Pfizer starting another Vaccine trial

Correction...

David Weaver

Last week, I read an article suggesting delta variant at 6%. It could've been weeks old. I see the correct figure now is just under 50%.

Thing to bear in mind, David, is

Wiley Horne

that Pfizer is taking all the risk. You and me and Americans in general have nothing to lose if the trial fails, and plenty to gain if it turns out to be needed.

There are plenty of ways Pfizer can take a total loss on the booster initiative. For example, if the control group—people like yourself who are double-vaccinated—do not log enough covid positives for statistical significance, then Pfizer loses all their money and skilled time invested. There’d be no buyers for the booster.

Remember also, the scientific committees advising up or down to CDC and FDA are not pussycats. They’re hard to diaper. Pfizer’s data will be carefully scrutinized, not accepted without question. If committee members raise objections which FDA ignores, members will quit and make a stink, as they did recently when FDA approved Biogen’s Alzheimers therapy against their advice. In such a case, Pfizer would stand a reputational loss, plus have to throw good money after bad trying to retrieve something from the mess.

Pfizer has all the risk; the citizenry cannot lose, can only gain.

Wiley

clarifying the misconceptions

Bill Tindall, E.Tn.

I am in a trial and as a result I have dozens of pages of documents on how the trial is conducted(100+ for the trial protocol), which I have studied. Hence, what follows should be considered fact.

There trials are "double blind". The person participating and the company running the trial do not know whether the participant has been vaccinated with vaccine or placebo. For example, at the trial site after whatever testing and screening was done by the trial staff, this staff cleared the area. New independent personnel, not reporting to Pfizer, came in and administered the "shot". Form this pint on data collected on me was and is reported to a 3rd party company.

I am monitored weekly. If I have an adverse reaction or get the disease Pfizer will be the 2nd to know, with this independent company first. This company collected the data and when a predetermined efficacy "end point" was reached the data was shared with Pfizer. In this case the data showed efficacy. Based on this data Pfizer prepared a report and request for emergency use authorization (EUA). At this point the data is public. One can go find the EUA application and data to support it and read it yourself and come to your own conclusions if you have the statistics background. FDA and various independent groups then pass judgement on the data. Were it up to Pfizer we could have been vaccinating by early November, but recall it took another month for the various parties to study the data and render an opinion.

A booster vaccine will follow the same path.

Whether this process, used for all vaccine applications, is good enough is an individual decision. But here is another fact.

Remember Chicken Pox. Everyone got it and as a result almost everyone got immune the old fashion way. Then a vaccine was developed and now nobody gets it except a few that eschew vaccination. It will be the same with Covid. You are going to get immune the old fashioned way, or you are going to be vaccinated. The only choice you have is how you get immune.

If you think getting immune the old fashion way is safer, more convenient or whatever other reason can be conjured, go for it. You will be highly infectious a day or two before you show symptoms, free to spread the virus to others that choose to become immune the old fashioned way. And eventually we will almost all be immune. In the mean time we will all suffer the pain in the ass of having to deal with a circulating deadly virus that could be defeated here in a month with vaccination acceptance.

Re: clarifying the misconceptions

David Weaver

Your comments need to be adjusted to people vaccinated with two shots. I doubt many are getting very sick and probably near none are passing sickness to others.

I'm not advocating for people who want to get covid without vaccination, but pointing out the supposition at this point that covid plus vaccination is suspected to have the best long term effect. Possibly lifetime. I remain skeptical that there is a significant advantage to being vaccinated for those who had mild cases and recovered, but I chose the vaccine route instead. That's what the data said to do, and the outcomes prove the efficacy.

There is no data at this point to suggest a need for a third shot without a cause, but a third shot could be worth 7 or 10 billion to Pfizer and when parsing the data comes about and recommendations are made, that needs to be kept in mind. The issue isn't the accuracy of the data, it's how it's mined and the recommendations that come from it.

Re: Thing to bear in mind, David, is

David Weaver

I'm not sure where the idea came from that the vaccine developers took all of the risk.

Pfizer received at least $445MM as a grant from Germany last year. We may not have contributed toward it.

We're getting far away from my original question - what data suggests the usefulness of a third shot?

To answer bill's question, which supposed some things that are not true for me (getting covid and getting very sick, unvaccinated, etc), would I rather get covid or get a third shot? I'd rather get a mild case of breakthrough covid (but it's far more likely that it would be asymptomatic). I suspect as the researchers are saying at this point that if there's something to gain with immune response, it would be complementing the two.

Two shots of pfizer makes me unafraid to be exposed to covid droplets.

If there is no need for further shots (at least regularly), pfizer will have a real shareholder problem. Their 2019 revenue was $51B. They expect revenue from the two shot vaccine to be $26B (I just picked that up from their statement).

I'll put placeholder here for what I expect - and we'll see:

* a third shot will boost effectiveness by 2 or 4 percentage points

* pfizer will go to the CDC and recommend that everyone get a third shot

No comparison will be made to a two-shot cohort that is also confirmed to have had covid at some point (which may test better).

I remain very skeptical that young children and fully vaccinated folks are passing much covid, just as I was and still am skeptical about the early stories that most cases were transmitted by people with no symptoms.

Tom's data proves my point - the only place we seem to be finding covid is in people who are dying and who also get tested. Some of them may be dying of covid, but many not, and the number is so small it couldn't have been wished for last year.

I'll add a complicating comment ...

David Weaver

..to this, because I'm sure there's a notion that I may be anti vaccine or anti profit.

No, to both. I'm super pleased with two shots of pfizer (it could've been moderna, either one, no real difference). I think the price for the pfizer vaccine was a bargain. I'm glad they were able to make margins in the high 20s (that puts a carrot out there if there's another - not-covid-but-similar in the future).

My comments are entirely about why there's even a notion that a third shot is needed.

If anything, I would think Pfizer should be trying to get people who took the chinese vaccines and other stuff that's not effective to take theirs. Look at our experience with delta (it's at this point about half of the cases - notice anything? i haven't). Look at England's experience with delta - not so great, but the cases among the vaccinated aren't, fortunately, causing death (among the unvaccinated, I'm sure they are). But folks are getting more cases there per capita than we our. Why? Flatly put, moderna and pfizer vaccines work better.

That is all separate from what I suspect will be a recommendation for a third shot. I have a problem with that part. Pfizer's shareholders will expect them to push for recommendation of a third shot if there is any positive improvement in the data (even if it doesn't make sense against the side effects of the shot when considered- that's not pfizer's problem - ongoing revenue of perhaps $13B or more for an annual booster shot is). At the same time, there is no measurable data suggesting that I (as someone who's been pfizerized twice) would gain from another shot.

Pfizer doesn’t recommend,

Wiley Horne

they submit data to CDC and FDA, who have professional committees critique the data. The data is submitted by Pfizer at milestones as they go—they don’t wait til the end and submit what is best for the case.

Reread Bill’s piece about the nitty gritty of testing, put it together with the data submittal/committee review—and you’ll see that Pfizer has almost no control of the process. Pfizer’s risk/reward analysis is what makes their decision; they have zero ability to wire an outcome.

To your starting question: why test a booster before a need is shown? Because we live in a capitalist economy where companies like Pfizer can take a gambling chance on making money, using their own money, and subject to all the rules snd protocols that FDA places on them. The citizenry commit nothing, and gain the benefit of immunity, if there is any benefit in the end.

You question should FDA even allow a booster trial? Because there is no downside. The trial participants volunteer. Safety is tested in Phase 1. The research is good, even if a booster turns out not needed. New variants emerge over time among the unvaxxed, so anything that is learned is to the good. It’s not complicated.

Wiley

I don't question the trial..

David Weaver

..I said what is the data that motivates it. If it's to collect information to see if there is something in the data that suggests a benefit, even that is fine.

What I am not in love with is what the outcome may be and what's recommended because of it. Specifically the scenario that I mentioned.

Perhaps the mRNA vaccines have longer lasting efficacy than they would like, and the nonsense scare stories about variants that have been run under our nose (based on weaknesses in vaccines used elsewhere) have predictably amounted to almost nothing. Each was going to put is back in trouble when the real trouble was the lack of vaccinated population (we don't have that now).

If pfizer remains 91-93% effective, and nearly nobody is being hospitalized, then I see nothing that needs to be solved. I wonder how we'll react to the shots as they accumulate and think it would be prudent to see that solved, just as I think if we get mild or asymptomatic covid (after vaccine), I would be surprised if that doesn't perform at least as well as more vaccine (and again, suggest that there's little evidence that asymptomatic cases and mild cases transmit much. I don't have trouble believing that asymptomatic individuals who become symptomatic later transmit covid at the beginning of their symptoms, and some before).

I'm not at all a fan of the push to get kids <12 vaccinated. I think they would be better of getting covid, and think we found out locally in the schools that kids are mostly one-way transmission (they get covid from someone older, but they do little transmitting).

Back to my original point - if none of us gets severe covid after a two-shot vaccine (let's say none for material purposes), what would we be potentially solving?

I'll be curious to see what the side effect profile is of the folks who get a third shot. My wife had a day and a half of misery from shot 2. I had little (I may have had a headache, and I did have a sore shoulder and slept a little better, but I get migraines so often that I could only speculate). It's likely that if my wife got covid, her experience would be nothing like she had from vaccine shot 2 - in fact, it's more likely that she wouldn't notice she has it and none of us would get it.

So, I stand on what I said. I see a potential small nominal benefit from the third shot in testing. I see little chance that relevant comparisons like I mentioned above will be brought up.

https://www.pennmedicine.org/news/news-releases/2021/april/penn-study-suggests-those-who-had-covid19-may-only-need-one-vaccine-dose

Re: clarifying the misconceptions

Larry Clinton At Frankfort, (Central) Indiana

I see a few items I disagree with in your statements!

First as Bill has outlined in the steps taken during his trial the data is not analyzed by the producer "Pfizer" in this case", therefore any benefit or recommended use will be after third party evaluation and approval.

Second (and the biggest one) is that we have very little factual information regarding variants of the Covid 19.

IE: Do variants occur when previous vaccinated persons contract a mild case? Do variants occur when young people contract the virus?

Also note that Cardiac physicians have advised that young people should definitely obtain the existing vaccine as death can occur in young people with existing cardiac issues (known or unknown).

If it is found that the existing vaccines do lower in efficiency, do the vaccinated people that contract "a mild asymptomatic case" have the ability to produce a variant.

To me (and my Engineering background) any valid Data that could possibly yield information in regard to existing and/or new variants could save many lives, if not now in the future!

There are several diseases we currently take booster shots for including the Flu, Tetanus etc. I personally cannot see ANY downside to a study of the possibility of a booster shot.

I and my wife obtained the Moderna vaccine as soon as I possibly could and if there is a possibility a booster shot will provide additional protection against either eliminating even an asymptomatic case I will be the first in line.

I don't see a downside to the study..

David Weaver

I see a downside to the possible interpretation of the results and recommendations from them.

In terms of variants and asymptomatic folks, the rest of the world is urgent. It's not the asymptomatic areas, but rather the areas of high transmission.

Alabama and other areas in the south will probably give us chance in the next few months to view the efficacy of the pfizer vaccine against delta in an area where there's still a fair amount of active virus.

AT this point, if we're trying to solve a problem, I'm not sure why we aren't coordinating getting effective vaccines to the rest of the world (other than finding a payer for them can be a problem, and that would also be a problem for pfizer as shareholder lawsuits will follow voluntary charitable acts that go above and beyond goodwill and associated value).

It's an irk of mine (perhaps due to laziness) - if we're collectively doing something, are we getting good mileage. If we're worried about covid, it would seem doing something to remove it from the rest of the world would be a good idea.

I'm suspicious of the idea that any of the variants would survive if the population had two shots of pfizer or moderna. Not because you can't catch them, but because there's no good information showing that mild or asymptomatic cases transmit much and I don't think it would transmit well. But if the rest of the world is using vaccines that have efficacy of 60% or something on average, that's a real problem.

The data suggests to me at this point that those of us double-shot would probably do *well* to be exposed to covid rather than trying to avoid getting it at all. Precisely because everything so far points to vaccine + covid exposure and reaction as being longer lasting.

(there are lots of bits in this that would be hard to study - what pfizer is looking at, just comparing cohorts, not nearly as hard to study).

You're correct though..

David Weaver

..I thought pfizer and others had more control over the study data and then presented a data set for audit.

That was sort of a secondary side comment. The study in general and what comes out of it when viewed in isolation is what gives me the willies a little (not the collection of data itself - not into censoring like that - you always hope when you've got a cynical view of a given scenario that you're wrong -at least I do, and I'd rather be proven wrong than assume correctness by shutting down exploring).

There's little bits contributing to this - that scenarios (Such as my comment about folks getting covid after one shot having more durable long term antibodies than folks getting two shots - but a researcher from Penn made a comment that mRNA vaccines are so effective with such a robust response that he suspected a strong possibility that the first two shots would be all that's ever needed. He's just supposing based on what he knows.). And that Pfizer on their investor call stated that they expect to be able to position the shots in a way that they're durable revenue like flu vaccines.

We do know enough now to know that if someone does get covid while vaccinated, the odds of it being a concern for most (who are in vaccinated households, etc) that it will generally be mild or asymptomatic. If the response is more durable, I wonder what the chances are that we'll get an objective study of infection rates of folks who have had two shots and covid vs. three shots. If the former fares better, will we hear, or is that to be censored because the objective now is too narrowly focused?

Stepping back from all of it, we're peeing in the breeze if any of this is about trying to phase out covid, though - it's the unvaccinated or geographies with ineffective vaccines that propagate covid, and so far, they are also the areas where significant new variants have originated.

Re: You're correct though..

Walt

Just a few seconds TV coverage while doing something else but one story was that existing vaccines seem to be not very effective against the Lambda strain - or something along those lines. Something like that would seem to justify a booster. Whoever said we're probably at the end of the beginning re COVID likely has it right IMO.

TV is just a bad source... *LINK*

John in NM

I stopped watching most TV news 20 ago for a reason - TV news reports were even more dumbed down than popular print media, which has unfortunately also slipped drastically in that time.

A quick search for "lamda variant" did yield an informative article which cites some pre-review studies showing that antibodies from mRNA vaccines seem to work well on it, whereas traditional vaccines made using neutralized virus are much less effective with this variant. The latter type of vaccine is generally reported as less effective with all covid types.


https://www.sciencefocus.com/news/lambda-variant/

An odd obsession...

John in NM

I've seen you make several references to Pfizer's profits, I find your focus on that to be irrational.

I have zero problem with Pfizer making a buck, or many billions of them. We would be stuck with marginally effective old school vaccines if companies like Pfizer were not in their business to make money.

From what I've heard, these vaccines are vastly cheaper than traditional ones - they are quicker to produce and easy to tweak if needed to counteract a dangerous variant. The innovation of these types of vaccines is an absolute good for humanity even if a company makes some money as a result.

Incorrect......

David Weaver

There is a lot of misinformation that doing vaccines is a losing proposition, etc. That's not the case here. Pfizer stated that they expect covid vaccines to be a durable source of earnings.

What do you do if you want a durable source of earnings? You run trials one after the other looking for any reason that the source can remain durable.

At this point, I think they're solving no problems. There is a potential they will find solving a problem, but if there is any, it's not people who have been vaccinated or variants, it's convincing people to get vaccinated and getting the superior mrna vaccine strains into people in other countries where traditional vaccines aren't so hot.

The other reason I am talking about pfizer is because bill mentioned that pfizer is trialing a third shot. I didn't see anything about moderna.

I think the problem that pfizer would like to solve is how to get more shots into the US market where the margin is better than getting the shot into other places in the world. I don't know that for sure, I suspect it.

If I were in the finance department there, that's what I'd do, too. If I were an ardent shareholder, that's also what I would expect.

ditto...

David Weaver

there have been tons of headlines that are intentionally misleading, talking about viruses getting past vaccines (at around the rate that they said they would in the first place), mentioning higher deaths in other locales where the mrna type isn't used and then tying the US vaccines in in text while being evasive (not making it clear bouncing back and forth).

The lambda variant is a popular topic, apparently, because it has the greatest scare factor and doesn't sound like a greek letter that everyone has heard for weeks (Delta).

I haven't watched TV news for at least 15 years. When you don't watch it for a long time and then you go back and watch it again, you wonder why you bothered. Same with "news" sites like businessinsider and other sites of the type that are pot stirrers but pretend they're not.

How do I even see the headlines in the first place? Simple - when I check email, it kicks me back to a news feed once I log out. I need to learn to not read it and instead seek information only when looking for it.

data

Bill Tindall, E.Tn.

David would have us to believe that Pfizer sees an opportunity to make substantial money from a constant stream of vaccine variations. What David suspects has not become apparent to investors who have vastly more information and experience estimating future earning streams.

Pulling out all the stops BioNtec partnering with Pfizer got a vaccine from lab to arms in 6 months, into significant arms in 9 months. In my trial arm I was told Pfizer paid enough that the research arm of HMG suspended their other trials to make room for the Pfizer trial, as an example of pulling out all the stops.

Two questions....If no one is running a trail to see if a booster provides benefit, how are we going to know if a booster will provide benefit? If there is another way, will it detect this need earlier or later than a booster trial?

And then, if we sit on our hands and wait till cases show up in hospitals to realize a booster is necessary either because immunity wears off or a vaccine resistant variant pops up, how long will it be to get a booster evaluated, manufactured and into 75% of our population?

Hot off the presses, Pfizer vaccine efficacy has dropped from 95 to 65% effective against new variants (data from Israel).

Personally, I hope Pfizer and Moderna are working 24/7 on a booster. I'll be in the Trial if selected. I will leave it up to the conspiracy theorists to get immune the old fashioned way.

I think investors...

David Weaver

..see something different than what Pfizer says about a durable supply. They can read, just as I have. They made the unicorn of vaccines. Once you have the buffer, you don't need more.

It should not be construed as me not being thankful for having received the pfizer vaccine.

Strangely enough, I was thinking the same thing this morning and went out and looked up pfizer stock to see what the market thinks will happen ( as I think their prospects for showing much improvement are grim. Boy could they show improvement in the rest of the world, though, but if it's done at a 30% discount or something, there will need to be incentives or other payers. It's a shame - imagine what covid would be like around the world if everyone had two shots of pfizer or moderna).

What, specifically is incorrect?

John in NM

Nothing you've just said changes my opinion. I think you are assuming the worst of motivations based on whatever it is you are reading about this subject. Sure there is a kernel of truth in it, but nothing more.

More likely is that they are looking into boosters because the moment that news of vaccine candidates came out, the click baiting media started getting everyone fretting over how long efficacy would last.

Re: I am 100% agreement with Bill.

Larry Clinton At Frankfort, (Central) Indiana

You stated was was obvious to me in concise terms!

Re: What, specifically is incorrect?

David Weaver

It's spread out over a lot of posts.

* bill said pfizer is trialing third shot

* I asked weeks ago "what problem are they solving?"

* Nobody answered, and I forgot about it

* since then, some study information has come up about likely long-term functional immunity, and confirmation has come that two shots of pfizer or moderna are excellent against all variants.

* I then voiced my opinion that this test is a data mining operation where there's no obvious problem, but you can always run a trial and see if you can gain something from it

All of the above is potentially solving a problem, but real problems do exist (folks who didn't get two shots of pfizer or moderna are far worse off than someone who may benefit from a third shot).

I suspect the problem that pfizer is looking to solve if they're not reformulating a shot for a specific variant is that they have the capacity to make a lot of vaccine doses and there's no obvious customer at this point.

I'll await data showing otherwise, and if I'm wrong about that, I certainly won't deny it.

I also certainly don't want a third shot for no good reason when the odds at this point are that the side effects of the third shot will be worse on average than getting covid (having had two shots). If side effect profile is going to become more negative, it would seem to me to be wise to save it for when it's needed, and side effect profile is something that's gamed in vaccine tests and data by calling placebo/baseline the side effect profile of another vaccine (rather than none at all).

If the effectiveness of two shots of pfizer or moderna was 50% by now, I would be first in line to trial a third/booster if they would allow me to.

separately...

David Weaver

If pfizer efficacy against delta is 88% here, one would wonder what's going on in israel - I'll go look at that data set. Something smells about as funny as the first alarm that delta is "8 times more likely" to get past the vaccine since there were 8 cases in a sample group vs. an expected 1.

We have a pretty easy case study to observe here - delta variant is here, and we'll see with our own data what the case rates are like among the vaccinated.

I hope the CDC is wise enough to track people who have had covid +2 shots in the longer term vs. folks with 3 shots (to see what the level of sickness/transmissibility is also for those who get mild or asymptomatic covid that never progresses).

I also wonder if the side effects of shot 3 will be compared to the meningitis vaccine while the symptoms of covid are compared to a healthy person (as in covid for someone who has had two shots - we know how bad covid is otherwise).

An excerpt from bloomberg

David Weaver

The vaccine protected 64% of people against the illness between June 6 and early July, down from a previous 94%. The drop was observed as the delta variant was spreading in Israel, the Health Ministry said. It also coincided with the lifting of virus restrictions at the start of June.

Despite the indications of increased infections, the data also showed the shot is protecting people from severe illness. Its effectiveness at preventing hospitalization fell to 93%, according to the Health Ministry, compared with at least 97% in an earlier government study.

https://www.bloomberg.com/news/articles/2021-07-05/israel-sees-decline-in-pfizer-vaccine-efficacy-rate-ynet-says

We'll see - different variant, different restrictions. The latter number appears to be key.

But we'll get a chance to observe the same thing here now that we have the delta variant and no restrictions (in most places - there are effectively none here).

Israel data; cost

Bill Tindall, E.Tn.

Israel partnered with Pfizer. Pfizer would give the country priority for getting vaccine supplies in Jan. and in return get data from the Israel health care system that keeps comprehensive records. Pfizer signed up something on the order of 40,000 in the trial Pfizer managed. Ideally these people from the US, Brazil, Turkey etc will live up to the agreement they entered into to provide weekly data to Pfizer. Make your guess as to how many are still reporting. In the mean time Pfizer has access to virus records from several million vaccinated and unvaccinated people in Israel.

The first data available in November was from the Pfizer managed trial . Breathlessly, the "News" reported the data from Israel a few months into the new year, as though the initial data never existed. It led confidence that the two data sets showed remarkable agreement.

Israel recently reported data on many hundred people that had been vaccinated and later were shown to have become infected. This data set will be hugely more useful than data from the few remaining in the US Pfizer trial that continue to report data. If anyone wants to continue discussing the topic go research the best data.

I would be astonished if J&J, Moderna, AZ and all the others were not studying booster.

Cost: Pfizer was the most expensive vaccine as reported some time early in the year, something about $18/ shot, with Moderna slightly less. J&J was about half that and AZ only a few dollars. Given the storage requirements for the RNA vaccines and the complex process to make them they were never intended for vaccinating the world.

Little known is how bogglingly difficult it is to make the RNA vaccines. We hear in the news that all that needed to be done was to sequence a piece of virus DNA and then make that sequence in quantity.

Not quite. Grafted on to that piece of virus RNA are several other RNA sequences than enable the piece needed to be stable, and enable it to get into your cells without driving your immune system crazy or the package getting destroyed by other means. Initially it took 180 days to make a batch. (Batch time has been shortened)

I recall (and am genuinely interested)

David Weaver

I recall hearing a few news stories about how difficult it is to manufacture the vaccine. Not enough was made about it as it was difficult for contracted locations to do it (so the idea of just popping up excess capacity and zooming it out makes no sense at all).

What was more commonly mentioned was how easy it is to modify RNA to match any new variant (so everyone thinks as you mentioned - two weeks and then someone can "start making it"). Makes no sense.

I find the data from various sources genuinely confusing and suspect there are a whole lot more mild and asymptomatic cases than were ever reported, and I'd guess that vaccinated individuals have had transient versions.

The important number to me from the pfizer data from israel is "93% protection from hospitalization", though one wonders about other bits of information that go in with that. What's the exposure for each vaccinated individual and over how long?

What qualifies as an infection, and how different is the testing? is the difference between 90 something and 60 something real?

What comes to mind for me is that during shutdown, for example, a lot of athletes weren't vaccinated. They would become symptomatic (and some were probably tested involuntarily) and then they'd be out. Then, they all got vaccinated and restrictions were lifted and there would be an "outbreak" and you'd read later in the story that all of the folks who tested positive were asymptomatic but were caught as part of regular screening. The difference is that after the vaccine was in place, the folks testing positive had no symptoms.

So how many of those are we actually missing because we're not testing?

I am a data guy. When I see the CDC case count and severity chart for vaccinated individuals, it makes no sense. There's almost no reporting of mild or asymptomatic cases.

If you take that dataset and then compare it against a cohort where there's more testing, the likely change would be that there would be lots more cases, but not lots more moderate or severe cases.

That's mind numbing.

One thing is clear to me - if we want to stop the assault of variants, we need to (but who is "we") figure out how to get mRNA vaccines dispatched around the world. It may not be profitable, and in some geographies, it may be impossible, but it's clear that in game theory terms the mRNA vaccines are dominant (which is something - in terms of game theory - that's reserved for strategies that are pretty special).

It's also seemingly clear at this point that not only are the other vaccines vastly inferior but they're likely short lived.

When I have a negative outlook (as I do with this - are we solving a problem, or are we solving the most important problems? Can we do both?), I always hope I'm wrong.