensive insurance costs, even with Obamacare support), this becomes a mute point. If that is the metric, then even Brazil (and many other 3rd word countries) also has good medical care, because it works for the small percent of the population with money to access it.
And in fact this is one of the big differentiators between 1st world and 3rd world countries: if the population has access to quality services, in health care or other important areas like education and sanitation. The US seems to be designing its systems to become a big 3rd world country.
> The US healthcare is good only when considering those who can pay to access it.
False: The third leading cause of death in the US is believed to be preventable medical errors. You can go to the best institutions in the US to get care, along with seeing the very best doctors, but you cannot evade a statistic like that, even if you are in the 1%. See: https://www.npr.org/sections/health-shots/2016/05/03/4766361...
The truth is that you can be in the top 1%, sitting on a mountain of cash, and still lose an unfathomable amount of money, even while insured, if you have cancer or a rare disease. Both of which are actually common.
It is not the doctors who are the problem here with respect to the medical errors: it’s the healthcare system. A good read on what’s wrong with the system is the short book Our Malady by Timothy Snyder.
If you want to stay alive long term, you may want to consult HealthData.org which analyzes each country’s healthcare systems in depth along with outcomes. The group is world renowned. Ironically, it is also the IMHE group that does the coronavirus statistics that everyone consults.
Personally, I am an American culturally, but I became an EU citizen (Croatia) over the US healthcare system. I never plan on working in the US. I do select the country I am working in now due to healthcare.
Your points are baked into the data that I linked. The metric within is "HAQ Index" which stands for "Healthcare Access and Quality". I.e., access is part of the measure. In the US everybody has access, which is part of the problem that drives costs higher.
E.g., if you don't have insurance you can walk into an emergency room and get treated even if it's not an emergent situation. If you don't have insurance, there is a higher risk you won't pay. That cost then gets spread to others who do.
You probably don't know how the US system works. The only access that is guaranteed by law is to emergency services. If you don't have a paid insurance (through your employer or yourself), then you cannot access preventive care or otherwise normal medical consultation. Millions of people in the US don't have access.
For example, if someone needs to treat cancer, it doesn't make any good to go to an emergency unit: they will discharge the patient as it is not an emergency situation.
>if someone needs to treat cancer, it doesn't make any good to go to an emergency unit
That's because the ER is meant to stabilize a patient, not cure chronic disease. Which is to my point: people will forgo preventative medicine until their condition deteriorates and they need to be stabilized in an ER. People get their non-emergent conditions treated all the time in American emergency rooms.
E.g., if I have diabetes, an ER will not put me on a long-term treatment plan. But if I ignore my disease until I start having hypoglycemic symptoms an ER will treat me until I am stabilized enough to be released. Is this the best system? Absolutely not, but it's much different than saying "only the rich have access to healthcare".
FWIW, I used to work in healthcare, including redesigning ER processes
And how would anyone know if he has diabetes (for example) if the person doesn't have regular visits to medical facilities? In such a case they will go to emergency only when an emergency happens, probably when it is already too late. By saying that such a person has access to health care, you're just redefining health care to "emergency health care".
If this was not enough, hospitals are catching up to the "loopholes" in the law and abandoning poor neighborhoods, to make it even harder for people to use emergency rooms.
In the example of diabetes, many people are diagnosed when they show later term symptoms that require an ER visit. Since it's chronic, they won't be "cured" of the disease, meaning an ER can be their main mode of healthcare and the main mode of being diagnosed.
You may not understand the nuances of the article you referenced. Take Detroit, one of the cities used to support the claim in the article. The baseline decade used is the 1960s. Detroit has only about a third of the population it had in the 1960s so it's not rational to think they would maintain their previous healthcare infrastructure. Further, much of that population left for the suburbs of metro Detroit, meaning the healthcare facilities being built are just following the population demographics. Add onto that the point that healthcare has changed dramatically over the last 60 years with much more emphasis on outpatient care, and there are rational, non malevolent reasons to decrease the number of urban hospitals
Curious, in your healthcare experience, what would you estimate is the percentage of people who do have good insurance, but don't get preventative care by choice?
E.g. for myself, I have good insurance, but I don't have a "primary care doctor." I don't go to the doctor unless I'm injured or sick. And I don't mean a sniffle or cough, I mean sick as in I have felt awful for several days.
I don't think I have a good representative sample because facilities I worked for were a specific sub-population that would probably have a very high percentage that fall into the category of "no need for healthcare until something is broken or bleeding profusely"
With that said, it seems to be quite a bit and skewing higher for males than females.
If you have insurance and are not going for a routine exam once a year, you're doing a disservice to yourself because you miss the opportunity to catch issues that can be easily fixed when caught early but catastrophic if not. In fact many corporate policies require people to have regular exams exactly for this reason.
A lot of countries do not do “yearly physicals” like the American healthcare system recommends. This is because in countries with universal healthcare, patients within the country go to their GP/Primary Care Doctor far many more times on average than the typical American. So, in many countries, this practice is non-existent, basically because people just go to the doctor whenever they feel it is necessary—and far more often than the typical American does.
The average American sees a doctor 3 times per year. In France it is 6-7 times per year. In Japan, it’s 13 times per year. This statistic is directly linked to the cost of care.
In Europe, Canada, Australia, etc everyone has access. Why doesn’t access drive up their cost? Clearly access isn’t what is driving up the costs in the USA.
Because it's not as simple a model as "access vs. cost". It's access vs. quality vs. cost.
Canada's HAQ index in 2015 was 87.6 vs. 81.3 for the US. However, Canada spent about $27B US on R&D vs. $495B for the US. On a per capita basis, the US outspends most the world on medical R&D. That drives the US total healthcare costs up while helping to drive down the healthcare quality costs elsewhere. To a certain extent, the US subsidizes the healthcare costs through much of the world, effectively allowing them to optimize for a 2 parameter model while the U.S. must still deal with a 3 parameter model.
Yes, the US spends much more per-capita on medical R&D than other countries. But how do we know all this money is going into real R&D? How do we know most of it is not going into e.g. me-too drugs?
That's a potential real problem, but the concern should be across the board (i.e., how do we know other countries aren't funding me-too drugs) so it doesn't really help illuminate any disparity between countries (which is the context of this discussion).
I'm not trying to be dismissive, I just don't know how it's germane to the discussion unless we view all the other data through the same lens. The data I linked is per country in absolute and per capita basis that tries to put it in unbiased terms.
Are you claiming the US is disproportionately funding non-useful research? If so, how do we measure "useful" research funding?
I do not know how to objectively measure useful research funding. However, this discussion reminded me of a graph I saw on the wtfhappenedin1971.com site [1]. It's not direct measurement of R&D development, but it sure as hell doesn't paint a good picture for all the spending that's going on. I wouldn't be surprised if a similar allocation of funds was happening in medical R&D as well.
Yes, I'm familiar with that graph. There's a similar one for college tuition in the U.S.; interesting that both are industries where costs have been growing at more than GDP year over year.
However, the point between comparing countries still holds. If you use older data, you'll see that the U.S. had even more disproportionate R&D funding
The important issue is that R&D spending is not a good measure of outcomes. A lot of R&D spending goes to high administrative salaries, equipment, facilities (real estate), and related costs that do not translate into outcomes.
What would you propose as a better metric of innovation?
I don't think there's a single perfect measure but if you put it in broader context of measures like Nobel prizes R&D spending, patents, etc. it does seem to paint the picture that the US disproportionately contributes to medical innovation.
It's very similar to the measure of health. There is no single great metric. Using a single metric like BMI or blood pressure is flawed. However, you can get a clearer picture if you bring together multiple metrics.
this is completely missing the point, people don't take chronic or slow-developing issues to the ER so they get worse and have catastrophic consequences resulting in both worse health outcomes and more expense because by the time they do come to ER it's a more serious intervention = $$$$
I addressed that in a different comment (I think we submitted comments at roughly the same time).
I completely agree that preventative healthcare is lacking, partly due to the system and partly due to culture. If the OP had originally said "preventative healthcare" I wouldn't have much to disagree on, but they used a blanket statement implying only the wealthy have access to healthcare in general.
The US also gives free preventative healthcare to many subsets of the population
As someone who migrated to Germany from Turkey, people like me (and everything we are involved in) are "German" when we do something they're[0] not proud of, we are "Turkish" if we ever come close to success, and "of Turkish descent" in the normal times. Of course it depends who you are asking :) It's a bit annoying to be honest but not a huge deal.
I didn't mean to make any judgment about the "Turkishness" or "Germanness" of Drs. Şahin and Türeci. I just mean to clarify that BioNTech was founded and is based in Germany, just as Google is an American company (not Russian-American) even though Sergey Brin was born in Moscow.
I have read it‘s a bigger problem and a source for islamism, especially for the 2nd or 3rd generation of descendents of immigrants: When Germans still see you as Turkish, but Turks see you as German, it makes sense to a) be angry and b) search for some other identity.
> The AstraZeneca vaccine also has 90 percent efficacy when used twice
No it doesn't. Both dosings use two shots, and the "90%" number from the smaller dosing is from an unreliably small sample set of 33 infections -- it could easily be 70-80% by next month when more data comes in.
I don't think we know based on public information. Some media report "up to 90%" which suggests the upper bound of the confidence interval, rather than the centre. Could also be a very wide CI, that overlaps with the standard dosage.
That's a fairer statement than the original which seemed biased towards only reporting the lower end of the interval without acknowledging the upper bound.
At the moment possibly wider error bars don’t come from just “33 infections” but more from possibly smaller number of those who received the observed treatment.
The bars are to be calculated using conditional probabilities.
>These two companies have collectively received more than $1.5 billion from the US government [1]. As I understand it, Pfizer have not taken any federal funding. They do have government purchase agreements, but they
So where did Pfizer's capital come from to shoulder these costs? It didn't come out of thin air, they've accumulated capital from somewhere. If not from taxpayers, someone is subsidizing Pfizer's expenses through Pfizer's revenue stream. Taxpayer subsidies really make sense here seeing how this issue effects everyone.
> someone is subsidizing Pfizer's expenses through Pfizer's revenue stream
Companies taking a portion of what they earn from their existing products and investing this money to create new products is beneficial, and we should have more of it.
Additionally, while this is probably not the case for Pfizer, another possibility is that a company can take outside investment to fund development of a new product.
Not the OP, but what she/he is probably hinting at is that the majority of Western Governments (i.e. both the US and the EU) have poured trillions of dollars/euros into the market as the pandemic started, money that has helped the capital markets stay afloat (and even more than that).
Without those trillions of dollars/euros most probably the capital markets would have been down by at least 50% (my guesstimate, or at least that's where we were headed mid-March), which means that the money available to companies like Pfizer would have been a lot less.
As such, Pfizer saying that they didn't receive federal money is technically correct, but without federal money most probably their market value would have been a lot less right now.
A 40-50% reduction in share price would have most probably eliminated the dividends completely, especially in a very adverse deflationary market, which most definitely would have seen the most of that $10 billion sum allocated to other things than R&D.
Pfizer's cash situation or ability to spend/pay a dividend has nothing to do with stock price. Pfizer does not have their cash balance invested in other stocks. Ability/willingness to pay a dividend has to do with excess cash.
To the extent there's any relation, it's a high stock price that discourages paying a dividend. If the dividend yield will be basically nothing, why bother spending down precious cash that could be reinvested (because obviously the market values future cash flows a lot more than current ones).
Deflation might encourage a little bit of holding of corporate cash rather than spending it on R&D, sure. But even then I think you're overstating the case.
The question was simply to stimulate a more holistic view of the example at hand: that Pfizer did this on their own and essentially didn't need/get any financial help. Sure, Pfizer didn't receive direct subsidy in the short term related to COVID R&D and is taking on risk.
But let's look at this more holistically. Pfizer and pharma benefit a reasonable amount from public research. Pfizer has received their fair share of governmental funding in the form of products, services, and research:
https://www.usaspending.gov/search/85a918fa6adf5152dbac723d2...
They've also been subsidized by people with illness over the years that isn't related to COVID (directly or through their insurance provider pools). It's in other cases the previously sick that have padded Pfizer's profit margins enough to enable them to accumulate enough capital they could take on this sort of risky R&D. Theres also the costs of enabling laws and defending their IP rights from external pressures the US pushes.
It may not be direct subsidy but there are plenty of indirect subsidies that enabled Pfizer to do this. Let's stop pretending these businesses pull themselves up by their bootstraps to success and take on all the risk: they don't. They very often take low risk returns and transfer to high risk and use subsidized activity (e.g. federally funded research) to their advantage. Anything high risk like pharma is prone to failure and needs assistance.
Should we continue assistance? Absolutely, I think so, it's good for everyone. As one parent mentioned, it is good to see these businesses reinvest in further R&D that lead to new discoveries in therapy and treatment as opposed to simply hoarding capital.
Apparently the thought of the narratives that Pfizer didn't pull themselves up by their bootstraps financially makes some people cranky. Everyone needs assistance (especially in high risk arenas), let's not pretend that assistance doesn't exist simply because its indirect, time delayed, and being shifted around.
I agree with your overall point that it needs to be looked at holistically, but I don't think I agree with your stance on some of the subsidy arguments.
A subsidy is, by definition, a governmental funding mechanism. "People with illness" who used Pfizer products in the past aren't subsidizing the COVID vaccine anymore than I subsidize an automobile manufacturer making pickups when I buy my tiny hatchback. It's built into the business model and not really a "subsidy".
I agree with you in terms that we shouldn't view these companies as operating in a vacuum, I just don't think the idea of the markets being propped up is the most congruent way of framing the discussion. Pfizer benefited along with most other publicly traded companies, irrespective of their COVID vaccine.
Is there somewhere any numbers on how much exactly does it cost? What portion is really "research" and what portion is marketing budget? How much trial phase 1/2/3 cost etc?
When I studied pharmaceutical sciences ten years ago, the rule-of-thumb was that it cost around 1 billion dollars from idea to the product being launched. That's only r&d costs and regulations have become stricter over the years, so I imagine the cost has risen since then
I’ve seen this number with some justification being the amortized cost of a successful product, which covers r&d and marketing but also the failed attempts that lead nowhere in between.
There are plenty of 50-100M pharma startups; they wouldn’t exist if your number was right.
>There are plenty of 50-100M pharma startups; they wouldn’t exist if your number was right.
Isn't there a selection bias in that the startups that got to 50-100M survived because they were lucky with a candidate treatment. The ones that failed were the ones that never found a candidate in time? The difference being that large pharmaceutical companies have to swallow ALL the failures, whereas startups can "just" die.
Not to say that pharma companies don't have some fat that can be trimmed...
>which covers r&d and marketing but also the failed attempts that lead nowhere in between.
How do you account for the failed attempts?
As yomly alludes to, pharma startups exist because they don't own the risk - their investors bought it when they were funded. Big pharma does own the risk.
You sum the expenditure and divide by number of successes, with some accounting for the delay. It is actually much easier than trying to figure out the cost of a specific drug, because research is sometimes shared.
"Pharma start-up" is a broad definition which might not only be drug development and there might already be work done on their product before they look for funding
A company that is spun out from a PhD project in a research group, that has done a lot of the groundwork on grants will need less funding
Same goes for a start-up that for instance make non-invasive assays for diagnosis, since the documentation requirements are lower for such products
Producing something that has to be injected into humans is an entirely different league, since the amount of documentation required for such products is staggering
The cost for marketing will vary significantly depending on your definition of the word, and I suspect that it might be misconstrued as only being "commercials and paid holidays for doctors"
GP said idea to product costs 1B just for r&d. That and 1B amortized over failures (and including marketing) cannot be true at the same time unless there are no failed attempts and unless marketing cost is zero.
I've seen you mention marketing several times. What expenditures would you include as a marketing expense?
I'm also not sure what you would define as a failure. Drug development often starts with several candidates for a target. Over the cause of development the list is trimmed, as candidates show lack of affinity for the target or have side-effects that make them unviable. Would you consider each of the excluded candidates a failure?
> I've seen you mention marketing several times. What expenditures would you include as a marketing expense?
I don't get to define that, companies do, but basically it includes everything that does not involve a lab, technician, doctor, nurse, statistician/programmer, etc. The US and the rest of the world are quite different here - if you've ever watched US broadcast in the evening, you'd see TONS of ads for prescription only medicine ("suffering from foo? Ask your doctor about bar"); that's marketing. Taking three hundred cardiologists on an all-expenses-paid 7-day cruise with one 30-minute "purely informative lecture about our new drug" and 7 days of fun? That's marketing too. Lobbying to congress? That's also marketing.
Outside of the US, the marketing budgets are smaller and less overt - but the cruise-style legal bribe-like events are prevalent everywhere.
> Would you consider each of the excluded candidates a failure?
Possibly. You've described one style, but it's not the only one. Many times, it's a weird result from some other research (how Viagra was discovered, how DCA tests were started).
But many things are essentially complete and utter failures - you have a line of research where no viable compound was found at all. BiondVax just failed a 15-year mission trying to develop a universal flu vaccine. Remdesivir is essentially failed even though it is FDA approved (It failed for Ebola; if you look at the data critically, it failed for SARS-COV-2 -- which the WHO's recent studies show even more clearly).
There is some benefit from this research - new techniques, often new devices - but the drug itself is a failure in the sense that it will not generate any income to the company.
Edit: just saw your earlier comment about marketing. It is those things (which you and I mentioned) and a lot more, but it is basically for the company to define in their books and a rule of the thumb would be “an expense a university department developing this to completion without expectation of profit would not have to spend”
The usual course for a biotech is multiple raises as the drug progresses through trials and an early IPO. At each step investors see it as a surer shot.
It's not so much the cost, it's also the delay. At a 5% cost of capital, and a 10 year lag between R&D and final approval, your real cash flows are 40% lower due to the delay. At a 10% cost of capital, they are 60% lower. Sales also take several additional years to ramp up.
This doesn't apply so much to Covid vaccines, as the time frame is accelerated and demand is already high.
The 1bn is only the out-of-pocket cost for development and doesn't factor in for instance opportunity cost. If we include everything required to develop a vaccine, I'd imagine we're looking at something north of 2.5bn
There's so many ways to calculate the cost, that I think it's more important to be aware of the assumptions made for the estimate, than the number itself (which I also failed to do in my original answer)
I think people underestimate the cost of drug development, because the numbers are so big, that it doesn't seem realistic for companies to survive
I talked to a bunch of CROs about the cost of Phase 3 trials. It varies, but is roughly $10,000 to $15,000 per patient year.
Pfizer’s trial will run for 2 years, so ~$900M for the trial alone. That’s excluding all the work to scale up the production, regulatory filing, distribution, etc.
Is it really $10-15k each additional patient year requires or it's more of "total cost was this much, we divide it by number of patients". Where do this money go to? Fx, with these covid trials, 40000 people in pfizer trial, half a year cost would be $200-300 mln. People presumably weren't paid for this. Of course there's some work by doctors that needs to be paid for, but that can't be this large amount. Also, does this all assume USA standards of pricing? Because in rest of the world healthcare is much cheaper.
I just think big pharma are fundamentally ok with huge cost for trials and are not motivated to decrease it/make it more efficient, since they're ok with their pie being larger. They will just shift costs to healthcare system and will be happy with larger profit.
Ha! You think big pharma likes spending that kind of money on trials? I’ve been a part of those negotiations with the FDA. It costs that much because the company says “we believe a 6 month trial is sufficient to prove both safety and efficacy” and the FDA says “if you want it approved, you need to collect 2 years of data”.
Now, $10-15k per patient-year is for a typical therapeutic. And that is an average across global trial sites, not just the US. It’s not much money. You go a 15 min doctors appointment and your insurance is billed $150. Now imagine going 1 per week and having multiple tests run each time. Or having to stay in the hospital for a day when the drug is administered. You can burn through $1,000 per month pretty damn quickly.
I don't see a reason they would be really against it. FDA says it to everyone, so all companies in same condition. And they can shift cost to healthcare system and have larger revenue. They probably don't mind their pie as a whole being larger, because having revenue of 50 billions and profit of 10 billions is better than revenue of 5 and profit of 1, even though proportionally it's the same. All big pharma companies are massively profitable, fx Novartis net income in 2017 $17.8bln on $50.4bln revenue. Pfizer's $14bln operating income on $53.6bln revenue in 2018. And it's year after year. They really don't seem to suffer from those high costs trials. Also, Pfizer reports only $8bln on R&D in same 2018. I'm sure there' a lot of inefficiencies in those trials, same as it turned out vaccine could be created in year instead of a decade. (btw, previous large scale epidemic of swine flu was largely profitable for pharma companies). They just don't have incentive to reduce the inefficiencies.
You're telling it's not just US but then you cite high healthcare costs (retail vs large scale trial, definitely can be cheaper at scale), which is much cheaper outside of US. I would be very interested in reading numbers of detailed case study of creation of some real world vaccine/drug.
They probably don't mind their pie as a whole being larger, because having revenue of 50 billions and profit of 10 billions is better than revenue of 5 and profit of 1, even though proportionally it's the same
It doesn't work this way. Pricing of pharmaceuticals is independent of the cost of development. Nobody will pay $200 per Covid vaccine dose just because the cost to develop it went up 10x. Every extra dollar spent on development, is one less dollar of profit.
That's why some drugs never make it to market - the cost to bring them to market and the low price means they'll never be profitable.
Even if it doesn't happen for each and every drug, that can easily be the trend on average. And it probably already happened with covid vaccines. Moderna comes out and says it will cost ~$30 per shot. Why not 3? And for others drugs, when price goes into thousands and don't have much competition that easily can be the case.
I'm a volunteer for this vaccine, in the first month I have three in-patients visits, involving two inoculations, 6 blood draws, 2 Covid tests, and three nasal absorption tests. My first visit lasted a little over three hours including a very comprehensive medical history and physical exam, and time taken to ensure that I was giving truely informed consent. I interacted with three medical professionals on the first visit, sometimes in the exam room, and sometimes via phone from the exam room to protect each other from long in person indoor exposure. Like any medical visit this year, a considerable amount of PPE was used. I was given an app use daily to record my health, and a digital thermometer so that all subjects are using the same calibrated equipment. Having reported a headache two days in a row in the app, there was a remote phone call follow up by a research clinician, in addition to the planned check in phone calls that I haven't mentioned. They do pay me a very modest ammount, so I've bought myself a couple of ebooks after paying for big city parking near the research clinic. They need to pay for that office space. Before I entered the study I needed to interact with recruiters, to qualify that it was safe enough for me to participate and to ensure that they were getting people from a variety of backgrounds. They needed to be ready to respond if I had a severe adverse reaction to the the trial vaccine. There is an entirely separate independent review board that I can go to with questions. In the event that I had Covid symptoms, there is an entirely separate set of assessments, visits and samples taken.
Given the amount of work being done by this and other research labs hired Astrazeneca, and comparing this to quotes I've received for a very modest UX usability studies, it's hard to see see this an sort of money grab.
No, it's not. Private R&D spending is at least doouble that of the gov't. Look up the budget of the NIH and compare it with the R&D budget of big pharma.
BioNTech developed the vaccine now mass-produced by Pfizer. For that, they received $445m from the German government. So, as a tax-paying German citizen I can say, not only will I do that, but even better, I already did.
It also feels deeply wrong to pull the "but all the research efforts that did not lead anywhere" argument, when Pfizer did not do the research in the first place. They should get compensation for organizing the huge trial, of course; that expertise was why they were on-boarded in the first place. And nobody expects them to manufacture that stuff at loss or cost. But we should not accept public money buying them goose laying golden eggs either.
Nobody’s getting a goose laying golden eggs from a covid vaccine. It’s a one time, relatively low-cost vaccine that is going to go out of demand once the population is immunized.
Oh, and now there are multiple competitors in the market.
Only if the vaccine gives permanent immunity, which I haven't found any research suggesting that it will. In all likelihood, it will be necessary to give yearly booster shots, so the companies developing the vaccines will be able to sell vaccines every year
The quantity of vaccines needed will make even a $0.50 markup worth billions of dollars every year
You can't measure long-term immunity on a virus that's only been in the wild for ~11 months. That said, all the recent studies I've seen show no signs that immunity is going to drop significantly after a year.
I hate to link to a Youtube video, but this doctor walking through the research in the first part of the video is honestly better than any news article I've seen:
https://www.youtube.com/watch?v=gFeJ2BqCFY0
Thank you for the link. The study definitely suggest a best-case scenario is viable. I do however think that the sample population of 183 subjects is too small to support the conclusion in the paper. The study only got a single sample from the majority of the participants andI couldn't find any indication of how many subjects from each location participated (or which locations were included outside of California), which makes me think it might not be a representative population used
I also noted that 40 of the participants were excluded because they had no PCR test done to confirm covid and no antibodies were found in the assay. This is in my opinion a major flaw, as the subjects could have been infected, but had no antibodies left, when the blood sample was taken
Finally seven of the 18 authors declare competing interests, which might have affected the research
Getting back to your post itself, I agree that you can't measure immunity for a longer period than the virus has been around, but that also means you can't say that there will only be a need for one round of vaccines, which was what I was disagreeing with
It might very well turn out, that you gain permanent immunity for a specific strain off the virus, but unfortunately that immunity also introduces selective pressure. Whether the virus is able to mutate in a way that bypass existing antibodies in a subject is obviously still an unknown, but we have seen that it's able to jump to other species like mink, which caused the emergence of the Cluster-5 variant
Since the virus is able to use other species as a reservoir and selective pressure is being introduced, I think it's reasonable to prepare for a scenario, where a vaccine won't be a permanent fix
Vaccines are not a great business in general. (Which is not the same as saying they're unprofitable.) But one reason vaccine makers are generally indemnified against lawsuits in the US, it that at least some companies would probably pull out of making vaccines if they weren't.
These nickle and dime arguments are for "old normal".
The society at large is making huge sacrifices and making painful changes to address this collective problem. Are these companies part of "Human society" or not? If they are party of Humanity, then they can make 'adjustments' as much as we are asked to make adjustments.
Have these companies provide a detailed list of expenses for researching and developing this vaccine, review that, pay it as a one time cost and THEN vacate the patent.
They then get to recover their R&D expenses and make a smaller but probably decent profit from its production.
Bankrupt? Not many. Bought for pennies on the dollar? Plenty. Where is Upjohn? Parke-Davis? Schering-Plough? All companies with multi-billion dollar sales figures and all swallowed up when the money stopped coming in.
And if you fold in the start-ups who have one shot and if it doesn’t work out? Plenty of those. They go bankrupt.
Busting the patents on Covid vaccines would be “socializing the gains and privatizing the losses”.
There are currently 54 vaccines being tested on humans. Getting the necessary data to obtain approval for human testing requires a lot of funding. Testing on humans requires a lot of funding. In the end, maybe 4 vaccines will be used. Do you think the companies that produced and tested the ~50 vaccines that will not be used will get their investment back?
This isn't responding to the OP's point, which was that war profiteering (making money by providing weapons to kill people) is morally different from selling vaccines (making money by providing medicines to save people's lives).
I'm very familiar with the perverse outcomes that emanate from profit-driven medical research, having been personally affected by illnesses that the mainstream medical science community sees no incentive to invest in.
But the reasons and ethics of the system being the way it is are separate from the reality of what it is for the purposes of getting things done in the here and now.
For better or worse, as things stand right now, pharmaceutical companies, like other companies, need to make profits - or at the very least avoid crippling losses - in order to survive and continue doing their work.
That includes covering the formidable costs of the many research studies that go nowhere and yield no revenues.
I'm sure you wouldn't find a single person in a pharmaceutical company who would feel good about withholding treatment from any person with a life threatening illness. But what they also have to care about is remaining in business so they can treat and cure many more people with serious illnesses.
Regarding vaccines and altruism I suggest you read up on Jonas Salk, who developed one of the first successful polio vaccines[1]
Money quote from linked article:
"News of the vaccine's success was first made public on April 12, 1955.[7] Salk was immediately hailed as a "miracle worker", and chose to not patent the vaccine or seek any profit from it in order to maximize its global distribution."
I do not dispute that altruistic people exist, and often do great things.
But I also know that my grandmother suffered terribly from rheumatoid arthritis, and it destroyed her life. Long after she died, enbrel was developed for profit which was the first really successful treatment for it.
No profits => no treatment => misery.
You can sit around waiting for and hoping for someone to step up and sacrifice their time and money for your benefit, but I prefer the much more reliable method of paying them.
Not to take anything away from his contribution, but it's a bit more complicated with Salk.
The organizations who funded the research looked into the viability of a patent and concluded it wouldn't have succeeded.
"the idea of patenting the vaccine had been directly analyzed and the decision was made not to apply for a patent mainly because it would not result in one."[1]
The distinction should also be made that a patent doesn't necessarily affect global distribution. It just gives the rights to license the technology. They could have patented it and then licensed it for free.
Here comes my old publicly traded corporation rant: a company with a well defined owner, even with a well defined group of owners, would, given the opportunity, profit handsomely. But not overdo it. They'd rather be seen as a global saviour, not as a global ransomer.
Enter public trading: the opportunity alone for global ransoming will inevitably become the projection that defines the street price for shares and once valuation is up there ransom-level profits would suddenly appear not excessive but appropriate, given the level of paper investments of the latest, valuation-defining round of buyers.
Private (as in: not publicly traded) is indeed pretty much equivalent to publicly traded if it's a private ownership structure consisting of VC funds. But that's a startup bubble peculiarity, elsewhere private ownership either means being a subsidiary where the parent ownership structure transitively applies (strictly speaking, the VC funded startup falls into this category as well) or a much more conventional setup where the role of outside investors is taken by old-fashioned banks whose possible returns are strictly limited to what the credit contract says.
The main issue is identifying what anti-social behavior is. It's easy to say "coal is anti-social! don't you care about the environment!", but it's just as anti-social to just shut down an industry and say "best of luck, I heard you can move to California and build websites in JavaScript". Often times there just aren't easy answers.
I also want to push back on "everything commercially successful is run by tyrants" kind of narrative. I get the frustration, but these blanket, ideological statements do not help anyone, anywhere. Do you make money? I guess you're a tyrant!
Let's not forget, the countries that we put up on a pedestal as the shining examples of how a country should be run (Norway or whatever) are very much capitalistic countries with free markets, IPOs, and commercial companies. I hardly see businesses there characterized as tyrannical.
I do really get the frustration, but it needs to be directed at the failures of our elected representatives. Not, commercial entities.
> The tyrannical boss is a classic trope due to the necessities of competition.
Eh, I think that’s kind of old-school thinking.
> Companies are unlikely to stay profitable if they’re overly generous. They need to profit handsomely to survive.
Yep. That’s fine. (Also ignores low-margin industries that rely on volume, but whatever).
If you want a modern society, people have to be able to take risks with their money in order to make more money. Otherwise we can go back to subsistence farming. Do you work? You’re charging a profit. How evil of you! Being a few steps removed from the transaction doesn’t make you any less guilty of profiteering. You’re just as bad as these tyrannical CEOs, the difference is you’re a sucker for building their product while they make money hand over fist.
(I don’t actually believe the last part, but w/e).
Today. Just 1 year ago the next pandemic was vaporware. In hindsight we know that covid happened, but there was no more reason to think it would have than any other unlikely event.
I doubt if vaccine research can be done just by a group of interested people. It's not a paper-and-pencil affair like pure maths. You need a lot of computers, drug manufacturing machinery; then you have to run big, well-organized RCTs. If you've got an example of volunteer-driven health research at scale, I'd like to hear about it.
Biontech didnt do vaccine. They pivoted because they saw a big opportunity using their approach might lead to a vaccine for Covid. So to justifies this pivot (and get the investments into the company) there need to be a possibility of big profit at the horizon.
A profit opportunity requiring significant investment has led to fast and fantastic results that will benefit us all. But you want to punish the opportunists who've absorbed significant risk to bring us those results because you've decided their motivation isn't sufficiently pure.
I pray anyone of like mind is never in a position to enact such progress-killing madness and fear terribly that government is already full of them.
And besides, it is mind-numbingly complicated to calculate "at-cost" because as others have pointed out, that includes all of the dead-end R&D, ongoing legal exposure, interest on the loans used to cashflow operations at pharmaceutical giants, appropriate licensing of existing intellectual property that these vaccines are built on, and the million other ways money is spent to develop pharmaceuticals.
While I think the current system helps, let's not pretend that profit is the sole reason people decide to work in medicine or research.
We all have things (and people) in our lives who are probably a net negative in terms of financial outcome, but we enjoy them anyways because our value systems are more complex than just "maximize profit"
I agree that in cases of overwhelming national interests patents and licensing should be ignored if they stand in the way.
But: this is not a medicine made of a molecule that can be synthesised by the chemical industry.
Such a vaccine requires input from the creator and then specialist equipment to manufacture. Poor countries don't have the infrastructure to manufacture and the creator labs are not going to tell you how to produce the vaccine just because you ask them.
In any case, governments should pressure labs to enforce an low prove.
In the context of the vaccination rush I often wonder how military aircraft procurement was doing it when extreme r&d progress and extreme mass production were coinciding during ww2. New types were developed by companies (even the Soviets maintained a healthy competition between design bureaus) but once a type was established and in volume demand it apparently was manufactured wherever a production line could be adapted. Was that just free market subcontracting in the US or did DoD design bids come with something like a premeditated licensing option baked in from the beginning?
I think that the "free market" stopped to operate during that time. The whole economy was redirected to the war effort and everyone with it.
These programs were federally-funded with the goal to produce as much as possible. For production I'm sure that factories were financially compensated for the work.
I’m sure you’d be willing to play that game? Let’s say your job becomes “essential”. The company pays your costs (rent, food) and nothing more. I mean, to “profit” is unacceptable.
While off-putting, these same capitalist forces are what made companies like Pfizer possible in the first place. Where are the socialist factories? I do not see any communist, religious and/or otherwise motivated groups of people producing anything of value right now. Lots of noise, very little substance.
No, the main driver for the price difference is that this is a "traditional" vaccine produced using existing technology, while Pfizer/Moderna are newfangled mRNA ones.
Also, all 3 have made various noises about not making a profit etc, it's quite hard to sort out the marketing from what will actually happen at this point. Oxford/Astra have committed to supplying at least 100M doses to low-income countries for under $3 though.
As I understand it, whatever gets us to herd immunity more quickly is the best solution. That probably means a mix of both heavily tilted to the Oxford one.
This vaccine is cheap, 90% efficient and easy to get people vaccinated. The other ones are expensive, 95% efficient and difficult to get people vaccinated.
No, it means deploy everything we have as fast as we can. If we have a choice prefer the mRNA vaccines as they seem to be more effective. If you are in a city with cold storage abilities (most have this already, though how much...) the Pfizer is better, but only to reserve the Moderna vaccine for those who don't live so close to cold storage.
The Oxford is best only if you either live in a very remote place, or are a very poor place. If you rely on the oxford vaccine it will be a little longer to get herd immunity, but overall your costs will be cheaper.
But I must reemphasize, the above is only about logistics. Because most people live in cities, all vaccines will be distributed in big cities just to get the numbers they need. What ever vaccine you are offered first is the one to take. You personally are unlikely to be offered a choice other than take it or leave it.
If they actually get to 90% or more, why would anyone bother with the more expensive and cumbersome vaccines? Except that the EU already signed a deal to buy the vaccines from AstraZeneca, Sanofi and Johnson & Johnson.
Especially in the next few months, supply of all of these will be limited by production capacity and supply chains. Having multiple available means more doses can be delivered sooner.
Because there is only so much to go around in the initial stages, so they will buy whichever one is available to them. The 10x increase in price is peanuts compared to the ecconomic benefits of getting more people vaccinated sooner.
Additionally, lots of countries have already preordered all the major candidates, so in those cases its already spent money.
Because 95% efficacy is twice as good as 90%. And some people are willing to pay the $30 it costs to be 5% likelihood to have a non-functioning vaccine vs. a 10% likelihood the vaccine you just got won't work on you.
Aren't people worried about the fact that mRNA vaccines haven't been deployed before? I don't see much apprehension about that generally, but a few months of testing of a brand new delivery technique don't sound that extensive to me.
The delivery technique relies on LNP (lipid nano particles) which is fairly refined and existing therapeutics use today. There are potential patent violations though (both Phizer and Moderna possibly violating Arbutus patent) but it’s unclear to me how this affects distribution.
No judge in their right mind will grant an injunction when doing so will cost the lives of third parties. All the harms can be solved with a big check.
Yeah I'm not 100% familiar with the potential case here but I'd imagine it's in everyone's best interest to ensure that the medicine is not hindered in its ability to be manufactured and delivered and that the company that holds patents on the delivery vehicle (LNP) would be compensated justly.
It isn't a new thing for what it's worth. Going back to earlier this year it has been looked at, but we don't really have a clear picture on what will shake out.
We don't have evidence that is possible. There have been vaccines in the past that protected without stopping spread. We think that the reasons that happened don't apply, but we don't know that.
Sure, maybe I just don't understand this whole charity thing. When governments can print trillions of dollars to ,,help the people in the pandemic'', why a few tens of billions of dollars matter when real companies with real experts are doing real work all day and night without sleeping. Instead of buying back bonds, governments should pay companies that help in this situation.
Honestly, why would any 1st world country "vaccinate everyone immediately"? Wouldn't it be more prudent for a rich country to wait until 3rd world countries vaccinate first in order to see what the side effects actually are? Not to mention the fact that we know nothing about potential long-term side-effects.
The mRNA vaccines are better and protect more people. AZ leaves 10% unprotected, mRNA leaves 5%. That's a big difference if trying to get to herd immunity.
While for now just speculation and without a doubt Machiavellian, it could be that this price difference ends up a significant factor for major economies in their choice for an expensive vaccine. I guess we will know, if/when/once examples of individual discrimination based on what vaccine people received start emerging (hopefully, never).
Regretfully, it would be not the first example of major economies using the current reality as an excuse/cover to conveniently push political policies/agendas that would otherwise have been impossible to implement (at least not without violating laws/treaties and maybe even basic human rights). I have no intention to fear monger, but I believe way too many are too naive about some of the things that are currently happening. That is, mostly people within those major economies, for people in less fortunate countries already learned the hard way how double-faced those major economies turned out.
How all this will eventually turn out ... anyone's guess is as good as mine. I guess we will all learn, when the immediate emergency of the current situation is over. I would prefer to be/remain optimistic, but thus far there appear to be more reasons for caution and skepticism (at best).
I've read this 3 times and can't figure out what you're trying to say.
Are you saying that rich countries are going to intentionally choose more expensive vaccines, with the intention of suppressing the lower classes?
That's so rediculous. In rich countries (other than the usa) the gov pays for these things not the citizens. Even then, the expensive vaccine is only $40, that's within the means of most poor people.
Not to mention that would screw over the rich people who want to benefit from (vaccine induced) heard immunity.
> .. the gov pays for these things not the citizens ..
You do know that the only money governments have, is the money they got from its citizens, right? That is, aside from what they may have earned (though plundered or extorted might be more fitting) from other nations.
> .. the expensive vaccine is only $40, that's within the means of most poor people ..
You may want to reevaluate your knowledge about the rest of the world. That is, outside the USA and some the more affluent parts of Europe. Also, that vaccine probably won't cost "just" $40 equally for everyone.
However, believe whatever you want. Time will no doubt teach us all a lessen. Personally, I hope it will teach me that I was wrong with my skepticism.
I'm not sure why i'm replying here. Guess i'm bored.
> Time will no doubt teach us all a lessen.
I doubt it. You need to actually have a position that can be shown to be true or false with the passage of time before you can learn something from the passage of time. You have a bizare, logically disconnected, rant that does not make any predictions. I don't think any course of events would prove you right (or wrong).
> You may want to reevaluate your knowledge about the rest of the world
In context, we were discussing afluent countries, canada europe, etc.
> Also, that vaccine probably won't cost "just" $40 equally for everyone.
They will cost $0 directly. As you say there will be indirect costs based on taxes. However that will be true regardless of if you get the vaccine and be scaled based on your income, so im not sure how you think that applies to your argument sbout class divide.
Needs to be repeated again & again:
"Governments have no money of their own, it's citizens' (past, present and future - mostly the latter these days) who provide the cash via taxes".
This changes nothing. If anything it is wise for goverments to pay for vaccine because that means that economy will no longer be stifled by lockdowns and that means more money in taxes.
In any cases many governments already said they will provide vaccine for free.
Price is not an issue for rich countries. 500 Million vaccines for USA leaving kids and some other out...cost, what $25 Billion? Peanuts, compared to the damage it did /can do. Same for USA, EU, Japan, CA, Australia etc.
Poor countries are hit by covid-19 as well. Those folks deserve a vaccine too. Even if you don't care about the Humanitarian side of this, the west benefits from that directly by not having giant reservoirs for the virus.
Plus, they travel to the rich countries.New vaccines are coming in. China will probably use their own, India will copy one and costs next to nothing. Donations will make sure everyone has one.
My understanding is that they actually haven't tested at anything but -80C, and that it is potentially possible that it could be stored at higher temperatures, but it hasn't been examined yet.
Dry ice is very common, and you get 5 days at refrigerator temperature. Everywhere in the world is reachable in 5 days if you need to. It gets really expensive to charter flights to many areas, but it is possible if you have money to burn.
Of course we now have reason to believe that vaccines that don't need dry ice will be approved, so logistics will direct the easier to ship ones to remote places.
You can reach everywhere in 5 days but that's not enough. People have to come and get it, there's also a chance there will be a slow start due to concerns over a new drug that the media may emphasize was "rushed". Then there's the logistics of scheduling so many people. If you don't bring yourself a cold storage freezer you're committing to using 100% of your doses within 5 days which may not be possible.
For the first few months all doses will go to high risk people. Most won't have the option to refuse it.
Eventually you are right. If the Pfizer vaccine is to be used in remote places the people getting the vaccine will need to schedule it in advance (and probably pay for it) to ensure that once it arrives it is used.
It is, especially for far flung places. This stable vaccine will be very useful in places like the pacific islands, where air transport isn’t always an option.
Any island that doesn't have air transport doesn't really need the vaccine (if transit take weeks, infections on ships burn out before they get there).
Realistically, every major population can be reached in 24 hours by modern transport, and the Pfizer 5000-dose transport package keeps the temperature for 5 days.
mRNA is a term from molecular biology [0]. "MRNA" is the stock symbol of Moderna [1]. Both Pfizer/BioNTech and Moderna use a mRNA based method for their vaccine.
You might want to update the comment to avoid confusion.
The key differentiator is the mechanism of action, not the storage system.
The other two current candidates are mRNA vaccines, an approach which hasn't been used in humans before -- looks like the harbinger of a revolution but we have no past experience.
This O/AZ uses the actual spike protein embedded in a simian virus (that does not affect humans and has its own DNA removed). It's possible to generate antibodies to the vehicle (virus) which is why a simian virus is used (humans won't already have encountered it) but also means your own immune system could target the vaccine itself. Loewe speculates that this is why the higher dose was less effective.
The storage system is important and a key differentiator, tons of countries cannot effectively distribute a virus at -70° to population in the most vulnerable spots. I don't know why you felt the need to be so dismissive.
I am dismissive because distribution is not big-H Hard. It consists of known unknowns and can "simply" be solved by application of money. Yes, actually it's a systems problem: there is not infinite money, there are political interests. But compared to the science the problems are well understood.
On the other hand we still have no idea how well these vaccines will work. First, we have (as I discussed) two different approaches in the three current candidates, one of which is fairly new and one which is completely novel. We have had only limited time to see how well they work and have only limited experience in broad efficacy, duration of effect, and, crucially, how long they last (it takes a long time to learn if you'll need a 10 year booster!). We don't know how fast the virus mutates away from the vaccine's target (though we do currently think we have a good idea). And we simply haven't tried enough people to get a good handle on side effects.
One of the difficulties in solving these is that new approaches contain unknown unknown. Look at CRISPR-CAS: got a (deserved) Nobel this year yet may already have been discovered to be ineffective or worse in the real world. That takes time to learn.
Now it's not that the people doing the work are idiots -- they know all these problems better than I do. But I am appalled that this is treated by the press as a distinction between, say, a pair of beta implementations of something, one in Python and one in Ruby.
Going back to systems issues: when we don't know these factors we take a calculated risk (really an estimated risk). The social aspects of vaccination (close to ubiquitous use, the risk of any side effects increasing the anti-vaxx rate for other immunizations, which itself could become a public health disaster etc) mean these factors are upmost in public health officials, not whether they have adequate refrigeration.
Vaccines are particularly difficult for reasons like these above -- there's a reason why they have their own special laws and government-assumed liability insurance. I haven't worked on vaccines, so take this as you will, but I have worked in anti-invectives, have designed preclinical and clinical protocols (including first-in-human) which were submitted and approved by the FDA, run clinical trials, have presented to the FDA and defended protocol design, so I have some idea what's involved and how to read the presented endpoints and findings.
What does this imply? Is the approach by Oxford worse, or just more well known / less surprises? Does this mean that dosing the vaccination is somehow more difficult?
I'd argue that it is more accessible to everyone including developed nations. It only requires a standard technology freezer - like that you have in a residential home. COVID-19 has already cost the UK hundreds of billions, so being able to roll out a vaccine with minimum hassle and without needing specialist storage and training on its handling, is an absolutely enormous benefit.
Honestly I feel like this vaccine is going to leave the mRNA-based vaccines trailing in its wake in terms of global government adoption.
Moderna vaccine also seems to have similar storage requirements with a high price tag. BioNTech otoh has impractical storage requirements for the third world. AstraZenca's price and storage combiation may open possibilities for distributing this globally.
I've been contracting for 8 years now. I'd recommend CWjobs / ContractRecruit and PurelyIT - just search and refine based on location / skills / required rate.
I’ve worked on this in London recently, presenting my working concept (and months of data in tableau by location behind it) at a few events. The industry is a few years off it, particularly the physical tech, which would require digital screens to be hooked up to an ad server of sorts (that doesn’t really exist programmatically either) and then serving custom ad formats (non IAB format) in real-time (taking in variable factors that could effect the demographic and/or volume of eyeballs). Measurement of the eyeballs and said demographic is the gap, though that’s more than currently exists in the Out of home market right now(nothing!).
It has legs, you just need serious commitment from an owner of inventory (physical boards), which are controlled by 3 or 4 organisations.
Perm - Mid level benefits + Pay (maybe options in a startup)
Contractor - Individual with their own Ltd company, pays less tax and much higher take home pay but without any benefits.
Consultant - On-site via a supplier on a framework of some kind, however, often a permanent employee of the supplier with the supplier cashing in the margin.
At least 50% of the tech workforce in companies I work with or where peers are at in London are made up of contractors, especially in Banking.
Totally agree with you here. The contracting market in the UK (particularly London) is much more lucrative than relative permanent roles, even when their benefits are taken into account. It's actually more lucrative on tax here, though the Gov't are trying their best to change that.
It's also my experience that you get what you pay for, contractors in the whole tend to have a much wider breadth of knowledge from various sectors and hit the ground running whereas I don't tend to see the same appetite from Permanent employees (in most cases!).
I've been using Momondo recently, which has all of these tools and a much better UX. This just feels like a re skin of the ITA site and a bit of a poor effort at that.
Timetabling (at that point) remained very much a manual process, I think they had to bring a poor chap out of retirement who wrote them by hand.