The American bubble

The world makes no sense to me.  At some point, I should just give up trying to understand the world.  But, I persist like a mad man!

Here in the US, people are dilly-dallying getting vaccinated.  Some are even refusing the shots.  There is no out-of-pocket cost to get vaccinated, and yet there is a high level of hesitancy!

So much so that state governments are offering lotteries as incentives to get vaccinated.  California has the largest pool of lottery money at $116.5 million.

Meanwhile, there is the rest of the world where there is severe vaccine shortage.  Let them eat cakes!

On my part, I have been regularly tweeting about the urgency for vaccine equity.  It doesn't matter to me if my tweets, like my blog, will not have any effect on the world.  After all, I am a mad man!

If only even the terribly selfish America First person understood that "we risk a forever pandemic with long-term cycles of lockdowns, economic damage and constant fear. We cannot just vaccinate rich countries and hope that we will be safe."

Even if we do not care a damn about the rest of the world, "the longer it takes for the United States to lead a global response, the more the risks compound."

In a politically polarized country in which millions believe that masks are useless, I am not sure how much the President can provide the beacon for the world.  The world "needs a Marshall Plan to invest billions in global health infrastructure, technology transfers, and exports of raw materials, ... and not just a patchwork of disjointed solutions."

The Marshall Plan happened under different circumstances.  But then the plan was also to primarily assist white people in European countries.  Now, the need is to help out a whole lot of brown people all over the world.  The America First voters have made it clear that they do not care about brown people.

Many Americans already struggle to sympathize with their neighbors—convincing them to care about poorer countries, particularly while recovering from what has been a tragic and difficult year, will surely be a tougher pitch.

A very tough pitch! It doesn't have to be that way :(

A shot in the arm

Conversations with my parents these days are only about Covid.  "There is a constant feeling of fear," my father remarked.  So did my mother.

I told them that vaccines are the key, and that there is no way out otherwise.  I drew a parallel with polio.  "They are doing research to develop tablet version of the vaccines," I told them.  Tablet is the Indian usage for a pill; to communicate, one needs to use the relevant usage.  I recall the confusion on a male student's face when as a fresh-off-the-boat student I asked him where the lift.  How would he know that I was referring to the elevator!

The tablet will be easy to administer, without the logistical hassles of the below-freezing temperatures needed for most of the Covid vaccines.  Imagine the Pfizer vaccine as a pill.  That will be a game-changer!

Pfizer’s experimental oral drug to treat Covid-19 at the first sign of illness could be available by the end of the year, CEO Albert Bourla told CNBC on Tuesday.

The company, which developed the first authorized Covid-19 vaccine in the U.S. with German drugmaker BioNTech, began in March an early stage clinical trial testing a new antiviral therapy for the disease.

Of course, there are also others in the race to develop an oral Covid vaccine.  But, until then, it will be shots.  Injections, which is the usage in India.

But, why the shots in the arm?

For one, easy access.  Imagine if every one of us has to get the injections in the buttocks.  It can't be done in the open.  I certainly do not want to reveal my bony butt to the world!

But, the buttocks too are sometimes the locations for injections.  Why the buttocks or the arm?  "Muscles make an excellent vaccine administration site because muscle tissue contains important immune cells."

Aha!

These immune cells recognize the antigen, a tiny piece of a virus or bacteria introduced by the vaccine that stimulates an immune response. In the case of the COVID-19 vaccine, it is not introducing an antigen but rather administering the blueprint for producing antigens. The immune cells in the muscle tissue pick up these antigens and present them to the lymph nodes. Injecting the vaccine into muscle tissue keeps the vaccine localized, allowing immune cells to sound the alarm to other immune cells and get to work.

Hence, the shot in the arm.

And, yes, injections in the arm are recent.  They are one of the many ways in which modern medicine has transformed our lives.  The literal "shot in the arm" that dates back to early 20th century is now also used as an idiom, as a metaphor, in discussions like a Keynesian economic stimulus program.  I suppose taking a pill will not be a powerful metaphor in the stimulus talks!

And on schedule, I had my second #PfizerVaccine shot earlier this morning.
🤞🏽on side effects #freedom starts on #MemorialDay

— K Sriram (@congoboy) May 18, 2021

Give Pfizer, et al, more money, dammit!

When we all started getting familiar with something called a "novel coronavirus," experts, who were way ahead of us and on top of a hill looking into the future, told us that eventually vaccines will be the only way out of the global pandemic.

A year ago, we knew that we will need vaccines to deliver us from the pandemic into some kind of normalcy.

Right?

Pharmaceutical companies also knew well about the money to be made from vaccines that could beat back COVID-19.  So, their scientists set out on the expedition, and amazed the world with the speed at which they developed, tested, and produced the vaccines.

What I don't understand is this: Why didn't governments, especially in affluent countries, offer all the needed dollars and euros in order to rush the production of billions of doses that can vaccinate the entire world?

Because big-pharma will make lots of money in the process?

Think about this: Isn't vaccinating the world worth the money?

Think about this also: The world's most profitable company is not a pharmaceutical giant.  Nor is it a fossil fuel company (if you set aside the strange monster that Saudi Aramco is.)  It is Apple.

Apple is one hell of a profit-generator:

Apple said on Wednesday that its profits more than doubled to $23.6 billion in the most recent quarter as people embraced its latest iPhones and bought more of its other products, striking results for what is already the world’s most valuable company.

Apple said its revenues soared by 54 percent to $89.6 billion, a record for the March quarter that meant Apple sold more than $1 billion on average each day.

Now, think about the massive profits earned by Apple versus the much lower profit rate that Pfizer earns from the Covid vaccine.  Which profit-maker is more important and valuable to humanity? (BTW, I have been complaining about Apple and its puke-inducing profits for a long time. Like this post from 2013)

We humans have a twisted relationship with vaccine development.  While we want to enjoy the benefits of vaccines, we don't want vaccine developers to profit from it.  Yet, we willingly fork over money to companies like Apple that don't deliver anything comparable to what vaccines do for our wellbeing.

On top of that, given the cost of vaccines, while we in the rich countries get the shots for free, without ever pausing to wonder who pays for the vaccine and its distribution, those in the poorer countries of the world are left to fend for themselves.

“It’s a moral issue,” said Boston Zimba, a doctor and vaccine expert in Malawi, which has vaccinated only 2 percent of its people. “This is something rich countries should be thinking about. It’s their conscience. It’s how they define themselves.”

To me, the solution is simple and is an expression of humanity: Pay the pharmaceutical companies that have already developed the COVID vaccines all the money they need in order to produce vaccines for humans everywhere.  And underwrite the expenses for the logistics of vaccine distribution.  Because, merely waiving patent protections doesn't do a damn thing to begin production at, say, Ghana!

Source

At the very least, do not complain about vaccine developers earning profits, even as big tech's profits dwarf other companies and even the economies of most countries!

Preventing the bad air

There are a few recurring topics in this blog.  I am obsessed with them.  Some day, when those issues end, I will stop blogging about them.

Like malaria and mosquitoes.  I hate those damn insects.  I have been blogging about them forever.  Soon after I brought the blog back up again, I wrote about the Asian tiger mosquito.  This was in 2009.  The Asian sucker went global and became “the most invasive mosquito in the world.”  Since then, there have been quite a few posts on the damn blood suckers that spread diseases and cause terrible human suffering.  

As a kid, I had only known about malaria.  Later, I learnt in school that there was something called a "yellow fever" that mosquitoes merrily spread.  Then dengue. Chikungunya.  Enough already!

I have been dreaming of a world without mosquitoes.  I won't miss them at all.  Instead of waging trillion dollar wars in which the US bombs the shit out of brown people, I have argued that the US should instead fund the development of anti-malarial vaccines that can vastly improve the quality of life of brown people.  All we did was elect a white supremacist, who said brown people should stay back in their shitholes!

Yet, there is a ray of hope.  There is promise of a malaria vaccine.

For the first time, a vaccine has shown high efficacy in trials – preventing the disease 77% of the time among those receiving it. This is a landmark achievement. The WHO’s target efficacy for malaria vaccines is over 75%. Until now, this level has never been reached.

In a pre-Covid world, this would have made the front pages of newspapers.  Now, when people are dropping dead from Covid, as my doctor described the happenings in his old country, 77% efficacy for a malaria vaccine in development doesn't seem to matter one bit.

Source

If researchers could have figured out the vaccine formula a couple months into the Covid-19 pandemic, how come we haven't achieved anything against malaria?

It took researchers less than a year to develop a roster of effective vaccines against COVID-19, but half a century of toil has still not yielded a vaccine against malaria that meets the World Health Organization’s efficacy goal. Part of the problem is low investment in preventing a disease that predominately affects low- and middle-income countries. Another issue is the malaria parasite (Plasmodium spp.) itself, which has a complex life cycle and the ability to mutate key proteins, generating fresh strains.

How do the Covid-19 virus and the malaria parasite compare?

The malaria parasite is complex, with more than 5,000 genes, meaning it has many different characteristics for vaccine designers to choose to target. SARS-CoV-2, the virus that causes COVID-19, has just 12 genes, and its spike protein was the obvious target for vaccine scientists.

Malaria parasites have evolved with humans and their ancestors over the last 30 million years, not only generating a multitude of strains but also impacting our own evolution, with gene variants that lessened the effects of malaria being passed on over time. Worse still, these parasites generate chronic infections in millions, suppressing the human immune response that a vaccine tries to generate.

It has been a long-running battle against these blood-sucking drones.  Even if we can't eliminate them, maybe we can at least eliminate one of the diseases that they spread.

A terrible year it has been. Now, roll up your sleeve!

Earlier this morning, I emailed my colleagues marking the completion of a year since the World Health Organization (WHO) declared coronavirus to be a global pandemic.

Sending that email is consistent with how I behave: I mark the passing of time, whether it is birthdays or deaths or, yes, even the awful pandemic.

Even as we struggled with the pandemic, here in Oregon we also had to deal with unprecedented fires and smoke, and snow/ice storms that triggered power outage also.  And, oh, I am also waiting for the final layoff decision, which could send me into premature retirement.

No wonder I am anxious all the time, and panicky quite a bit.

But, hey, I am alive.  Beats the alternative, right?

Like millions around the world, I am waiting for my turn to get vaccinated. A year ago, when the pandemic forced us to learn about a whole bunch of epidemiology, experts suggested that a vaccine might be not available for a while, and that it might take 18 to 24 months.

The reality has turned out to be much, much rosier than that.  Scientists set out to develop a vaccine well before WHO's announcement, and as soon as the coronavirus structure was figured out.  As I noted in this post about the Turkish immigrant scientists in Germany who developed the vaccine that Pfizer markets and distributes:

BioNTech began work on the vaccine in January, after Dr. Sahin read an article in the medical journal The Lancet that left him convinced that the coronavirus, at the time spreading quickly in parts of China, would explode into a full-blown pandemic.

They began the work in January of 2020!

If not for the scientific advancements, the past year would have been even more disastrous for humans.  Beyond our wildest imaginations!

Now, a year after WHO's determination that it was a pandemic, a summer of near-normalcy seems within reach.  

Wait for your turn to get jabbed. 

The poor you will always have with you

 In October 2009--yes, 2009--I wrote in this post:

When I was in India this past summer, as reports of swine flu came to dominate the news and conversations, I sincerely suggested to my parents that they should frequently wash their hands, and time it by humming the “happy birthday” song.

Wash hands and time it by humming the "happy birthday" song.  How familiar is that one now, right?  But, that was the public health advisory 12 years ago too.

In that post, I also wrote how absurd such a suggestion was:

As the words slipped out of my mouth, I knew it was a stupid and incongruous advice because of the water shortage in the city.  Apartment complexes were paying hefty amounts to private operators who supplied water by transporting them in special water-tankers.  When that was the condition for middle-class households, I cannot imagine the less affluent spending their precious money to wash hands in order to battle an invisible enemy.    Clean water is a super-luxury for the poor.

Which is why I suggested back then--yes, 12 years ago:

I do not mean to minimize the risks of a global pandemic, particularly if the swine flu virus were to mutate into a highly virulent form.  But, I do want to point out that the global focus on the swine flu, which we have rightfully managed to accomplish, should remind us that being a good citizen of the world also means that we ought to pay attention to the priorities of the rest of the world—in particular, the sufferings of the poor, who are almost always voiceless in the international arena.

Unfortunately, our track record has not been one that we can proudly hold up when it comes to supporting public health programs for the world’s poor.

We know well how much the 45th President of the US loved supporting the rest of the world, especially its poor.  His America First policy extended to global public health during the pandemic too.  He couldn't care to work with the world's countries on vaccine development and distribution because he hated the World Health Organization.

The Biden administration has been doing things to re-integrate into the world, and to participate in fighting the world's challenges.  The US rejoined WHO on day one of Biden's presidency.

Further, Biden put our money where our mouth is:

In a reversal of his predecessor's U.S.-centric approach to tackling the coronavirus pandemic, President Biden is ramping up pressure on America's wealthiest allies Friday to get COVID-19 vaccine doses into poor and developing countries. Mr. Biden told his fellow G7 leaders during a virtual summit that the U.S. would contribute up to $4 billion to COVAX, the World Health Organization-backed initiative aimed at ensuring equitable access to vaccines around the world.

Virus knows no borders.  And we have a moral responsibility to help out the poorer countries:

So far, richer countries have been able to buy far more Covid jabs than poorer ones.

Covax hopes to deliver more than two billion doses to people in 190 countries in less than a year.

In particular, it wants to ensure 92 poorer countries will receive access to vaccines at the same time as 98 wealthier countries.

Often, people don't care for moral arguments. As a fellow-graduate school student put it once, material incentives beat moral incentives!

Even the dollars-and-sense approach shows that it is in the rich countries' interest to subsidize vaccines for the poorer countries:

[Unequal] vaccine access among countries will likely lead to a “total cost for the world” between $1.8 trillion and $3.8 trillion, with up to half the losses paid for by wealthier nations. In contrast, the cost of vaccinating one-fifth of the world’s vulnerable population, as the World Health Organization’s covax initiative aims to do, would cost less than forty billion dollars, with expenses decreasing over time. 

If only we understood that we are all in this together!

The philosophy of life?

We are into the second year of the pandemic.

On January 21, 2020, there was confirmation of Patient One.  Six weeks after that, schools and offices closed, and working from home became the norm.

We knew that eventually vaccines will be needed to deliver us from the pandemic.  We knew that right when schools and offices closed.  Many of us assumed that the machinery of the government would create various task-forces in order to deal with the multiple aspects of vaccine delivery.

While that assumption is logical, it did not work out that way.  It has been a colossal failure.

They didn't even bother to layout a clear plan for priority among the population.  Who gets the vaccine first?  Who are the people who can be sent to the back of the line for vaccination?  Even worse has been the messaging about it.

The World Health Organization (WHO) developed a blueprint, which notes: "Setting priorities and rationing resources in this context means making tragic choices, but these tragic choices can be ethically justified. This is why we have ethics."

That is why we have ethics.  What a concept!

A commentary, in The American Journal of Medicine, on the ethical dimension of allocating vaccines during a pandemic, reminds us that "the benefits of vaccines are communal in the sense that vaccinating 1 individual confers benefits on other members of the community as well. What is to be fairly allocated, then,is not the vaccines per se but, rather, the benefits thereof."

If it is about the benefits of vaccination, then who gets priority?  What are the ethics in this?

Allocating vaccines to those most responsible for the trans-mission of COVID-19 may confer more benefit to the population at large. Allocation guidelines must balance the obligation to assist individuals most likely to benefit against the obligation to secure the greatest aggregate benefit across the population.

The greatest benefit across the population.  So, who gets priority?

It is one hell of a tough question, and I don't want to pretend that I know better than others.

Think about a person like my 91-year old father, who hasn't stepped out over the year, versus a 31-year old high school teacher.  Vaccinating which of these two will "secure the greatest aggregate benefit across the population"?  The elderly, in this logic, will have to step away from the line for now, right?

WHO notes in that blueprint that the population "falling into each category may change over time."  This is also something that leaders should have communicated to people, right?  They did not.

So, it is clear that confusion will reign.  "Is there something that you would offer us as a general guideline as people wait their turn?"

Maybe it's a time to think about character and personal values and emphasize the importance now more than ever of the virtues of patience, of empathy, of recognizing that not everybody can protect themselves the way perhaps I might be positioned or you might be positioned to protect themselves from infection and disease, and of solidarity. It maybe is a little bit too trite to say that we're all in this together. Some of us are suffering far more than others of us, but we are all really suffering. And so if we can remember - right? - to be patient, to be empathetic and to be committed to making this world better than it was before, I think we can get through this.

As we wait our turns, perhaps we can also read up and think more about ethics.  We don't have to abandon that effort just because philosophy departments are being closed down!

Immigrants and Project Lightspeed

The tRump regime--"administration" doesn't really describe it--loudly and openly beat up on immigrants and Muslims.  Remember how one of the first things he tried to do was a blatant Muslim ban?  He then had to scale it down and pretend it was not really a Muslim ban when it was.

During those dark days, social media--from the anti-tRump side--pointed out how Apple might not have happened if a certain Syrian immigrant had not come to the US.  Steve Jobs' biological father, Abdulfattah Jandali, was an Arab Muslim from Syria, who came to the US to pursue a PhD.

Now, it is another Muslim immigrant to the rescue.  Make that two immigrants.  Not here in the US, but in Germany.  But, it is also an American story.

Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.

New York City-based drug company Pfizer made the announcement on 9 November. It offers the first compelling evidence that a vaccine can prevent COVID-19 — and bodes well for other COVID-19 vaccines in development.

Pfizer being a US-based company.  But, the immigrants who provided the scientific breakthrough are not here.  They are in Germany, born to Turkish immigrants.

Dr. [Ugur] Sahin, 55, was born in Iskenderun, Turkey. When he was 4, his family moved to Cologne, Germany, where his parents worked at a Ford factory. He grew up wanting to be a doctor, and became a physician at the University of Cologne. In 1993, he earned a doctorate from the university for his work on immunotherapy in tumor cells.

Early in his career, he met Dr. [Özlem] Türeci. She had early hopes to become a nun and ultimately wound up studying medicine. Dr. Türeci, now 53 and the chief medical officer of BioNTech, was born in Germany, the daughter of a Turkish physician who immigrated from Istanbul.

BioNTech is the firm that the couple founded.

BioNTech began work on the vaccine in January, after Dr. Sahin read an article in the medical journal The Lancet that left him convinced that the coronavirus, at the time spreading quickly in parts of China, would explode into a full-blown pandemic. Scientists at the company, based in Mainz, Germany, canceled vacations and set to work on what they called Project Lightspeed.

They partnered with Pfizer, whose CEO is Greek!

Albert Bourla was born and raised in Thessaloniki, Greece.^[2] Born into a Jewish family, he earned his doctorate in the biotechnology of reproduction at Aristotle University of Thessaloniki's Veterinary School.^[3] He left Greece with his wife when he was 34 and since then he has lived in seven different cities, in four different countries.

The tRump regime eagerly broadcast the Pfizer success as one that was made possible through its Operation Warp Speed.  Controversies are in plenty on how much Warp Speed really made it possible.  Whatever that might be, did the regime say anything about how it was immigrants who created this success?  Did the regime say anything about the Turkish Muslim backgrounds of the two scientists in Germany?

I am glad that the fucking tRump regime is on its way out, though they will torch everything they possibly can during the exit.  I can only hope that we Americans have inoculated ourselves against that kind of a political virus.

Meanwhile, I hope that the Pfizer vaccine and the others under development will deliver us from the global pandemic in a matter of mere months from now.

Walk like an Egyptian ... Think like a Norwegian

COVID-19 has infected at least 31 million people around the world. The confirmed death toll is nearing 1 million. Both numbers are likely underestimates. The annual “Goalkeepers Report” from the Bill & Melinda Gates Foundation, which is usually a hopeful account of an improving world, is instead a litany of loss. The global economy will decline by at least $12 trillion by the end of 2021. About 37 million people have already been pushed into extreme poverty. Twenty-five years of progress in vaccine coverage have disappeared in 25 weeks.

Bill Gates adds: "Certainly humility is called for because the damage—whether it’s economic, educational, mental health—is so large."

Sigh!

Anything else?

I think the prescription is still the same as it was before this pandemic, and the cost of doing it is in the tens of billions, not hundreds of billions. Compared to, say, defense budgets, this is not a gigantic additional burden.

Awful, isn't it, that our country and the Republicans in particular are always ready to spend gazillions on bombs and fighter jets, but become penny-pinching paupers when it comes to public health!

Sigh!  

If you are like me, you have been wondering these past few days why there haven't been any updates about the various Covid vaccines in development.  Because, they are still only in the testing phase.

But, the good news is that there is more than one: "A fourth Phase 3 clinical trial evaluating an investigational vaccine for coronavirus disease 2019 (COVID-19) has begun enrolling adult volunteers."

Meanwhile, as a cartoon in The New Yorker puts it, we dread the oncoming winter.

Confined to our homes. Through the long dark, damp, and cold days.  It will be a miserable December, January, February.

We just have to adopt a different mindset.  Like what the Norwegians in the Arctic do.

People who see stressful events as “challenges”, with an opportunity to learn and adapt, tend to cope much better than those who focus more on the threatening aspects – like the possibility of failure, embarrassment or illness. These differences in mindset not only influence people’s mood, but also their physiological responses, such as changes in blood pressure and heart rate, and how quickly they recover after the event. And the impact can be long-lasting, even during major transitions

Not easy to do.  But there is no other choice either.  And that's exactly how the Arctic Norwegians deal with the long, long, long dark winter--they adopt a healthy mindset:

Leibowitz found that these attitudes actually increase with latitude, in the regions where the winters will be even harsher. People in Svalbard (at 78 deg north) had a more positive mindset than the people in Tromsø (69 deg north), who took a more optimistic view than people in Oslo (60 deg north). In other words, the positive wintertime mindset is most common where it’s most needed.

And I want to complain from here at 45 degrees north?

But, there is no way that I will watch any Norwegian slow TV! ;)

Today's moronic idea ... is tomorrow's death!

When the demagogue and his minions love a Kennedy, then certainly those strange bedfellows can lead us only in one direction: Insanity!

It is more than insanity.  It is deadly.  Literally.

Robert F. Kennedy, Jr., and the demagogue are simpaticos when it comes to vaccine and autism.

vaccine denialism became a central issue in American public health as a result of his study. And Kennedy, along with the actress Jenny McCarthy, became one of the cause’s most famous supporters. ... Perhaps it should come as no surprise, then, that Kennedy told reporters yesterday that Donald Trump—who has, over the years, issued a stream of inaccurate and conspiratorial tweets on the subject of vaccines and autism—has asked him to “chair a commission on vaccine safety and scientific integrity.’’

Welcome to the United States of Bullshit; it is most fitting that the demagogue will now become the Bullshitter-in-Chief!

[The] Trump vaccine commission is not simply a bad idea—it is a deadly one. Asking Robert F. Kennedy, Jr., to chair a commission on scientific integrity is like asking Ted Kaczynski to run the United States Postal Service.

I love that line about Kaczynski ;)

But, smile and laugh we cannot.

A conspiracy theory such as the one about the autism vaccine is like an untreated wound. It has festered for years, and yesterday Trump and Kennedy guaranteed that it can only deepen—causing tremendous destruction and needless pain.

Thanks, you atrocious Republican voters who elected the demagogue!