Agreed, but the Pfizer vaccine isn't as bad as most people think: you get 5 days are normal freezer temperatures. That is more than enough time to drive from their manufacturing location in Wisconsin (this might be a cold storage faultily and manufacturing elsewhere - I'm not sure) to anywhere in North America - so long as wherever you drive to already has people lined up to get the vaccine.

The above won't be hard to do for the first 3 months at least: just give the shot to health care workers as they come in for their scheduled shift. What gets hard is when you want to do a walk-in clinic: you need to figure out how much to order without knowing how many people will show up.

Note, don't take the above as a statement that Pfizer will (or should) ship at higher temperatures. While it works out on paper that they can, they have been putting effort into arranging really cold shipment for a reason: it is best to give the entire time stored at higher temperatures to the end clinic. Human logistics are the hardest part of this and this and really cold shipment gives more flexibility to the hardest part.

In any case: with both vaccines the hard part is ensuring people get their second dose on time after starting the shots! This is by far the most difficult logistical issue with either vaccine.

I would expect vaccination to be fully booked for a while, since it's going to be the most important thing in life to do for anyone not suffering from other serious issues and without anti-vaccination beliefs.

I presume that like most vaccines, there is a gap between you receiving it and developing immunity?

I hope everyplace offering vaccinations will have something in place to prevent anyone who comes in who is already infected but asymptomatic from infecting others there.

Given some states' track records on how they handled other things that attracted a lot of people, such as in-person voting, I'm not at all confident that we won't have some states that manage to turn vaccination clinics into super spreader events, which should be deeply embarrassing.

A good way to handle it is the way Kaiser handled flu vaccinations this year in western Washington. They had 10 minute windows available. You reserved online your spot in one of those windows. When you arrived a person at the door asked your name, checked you off the list, and gave you a pre-printed label with your information, and sent you in.

There were two or three people administering the vaccine, so two or three people for each 10 minute window. You went an stood in line with the others who shared your window, with the line very spread out.

When it was your turn you went in to get the vaccination, gave the person their your label, got vaccinated, and were sent out a side or back door so you would not cross paths with the people waiting or arriving.

> I hope everyplace offering vaccinations will have something in place to prevent anyone who comes in who is already infected but asymptomatic from infecting others there.

In the 2009 H1N1 flu outbreak

https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemi...

I remember getting the vaccine and it was offered outdoors, with a line in a parking lot and a nurse having a tent or a table or something. So that was good (although we weren't wearing masks -- the level of concern and associated precautions with H1N1 felt high at the time but now seems pretty trivial compared to COVID-19).

I recently went to my doctor's office for a seasonal flu shot and the office had separated spaces in the waiting room, lots of air filters going, and all patients and workers wearing face masks. And I think they wouldn't allow more than 4 or 5 patients in the office at a time. So those same precautions would feel pretty decent to me for COVID vaccination.

Edit: I guess I'm reflexively thinking of San Francisco in imagining this -- the outdoor line-up seems perfectly fine here, but it might be pretty unpleasant in January in New York or St. Petersburg or Edmonton...

Several food trucks have sprung up in my neighborhood that seem to have an even better impromptu system. You walk up to the window, they hand you a small device and send you back to your car. When your device lights up, you go to the pickup window. There is no line at all.

I don't know how many hundred dollars it cost them to buy a couple dozen devices or how much it costs to wipe each one down and put it back under the infrared/anti-cootie lamp each use. But there are orders going out the window about every 2 minutes and no customers within 50 feet of each other.

I assume these are the same devices some restaurants use to tell you when your table is ready?

Honestly, I'd prefer to be texted - no need to pass around a hot potato.

And I prefer not to give my telephone number. I guess it is better to set up a display for the ready order numbers and/or an announcement.

that's why we need to stop treating phone numbers as personal identifiers... nobody in the world would dream of using IPv6 addresses as personal identifiers

to this point you (everybody, really) should have a burner phone number

web apps can send you notifications or do you also prefer not to give your IP address?

FWIW, I found Kaiser's flu shot system to be a nightmare to navigate for my family. There were different appointment times for kids and adults, so it was going to involve multiple trips on multiple days.

We ended up just going to Target, which was much more risky, but actually something we could accomplish.

As always, the place to go for good commentary is Derek Lowe's blog. https://blogs.sciencemag.org/pipeline/archives/2020/11/16/mo...

He points out that the standard being adopted by these studies for the point efficacy is 14 days after the second dose. That's honestly not too bad. It's no magic bullet, but it's survivable.

During covid time local clinic did drive through flu vaccination. It's as distanced as you can realistically expect. And with prebooking you're not overwhelmed.

> other serious issues and without anti-vaccination beliefs

This was redundant. Anti-vaccination “belief“ is a serious, mental, issue.

Against HN rules, but it’s time to stop being so easy on people who try to distort science and reality and call them for what it is. You cannot have a eye to eye conversation with anti-vacciners, flat-earthers, climate-change deniers, election-fraud believers and Trump supporters.

The more leeway we give the more they try to win public opinion and damage our world.

Really don't think being less tolerant is the answer here. It certainly doesn't help change minds, you're not going to force your beliefs on them.

Well, tolerance has got us non-solutions like vaccine waivers for schools, and legislation that makes it easier for people who choose not to vaccinate their kids to spread easily preventable diseases. It also got us sick and dead kids.

> you're not going to force your beliefs on them

Beliefs? Science, and scientific evidence became “beliefs”

That’s the problem right here.

Yes, it's a belief/acceptance/trust/whatever you want to call it. I believe demonstrated science is fact, but that's still a belief about the world. My parents are in scientific fields, I received a science and engineering based education, and generally have faith in the scientific method as performed by most scientists.

But we DO have to convince people, we have to convince people by showing them how it works, and letting them decide that that makes sense, you can't just mandate belief as a science authoritarian.

And science is still performed by humans, and we're fallible, and our incentives aren't always good, and every time there's a public failure of the process, and every time a scientist goes on record to shill for a company's chosen viewpoint, it dings the general public's faith in science and scientific experts in general.

You arguments here are the problem. I know that you mean well and in a perfect world what you say would make sense, but when you say “science is still performed by humans” is an opportunity for the school dropout to say, “see even between them they have doubts, the earth is flat”.

What’s the better alternative? If you don’t explain how we know the earth is roughly spherical, that’s the opportunity for that person to conclude “see, they can’t even refute it; look for yourself, sheeple...”

Your understanding of science is pretty bad if you seriously believe there are no rational objections (re: long-term effects) to consuming a drug that didn't even exist a year ago.

Done right, being less tolerant of speech/behavior that can be detrimental to the common good does change minds for the better. Any "code of conduct" is precisely this: directly calling out detrimental behavior as vile with no tolerance for it. The fact that nearly half of voters in the United States support Trump does not change this.

So you're saying that authoritarian measures are the way? Codes of conduct change minds if people are receptive, or they play along so that they don't get abused, and it looks like it's changed their mind.

From where I'm sitting, perceived authoritarian tendencies on the democratic side is a large part of what really motivates Trump voters. That's certainly a lot of the narrative, if you ever visit that side of the media landscape.

Nobody talked about censorship and authoritarian measures. It’s about:

1. Don’t even entertain their distorted reality

2. Put a stop on the spread of misinformation

Stopping your anti-vaccine post from going viral on social media is in no way any different than a scientific magazine refusing to publish the same.

> nobody talked about censorship

> put a stop on spread of misinformation

That’s what censorship is. A small group of people will decide what is considered misinformation and will censor everything that goes against that

> That’s what censorship is. A small group of people will decide what is considered misinformation and will censor everything that goes against that

This is not censorship. Censorship is stopping you from expressing your thoughts. Not publishing your thoughts is not. You can say whatever you want but no newspaper is in any obligation to publish it.

Similar with social media, you can write whatever you want on your personal "page", but they are under no obligation to make sure it reaches other people's feed.

"but they are under no obligation to make sure it reaches other people's feed.."

Nice euphemism for censorship.

Social media is common people writing and reading. And they choose which people to follow etc.

"stopping a post to go viral" means in this context activily manipulating and interfering what information does and does not reach other people.

That is something very different than a newspaper refusing to publish a certain article.

Is censorship really the greatest crime? Is there no intelligent way to facilitate the search for truth that doesn’t require us to get bogged down in accepting every possibility as equally plausible? Of course there is. One thing is certain. Crying “that’s censorship!” will not get us to that place.

There is a time in not that long ago recorded history where this would have risked settling on the conclusion that the Earth was the center of the universe (and it was flat), leeches and blood-letting were a treatment for diseases, and heavier than air flying machines were impossible.

If you’ll permit a scientifically inaccurate analogy here: sunlight is the best disinfectant.

So is fighting misinformation a lost cause, or can we come up with some plan that doesn't involve a small group of people censoring it? Would some kind of distributed rating system like upvotes/downvotes be acceptable, or is the better course of action to be okay with letting all information -- even if specifically designed to trick people, not only the most gullible, but even the most discerning skeptics -- circulate?

I believe the government should not have a say in whether or not all information circulates, but ordinary people who build information sharing systems (and I don't just mean electronic ones) have an opportunity to figure this out. Should they not?

I don't think authoritarian measures are an appropriate way for a government to operate, but in the context of whether something is "against HN rules" I think making it known that an idea is harmful is a good thing.

It all comes down to whether or not the community in question is one in which members can readily leave without cost. I don't agree with making anti-vaxxers change their ways by government force, but I'm into being intolerant of them in other ways to the point that they'll come around and obviate any need for governmental force in the first place.

How can you be sure that the censors will always be on the side of the angels?

Follow-up question: how can you be sure that you, personally, are on the side of the angels? Especially if you have never been allowed to hear the opposing point of view?

Seriously, the growing support for censorship in the previously libertarianish Tech community has been the worst development of the last decade.

Actually, I don't care for censorship. I'd rather let the idea be presented and let the intolerance for it drown it out by way of copious rebuttals, not removal. I won't know if I'm on the side of the angels, but I'll know I'm in good company and I'll have heard both sides at levels roughly proportionate to the size of the population interested in defending each side.

In hindsight, I see how citing codes of conduct implies support for censorship, when my actual intent was simply to demonstrate another example of "intolerance" having noble goals.

These are fine questions, and their answers should sit uncomfortably in all humans. But unless we are content to let human knowledge dissolve into meaninglessness, we must look to something external to our own reasoning to help decide what to believe. For me, I have drawn that line at Scientific Consensus because it has proved the most robust tool humanity has ever found for determining what is actually true. Is it perfect? No. Is it better than everything else? Undoubtedly yes. I think it must be the starting point and possibly the ending point for all discussions of this nature. To use another tool you must first convince me it is better than Scientific Consensus.

"ut unless we are content to let human knowledge dissolve into meaninglessness, we must look to something external to our own reasoning to help decide what to believe. For me, I have drawn that line at Scientific Consensus because it has proved the most robust tool humanity has ever found for determining what is actually true"

Well, I agree with the scientific consensus on a general base. But since science was not always right, I don't see a valid argument from there to censorship.

You want to censor ideas not covered by scientific consensus?

"and their answers should sit uncomfortably in all humans"

Because, also no. I do not feel uncomfortable. I am strongly against censorship. Open, unrestricted exchange of ideas. If the scientific way is the best (which I believe), then the crackpot approaches will fail naturally. But if you censor those other approaches, you might actually strenghten them.

Your plan is reasonable if human minds were genuinely and effectively open to letting the best ideas win. But they are not. Human minds care more about reputation than veracity and this has important ramifications for plans like yours: namely that they don’t work. Confirmation bias is real and pervasive and as completely in control of my mind as it is of yours. I encourage you to read Haidt’s The Righteous Mind and see if what you purpose still makes sense.

And this is the root of the divide, as far as I can tell. It's quite literally nerds and bullies all over again. Those who see the light and those who think you're a tool for doing so.

Netiquette 101: Don't feed the trolls. (But here we are.)

Everyone thinks the other side is a tool. This is so pervasive it must be completely discarded as a measure of truth.

really?

My fear that is that not enough folks will take the vaccine. I've been hearing a lot about anti-vaxxers lately. interesting bunch.

> I've been hearing a lot about anti-vaxxers lately. interesting bunch.

Reason is not a universal attribute of human beings. Some of us have it. Some don't (they just simulate it more or less successfully).

Reason is not an attribute of human beings.

Out of curiosity, which category do you think you fall into? And how do you know?

Every single human being can be assumed to think they fall in the reasonable bunch. This is a combination of hardwired bootstrapping (seems unavoidable), self-serving biases, and the fact that most mistakes won’t be recognized even in hindsight (so much for saying hindsight is 20/20).

Let's also accept that many judgements on outcome are not only subjective but culturally biased. Assuming we both agreed on values and we were analyzing identical scenarios then you could argue that a difference in choice would boil down to differences in the effective use of reasoning

Most people disagreeing on most subjects have probably barely applied any sort of reasoning to get there.

Most pro-vaxxers have simply picked up the dominant opinion from the surrounding society -- not a bad heuristic in practice. Most anti-vaxxers have picked up an opinion from a persuasive single source and then read some other sources that back it up.

I admit I'm in the first category, I certainly vaccinate my own children, but I can't really claim that I've come to this decision after a thorough understanding of immunology, I have simply followed the path of least resistance.

You don't need a degree in immunology to be very skeptical of anti-vaxxers' claims. Reading a bit of history is enough to know what happens when vaccines don't exist.

The steelman version of antivaxxism isn't "vaccines shouldn't exist", it's "on an individual basis, the risk-reward ratio of certain vaccines is not worth it. I should personally not vaccinate myself or anyone I care about, and be a free rider on societal herd immunity"

That particular version of antivaxxism is the one I would have the most trouble refuting. It's especially troubling since if it were true then the powers that be would have every incentive to try to keep it quiet and attack anyone who suggests it.

I mean, I make the same judgement call every year for flu shots. Is it at least plausible that I would be better off overall making the same call for some other disease?

> (...) I should personally not vaccinate myself or anyone I care about, and be a free rider on societal herd immunity"

> That particular version of antivaxxism is the one I would have the most trouble refuting.

What's hard to refute? I mean, the exceptionalism argument only sticks with sociopaths who believe society exists only to serve their personal interests without having to contribute anything in return.

> it's "on an individual basis, the risk-reward ratio of certain vaccines is not worth it."

That's not really true though. The risks involved in getting a vaccine are much, much smaller than the risks involved in not getting the vaccine, especially with diseases like Covid.

Since you opened this "back-and-forth" I feel I need to correct the perception with some sources and point out your framing:

1. I couldn't find a source for your 3-4 k number,if you can point me to it I'd be greatful. I did find a a source of 532 developing Guillan-Barré https://www.newscientist.com/article/dn18014-swine-flu-myth-...

2. That same source lays out why worrying about this risk is not rational (in this case)

3. No-one is seriously calling for forced vaccination for corona

4. (my opinion) by over-emphasizing the "personal choice" angle we are letting anti-vaxxination pseudo science and conspiracy beliefs spread without being challenged. Some things are more wrong than others and the science for the harm of vaccines has oveerwhelmingly failed to arrive. So using the term "without anti-vaccination beliefs" is fair in this case, since I will argue the only reason why you'd reject a vaccine that is recommended by a physician is an irrational belief not grounded in evidence

> No-one is seriously calling for forced vaccination for corona

There will be de facto mandatory vaccination, to a degree. This is a Canadian news source but read about the companies involved with creating this program (by the way—-it’s not Ticketmaster). It is definitely coming to America and already underway.

No coronavirus vaccine, no entry? Experts say it’s possible in pandemic’s next stage

https://globalnews.ca/news/7457999/ticketmaster-covid19-vacc...

In Europe, mandatory vaccinations do exist in some countries, for both children and adults. Also, in Croatia (which is part of the European Union), if you refuse to have your child vaccinated, it is legally considered to be child abuse. In Croatia, they have school doctors that literally come to the schools with nurses that not only ensure the health of all of the kids, but also have them vaccinated there. Homeschooling is also illegal in Croatia.

>3. No-one is seriously calling for forced vaccination for corona

That is not true:

https://nysba.org/new-york-state-bar-association-calls-upon-...

>>The New York State Bar Association (NYSBA) is recommending that the state consider mandating a COVID-19 vaccine once a scientific consensus emerges that it is safe, effective and necessary.

It is also not definitive that the 532 cases of Guillan-Barré were actually caused by the vaccine. In any large scale vaccination effort people die/get sick just because that is what happens in any large population.

> No-one is seriously calling for forced vaccination for corona

Define forced. I'm not in favor of pinning people down and forcibly injecting them with something, but I am all for some kind of vaccination "passport", where if you don't have proof of vaccination you stop enjoying the benefits of society. No public schools or services, right for businesses to refuse service, etc. Or at the very least, a heavy tax fine or something a long those lines.

If people choose to not get a vaccine, that's fine. But its time we align incentives to eliminate these externalities being born from societal free-loaders who believe in quack-science.

In response to 3, many rational people are. And I agree with them. We have mandatory vaccinations for MMR and for dTAP. Have you ever heard of anyone catching diphtheria? A reasonable risk profile puts COVID-19 at higher risk than whooping cough, as the chances of getting it are so much higher, even if the fatality rate is lower.

"Mandatory" vaccination for children in the USA usually aren't: all states allow exemption for true medical reason, and [edit: --some--] almost all allow exemption on religious grounds. Sixteen allow exemption for parental objection.

> We have mandatory vaccinations for MMR and for dTAP. Have you ever heard of anyone catching diphtheria?

Not specifically, but DTaP vaccinates against pertussis which has seen epidemic-level outbreaks in the past decade in multiple states.

I'd expect any SARS-CoV-2 vaccinations to be targeted at adults for the foreseeable future, but who knows.

If there's a law you have to get it, and the burden of proof is that the law doesn't apply to you, it's mandatory.

>Have you ever heard of anyone catching diphtheria?

Nope, I wonder why.

> I did find a a source of 532 developing Guillan-Barré

You should have mentioned that the 532 cases of Guillan-Barré were found within the 48 million people receiving the swine flu vaccine.

Accordig to Wikipedia, the incidence of Guillam-Barré is about 2 per 100,000 people per year.

Statistically speaking, your example suggests that taking the swine flu vaccine is linked with a lower incidence of Guillam-Barre syndrome, nearly lowering it to about 60% of the baseline.

If we're allowed to play fast and loose with back-of-the-napkin statistics, your example contradicts your original claims, and indeed makes a strong case in favour of vaccination.

Physicians recommend many drugs that end up proving to have dangerous side effects. The anti-inflamatory Vioxx is just one that comes to mind without doing any research.

That's like saying that there have been unsafe cars in history without understand which cars and why and why they're unsafe.

There's a lot of unsafe stuff, but this example is so absurdly generalized that it seems either malicious or just so ignorant that it's not even a worthy position to take.

>since I will argue the only reason why you'd reject a vaccine that is recommended by a physician is an irrational belief not grounded in evidence

https://en.m.wikipedia.org/wiki/Dengvaxia_controversy

https://ijme.in/articles/deaths-in-a-trial-of-the-hpv-vaccin...

https://www.nationthailand.com/news/30352154

Vaccine manufacturers have a poor track record of releasing dangerous barely tested vaccines onto populations, causing deaths and avoiding lawsuits.

Personally, I am skeptical about this vaccine, or any other rushed out for a disease with a 97% survival rate.

https://www.worldometers.info/coronavirus/?utm_campaign=home...

I've had lots of vaccines in my life, the thing is, all those were for diseases that had a high risk of crippling or killing me.

Why would I want a vaccine that is actually less effective than my chances of surviving?

If I get the vaccine, there's a 95% chance it'll work, if I get covid, there's a 97% chance i'll live.

All I know is, if you told someone they had a 97% chance of winning at a casino, they'd be down there in a flash.

Why would I choose to have some barely tested vaccine with not fully studied long term side effects made by companies who have extremely poor track records with medication in general?

Pfizer is bascially responsible for the oxycontin epidemic. Their reps bribe doctors into pushing their drugs.

Moderna's some secretive biotech company that just appeared out of nowhere with this whole covid thing.

What reason do I have to trust any of these companies over the 97% survival rate I can expect from getting covid?

It's the other way around - for any given chance of you getting COVID, there's a (to use your number) 3% mortality rate - if you take the vaccine - that outcome changes because you now have much smaller risk of infection, to 0.15% chance.

Your choice is between 3% and 0.15% - not 95% and 97%.

I don't think this individualistic way of looking at things is sound, though. First 3% mortality sounds way high - even given health system collapse (basically turning every ventilator survivor into a dead patient).

And on the other hand, mostly the old and those with pre-conditions will die - we alltake the vaccine to protect everyone. That way we might avoid a population wide 0.5% (or thereabouts) mortality rate.

That would still 1 in 200 - most people would likely know a handful of people dying from the disease if there's no mitigation.

> Your choice is between 3% and 0.15% - not 95% and 97%.

I would put it differently: if we become covid carriers, we become spreaders. Those 3% are, thus, applied to a large population comprised of everyone we interact ina daily basis.

Thus even if at most the likelihood that we die of covid is only 3% tops, the likelihood that at least one person that catches covid from us does is proportional to the number of people we infect.

With a 3% fatality rate, the likelihood that at least one person we infect will die can reach 80% if we spread it to over 50 people.

If we infect someone over 60, the likelihood that they will die from covid grows from that 3% to about 20%.

So unless you are infected while living in a bubble, the real risk is far higher.

I live in a US state with essentially no lock down measures in place. Companies around me are going out of business by the dozen. These companies are not going out of business due to any government mandate they are going out of business because of economic uncertainty and people not spending as they dont want to go to places and potentially get sick. I used to spend ~$500 a month on eating out, I spend almost zero now as I dont want to take the risk. This has nothing to do with government choices and fully to do with mine. Now multiply this by tens of thousands of other people making the same choice and you will understand why an effective widely used vaccine is important for an economic recovery. Until the virus is under control I and many others will severely curtail our spending and there will be only a limited economic recovery.

In addition I dont go out as I have elderly relatives who I dont want to sicken, they dont expect it, its my choice. So blaming others for being selfish is really missing the point and is an illustration of not really understanding the current economic situation.

Your point is perfectly true, but there is also one more thing to consider. It is possible for the health care system to get overworked like they did in NYC and North Italy. There are signs it could happens in other places in the US now like Wisconsin.

At that point everything else suddenly becomes critical, because there is no ICU left.

Also, at least in CA, doctors/hospitals/dentists etc are only doing what is critical right now to avoid the whole hospital going into lockdown. That has large consequences for health outcomes and for the economy of those practises.

To add some data to that: there is a correlation between disease spread and GDP reduction, and it's the one that consistent with your anecdote: The economic impact is greater where the disease is left unchecked :

https://ourworldindata.org/covid-health-economy, and then specificaly this scatterplot: https://ourworldindata.org/grapher/q2-gdp-growth-vs-confirme...

(unfortunately, the graph doesn't include countries like china, vietnam, and many other asian countries, because that would make the trend even clearer.)

average of 17 pedestrians are killed by cars in the US every day (data from 2018). Over 1,000 people per day are dying from covid in the US. So your odds of dying crossing the road on any given day are actually far, far less than your odds of dying from covid...

I think it's easy to look at a mortality rate of half a percent, and think "no big deal" - but it really is. One in every 200 people dying would mean most of us have a close connection to a couple of victims.

And there's already more dead from covid-19 in the US than casualties during the Vietnam War. Granted, more elderly people than young, but it's still a bit difficult to accept that it's insignificant.

Add to this what could happen with an exponential surge, with icus being over-run - and a) you'd end up being more likely to die from other causes, like a traffic accident - and b) many of the current covid-19 survivors would end up as casualties.

https://time.com/5843349/coronavirus-death-toll-100000/

You sound like a child. No one is panicking, the problem is it's killing people and hospitalizing even more people to the point of overrunning hospitals.

Very very few hospitals have actually been overrun. Many were and still are empty (or flooding in with people who couldn't get treatment for other things during the lockdowns). The cases in NYC, Michigan and Kirkland (Seattle) were all due to orders that packed elderly care facilities with sick. Governors Whitmer and Cuomo made huge mistakes with their orders and neither is owing up to it.

The problem is that with the infection spreading exponentially you might have hospitals half empty one day and at 200% a week later.

Here in Czech Republic it looks like we managed to avoid running out of capacity during the ongoing second wave, but just. The measures taken included canceling any elective and non-life-threatening surgeries, drafting medical school students, many foreign doctors that came to help and moving covid patients in critical state from overloaded hospitals hospitals.

We even built two full field hospitals which we will thankfully not need as it looks like. BTW, building one of them took about a week - which you migh not have, once you hit exponential growth. Not to mention having spare medical personnel to run it.

How many elective procedures are happening across America? Hint: not many.

All that you say makes sense. But hey we live in an irrational world (my based opinion).

Good luck surviving among a bunch of simians, who think they have figured it all out.

> Why would I want a vaccine that is actually less effective than my chances of surviving?

Well, the vaccine hopefully doesn't kill you if it's ineffective, so the numbers aren't exactly comparable.

The reasoning in this comment is wild. Let's take it back to the math a moment:

Let's take your 3% chance of death (actually the population survival rate is significantly higher IIRC, but OTOH there's long haul COVID to consider too). If the vaccine is 95% effective, all else being equal you have a 3% chance of death without the vaccine, and a 0.15% chance of death with the vaccine. So the question becomes: is there a greater than 2.85% chance of the vaccine killing you or doing you crippling injury? If not, you're probably better off taking the vaccine.

Numbers depend on the age. Bulk of deaths are concentrated in older populations. CDC recently updated estimated infection fatality rates for COVID. Here are the updated survival rates by age group:

0-19: 99.997% 20-49: 99.98% 50-69: 99.5% 70+: 94.6%

Edit - typo.

The CDC updated their pandemic planning scenarios[0] based on earlier studies in Europe plus some educated guesswork using data collected from the US through August 8. The numbers which you represent as the CDC’s sole official estimate of true IFR are only one of three possible sets of parameters that they provide for scenario modelling. Furthermore, the footnote on these estimates states “The estimates for persons ≥70 years old presented here do not include persons ≥80 years old”, since the underlying study they base the model on assumed that CFR = IFR for people ≥80 years old. Why they label this 70+ instead of 70–79 is beyond me, and I have no idea how sound the methodology is that they used to derive these estimates.

I would also mention that there are studies in peer review on patient populations in the United States which suggest IFRs closer to CDC planning scenario 4/5 than 3—for example, this one from Connecticut[1]:

  18-29 0.01 (0.01–NE)
  30-44 0.11 (0.06–1.74)
  45-54 0.18 (0.11–0.63)
  55-64 1.30 (0.68–16.94)
  ≥65 16.46 (6.58–NE)

We all hope for the best—that the lower bounds are true—but I think we should also be prepared for the reality that the upper bounds might be the correct ones, and act conservatively.

Also, you know, all IFR estimates assume that patients will actually be able to access care. Without hospitals, IFR approaches IHR, and the hospitalisation rates from the Connecticut study are grim: 0.8%, 2.68%, 3.09%, 12.43%, and 79.89%.

[0] https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...

[1] https://www.medrxiv.org/content/10.1101/2020.10.30.20223461v...

" if you told someone they had a 97% chance of winning at a casino, they'd be down there in a flash" this is a bad analogy, what if you also told them that if they lost they were taken out back and shot? I bet a lot fewer people would show up. In this particular case, winning just means not dying, if I could increase my odds of not dying I would probably do so.

Also there is no proof that getting covid grants lifetime immunity, so lets assume immunity lasts a year, every year you now have a 3% chance of dying from covid using your numbers. 3% is not that low, there is a ~3% chance of rolling double sixes with 2 dice, and that happens all the time.

Your IJME link does not support in any way your assertion about the "danger" of the HPV vaccine. From the link, 30,000 were vaccinated. Three girls died for reasons that are never stated. The article provides that "there is no conclusive evidence of a causal link between the vaccine and the deaths."

> Pfizer is bascially responsible for the oxycontin epidemic. Their reps bribe doctors into pushing their drugs.

That was Purdue Pharma, not Pfizer.

I take the general gist of some of your points, but it might be worth reframing some of your logic. To take just one point, let's go to the casino: you have a 97% chance of winning...pretty great! The downside is that if you lose, we take you out back and shoot you. Do you still want to go?

Looking at your individual risk profile is a good way to decide who ought to get vaccinated first its a poor way to decide who gets vaccinated at all. There are some parties including those who are too young to vaccinate or who have poor immune systems whom are only protected by the surrounding population not passing around virii like baseball cards.

Having a large enough host population to sustain an outbreak means those vulnerable parties are fucked and the rest of the population even those for whom the vaccine is 90% effective are at still at some risk. Worse the selection pressure among millions of vectors to develop a strain that can infect the previously safe population is high and the possibility is real.

This is to say that the proper assessment of safety is the likely net effect on the entire population of an increasingly large portion of society not vaccinating.

Existing precedent would seem to suggest that its impossible to force you to vaccinate but possible to prevent you from participating in society if you do not. For example the state can put you in jail for not putting your kid in school but not let you do so unless you vaccinate your kid.

I would not be terribly surprised if people, especially vulnerable people argued that a work allowing anti vaxxers to work alongside them violated their right to a safe workplace.

Imagine one lawsuit from someones family that lost a baby or a family member resulting in an 7-8 figure settlement. There wont have to be a law. The lawsuits will be from anti vaxxers alleging that this violates their rights and will take place over the following 2 years after every major workplace in America adopts such rules giving American workers the choice between employment and remaining an antivaxxer.

I'm not anti-vax by any means, but I would rather have 3 months of outcomes from widespread deployment prior to being vaccinated or having my low-risk family members be vaccinated.

That this vaccine is mRNA-based makes it likely safer than some other lightly-tested vaccines, but if you're young, healthy, and at low-risk of serious COVID infection, I'm not sure it's wise to be among the first in line for this vaccine.

Its better for the whole population if you get a vaccine as soon as it becomes generally available instead of becoming a vector in that 3 months.

Yes, of course it is, provided that the vaccine that I take would otherwise go un-given in that 3 month period. That seems unlikely to me as we are likely to be vaccinating as many people as we can manufacture doses during that period and the difference is "which" rather than "how many".

I leave my house about once a week, wearing a mask, to spend 20 minutes grocery shopping. My risk of contracting, contracting and dying from, or contracting and spreading the disease is extremely low and quite possibly lower than leaving that dose for someone else who is leaving their house and being around people more than 4 hours in those 3 months. Bonus is that someone at higher risk gets "my" dose and I get 3 additional months of population-wide study of safety, side-effects, and efficacy.

You're fine then, because the young, healthy and low-risk won't be able to access any vaccine for months after higher-risk people. It's probably closer to a year before the really low-risk people get any.

Wouldn't the overvaxxers be protected? Wouldn't a baby be less likely to get covid or die from covid?

Parents homeschool kids in states that force vaccinations. Parents get in trouble when they are registered to a school and the kid doesn't show up.

A little, but when you are talking about my baby that is going to the part with older kids. A lot of kids do look at my baby first learning to crawl and run up to get a close look.

Agreed. I think vaccines are generally a good idea, but that there are risks involved in beta testing them.

Also, there are some interesting treatments targeting the ACE2 receptors that SARS-CoV-2 binds to which looks like they are reducing mortality rates, and perhaps long-term scarring in the lungs. Among these are Vitamin-D (which people are probably nutritionally-deficient anyways), and human recombinant soluable ACE2 (basically, injecting a form of ACE2 into the body so that the virus binds to that, instead of to cells with a lot of ACE2 receptors, thus short-circuiting the replication pathway). I would be interested to see if nutritionally-sufficient vitamin-d is better at preventing severe cases of covid-19 than masking or social distancing.

My own opinion is that it is foolish to pin all the hopes on a single strategy (prevention, via vaccination), which is not guaranteed to work or guaranteed to be safe. To add forced vaccination is folly. I think it is better to see a depth of prevention and treatment options (including vaccination).

One of my concerns is what happened with the SARS vaccine (meaning, the original SARS.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335060/

The study described findings of antibody-dependent enhancement with the original SARS. I am no expert, but my understanding is that when test subjects were given the vaccine, and then later 'challenged' by the SARS virus, they developed a pathological response. In other words, taking the vaccine had a potential to make their response to SARS and potentially other coronaviruses worse.

The study I linked therefore recommended caution in giving the vaccine to humans.

Obviously this is something that vaccine researchers are aware of (see https://www.nature.com/articles/s41564-020-00789-5), but I think it's something that is perfectly rational to be concerned about given the time and money pressures available with SARS-CoV-2 vaccination.

I believe this entire category of vaccines is no longer considered for human use at all, precisely because of this concerning result.

> forced vaccination

There won’t be enough vaccines to go around, so no one will be forced to take anything for at least a year. By then we might be at 60-70% of the population vaccinated, at which point the R0 of the virus would be much lower.

Don’t worry about it for now, the rest of us will take the risk so you don’t have to.

Would you? Thanks, that would be great!

I feel like we are about to enter the variation on the prisoner's dilemma where we all get a massive benefit if at least 70% of us get the vaccine, but getting the vaccine has a cost (please roll a D20 to select your random side effect) so everyone has an incentive to be one of the shirkers.

I foresee things getting ugly as we collectively all get together to shame, bully and trick the shirkers into compliance.

The immunocompromised and the economy get a benefit if we get to 70% vaccinated; I get a benefit for myself just by getting the vaccine.

I’ll allow that there is seemingly a significant portion of the population who believes they don’t personally benefit from a vaccine, but your comment said -everyone- is incentivized to shirk: that’s just not true.

That is fair. But I think that the fraction of people who individually benefit from getting the vaccine is less than the 70% who need to get it, do there's going to be a gap that will need to be filled with lies, bullying and shaming.

Of course this depends on the unknown factor of how bad the side effects are, if they are nonexistent then it's a different story, but if they are on average as bad as a flu shot then it becomes tricky.

I suppose I'm really thinking in the context of countries like Australia which have essentially eradicated the virus. My risk of getting the virus right now is practically zero, so my only incentive to get vaccinated is that we can eventually reopen our borders once enough people are vaccinated. And personally I'm in no hurry to get flooded by foreign tourists anyway.

This is not how the Prisoner's dilemma works since not getting the vaccine is not a purely dominant strategy. You are neglecting to adjust the vaccination scenario payout to account for the fact that you personally are much less likely to get Covid-19 if exposed to someone infected. This benefit largely exceeds any cost of receiving the vaccine based on current data.

This is not a prisoner's dilemma. The expected payoff if you get vaccinated is still far higher than the cost, whatever the rest of the population does, so you can ignore the cost in your calculation. It's like if the situation for the prisoner was that if you stay silent you go free, but if you both stay silent you both go free and the rest of your gang gets a reduced sentence too. Why would you ever defect?

The alternative is a high chance of becoming ill with COVID, which according to the data available so far is much riskier than the vaccine (1-2% hospitalization risk even for healthy young adults, evidence of long term issues at least in some people).

Unless of course your alternative plan is full isolation for years, in which case not taking the vaccine is the correct choice, but such isolation is only reasonable if you don't care about going outside anyway at all.

There looks like treatments developing that can reduce the mortality or severity of COVID after contracting it, including possibly reducing long-term scarring from it. These treatments are coming out of better modeling and understanding on how COVID spreads in the body and kills people.

It isn't so binary or black and white -- vaccinate or risk dying. We're starting to get other options.

Why are you more scared of a vaccine than other new covid treatments?

I’m not scared of a vaccine. I am not sure what words I used to give you that impression.

I do see a lot of people fixating on vaccines as if it will make everything better. Vaccines will help, but better if there are other treatments as well. I think that if mortality rates and long-term scarring decreases, then people won’t feel like their survival depends upon other people’s cooperation.

Presumably because any side-effects of new COVID treatments would only affected those who get a serious form of COVID while any side-effects of a vaccine would be applied to the entire population.

Some of those options, like monoclonal antibodies, are extremely expensive and hard to produce and distribute at scale, plus they only work early in the course of the disease. I'm not aware of any small-molecule drugs that have hopes of great efficacy on the horizon. You're not going to pump out 150K/day doses of MABs.

It really is vaccinate or risk dying. The other options are too expensive, too timing-dependent or too ineffective.

Vaccines are the only way we can end the pandemic though. However great a treatment is, it won't stop anyone catching it or spreading it. If we're to be able to go back to anything resembling normal, we need to stop widespread transmission in the population, and the only way to do that without these restrictions is for an effective sterilising vaccine.

The strong asymptomatic spread of this virus, however, makes these decisions more complicated and less individualistic than “what happens to me if I catch it”.

What is the average hospitalization and fatality rate among cases where the patient was taking a high dose vitamin D regimen?

There's a recent quasi-exprimental study on that, showing that vitamin-d is likely one of the central factors in better outcomes for severe cases of covid-19:

https://www.sciencedirect.com/science/article/pii/S096007602...

According to this study, vitamin-d gives better outcome than the other treatments, including hospitalization:

"Regarding care dedicated to COVID-19, only the proportion of patients who received a bolus of vitamin D3 during or just before COVID-19 differed between deceased participants and survivors, with a higher prevalence in survivors (respectively 92.2 % versus 66.7 %, P = 0.023). In contrast, there was no between-group difference in the proportion of patients treated with corticosteroids, hydroxychloroquine or dedicated antibiotics, or hospitalized for COVID-19."

And this has to do with Vitamin-D's role with the ACE2 receptor. SARS-CoV-2 has a binding affinity to ACE2, aggressively invading cells with proportionally higher ACE2 receptors (including the lungs).

In fact, someone had tried injecting hrsACE2 into someone as a treatment -- that is, letting the virus bind to hrsACE2 instead of the ACE2 receptors in the cells.

https://www.nature.com/articles/s41392-020-00374-6

A treatment with hrsACE2 isn't generally-available, and needs a lot more study. The logsitics in producing them at scale would need to be solved, if this is a viable treatment. But this looks promising to me.

I'm not sure about the combination of covid + vitamin D. But you can also overdose on vitamin D since it's fat soluble.

https://www.healthline.com/nutrition/vitamin-d-side-effects#...

Anyone remember hydroxychloroquine?

The logistic problem will be a major blocker in most of the other parts of the world, for e.g. anywhere in developing world. Even though it might work for US, rest of the world will still have the logistic problem due to the temperature restrictions.

IDK, put that shit in a properly insulated box stuffed with dry ice pellets, you'll maintain ultra-cold for three days easy with no electricity. So if you're loading a plane in Europe that spends 24 hours flying to $remote_destination, it still leaves you with 48 hours to do distribution by road, then you have another 5 days at normal freezer temperatures that is available for actually giving people the vaccine.

Flight from Wisconsin to any airport in the world in 24 hours. Plenty of time to distribute from then - especially as it’s cities (near airports) that are the main targets

It’s not like aircraft are busy at the moment.

> (this might be a cold storage faultily and manufacturing elsewhere - I'm not sure)

COLD is the stock symbol and company that own temperature control storage facilities. They're international too and a REIT.

Do note I own this stock.

There are more countries in the world than just North America, though.

The bigger takeaway is that Moderna's vaccine doesn't produce CD8+ (T-Cell) responses. Pfizer's T-Cell responses are off-the-charts good. This could affect your immune system's memory ability and could offer longer protection. Both the Moderna and Pfizer vaccine offers CD4 T-Cell responses. CD8+ is a nice-to-have, so the Pfizer vaccine would be an A+ grade, and this Moderna one is a solid "A".

The 2nd key takeaway here is that while 5 patients in the vaccination group tested positive for coronavirus, none of them had severe disease. Which means to me that while this vaccine isn't a magic shield, if you do get it, it will keep you out of the hospital and probably make it a very mild experience.

> Which means to me that while this vaccine isn't a magic shield, if you do get it, it will keep you out of the hospital and probably make it a very mild experience.

Is that conclusion warranted given the small number of people who got it? Perhaps in another population one of those 5 will indeed have severe, hospital-needed symptoms?

If the immune reaction in the vaccinated was good enough to avoid symptoms but a few still tested positive then those five are surely not the only ones. What are the chances that a random person without symptoms would be getting tested exactly those days that a very mild infection lasts? Those studies don't observe the subjects with daily PCR or something like that (impossible for ten thousands) and most mild infections remain undiscovered. And mild, hard to discover infections aren't exceptionally rare even without a vaccine, as antibody testing studies have shown again and again.

The pressing follow-up question is this: how many of the control group were discovered with (and despite of) equally weak symptoms? The answer could be anything between many more and many less. If it's more (more discovered very mild cases amongst the placebo group) then the vaccine apparently prevents most infections from happening at all, but if it's less then the vaccine doesn't really reduce the number of infected (and infective), it only prevents bad outcomes (which usually remain undiscovered, even in a phase III trial group).

A vaccine that only prevents bad outcomes would still be very valuable, but only to the vaccinated themselves because it would not create a herd immunity effect. This virus is very good at spreading from a mild case, so if the vaccinated still get unnoticeable mild cases they would still serve the virus as stopovers.

Not a doctor, but I thought that asymptomatic is not as big of deal as we thought it was based on contact tracing.

http://www.emro.who.int/health-topics/corona-virus/transmiss....

Contract tracing is more likely to identify sources of infection when the people remember being in the same room with someone who had symptoms. This is also why public transport is virtually absent as a infection source in contact tracing data, but private parties are very prominent.

From what I've heard, virus concentration in the upper respiratory tract (i.e. where the aerosols come from) peaks two or three days before symptoms start.

Here in Germany there's the statistic of "75% of infection sources are not found by tracing" circulating hard through public discussions. I doubt that many of those untraceable infections could be coming from symptomatic carriers, given the level of awareness. Coughing people basically do not exist in the 2020 public. And tracing should still be good enough to recognize most cases when the source became symptomatic after the contact (which would very likely be before the receiver became aware of the infection, triggering tracing). I consider this a pretty strong indication of asymptomatic spread, or very weakly symptomatic (thresholds are very subjective).

I would be surprised if they didn't specifically test all participants in the trial for covid antibodies, symptoms or not. Does anybody know what validation was done?

Depends a lot on the question of whether the antibody test can distinguish the immune system's reaction to the virus from the immune system's reaction to the vaccine (or in this case: to the proteins built from mRNA blueprints in the vaccine). If they can't, and this is quite likely given that they all target the same spike protein, the outcome would hopefully be positive for all of the vaccinated.

In the Pfizer trial, all the subjects in the interim evaluation had symptomatic infection confirmed by PCR test. I'm not sure about Moderna, but it's likely to use the same or similar methods.

> Which means to me that while this vaccine isn't a magic shield, if you do get it, it will keep you out of the hospital and probably make it a very mild experience.

With an n of 5, isn't this a premature conclusion?

If you compare the endpoint "severe illness"... 11 out of ~15000 ended up with severe illness on placebo, and 0 out of ~15000 ended up with severe illness in the treated group.

This corresponds to binomial 95% confidence intervals of (0.0004, 0.0013) and (0.0000, 0.0002). So it seems to prevent severe illness.

Whether it reduces the odds of severe illness IF YOU ARE INFECTED or purely reduces the odds of severe illness by preventing infection--- you're right, there's not nearly enough n to know.

> so the Pfizer vaccine would be an A+ grade, and this Moderna one is a solid "A".

Right now, ease of rolling out a vaccine is more important than its effectiveness, within reason. As long as the vaccine is effective enough to slow the spread of the virus it will save lives -- the more people we vaccinate, the fewer potential spreaders there will be, and that should help us protect people who have not been vaccinated yet.

Today, we would probably be better off with an A grade vaccine that is easier to store and ship across the country than we would be with an A+ vaccine that is more picky about storage temperature.

Of course, we can probably have both vaccines at the same time once the manufacturing capacity spins up.

Can you explain a little bit what the difference between the two T-Cell types are?

The immune system is extremely complicated, but very broadly: CD8+ T-cells (also known as killer T-cells) kill infected cells directly, whereas CD4+ T-cells (also known as helper T-cells) release signals that guide many aspects of immune response, including activating CD8+ cells

They used different assays and at different time points looking for CD8, so we can't say for certain yet that they are different.

It can already be a very mild experience for some people. The question is WHY?

The immune system at its core is basically rolling dice like crazy for new random RNA source code that is compiled into molecule hardware that will hopefully work against the invasor somehow. It even has a mechanism to deposit samples of the invasor were the freshly rolled candidates are let loose. Apparently it's buying into the TDD paradigm. The dice are probably not rolled to try completely random RNA sequences with a D4 for each base, more like mashups of the existing library from previous infections. Different immune systems can come up with different solutions to the same virus and even the same solution can be stumbled upon very early or reached very late, only hours before EOL. The content of the existing library likely plays a decisive role and even more does the general bandwidth of mashup attempts. This apparently shrinks drastically from children to elderly. Maybe an evolutionary tradeoff to compensate for the weak library children have, maybe a side effect of the existing library.

(source: mostly stuff I read linked from the hn page, hopefully without excessive misreading)

This was a pretty interesting explanation, thanks!

Most of the time its because the person was young and fit. Unfortunately the majority of people are not healthy.

Totally anecdotally, the 4 people in my family who got it are all 65+ with multiple underlying issues. It was a bad head cold for a week and half, all recovered. I know, sadly, that isn't the case for so many. I just don't know what to think.

Even in the 80+ population most people are okay. A sample of four is not big enough to see the catastrophic effects even fairly small hospitalization numbers have when millions get infected.

This is exactly my point, and yet my comment gets downvoted.

People seem content with vaccines, meanwhile I want to understand WHY some people fair better than others. There's a far better solution than vaccines to be found, if people are willing to ask the question, and look for it.

Not to downplay Pfizer's role in logistics here, but they didn't really develop the vaccine. They're the logistics+manufacturing branch of the joint Biontech-Pfizer venture in this, while Biontech did the RND.

I am assuming they are also responsible for the clinical trials, but I'm not sure about that. It would make sense, though, because navigating the approval processes of the different agencies requires very specialized experience and domain knowledge.

Yes, Biontech appears to be more of a long shot project aiming for a future where you can manipulate your immune system into fighting your cancer with a personalized vaccine. That's why they were in the unique position of having the skills for putting together an mRNA vaccine targeting the SARS-COV2 spike on very short notice without having established organizational knowledge of running those approval trials.

Moderna has the same setup. They just happened to be able and willing to raise huge amounts of money (and play ball with the .gov) to produce it themselves. It's also why Pfizer is claiming they can produce a billion vaccines over the next year while Moderna is only saying they can do 100 million.

From the linked article: "Moderna said it could potentially manufacture 1bn doses by the end of 2021, adding to a further 1.3bn from Pfizer/BioNTech in the same timeframe."

Given the timelines and uncertainty, I don't think 1B and 1.3B are materially different. Both require 2 doses per vaccination.

Oh great, capitalism at it's best: there's an acute crisis, we might have the solution, but if we don't solve it vertically integrated we would have to share the spoils with a cooperation partner. This can't happen, quick! Bring in the investors!

Take a step back. Why did Moderna founders invest in research and technology? Are they selfless idealists? Probably not, at least that is not the only driving motivator. And even if they are, they still want the company to earn money in order to invest it into more research.

Bottom line is they want the company to be successful, so their long-term plan is to profit from making drugs. If they lived in a socialist economy where no such profit was possible, they would not have bothered, and then there would be no cure. If that is the world you prefer to live in, you have options (North Korea, Cuba and Venezuela currently, the rest having collapsed or transitioned to free market some time ago).

Isn't the difference more due to tests levels and announcement precautions ? Pfizer's announced temperature looks like the one for very long term ARN storage while standard fridge for a month doesn't look like it should alter ARN much.

I'm not sure there's a real difference here.

Pfizer's can actually be stored for 5 days at normal fridge temperatures after removing it from deep-cold storage.

I read in the New York Times article that Moderna and Pfizer use different (proprietary) lipid solutions in the vaccines. It's possible that Pfizer is just being overly cautious and they don't need the ultra cold storage, but it's also possible that Moderna has a fundamentally better solution.

Anyone know the difference in delivery mechanism between these two? Both are mRNA right?

>Anyone know the difference in delivery mechanism between these two? Both are mRNA right?

They're extremely similar. Both are mRNA delivered via lipid nanoparticle vector.

Who knows. Almost all therapeutic rnas have unnatural RNA bases or base linkages that are, for example, resistant to internal phosphatases/autohydrolysis to improve half life; half life can also depend on secondary structure, and of course as a sibling comment mentioned, it can depend on the stability of the lipid nanoparticles.

I’m curious - why is there such a difference between them? What is it specifically about the pfizer one that requires a lower temp? Does anyone know what the other potential vaccines (Oxford in particular) will require?

RNA is fragile. DNA is pretty stable. Proteins are somewhere in between but can be engineered to be very stable.

Most vaccines are a protein (originally a fragment from the (inactivated) virus, now more often a synthetically manufactured fragment of the virus).

These vaccines (Moderna & Pfizer) are delivered as the RNA that encodes a fragment of the virus (that your own body then uses to produce a fragment of the virus). The delivery mechanism is very different, but the viral fragment that your body sees is the same as it would if the protein was delivered directly, as is traditional.

RNA can't reliably survive on a surface for more than a few minutes (which is somewhat good news since coronovirus itself is an RNA virus), or more than a few days unrefrigerated, and is very sensitive to any contamination by bacteria or other organisms.

Traditional proteins are generally much less fragile both chemically and as food for other organisms. And sometimes a protein (vaccine) can be specifically engineered to be even more stable in room-temperature, dry, or other unforgiving conditions.

And none of this takes into account specific formulations, or other chemicals that are used to aide the delivery process. Much of this has to be measured empirically. It's not clear to me if there is some chemical difference between the Pfizer & Moderna vaccines, or if the different temps are just what they use as their protocol filed with the FDA.

Further, see /u/dnautics below, often RNA therapeutics aren't completely true RNA (they can have chemical features to enhance stability).

A biologists might be able to provide more detail but some big molecules are just inherently more stable than others, it can be incredibly tricky to predict this up front since it depends on complex interactions within the molecule itself. These are the kind of problems that projects like Folding@Home try to solve with lots of computing power (though I think they focus more on proteins, not sure if they also do RNA).

I read it mostly comes down to testing. Moderna is just further ahead and the pfizer vaccine may also survive higher temps.

Pfizer release their data ahead of Moderna. How is Moderna "ahead"?

And no, stability testing happens pretty early on. Pfizer would have definitely collected enough data at this point to say whether or not their vaccine is stable at higher temperatures.

Pfizer released a press release, but as far as I can tell that isn't as much data. Given the time I'd guess that the mathematicians at Moderna worked all weekend crunching numbers and writing a paper (which is what I'd do if I was a statistician there).

Pfizer is big enough to have/let a PR department do a press release during business hours. Of course given that Pfizer did a press release first Moderna for PR reasons needed to release more data to make a bigger splash.

No matter how you look at it, there is important data that will be in the FDA (and equivalent in other countries) submission that we don't have. There could be a "thats funny" thing burred, though odds are against it.

As far as I can tell, the Pfizer and Moderna "data releases" are identical. Basically press releases giving the top line result.

Pfizer hit their interim analysis point before Moderna did, but only by a few days.

They are not identical, unless (unknown to me, but possible) Pfizer has released more since the initial press release. Pfizer (again at least in the initial release) said a number of infections, and "at least 90% effective". Moderna released a number of infections and the number in that who got the placebo vs vaccine.

The difference is not very big, but to those who like numbers it is big enough.

I mean that Moderna has more data on storage than pfizer. They've been working on mrna vaccines for quite some time.

Competition is always good!