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Gates Package, p.1152 · gates:exh:00562
Page text: p.1152 · original PDF
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- Vaccines
Page 132, para 3, line 1: the statement that COVID is easy to target with a vaccine is debatable in some
senses of "easy". The mRNA vaccines have short duration protective effects, so they are not vaccines to
control COVID completely, just stopgaps to buy more time. Their fast approval, mentioned on top of
page 133 is great, but we don't yet know that this approach will work as well in future pandemics with
other agents. That some mRNA vaccines for other agents have failed is not encouraging. While we
celebrate the triumph of these vaccines, we need also to be studying their limitations. Maybe not the
panacea we want? Time will tell.
Page 136, para 4: mRNA vaccines arose from cancer vaccine research, an example of why basic research
needs to go on, in addition to managed and targeted research. See comments below.
Page 137, top 3 lines: Partially redundant with a few sentences earlier.
Page 140, line 3: WHAT plan? More specifics about this would be great, as it's hard to envision a plan
that will work.
Page 140, para 4. Re universal vaccines: in most cases no one has any workable idea about how to go
about this, and most of the ideas tested (e.g., for glycoprotein stem antigens) have failed. Here and in
some other areas, the science "isn't there", and no amount of money can fix it. Although we should
keep trying!
Page 143, para: again, mRNA vaccines probably won't prove to be the holy grail. They have been great
over the last year, but their future value remains to be determined, and we need to forge ahead with
other approaches.
Page 147, first 3 lines: again, may be too optimistic.
Page 149, para 3: it might be worthy of note that it was around this time that the US Marine Hospital
Service embarked upon the 3rd of 3 initiatives (the control over biological products directly resulting
from the St. Louis incident) that eventually led to the FDA, NIH, and CDC. They all arose from a "national
health department in waiting" that was eventually broken up into discrete federal agencies.
Page 158, para 2: again, I am uneasy at the overly optimistic view of the upcoming role of mRNA
vaccines. I see their considerable value as being in the realm of early stopgaps, but not final solutions to
pandemic control. I hope I am wrong, but I suggest some additional perspective on this.
Page 166, bottom para: here is mention of the Tuskegee studies, alluded to above in the context of
David Sencer's role. I would recommend not even getting into these experiments, which I would never
defend, but at the same time regret that they have, because of one popular hatchet-job of a book some
decades ago, come to stand for scientific evil. The truth is far more complex, and not necessary, in my
view, for inclusion here.
Page 168-170: these points are all desirable, and aspirational, but they shouldn't prevent us from finding
the best vaccines possible that DON'T meet all these goals, because in all likelihood the best vaccines of
the foreseeable future will fail these tests. I would think of these not as "how to make future vaccines"
but rather "how to perfect great vaccines once we have them". That is, the perfect shouldn't be the
enemy of the good.