Granting immunity: America weighs vaccine approval

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Hello and welcome to the intelligence on Economist Radio. I'm your host, Jason Palmer. Every weekday we provide a fresh perspective on the events shaping your world. There's a lot of evidence that multiple generations living together benefits them all. Sharing experiences and sparing loneliness. It's a trend that despite the pandemic's prescription that people stay apart is bringing more of them together. And in the Christian world today, many people will be opening the eighth door of their Advent calendars. We peer through the doors of history to find how a religious tradition ended up with calendars stocked with booze, jewelry and even sex toys. But first, In Britain this morning, the first doses of a coronavirus vaccine from Pfizer and Biontech have been administered. 90 year old Margaret Keenan became the first person in the world outside of clinical trials to receive the jab and a round of applause for it. That same vaccine is still awaiting emergency authorization. In America, protocols there have been a bit more prolonged and authorities promised a public hearing before approval. As that hearing approaches and trial data are tallied and discussed, this week will be crucial for the country's vaccine rollout.

The news today is that there'll be a vaccine summit at the White House with vaccine makers and drug distributors.

Natasha Loder is the Economist's health policy editor.

This is seen as political Showmanship, really, we don't expect much to happen, but on Thursday, the action's going to be with the fda. They're convening a big meeting to review and scrutinise the Pfizer vaccine in order to figure out whether it should be granted an emergency license for distribution.

And so what exactly will happen at that FDA meeting?

The meeting will see an independent committee ask lots of questions about the data from the clinical trial. They'll ask about side effects. They may ask about manufacturing details, the efficacy data. And then at the end of the meeting, the advisory committee will then vote and whether or not they think the FDA should license this product. And the FDA has to either accept these recommendations or reject them.

And presuming that no showstoppers emerge, I mean, how quickly would the FDA be expected to approve? And then what happens?

Well, that's a really good question. We don't really know. Some people say it could take them days to approve it. Some people are saying it could take weeks. In terms of distribution, America's Operation Warp Speed, which is the body that has been set the task of trying to accelerate the movement of vaccine development and distribution, are very keen to get this happening as quickly as possible. They're saying they will distribute within 24 hours of getting some sort of approval from the FDA. Operation Warp Speed has made a pledge to vaccinate 20 million Americans this December. But but that is seen as quite unrealistic. There's a health website called Stat News and they talk about four health systems and they expected to be giving a lot of these early doses in January. So I think expectations for distribution are quite high and I think there could be some disappointment.

But however, many are actually distributed. Who's going to be first on the list to get vaccinated?

The plan is to vaccinate all healthcare workers and then long term care residents first of all. And then after that it's going to be essential workers at high risk of infection, police officers, teachers, bus drivers, and people with high risk medical conditions, and those over the age of 65. In terms of how that will actually happen. As vaccine supplies become available, they're going to be divided up among states and big metropolitan areas in proportion to the number of people who live there. And then each state then decides how to distribute them. But of course there is always the potential that states may vary slightly how they choose to implement these priorities.

And we've been talking only about Pfizer's vaccine so far, presumably that the procedures will all be the same when the time comes.

Yes, every Vaccine that wants to apply for an emergency licence is going to have to go through pretty much the same process. And then also, it's worth pointing out that all of these vaccines will. Will also have to go through a second process, which is to get a full approval, because what we're talking here is a sort of an emergency licence, it's not a full approval, which is a slightly longer process.

And so why is it that America seems to have been slower to reach this stage of approval than Britain has?

There's two reasons. One is that the UK did a slightly different process, which is called a rolling review. What this means is that whenever data became available, the regulatory agency accepted this from the pharma company and reviewed it when they had it. If you do rolling review, it means that when the pharma company is finished, there's less to look at, as opposed to sort of waiting for a big package of data to be sent. But there is an important difference between the way that the FDA works and the way that the UK has done its job. And very simply, the FDA has a more thorough process. What happens is that the pharmaceutical companies, they've done statistical analyses, they've produced summary data and you can look at those and you can come to a conclusion. But if, on the other hand, you want to reanalyse the data yourself and check that they've done their sums correctly and question how they've done their analyses, you do have to basically look at the raw data and be a bit more thorough. And that is essentially what the FDA is doing. And I have to say, it is good that someone is doing it, because although there's nothing necessarily to worry about, these vaccines could end up being given to hundreds of millions of people. And so you kind of really want to make sure that all the T's are crossed and all the I's are dotted.

I mean, there are already a lot of concerns around safety because these things have been developed so quickly. And you're drawing a distinction here in the regulatory regime that might heighten those concerns.

Well, we are in a rush. That is the other side of the argument. Given that all vaccine and drug approvals are essentially trying to trade off risks versus benefits, how much time do we want to spend sifting through every last data point if every day there are hundreds of people dying? The one answer you can give is you can say, well, it's an emergency license. It's an extraordinary situation. We're in a pandemic, we're making difficult but necessary decisions, and the UK went one way and The US went another and I think it's actually too early to tell who took the right decision. But I do think that at some point somebody will do study and they'll say in the extra time that it took for say the FDA to more finally scrutinize the data, how many people died and was that a worthwhile wait?

But in any case, all of the analyses so far point to these vaccines being very safe.

Well, I think so, yes. The vaccines that we're talking about are not unknown quantities at all. They have been used certainly in clinical trials over a number of decades. People have been looking at them for cancer medicines. They've been in trials involving 73,000 volunteers this year, half of whom have been given the vaccine. So we do have a large set of data now to look at and they do seem to have been well tolerated with no serious side effects. So from what I understand about the vaccine, it seems likely to be very safe and very effective. And, you know, I'm hoping I'll get offered it.

Natasha, thank you very much for joining us.

Thank you very much, Jason.

For a lot of people, coming home at the end of the day is a chance to shut out the world. Not so in one former retirement home.

So we made a mishmash of everything. We made actually society in little form.

Dragona Surovi is the project manager of Salbo, a multi generational housing experiment in southern Sweden.

It's an integration project which is made to counteract involuntary loneliness and to help to social inclusion for the residents in the house.

More than half of the residents in the 50 apartments are older than 70 and the rest between 18 and 25. In order to make sure residents interact, they all have to spend at least two hours a week with their neighbors.

There's always people around. There are some students who are studying home, so they are maybe in the library or in the big daily room. While the elderly would do everything. They're singing, they're playing music, they're playing canasta. They are puzzling. They're actually managing the garden by themselves. There is a group and it's beautiful.

It's not just in Salbo. Around the western world, more people are reassessing the benefits of living communally.

So this sort of idea of living with a single family in one household alone is really an outlier in human history.

Sarah Burke is a foreign correspondent for the Economist.

From far back in ancient days when we were hunter gatherers to more recent workhouses, people lived together in bigger groups with people they related to, but also usually not people they were related to. And it's only really after industrialization, when work actually moved outside of the home, that people started to live in these nuclear families, single household families, and that's.

Been pretty stable since industrialisation.

That was changing before the pandemic hit. So in Canada, multi generational households were the most rapidly increasing category of household. In Australia, there was 5 million people in 2016, which is the latest census, living communally, which is a 40% increase on 15 years before that. And then you have other parts of the world where it's just the norm, it's never changed to be the single family household. And that's especially the case in poorer parts of the world. So Senegal, two thirds of households are actually extended family households and that provides a safety net where states often don't provide one.

And what do you think is behind the recent resurgence of co living in the West?

So one, there's demographical change. So in America, households of married people with children halved between 1970 and 2012. That's partly because fewer people marry and when they do marry, they marry later. And often their marriages are shorter because they end in divorce. Because of that. The sort of flip side of the coin is that there's a dramatic rise in single person households. So you're talking in countries from Finland to Japan, sort of 30 to 40% of households are now just one person. And there's a shift in attitudes as well. So in the past, people saw communal living in a suspicious way and today that sort of persists. You think of hippie communes or weird cult. So since the 1970s it's been revived and that started in Denmark, although it was also in place in other countries, Australia, New Zealand, etc. And some of it was environmental, so people saw it as more friendly to the planet. Some of it was a political backlash against some of the capitalism that was around in the post war generation. And some feminists saw it as actually a way of freeing women up to work where they weren't stuck at home looking after children or the household. But actually what you see today is much more run of the mill in.

The sense that it's not just communes and hippies anymore.

Yeah, I mean, so more recently it's different. Not to say people don't care about the environment or politics or feminist issues, but a lot of it's to do with economic pressure. So house prices are rising, people who aren't married, they only have one income, so lots of people can't afford a house and so they move back in with Their parents, the so called boomerangs, or they have to find other ways of sharing housing, whether it's a co living building where you rent a studio, but there's shared facilities with other people. And this idea has more common currency because the sharing economy is something everyone's very used to. You rent your house out on Airbnb, you might borrow something from someone. So the idea of shared living as well is that you need fewer things. You have one lawnmower between a group of you rather than one per household.

And I suppose there are emotional implications too for not living alone.

Yeah. So the second biggest reason, aside from economic pressures, that people say for why they live with others is loneliness. It's the idea that when you live on your own, you have no one to come home to, there's no one to share tasks with. You know, it's something that's rising especially across the Western world. You have three out of five adults in America who sometimes or always say that they're lonely. And it's worse among young adults as well. And so these shared accommodations mean that people aren't on their own, that they've got social connections, that they don't need to make an effort to see people because they're where they live. And that's good for both your physical and your mental health. I mean, there are lots and lots and lots of studies that show that people who have good social connections have fewer health problems and live longer. One study found that those without strong connections have a 50% increased chance of dying, which you could quantify as something like smoking 15 cigarettes a day.

No, but the one thing about shared housing is that you lose your privacy.

Yeah, you know, it's not for everyone. That should be the first thing that one could say. Lots of people are actually very happy living alone and wouldn't want to live with anyone else. But yeah, the people who do want to live with others, their biggest concern is privacy. And now that can be mitigated by design. It's not that you have to share one house. A lot of the more contemporary arrangements, you have several houses around, shared facilities on shared grounds, or you have your own apartment with its kitchen, its bathroom. You don't have to share any of those. You can stay there the whole time if you like. But there's a common room, a shared kitchen if you want to cook there, various other facilities. So I spoke to Grace Kim, and she's an architect in Seattle and she lives with eight other families in a building that she and her husband designed. So she talked quite A lot about how you go about designing buildings that balance the need for privacy with the want to live communally. So in her place, where she lives, you can see into some kitchens where people are washing up, they can see each other in the evening, but you can't see into each other's living rooms from the different houses.

But isn't this trend somewhat confused by frustrated by the notion that at the moment, anyway, there's a pandemic spreading where high density living is inherently more dangerous.

So there are two sides to this as well. You know, on the one hand, yes, if you live with more people, the virus can spread more easily, especially if that's a multi generational family where you might be a young person going out to work, socialising a bit more than other people and then bringing it back home to your vulnerable parents or grandparents even, or communal living with shared facilities. But a lot of those worries haven't actually come to be. There've been shared spaces and shared events have obviously been shut off to protect people. And lots of people who live in this way say actually during the pandemic they found themselves insulated from some of the shocks that other people have had. So for example, I spoke to some people in a residency in Sweden and younger residents had gone out and done shopping for older residents who were shielding and didn't want to expose themselves to the virus.

Covid has made the socialization develop much faster. They are like a family, they feel very near to each other. It became a little bubble where they feel very safe.

So I think on the whole it could be something that the pandemic actually pushes and people start to see the advantages of living with other people.

Sarah, thanks very much for your time.

Thank you.

For many in the northern hemisphere, the darkest days of winter are approaching to beat the gloom.

Some have taken to welcome back my Advent addicts.

I am super happy. This is the.

I think it's just called Wizarding World Cube Advent Calendar. Hey everyone. Today I will be unboxing the new Dior Luxury Beauty Advent calendar for 2020.

Well, maybe not exactly that. Still though, the daily door opening ritual in a well stocked Advent calendar can provide a little bit of excitement during an otherwise gloomy year. But with those calendars getting ever bigger and more elaborate, are we due for a reset?

Like lots of western Christmas traditions like Christmas markets, mulled wine, Advent calendars came from Germany.

Fiumetto Rocco is the Economist's culture correspondent.

In the early 19th century, Protestants used to put a lit candle or a little religious image every night in a window or put a chalk mark on the door in the run up to Christmas.

But how did that turn into a box you buy at this time of year?

Well, in the years before the First World War, a man called Gerhard Lang remembered that when he was a child, his mother used to sew what they called wibeles, sort of small sweet biscuits, 24 of them onto the lid of a box. And he was allowed to eat a one a day. In the run up to Christmas, thinking over how he might make this into a business, he turned them first into card, then he added the little doors and then in the twenties he added chocolates. So very much the Advent calendar as we know it today.

And how did the tradition get out of Germany?

Lang's business collapsed as a result of the Second World War. But another man called Richard Selma launched a business after 1945 and he really took it international. He made a lot of very, very good connections with American buyers, trade fairs, he was friends with a lot of political leaders who came to his publishing house in Stuttgart. And in fact, Selma Verlaug is still probably the biggest exporter of Advent calendars in the world, shipping millions of them to 30 countries. Now, the Advent calendar was clearly too good a thing to waste just on children. Grown ups wanted to get into it too. And now you start to see things building up.

How do you mean?

There was a poll last year which said half the adults in Britain were going to get a luxury advent calendar. 6% of them opted for little doors producing alcohol. 7% choose foods other than chocolate. Then there's Wedgwood china tree decorations. Company called Love Honey makes adult gifts for the adult Advent calendar to make that run up to Christmas just a bit more exciting. And if that's still too low key, Beaver Brooks, a British jeweller, has a diamond a day Advent calendar yours for £100,000. Only Liberty has an Advent calendar with beauty products for that special person in your life. They say it's the fastest seller in their 145 year history with items worth almost £800.

So it sounds as if we are in some sort of Advent calendar arms race here.

Well, you know, the funny thing is.

That I think the tide may be turning because Covid increased awareness of environmental impact. The great big move in to the Advent calendar as a marketing thing seems now really to be about sustainability rather than lavish. People are making their own Advent calendars, hand sewing little pockets, little jars of sweets and jams and biscuits. And I've even seen Advent calendar on Twitter from a publisher who puts up a new book every single day.

And so amid all of this variety, what have you settled on? What kind of Advent calendar do you have?

Well, I think I'm going to have a very cool yule this year. I've found two things. Occitane, which is a French maker from Provence of bath stuff. There's as much as you could possibly have, having a new kind of hot bath every single night. And then my absolute favorite from OTO is a CBD oil calendar made from marijuana. Mon bong for your buck, I call it.

Well, keeping it chill this Christmas. Fiametta, thank you very much for your time.

Thank you, Jason.

That's all for this episode of the Intelligence. If you like us, give us a rating on Apple Podcasts and you can subscribe to the economist@examiner.com intelligence offer. The link is in the show Notes. See you back here tomorrow.