I recall that another fortuitous concurrence was that when Ebola arrived in Lagos, the Nigerian megacity, a nightmare scenario was avoided thanks to the containment skills of the polio eradication team that had been recently trained using Gates Foundation money. Here's one link I found:
https://fortune.com/2015/10/14/polio-surge-ebola-gates-found...
This article is an awesome write-up. I love how it walks through the process of discovery from the beginning- or as close to it as readers will bear. Its insane to think that we are at a point where we can just swap a coating on a virus as easily as I can un-solder a component from a motherboard. Its also scary as hell to think about what plagues could be created in these labs for biological war.
Like sure we get atomic power its super clean- but now we also have nukes. Tasty yummy nukes.
Where is the biological nuke equivalent here? I don't want to spread Microsoft style FUD about such exciting news but it does make me wonder what classified work is being done in Andromeda strain style labs.
I am both excited and scared as hell about what we can do these days.
The account of the German researcher pricking her finger with a needle containing the Ebola virus... Oh man, that's terrifying. It's very reassuring to hear the vaccine worked out for her.
Reminds me of the first week of my internship at Los Angeles County-University of Southern California Medical Center in July 1974. I needed to get an arterial blood gas from one of my patients — a drug addict with hepatitis and so-called "cannonball" fungal lesions in both lungs. I couldn't find the radial artery in either of his wrists, so I took the syringe and needle and moved down to his groin and tried a femoral stick. He was really obese and I couldn't feel his femoral pulse, so I tried to separate his abdominal fat pannus from his thigh with my right hand while plunging the needle into what I hoped would be his femoral triangle. The blind stick impaled my right index finger. My heart sank. I was sure I was gonna get hepatitis and/or his fungal infection, and spent the next month or so on tenterhooks waiting to wake up one day feeling sick. By some good fortune, I didn't get either of his illnesses.
When I hear what you medical guys go through, I realize how not cut out I am for it. I wish I was, because it is very fascinating and important to all of us. But I almost got faint just picturing what you described.
Would you describe your motivation to help that man as being a factor of great empathy for his situation or cold detachment from him as a person? I'm not trying to degrade him as a person, but I'm curious how you learn to cope with the realities of certain people's bodies.
Inadvertent needle sticks? Every now and then. I'm not trying to avoid your question or be funny. It's one of the unavoidable risks of being a health care worker.
Haha reminds me of a story a psychiatrist once told about how he/she would generalize people's problems that happen to all sorts of patients and yet would routinely be accused of sharing a unique and deeply embarrassing story by their patients, who don't realize it but all face the same problems.
if it happens to all or just almost all or even just some of the patients it would still be sharing a somewhat private story from all of them, no? Being accused of sharing this (not so) unique story tells me it was even told to somebody that knew both people. I think you should refrain from that in this profession...
Psychiatrists have to tell these stories in order to train new psychiatrists. The only thing they cannot share is personally identifiable information. Sadly, so many people think they are struggling alone and their situation is completely unique, which is rarely ever the case.
July 1974?! That was over 45 years ago. Those medical records were discarded forever long before the year 2000. What period of time would make you comfortable?
“The WHO identified burial rites for the dead as one of the contributing factors in the disease’s spread. The burial rites included family members washing and oiling the corpse, and sometimes physically modifying it for burial .. Additionally, the practice of moving the body to be buried in a different village impeded efforts to quarantine certain areas.”
The first firm to make an HIV vaccine will print money selling to various NGO and world governments so I think there's plenty of incentive to develop one.
HIV is a different animal from most viruses since it targets the immune cells, the very thing that allows vaccines to work, so I imagine its a lot more complicated than other vaccines to develop.
From my college years I remember that vaccination was hard because the outer shell of the virus is capable of mutating so rapidly that it's hard to make antibodies specific to it.
The difference, as I (also not an expert) understand it is that HIV is unique in that it's so variable that the host never develops immunity to the disease. In most viruses, the immune system eventually develops an immunity and eliminates the disease. Influenza is an example of this; your immune system learns to fight off the strain that you get. The new vaccine every year is for the new strains.
The HIV vaccine mutates quickly enough that the host never develops immunity themselves, which makes triggering immunity with a vaccine very difficult.
In the short term they will make money yes, but someone used to make money selling smallpox vaccine. :-)
Having spent some time at a Fortune 500 company I cannot imagine a day where someone voluntarily creates a plan to eliminate billions of dollars of sales in monthly doses of medicine in exchange for a single or double dose per patient product. Corporations just don't think like that. Some might say it's even illegal for them to value the patients over the shareholders under current regulations.
I take your point on the complexity of HIV. However there are creative strategies that can be used like targeting surface proteins (?) perhaps. There are a great many intelligent people in the field. I have dim memories of work showing promise in the early years of the disease. It seems to have gone silent after the introduction of the drug cocktail approach. Coincidence? Perhaps...
Yes. This is literally the business model of tons of successful billion dollar companies in bio and pharma who continually find new revenue streams by attracting talent and acquiring new “exciting firms”.
The OPs conspiracies don’t hold any water to reality.
Perhaps, but I can certainly imagine a day where someone voluntarily creates a plan to create a new product that is extraordinarily valuable to a lot of deep-pocketed customers, that competitors cannot match for years potentially, and even reduces customers for the current product on the market that their competitors can match (cocktail). Not to mention that 1) new vaccines will need to be created to match virus mutation, and 2) thousands of new customers will enter the market daily by sheer virtue of population expansion, especially in areas hit hard by HIV [1].
I'm sorry but there isn't a global conspiracy to stop development of an HIV vaccine. Much of what big pharma does is incredibly cyncial and deserves scrutiny, but even viewing it within that lens, there is a clear business case here.
It is an unfounded conspiracy theory that has nothing really to do with this topic. It also shows a great deal of ignorance around how HIV invades the body (and why it is so difficult to completely eradicate e.g. [0]).
I didn't downvote it, but it isn't exactly hard to see why some might. It is less that HN is "ridiculously polarized" and more that the signal:noise on that specific comment is exceptionally low.
No, it's just that the difficulties surrounding the development of an HIV vaccine are well established. Unwarranted suggestions of a global conspiracy suppressing The Truth tend to get downvoted as daft.
"Could it be because charging people $1000++ a month for drugs, for the rest of their life, is a better business model?" Or could it be that the poster hadn't bothered to look at the reasons.
I get what you're saying. I just think it's hyperbolic to downvote someone making that kind of speculation. It seems as if you're reading a lot into that one sentence. I didn't see anything about a "global conspiracy"; he's just asking if the economics around HIV drugs are discouraging research into an HIV vaccine which, even if it's not correct, isn't totally outrageous or unrelated to the thread. Ebola, in contrast to HIV, doesn't have the same economic pressure that could dissuade drug companies from developing a vaccine. As far as I'm aware, there's no expensive drug that suppresses Ebola symptoms.
A better thing for people to do would have been to just reply with the kind of information that you provided.
It's a nice attempt to spin this as an economics argument but that's definitely not what this is. There's not even any evidence to reinforce their hypothesis.
I could just as well say something like "it's interesting that the WTC collapsed the way it did in 9/11. Could it be because if it toppled over then the damage would have been too catastrophic? I'm just making an economics argument!"
I think the economic lens is the way to go. It clearly applies to ebola itself. How come there wasn't a vaccine before now? Because it's a virus endemic to a poor continent that kills its host quickly. And the sudden effort over the past few years? Spurred by Western medicine's realization of the grave potential of an ebola pandemic, because of experience with the epidemics of the past few years.
I find it hard to believe that we couldn't moonshot an HIV/AIDS vaccine or cure, but it's also clear that the incentive isn't there. That doesn't take a conspiracy, just the people who could fund an organize a concerted, focused global effort simply not caring enough about a disease that is still stigmatized by its infection rate among "gays, druggies, and blacks" (particularly when they can rent-seek on bodies that have historically been commodified anyway).
It requires all drug companies to have at least an internal conspiracy to suppress the results if HIV vaccine research - we know that they are investing plenty of money into the research from publicly available figures, so the implication is that they will be either suppressing the results or tampering with research to make it fail.
> As far as I'm aware, there's no expensive drug that suppresses Ebola symptoms.
"In the light of this I find it very surprising that drug companies haven't developed a drug that allows them to charge people $1000++ a month for drugs, for the rest of their life, isn't that a better business model? How on earth did the companies allow this vaccine research to escape?!!
Dude, what's with the snark? Can't we have a civilized discussion? You had a point there, but I'm not really inclined to engage with you after the last thing you said.
It's being downvoted because it's such an incredibly ignorant statement that is doing nothing but perpetrating conspiracy theories.
If the OP had done even a little bit of research, they would have quickly realized that AIDS has unique properties that makes making a vaccine incredibly complicated despite a ton of effort that has gone into it so far.
In my experience the people who make claims like the OP's almost invariably know nothing about either biology, drug development, or big pharma. But the amount of disinformation circling the whole drug price debate has always been epic.
Run the numbers on all HIV patients requiring perpetual treatment versus a vaccine slowly eliminating the virus from the population over 5,10 and 20 years.
Vaccines are not a great business model compared to the latter. Analogous to the dearth of Antibiotic research currently. Other drugs like statins for example are much more profitable due to perpetual use requirement.
Where would you invest the companies resources if you were running the show? And make no mistake. The resources are finite when you are charged with growing multi tens of billions of annual revenue. Miss by 5% and your head rolls and your stock options are upside down.
So place your bets wisely.
You do realize that vaccines can be incredibly profitable in some cases? Pfizer’s Prenvar sold $5.8B in 2017. That easily exceeds many chronic treatments.
And I would argue that an AIDS vaccine, like Gilead’s cure for HCV, could be priced quite aggressively.
A chronic treatment does not suggest a continued stream of revenue as competitors often enter the market with 2nd generation products.
That's a good number for a globally marketable product.
I read that Genoya for AIDS generated $4.8B USD in 2018 and Truvada, by the same company, Gilead, generated another $3B USD. So that's almost $8B per year and Truvada has a 3 year CAGR of 82% so it's really grabbing market share.
To your point there are other companies with competitive products but Gilead seems to be the leader.
My point is simply that one model, drugs at 8B per year, assumes a continuous disease state while the other at 5B per year assumes a continuous reduction in diseased hosts as was seen with Polio, Smallpox and until recently +measles for example.
One is better for the corporation. The other better for the commons. That's all I got.
+Measles was declared eradicated, in the USA, early in this century.
It’s the cynic in me that notices that over a thousand poor brown deaths is a nonstarter for human trials to move the vaccine forward, but when the white researcher lady might die, suddenly the machinery all kicks into gear.l
Same way I can assume the majority of the 1000+ ebola deaths mentioned by the article were people of color: the majority of people from Germany are white.
It's a balancing act, the vaccine might have killed her too. Experimental drugs sometimes do that. Presumably she could understand the risks better than any layman.
One, because a new vaccine hasn't been proven safe to administer yet. And even 'proven safe' just means that the vast majority of recipients won't experience permanent side effects. You're intentionally triggering an immune response in the patient. What if you triggered an autoimmune response? Now you have a created a whole new autoimmune disease (and I dunno if you've noticed, but we mostly treat symptoms and not that well).
That said, a few people react even to approved vaccines badly. Unfortunately this fact feeds the anti-vax people, who don't seem to understand how to model risks. Just going to the drugstore to pick up antibiotics that will save your life has a larger chance of death (due to a car accident). It's more dangerous to drive to the doctor to get vaccinated than it is to get vaccinated.
Just living is dangerous. I'm running out of fingers on one hand to count the number of times I've tried to choke to death eating or drinking something, and I've got half a billion years of evolution trying to keep me from killing myself just trying to absorb nutrients.
Nothing is guaranteed. Anything can kill you. Better to get on with life rather than wait for Death to find you.
Where was I? Medical ethics.
Medical ethics has some opinions on how 'informed' a person can be to volunteer for experiments. A peer who is in your field is presumed to know the consequences of their choices better than just about anybody. So yes, a medical researcher experimenting essentially on themselves is quite different than the same person doing trials on others.
See also the doctor who gave himself an ulcer to prove that ulcers were of bacterial origin. Won a Nobel Prize for that discovery. If he'd done it on someone else he'd have been in big trouble.
