People are making fun of President Trump for insistently thinking that a vaccine for the new coronavirus can be put out quickly, but as entertaining as it can be to make fun of politicians who are out of their depth in a highly technical area, the man has a point. A more constructive conversation might have gone like this:

President: So what takes so long? People have candidate vaccines already, so what actually would you be doing during that year that you're telling me is necessary to get a vaccine out?

Official: That's for testing the vaccine to make sure it's safe and efficacious. It's what our rules require.

President: What if we waived some of those rules? I mean, they're telling me this new virus might kill millions.

Official: Well, the rules are there for a reason. Vaccines can have bad side effects. In 1976, the flu vaccine put hundreds of people in the hospital with Guillian-Barré syndrome, after a big scare over the swine flu.

President: Guillian-Barré syndrome? How bad is that?

Official: It paralyzes you. It's an autoimmune attack on the nerves, brough on by the vaccination. It still happens very occasionally with current vaccines, though that old swine flu vaccine was particularly bad. Patients usually recover, but they are incapacitated for weeks, and many die.

President: So did they withdraw the vaccine?

Official: No, they kept on vaccinating with it. Those hundreds of people are only a tiny fraction of the tens of millions who were vaccinated.

President: Seriously? Look, they're telling me this new virus kills something like four percent of the people it infects. And it seems like it's out of control, spreading rapidly. Even people with no symptoms can spread it, they tell me. Just a few weeks more of exponential growth, and we might be looking at millions dead.

Official: Well, we still might be able to muddle through. Yes, there seems to be some spread from asymptomatic people, but it's people coughing up a storm who are the main spreaders. And that four percent is the high end of the estimates; it might be less than one percent. Also, we can expect the virus to mutate to a lower lethality, since people who have mild cases won't seek treatment while people with bad cases will be hospitalized and their contacts quarantined. This is an RNA virus, so it has a high rate of mutation. Also, warm weather is coming soon, and that'll probably lower the rate of transmission. And remember, we're going to be blamed for all the bad side effects of a vaccine, especially if it's completely successful and puts a halt to the epidemic: people won't realize how bad it could have been.

President: That still seems better to me than being thought of like Nero, who fiddled while Rome burned. Even if the lethality goes down to half a percent, that's still maybe a million Americans dead. Tell me again what exactly you'd be doing during that year.

Official: Well, the thing that takes the longest are the clinical trials. Placebo-controlled double-blind trials are the gold standard of evidence in medicine.

President: Don't you realize this nation went off the gold standard a long time ago? And do you think I ever have a placebo-controlled double-blind trial to tell me how to make a decision? Look, I want you to go back to the office and get your people to spend two days preparing a list of the ways we might accelerate this. You're telling me a year; I want every option from that down to a week. Yes, I know you're not going to formally approve anything in a week; I'm talking about getting it out there on an experimental basis, with continual monitoring. And probably more than one candidate vaccine at once, since I figure most of them won't work. Oh, and for each option for the timescale, give me a scientific wild-ass guess as to its risks: tell me how many people would probably die or be crippled from side effects, versus how many it'd probably save.

Official: Okay, will do. If we had to take responsibility for this ourselves we'd still say a year, but if you're willing to fly top cover for us, that changes things.


(Of course people are never really that eloquent in offhand conversation; really I'd expect a half hour of considerably more confused talk, of which the above would just be the gist. And as usual in theatrical conversations, I've made them say some things out loud that would really be left unsaid, such as the last sentence.)