6 ms·

You've got the right Robin Hanson. The key argument is that there is lots of uncertainty, but variolation is probably worth trying. And if volunteers can be fo

by skosch 6y ago

You've got the right Robin Hanson. The key argument is that there is lots of uncertainty, but variolation is probably worth trying. And if volunteers can be found, why not? One shouldn't need to be a virologist to credibly make that argument.

zbjornson 6y ago
Well, for one, orthopoxviruses cause skin lesions, replicate in keratinocytes, dermal fibroblasts and other skin cells and evoke strong immune responses there. Coronaviruses don't.
- pmayrgundter 6y ago
  I've been looking into this.. you might be interested in my work on a Live Virus Skin Vaccine for CoV2. Comments welcome! https://docs.google.com/document/d/1x91Ef7G6xbm77DcRDvjAXbFmkn6jklTf_4-U_aepDbQ/edit https://docs.google.com/document/d/1x91Ef7G6xbm77DcRDvjAXbFm...
powersnail 6y ago
I'm not a medicine professional, so I'm just curious here. Since variolation has basically the same principle as vaccination, it's hardly an alternative to vaccination. Is it really worth trying? To me (with my very crude understanding), proposing variolation as an alternative to vaccination is akin to proposing knife without a handle as an alternative to a regular knife. Is there any case where vaccination fails to work, while variolation succeed?
- frank2 6y ago
  A vaccine is months or years away whereas variolation can be deployed right now.
  - powersnail 6y ago
    To deploy it, wouldn't it need to be tested just like a vaccine? Or is it suggested to just deploy virolation without testing?
    - frank2 6y ago
      >is it suggested to just deploy [variolation] without testing? Yes: the blog post by economist Robin Hanson suggested deploying it without waiting for the results of testing. (Of course, it would be good to test as fast and as much as possible concurrent with the deployment.) "deploying it": making available to the public a variolation service or procedure designed by medical experts.
      - vikramkr 6y ago
        If we're lowering the standard, why only lower it for inoculation? We can just start deploying the dozen+ vaccines we have in development too if we decide testing isn't important.
        ggreer 6y ago
        I'm pretty sure Robin Hanson would want challenge trials with experimental vaccines as well. The issue is that authorities won't allow such trials, not that there is a lack of willing medical experts or volunteers. Though vaccine trials aren't quite as safe for the public as variolation. If a vaccine doesn't work, the person can spread the disease. If variolation doesn't work, then it has the same mortality as natural infection, but afterwards the person is immune and can't spread the disease.
  - janekm 6y ago
    The reason a vaccine is months or years away is only because we are testing whether it is safe enough to give to billions of people. The reason we do that is because a virus can cause disease both directly but also in unexpected ways (e.g. by immune over-reaction to some of the viral RNA in some individuals). Variolation as a public policy would have to go through the same safety testing for the same reasons (as it is a form of vaccination with un-weakened virus). You would also still have to produce doses of the variolate, both in terms of replicating the virus and bottling it. There is no real time advantage to variolation. Anybody making the case for variolation without validation would be better off making the case for vaccination with one or several of the 30 vaccine candidates under study for SARS-Cov-2 right now (a case could be made... allow volunteers to be given the candidate vaccine of their choice in larger numbers than normal clinical trials, scaling up as the risk profile of each candidate vaccine is known).
    - frank2 6y ago
      I am not an expert (but neither are you, I am guessing). >Anybody making the case for variolation without validation would be better off making the case for vaccination with one or several of the 30 vaccine candidates under study for SARS-Cov-2 right now The advantage variolation has over the 30 vaccine candidates, I am guessing if the question is what to do before the results of testing are available is that most of those 30 candidates will turn out after being tested to fail to confer significant immunity. I believe that the fate of most vaccine candidates for any disease is that testing reveals that the candidate fails to confer immunity to most or all of the people it is given to. Also I believe that it usually takes at least a year to produce enough of a vaccine to test, then test, then analyze the results of the testing.
      - vikramkr 6y ago
        Variolation could fail as well. It would still need to be tested for safety and efficacy.
        Matticus_Rex 6y ago
        Tested for safety? We know what it does. It gives a low dose of the virus. If we know most people will get it anyway, then we don't need to know more than that in terms of either safety or efficacy.
- BurningFrog 6y ago
  The point you're missing is that there is no vaccine for Covid-19. If there was, no one would consider variolation.
  - janekm 6y ago
    There are 30 candidate vaccines (probably a lot more by now). 32 if you include the two that are non-weakened forms of virus that are being proposed for variolation.
    - bradj 6y ago
      Having "candidate vaccines" is very different from having a "vaccine". Variolation is a reasonable alternative to the lack of a known, effective vaccine.
      - vikramkr 6y ago
        Variolation as a term only applies to smallpox. Giving small doses of the live virus as hanson suggests is literally just a lame vaccine. It's also not known to be safe or effective and would have to go through all the trials anyway.
        ggreer 6y ago
        Hanson is saying we should do those trials, not that we should start deliberately infecting the masses ASAP. The issue is that such trials are banned.
    - pmayrgundter 6y ago
      Are these 2 others actual registered trials? Or are you referring to public proposals for such, like Hanson's? I'm working on just such a public proposal [1] and have been in correspondence with Hanson but haven't heard of any registered. [1] "SARS-CoV2 Live Virus Skin Vaccine" - https://tinyurl.com/y8ujrcze https://tinyurl.com/y8ujrcze
  - vikramkr 6y ago

by skosch 6y ago

zbjornson 6y ago

Well, for one, orthopoxviruses cause skin lesions, replicate in keratinocytes, dermal fibroblasts and other skin cells and evoke strong immune responses there. Coronaviruses don't.

pmayrgundter 6y ago
I've been looking into this.. you might be interested in my work on a Live Virus Skin Vaccine for CoV2. Comments welcome! https://docs.google.com/document/d/1x91Ef7G6xbm77DcRDvjAXbFmkn6jklTf_4-U_aepDbQ/edit https://docs.google.com/document/d/1x91Ef7G6xbm77DcRDvjAXbFm...

powersnail 6y ago

I'm not a medicine professional, so I'm just curious here. Since variolation has basically the same principle as vaccination, it's hardly an alternative to vaccination. Is it really worth trying? To me (with my very crude understanding), proposing variolation as an alternative to vaccination is akin to proposing knife without a handle as an alternative to a regular knife. Is there any case where vaccination fails to work, while variolation succeed?

frank2 6y ago
A vaccine is months or years away whereas variolation can be deployed right now.
- powersnail 6y ago
  To deploy it, wouldn't it need to be tested just like a vaccine? Or is it suggested to just deploy virolation without testing?
  - frank2 6y ago
    >is it suggested to just deploy [variolation] without testing? Yes: the blog post by economist Robin Hanson suggested deploying it without waiting for the results of testing. (Of course, it would be good to test as fast and as much as possible concurrent with the deployment.) "deploying it": making available to the public a variolation service or procedure designed by medical experts.
    - vikramkr 6y ago
      If we're lowering the standard, why only lower it for inoculation? We can just start deploying the dozen+ vaccines we have in development too if we decide testing isn't important.
      - ggreer 6y ago
        I'm pretty sure Robin Hanson would want challenge trials with experimental vaccines as well. The issue is that authorities won't allow such trials, not that there is a lack of willing medical experts or volunteers. Though vaccine trials aren't quite as safe for the public as variolation. If a vaccine doesn't work, the person can spread the disease. If variolation doesn't work, then it has the same mortality as natural infection, but afterwards the person is immune and can't spread the disease.
- janekm 6y ago
  The reason a vaccine is months or years away is only because we are testing whether it is safe enough to give to billions of people. The reason we do that is because a virus can cause disease both directly but also in unexpected ways (e.g. by immune over-reaction to some of the viral RNA in some individuals). Variolation as a public policy would have to go through the same safety testing for the same reasons (as it is a form of vaccination with un-weakened virus). You would also still have to produce doses of the variolate, both in terms of replicating the virus and bottling it. There is no real time advantage to variolation. Anybody making the case for variolation without validation would be better off making the case for vaccination with one or several of the 30 vaccine candidates under study for SARS-Cov-2 right now (a case could be made... allow volunteers to be given the candidate vaccine of their choice in larger numbers than normal clinical trials, scaling up as the risk profile of each candidate vaccine is known).
  - frank2 6y ago
    I am not an expert (but neither are you, I am guessing). >Anybody making the case for variolation without validation would be better off making the case for vaccination with one or several of the 30 vaccine candidates under study for SARS-Cov-2 right now The advantage variolation has over the 30 vaccine candidates, I am guessing if the question is what to do before the results of testing are available is that most of those 30 candidates will turn out after being tested to fail to confer significant immunity. I believe that the fate of most vaccine candidates for any disease is that testing reveals that the candidate fails to confer immunity to most or all of the people it is given to. Also I believe that it usually takes at least a year to produce enough of a vaccine to test, then test, then analyze the results of the testing.
    - vikramkr 6y ago
      Variolation could fail as well. It would still need to be tested for safety and efficacy.
      - Matticus_Rex 6y ago
        Tested for safety? We know what it does. It gives a low dose of the virus. If we know most people will get it anyway, then we don't need to know more than that in terms of either safety or efficacy.
BurningFrog 6y ago
The point you're missing is that there is no vaccine for Covid-19. If there was, no one would consider variolation.
- janekm 6y ago
  There are 30 candidate vaccines (probably a lot more by now). 32 if you include the two that are non-weakened forms of virus that are being proposed for variolation.
  - bradj 6y ago
    Having "candidate vaccines" is very different from having a "vaccine". Variolation is a reasonable alternative to the lack of a known, effective vaccine.
    - vikramkr 6y ago
      Variolation as a term only applies to smallpox. Giving small doses of the live virus as hanson suggests is literally just a lame vaccine. It's also not known to be safe or effective and would have to go through all the trials anyway.
      - ggreer 6y ago
        Hanson is saying we should do those trials, not that we should start deliberately infecting the masses ASAP. The issue is that such trials are banned.
  - pmayrgundter 6y ago
    Are these 2 others actual registered trials? Or are you referring to public proposals for such, like Hanson's? I'm working on just such a public proposal [1] and have been in correspondence with Hanson but haven't heard of any registered. [1] "SARS-CoV2 Live Virus Skin Vaccine" - https://tinyurl.com/y8ujrcze https://tinyurl.com/y8ujrcze
- vikramkr 6y ago