Thursday, October 16, 2014

Another Nail In the Coffin: Expecting Miracles



On another blog, in discussing the current outbreak (which is now probably approaching the #1 Internet topic) the possibility of a vaccine came up.
It was observed that pharmaceutical company press releases, including from GlaxoSmithKline (GSK), a British Big Pharma megacorporation with $11B annual profits, are supposedly going to be able to deliver the first 15,000 doses of an Ebola vaccine by December. (Whether that's Dec. 1st or 31st we'll set aside for the moment.)

So first, an assumption:
We'll grant, arguendo, that it'll work.
Not 50%, 90%, 95%, or 98%, but a full 100% efficacy.

Then, we'll further assume that they mean Dec. 1st, not  Dec. 31st.

So now, let's look at what we'll be facing.

Currently, there are +/- 9000 Ebola cases in W. Africa (Guinea, Liberia, Sierra Leone).
And they double about every three weeks on average, currently.
So on Dec. 1st, we're looking at nearly 40,000 Ebola cases.

But they aren't the problem.
The problem is the people who haven't gotten it yet, for whom a vaccine would be useful, in order to halt the further spread.

Guinea: Population 11,474,383
Liberia: Population 4,092,310
Sierra Leone: Population 5,743,725
Total: 21,310,418.

Oh, and lest we forget, there's a nifty little separate Ebola outbreak in Democratic Congo going on right now too. We're ignoring it in the main, because it's a separate event, and still rather small so far. But probably we want to nip that one before they get to 100 or 1000 cases, before it turns into Liberia 2.0, right?

Democratic Republic of Congo: Population 77,433,744
So our total target population to vaccinate immediately is 98,744,162.
(Less the 5,000 or so who've helpfully died of Ebola already, and another fraction who've survived Ebola, thus theoretically immune.)

So, those companies' 15,000 doses are going to be juuuuuuuuuuuust a little bit short.

But let's say they have the Mother Of All Production Lines, and they're going to make 15,000 doses a day!

Much better. At that rate, it would only take them 6,583 days (that would be NLT December 14th, 2032, before we have enough medicine just to dose the four critical populations).
Not so spiffy.

Okay, gonna need to ramp things up even more: 15,000 doses per HOUR!

Much, much better. Now they'll only need 274 days to get us the doses we'll need.
So, at current rate of Ebola spread, in 274 days where are we?
Everyone in Guinea, Sierra Leone, and Liberia already has Ebola, 70-90% of them are dead, their governments long-since collapsed, infected populations spread to the four points of the compass, and Africa is amidst a biblical continent-wide pandemic.

Which means we'll need another 1,000,000,000 doses right away just for Africa.

Of course, if it goes continent-wide in Africa, it'll probably have spread to cities like Cairo (pop. 7.7M) and over to South America, greater Arabia, Europe, and Asia, and that's before we start thinking about air travel to South and East Asia and North America.
Better just make the order 8B doses, to be safe.

And we'll ramp up production to 15,000 doses a MINUTE!!!

No sweat. Now they'll be able to carpet the world in only 370 days, which means with production at only 1,440 times, every minute the amount they'll produce currently in 6-10 more weeks, they'll be able to make enough for everyone, just a few months after Ebola has circled the world and killed some apocalyptically huge swath of humanity, perhaps as much as 90% of it, at least of those unvaccinated.

I'm thinking that at some moment ahead of that point in time, Ebola alone won't any longer be the most pressing concern on the planet.

And even the barest initial efforts will be directed at vaccinating populations in the most backwards, politically corrupt, medically under-served, and logistically unimproved and inaccessible portions of Africa, which is to say, anywhere in the world.

That will be like chipping away at an iceberg with a rock pick, which is how far beyond bad global lethargy and official indifference has let this situation get.

We won't even talk about if it turns our the vaccine is a flop.

It's nice to hope for miracles. But absent flocks of angels from heaven flying across the planet with healing in their wings, a vaccine solution alone isn't going to be much use if we can't isolate the disease now, and stop the spread very quickly, with far less fanciful solutions.

If you're a prudent person, plan ahead for other eventualities.

14 comments:

Shrimp said...

Have you seen this?


http://www.npr.org/blogs/goatsandsoda/2014/10/06/354054915/firestone-did-what-governments-have-not-stopped-ebola-in-its-tracks

Emily Disraeli said...

Ok, plan A,find a hole and crawl in 'a big hole.' Plan B, uh no plan B. Anyone have a nice hole for sale?

A Texan said...

There is too much normalcy bias, and too many PC bullshit games being played, to get this under control. If the stupid bastards (and one particularly stupid one, at that) can't even ban incoming flights from West Africa because it might fucking LOOK BAD (to whom?), then we are sunk.

what few people are even considering is the second and third order effects of this thing if it becomes a true pandemic. Leave primary thing that will affect everyone is that we will lose something like 90 of our health professionals. In this battle, they are our frontline soldiers, so they will bear a disproportionate share of the casualties. This will necessarily have a highly negative impact on the future health of the nation, even supposing that there is a nation left after the pandemic. That last part, which most people are simply not even considering, is what worries me. After all, in a few years you can have the remaining medical professionals train many more doctors and nurses, and within 10 or 15 years there will be a lot of experience among the new cohorts. What concerns me is that if you have a breakdown of government and essential services, like is beginning to happen in West Africa, that many or most of the survivors of the pandemic will died of other causes. Starvation comes to mind, as does fighting over the remaining meager supplies of food. there will be NO production to speak of in the areas of fuel, medications, pesticides and electricity. Oh, and the latter is of far greater significance than anyone can imagine. With out having an electrical supply, heat pumps circulating cooling water in nuclear plants will cease to operate once there reserves of fuel for generators is exhausted. That should be about 2 weeks. Don't ask me why, but whoever designed the cooling pumps decided that the plants themselves would not be supplying their power. We have some 400 nuclear plants spread across this country. If even just a few of them experienced meltdowns like Fukushima, we will be in the position of never being able to recover. This is, indeed, an extinction level event if we don't get control of it very quickly. My fear underlying all of this is that it may not matter how isolated and well prepared a particular individual, family or group maybe. Those second and third level consequences will overwhelm any other efforts to survive.

Anonymous said...

I've wondered all along if a vaccine was already being beta-tested…Like on the high-ranking Obama administration officials. Perhaps thats why they seem so smug and unconcerned and feel no need to ban travel to the US from the Hotzone.

A Texan said...

OK, sorry about the multitude of typos on my previous post - I was dictating it to my phone on the way to work. Here is the corrected text after the 1st paragraph:


"What few people are even considering is the second and third order effects of this thing if it becomes a true pandemic. The primary thing that will affect everyone is that we will lose something like 90% of our health professionals. In this battle, they are our frontline soldiers, so they will bear a disproportionate share of the casualties. This will necessarily have a highly negative impact on the future health of the nation, even supposing that there is a nation left after the pandemic. That last part, which most people are simply not even considering, is what worries me. After all, in a few years you can have the remaining medical professionals train many more doctors and nurses, and within 10 or 15 years there will be a lot of experience among the new cohort. What concerns me is that if you have a breakdown of government and essential services, like is beginning to happen in West Africa, that many or most of the survivors of the pandemic will die of other causes. Starvation comes to mind, as does fighting over the remaining meager supplies of food. There will be NO production to speak of in the areas of fuel, medications, pesticides and electricity. Oh, and the latter is of far greater significance than most anyone can imagine. Without having an electrical supply, the pumps circulating cooling water in nuclear plants will cease to operate once there reserves of fuel for their generators is exhausted. That should be about 2 weeks. Don't ask me why, but whoever designed the cooling pumps decided that the plants themselves would not be supplying their power. We have some 400 nuclear plants spread across this country. If even just a few of them experienced meltdowns like Fukushima, we will be in the position of never being able to recover. The same story will replay itself in Europe, Japan and the old USSR (where most of the rest of the nukes are located).

This is, indeed, an extinction level event if we don't get control of it very quickly. My fear underlying all of this is that it may not matter how isolated and well prepared a particular individual, family or group may be. Those second and third level consequences will overwhelm any other efforts to survive."

Anonymous said...

"I've wondered all along if a vaccine was already being beta-tested…Like on the high-ranking Obama administration officials. Perhaps thats why they seem so smug and unconcerned and feel no need to ban travel to the US from the Hotzone."

Who among the unvaccinated is going to provide their food, medical care, various services, etc.? There won't be many left, and a lot of those will be hunting for the ones responsible (I'm not advocating, just speculating).

Anonymous said...

This is the first I've heard of a viable safe and effective Ebola vaccine. Just seems odd that suddenly NIAID announces it has a vaccine ready for human trials. Last report I saw on non-human primate trials showed around 60% mortality of vaccinated subjects when subsequently exposed to EBV.

Anonymous said...

Sorry, meant to say EVD not EBV!

Aesop said...

Not assuming it'll be viable, safe, nor effective, I was just granting those premises to show that even if everything was 6-sigma perfect, we're still hosed.

There have been virus vaccines in progress for years. But the recent urgency is allowing protocols to get short-sheeted and corners cut to an incredible degree, just in case they come up with something that works.
Government isn't the only ones who "never let a good crisis go to waste".

Aesop said...

@A Texan
I can kill your first post if you'd like, now that you've typo-corrected it in the second.

And yeah, things will snowball, and this will become less about the Ebola, and more about the systems it disrupts, as I hinted at in the O.P.

Anonymous said...

As long as the elites are protected what do they care about the kulaks.

Anonymous said...

I don't expect miracles either and I was probably out smokin in the parking lot when they discussed this in school...

Has there ever been a 100% effective vaccine for a virus? Somewhat effective?

Would any amount of vaccine availability change the rate of the spread?

I'm not smart enough to know this stuff

Aesop said...

There's always going to be people who can't get the vaccine because they're allergic, or it doesn't take, etc.

And sure, if someone could make 20M doses/day that'd be just spiffy. Then we're only dealing with the logistics of getting 20M syringes & needles a day to the 200,000 doctors, nurses, and techs to give the actual injections. Piece of cake.

A Texan said...

Yeah, kill it...but see if you can save the first paragraph - I didn't repeat it. If not, so be it.

Thanks for all you do.