I was early arguing that Covid is bad, back when it’s just the flu was the sophisticated answer. Lately, however, I have found myself on the other side. As I wrote last week, I think that the end of covid is here, it’s just not evenly distributed. Distributing vaccines is still an on-going logistical challenge, but the world is currently doing >30 million covid vaccine doses per day (a number that has been going steadily up), so by mid-to-late 2022, it will be mostly over (mid-to-late 2021 for rich countries, mid-to-late 2022 for the rest of the world).1 Complete eradication is unlikely (although not impossible), but covid as a public health concern is on the way out.
This image of survivorship bias has been so over-used on Twitter that posting it by itself has become its own joke:
When I voice this opinion, even informed people will often retort What about variants? There is still no vaccine for the flu or HIV? Malaria? Our intuitions about disease have been molded by the persistence of these hard-to-vaccinate-against diseases. But the fact that these diseases are the ones that come to mind is survivorship bias.
Covid is probably a normal disease, one that can be (almost-)eradicated with vaccines like so many of the ones that used to be a problem and are now gone (polio, smallpox, measles…). Mid 20th-century pro-tech intuitions probably serve us better here: we have a vaccine and we have, therefore, a solution.
Flu, HIV, and malaria all have very specific immune-system evasion mechanisms, while Covid does not. Covid’s variants seem to have arisen from traditional mutations and the virus is probably stuck at a local minimum. Even if one of the variants does escape vaccine protection enough to be contagious, it will probably be a single booster shot, given one time.2
Even eradication is possible (although I am not predicting it will happen). It’s not clear that there are long-term animal or human reservoirs and it is possible the virus will flame out even if not everyone in the world is vaccinated. Again, diseases that cross the world and flame out would, by definition, not be present in our mental models.
Links of the Week
From Marginal Revolution, more public-goods failure: Fractional dose trials now (see my post last week: First doses first: why didn't anyone test it out?)
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Photos
At 2 doses per person, it’s 15 million per day, with about 1 billion people having gotten theirs already. So, to get the other 6 billion at 15 million per day, you need 400 days, which is just over a year. On the one hand, the pace of vaccine production is also accelerating, which would mean that enough doses will be produced even faster. On the other hand, though, the bottlenecks won’t be all about vaccine availability. Eventually, people not wishing to take the vaccine will be the biggest challenge.
Another public health failure of the last six months is that the mRNA vaccines could by now be multi-variant cocktails, but there seems to be little interest in developing these fast.