Most of the readers of this blog should need no extra convincing to understand that approving the AstraZeneca vaccine immediately is necessary to save thousands of lives that will be lost otherwise. Here’s some recent news that makes the case even stronger:
The WHO has approved the AstraZeneca vaccine for emergency use and has recommended it be administered to as many people as possible as quickly as possible regardless of age or where they live. They made this decision despite results from a small study on young adults in South Africa showing that the AZ vaccine is only ~20% effective at preventing mild illness from the “South African” (ZA) variant (B.1.351 lineage). There are good reasons to believe that the AZ vaccine should be close to 100% effective at preventing serious illness and death from the ZA variant, though, and that is what matters most for those interested in reducing loss of QALYs. For instance, the J&J vaccine, a similar adenovirus vaccine, has Phase III data showing an efficacy of ~85% against severe disease from the ZA variant. Given the life-saving potential of the AZ vaccine, the excellent results in the UK so far, the fact it does not require ultra-cold storage, and the ability to manufacture it legacy infrastructure (as opposed to new mRNA vaccines), it is not surprising the WHO made the recommendation they did.
An excellent article in The Atlantic makes the #ApproveAstraZeneca case, stating that there are “tens of millions of doses” of the Oxford-AstraZeneca vaccine sitting in a factory in Baltimore. The CEO of Emergent Biotech, which operates the plant, has confirmed they will have “a significant stockpile” by the time the FDA finally approves the vaccine. The total number of doses that have been manufactured and are sitting in refrigerators while 2,000 - 3,000 people die each day is still unkown, but it very likely in the tens of millions. Emergent Biotech has stood up a second manufacturing plant in Rockville, Maryland, and last summer AstraZeneca also tapped Catalant to manufacture precursors for the vaccine production.
There are 70 Million doses of AstraZeneca vaccine sitting in a Serum Institute factory in India, already purchased by contracts, which cannot be shipped because they are “waiting for regulatory approval”. Many if not all of these are probably vaccines purchased by the Gates Foundation to be distributed in developing countries. Disturbingly, the vaccines will expire in April. (See this interview with the Serum Institute’s CEO in The Guardian.)
A new preprint was published which performs a retrospective study on hospital admissions data for millions of people in Scotland. They found that a single dose of the AstraZeneca vaccine offers 94% protection against hospitalization (95% confidence interval of 73-99), and that the AstraZeneca vaccine outperformed Pfizer’s vaccine, which offered 85% protection (95% CI of 76 -91). Furthermore, as expected from the Phase I/II data immune response data, these vaccines did equally well in those aged 80+.
A few weeks ago my friend Tim Liptrott (@TimothyLiptrott) decided to launch the #UnclogTheFDA social media campaign (official Twitter: @unclogTheFDA). The campaign will start with a focus on #ApproveAstraZeneca but we have plans to broaden it to many other topics such as first doses first, lowering regulatory burdens for testing innovation, future approval of mRNA platforms, free-to-choose medicine tracks for certain treatments, and adaptive licensing.
To the extent we can, we are trying to replicate practices developed in the area of political campaigning on social media. Tim has described some of his thinking on social media strategy in a LessWrong post here.
Last Monday a small group of volunteers including Tim, myself, Gennady Stolyarov II from the US Transhumanist Party, and Jim O’Neil from SENS research foundation tweeted out a number of tweets with the #ApproveAstraZeneca and #UnclogTheFDA hashtags around 1pm in an experiment to see if we could get either hashtag on Twitter’s list of trending hashtags. While we did get a number of retweets and likes, the experiment failed. I estimate we would need at least a thousand unique tweets from multiple accounts to be tweeted out in less than an hour interval in order to have a chance to get on the “currently trending” page. While that seems out of reach, I believe building a campaign around both hashtags can be impactful in a meaningful way. Certainly the collective efforts of everyone in this movement are having an effect - the Approve AstraZeneca petition, for instance, has now gotten over 20,000 signatures.
I recently worked with a graphic designer in DC who has experience working on campaigns to influence government policy like this. The graphics that were produced have already been shared on Twitter and my Facebook, but they haven’t gotten as much traction as I think they ultimately could. So, I am sharing them here as well in hopes that more people will share them.
The most popular of these are the these three infographics:
Next, we have some of the quotes from public health experts which appeared in my previous Substack post.
Finally, here is our logo:
Frames, optics, and halos
It’s bearing in mind that humans are not purely rational. Over 100 cognitive biases have been discovered where humans consistently veer away from perfect rationality. Two that are particularly relevant here are the framing effect and the horn effect, a variety of the halo effect. One of the takeaways from the framing effect is that people are more receptive when a policy is couched in positive terms rather than negatives (ie in terms of lives saved etc). One of the takeaways from the horn effect is that superficial features related to a message or advertisement (such as asthetics etc) can have a huge effect. For example, someone who has an unattractive face or a stain on their shirt may be taken much less seriously even if they have very good policy arguments. In politics, this is called “optics”. I personally try to avoid using pictures of syringes in any of my messages about tweets because I worry about a horn effect from doing so. I also made a point of dressing nicely when I went out to protest in front of the FDA.
Much, much more could be said about cognitive biases, but with that short preamble out of the way, it seems discovering the best frames is very much a trial-and-error process. To see what has worked well so far, I’ve dug up some tweets exhibiting a variety of frames that seemed to do particularly well (at least relative to the number of followers each person has):
New York Post @nypostOregon law decriminalizing all street drugs goes into effect https://t.co/3Cs9NSy3ni https://t.co/mBEdlDZABH
Randall Parker #ApproveMoreVaccines @futurepunditWhy should the decision take weeks? https://t.co/9ILGr6nY5t
Here are some other ideas for framing:
People should be free to take medicines to protect themselves (ie provide a libertarian and/or utilitarian argument for Free to Choose medicine / bodily autonomy, etc).
Viewing the FDA as a doctor that has to do a risk-benefit calculation to treat their sick patient - the US public.
Emphasize the political angles. For instance, the pressure from Nancy Pelosi on the FDA to hold off approval of the AZ vaccine can get a lot of play in conservative circles as well as more cosmopolitan circles, where it can be pointed to as another example of vaccine nationalism.
Britain has already distributed N AstraZeneca vaccines with x affect. (ie show the graphs and stats on drops in deaths and cases in the UK relative to countries that have not had the UK’s levels of mass vaccination.)
A rapidly evolving crisis requires ability to take decisive actions. FDA is not equipped to make such actions - so we need Biden to step in and longer term reforms so the FDA can take swift action in emergencies.
Compelling personal stories about how people have been affected by FDA delay. For instance:
My loved one died waiting to get a vaccine.
My grandfather/ grandmother has been struggling for weeks to obtain a vaccine. AZ would be a literal life saver.
Stories about job loss... the sooner pandemic ends the sooner I can get back to work and pay my bills etc etc.
The #InvisibleGraveyard frame - picture of a graveyard and estimated stats about lives loss due to FDA delay.
Emphasize AZ likely to prevent death and hospitalization for the SA strain (provide quotes / limited data from trial).
Emphasize lower cost and no need for "deep freeze" ultra-low temp refrigeration for AZ and how it will make distribution easier (ie to normal CVS and Wallgreens). Include pictures of the long lines of people in Maryland and California who are desperate for vaccines.
Articles to share
Here are some relevant articles, nicely prepackaged for easy Twitter dissemination with the #UnclogTheFDA hashtag:
.@ATabarrok : “What are we waiting for?” #UnclogTheFDA
.@Atabarrok : “The AstraZeneca factory in Baltimore” #UnclogTheFDA
.@Atbarrok : “The Big Push: A Plan to Accelerate V-Day” #UnclogTheFDA
.@GarettJones : “Why won't the FDA approve this promising COVID-19 vaccine?” #UnclogTheFDA
.@jacobgrier : “Where Are The Pro-Vaccine Protests?” #UnclogTheFDA
.@CPopeHC : “Is It Time to Approve the AstraZeneca Vaccine?” #UnclogTheFDA
.@DKThomp : “How to Beat the Pandemic by Summer” #UnclogTheFDA https://www.theatlantic.com/ideas/archive/2021/02/end-pandemic-sight-how-we-win/618016
.@moreisdifferent : “Let’s unclog the FDA and save lives!” #UnclogTheFDA
.@moreisdifferent : “Reasoning about vaccines” #UnclogTheFDA
.@JeffreyBrodsky5 : “Why Are Millions of Doses of COVID Vaccines Sitting in Warehouses?” #UnclogTheFDA
.@GStolyarovII :“Reject The Deadly Precautionary Principle: Approve All COVID-19 Vaccines Immediately!” #UnclogTheFDA
Happy tweeting !!