7 ms·

Listening to the panel, I was struck by how big the gaps are in our knowledge of the vaccine. For instance, members of the panel raised the following issues: 1

Listening to the panel, I was struck by how big the gaps are in our knowledge of the vaccine. For instance, members of the panel raised the following issues: 1. We still haven't been able to correlate antibody titers to protection. 2. The vaccine's effects on transmission are not clear. 3. It seems there is virtually no meaningful data on memory B and T cell responses even though we know this is a critical part of immunity. Even more striking to me was how weak Pfizer's presentation/argument for a 3rd booster was.

mschuster91 5y ago
> I was struck by how big the gaps are in our knowledge of the vaccine. Most of what you describe is not just "knowledge of the vaccine", it's "knowledge about how immune systems actually work". For example, we still have no certain knowledge about how measles manages to wipe out your immune system. Most of medicine is (although often very good!) guesswork. > 2. The vaccine's effects on transmission are not clear. Indeed, but the vaccine's effects on infection are clear. Less infected people automatically means less people transmitting the virus.
- LurkingPenguin 5y ago
  Did you even listen to the panel? You seem to be casually dismissing issues that the members themselves raised.
  - mschuster91 5y ago
    The issues described (or rather, the lack of knowledge that is at the bottom of these issues) are not new, they are true for many, many forms of medicine we use today. ffs we don't even know how exactly virtually all medicine used in treatment of mental illnesses such as schizophrenia and depression work - most medical treatments consist of trying all available candidates and varying the dosage until you find a somewhat effective one - and yet we accept this lack of knowledge. As for what this means for vaccines: It is by now widely accepted that a vaccination drastically reduces the effects of a COVID19 infection and all but eliminates the risk of fatal outcomes and that in billions of people vaccinated by billions of doses of various vaccines the side effects were negligibly small, and it is widely accepted that even in young healthy people, COVID19 can cause severe, even long-term cases. Therefore, the potential risks of vaccination are nowhere near as risky as risking the infection with the actual pathogen.
    - LurkingPenguin 5y ago
      > As for what this means for vaccines: It is by now widely accepted that a vaccination drastically reduces the effects of a COVID19 infection and all but eliminates the risk of fatal outcomes and that in billions of people vaccinated by billions of doses of various vaccines the side effects were negligibly small, and it is widely accepted that even in young healthy people, COVID19 can cause severe, even long-term cases. Therefore, the potential risks of vaccination are nowhere near as risky as risking the infection with the actual pathogen. The vaccination discussion you're trying to have has already been settled. The panel was not revisiting the approved 2-dose course. It was considering the benefits and risks of a third (booster) jab for individuals aged 16 and above. If you had listened to the panel, you'd understand the vote: there is not enough data at this time to conclude that the benefits outweigh the risks for a booster in such a broad group.
- WalterBright 5y ago
  It also seems patently obvious that in order for the vaccinated immune system to destroy the virus, one must first have the virus in the body, i.e. be infected with the virus. This will take a non-zero amount of time. Hence, a vaccinated person can in the interim test positive for the virus, even if the vaccine protection is working perfectly fine.
  - Throwawayaerlei 5y ago
    Not necessarily so from what I've read about neutralizing antibodies. You'll only have a lot of them for a while after an exposure, but if they latch onto, in this case, every spike protein on the surface of a SARS-CoV-2 virus, the virus will never get a chance to infect a cell. Antibodies latched onto surface proteins can also stick to each other and form clumps that limit or eliminate the ability to infect. Otherwise you're correct as far as I know, the other mechanisms of the adaptive immune system only come into play once cells get infected. But there might not be very many of them, perhaps not enough for a RT-PCR test to find.
heisenbit 5y ago
The immune system is a curious thing. There is e.g. a vaccine against pneumonia but you my doctor explained to me that you can only get it once in your life. There is another one which is not as good so you may get that some years later. The recommendation is - at least here in Germany - to take the vaccine only once you are older and have a higher hospitalization (and with it associated infection) risk. Clearly a booster would reduce infections but that effect probably is dwarfed by vaccinating the un-vaccinated. Rolling out a booster across a large population takes resources (and the health sector is running very, very low on resources - Idaho gave up on normal standards of care now). The question is also what is the impact of the booster on medium term development, medium term options and vaccination discipline of the general population. We also lack understanding of Pfizer vs. Moderna stats. Then the is the lack of understanding what repeated short term boosting does - it is not typically done. And last but not least the question is what is the best strategy to deal with the threat of new variants emerging. Reducing infections in the US will help reduce the chance for a concerning variant to emerge but possibly these resources are better spent fighting the virus globally as these variants tend not to stay in one place only. Pushing for a quick approval and rollout for the first vaccine was a relatively clear cut risk - benefit trade-off. There are risks with the booster (small but there are with any medicine) and the benefit is vastly smaller. The trade-off is different and we should not pressure experts to come to conclusions on a shortened timeline.
- trident5000 5y ago
  This is just getting ridiculous. Get everyone who wants it the vaccine and then drop the distancing measures and masks so heard immunity builds and repeat exposure keeps peoples immune system responsive to it in perpetuity. Pharma companies are going to push boosters forever as they make money on it. downvote this all you want and tremble in your basement with the blinds closed but this is how we move past this.
  - jasonlaramburu 5y ago
    >Get everyone who wants it the vaccine Presumably this has already occurred. COVID daily death rates in the US are on track to meet or exceed the previous all time high. It is undeniable at this point that the vaccine effectively eliminates the possibility of death from COVID-19, so there are presumably still many Americans without protective immunity. Government should do everything to get people vaccinated and prevent needless death. >heard [sic] immunity builds and repeat exposure keeps peoples immune system responsive to it in perpetuity This does not seem to be an accurate understanding. I know of many people who contracted COVID-19 during the alpha wave, declined vaccination thinking they had protective immunity, and then contracted Delta with severe symptoms a year later. >this is how we move past this. How do you figure? If we don't get more people vaccinated, deaths will continue to accelerate. There is also no known protective immunity better than vaccine + infection.
nradov 5y ago
In March 2021 the FDA authorized the Adaptive Biotechnologies T-Detect test which assays one aspect of memory T cell responses. It's disappointing that most recent studies still aren't routinely using that test in combination with PCR and antibody tests. It could give us a more complete picture of population immunity levels and changes following infection or vaccination. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-adaptive-biotechnologies-t-detect-covid-test https://www.fda.gov/news-events/press-announcements/coronavi...
oezi 5y ago
Sometimes I wish the experts would not just talk about their desire to know more, but also considering the consequences of taking or not taking chances. For example there wasn't enough data to support giving AZ to elderly people, which made Germany not give it to elderly people, which turned out doubly bad: AZ works in older people, but is more dangerous in younger ones (well 1 in 100.000 dead dangerous). This likely cost us something like 5.000 to 10.000 of our 90.000 deaths. In hindsight waiting for phase 3 trials on the vaccines similarly cost so many lives around the world it seems crazy now. Could we have prevented some of the last fall wave? Boosters seem to be in a similar position. If you have the guts (like Israel) to take a chance as a society you might save another 1 life per 2.000 to 10.000 this fall.
- arcticbull 5y ago
  This is the psychology of prison reform. You don't want to be the elected official who's responsible for one released prisoner killing someone so you lock up all the prisoners forever. [edit] it's also the psychology of investing in infrastructure for your software project. It's impossible to count the set of things that didn't happen because of your work. It's much easier to count the set of negative things that did happen as a result of your not doing that work.
  - oezi 5y ago
    But we want prison reform. We should demand it rather than letting politicians hide behind status quo in-action. Right? Investing software quality is a goos example because we all know the trade-off between perfect software and launching with bugs. The conversation with vaccines in the epidemic has been too much looking for perfection.
    - arcticbull 5y ago
      Agreed, it's been a lot of demanding perfection from vaccines in case there's some nebulous potential harm - a feeling we can never assuage - while allowing the virus with known, realized, actual harm run rampant. I still hear people talk about how they don't want the vaccine "because it hasn't been studied enough" when it's literally been given almost six billion times.

mschuster91 5y ago

> I was struck by how big the gaps are in our knowledge of the vaccine. Most of what you describe is not just "knowledge of the vaccine", it's "knowledge about how immune systems actually work". For example, we still have no certain knowledge about how measles manages to wipe out your immune system. Most of medicine is (although often very good!) guesswork. > 2. The vaccine's effects on transmission are not clear. Indeed, but the vaccine's effects on infection are clear. Less infected people automatically means less people transmitting the virus.

LurkingPenguin 5y ago
Did you even listen to the panel? You seem to be casually dismissing issues that the members themselves raised.
- mschuster91 5y ago
  The issues described (or rather, the lack of knowledge that is at the bottom of these issues) are not new, they are true for many, many forms of medicine we use today. ffs we don't even know how exactly virtually all medicine used in treatment of mental illnesses such as schizophrenia and depression work - most medical treatments consist of trying all available candidates and varying the dosage until you find a somewhat effective one - and yet we accept this lack of knowledge. As for what this means for vaccines: It is by now widely accepted that a vaccination drastically reduces the effects of a COVID19 infection and all but eliminates the risk of fatal outcomes and that in billions of people vaccinated by billions of doses of various vaccines the side effects were negligibly small, and it is widely accepted that even in young healthy people, COVID19 can cause severe, even long-term cases. Therefore, the potential risks of vaccination are nowhere near as risky as risking the infection with the actual pathogen.
  - LurkingPenguin 5y ago
    > As for what this means for vaccines: It is by now widely accepted that a vaccination drastically reduces the effects of a COVID19 infection and all but eliminates the risk of fatal outcomes and that in billions of people vaccinated by billions of doses of various vaccines the side effects were negligibly small, and it is widely accepted that even in young healthy people, COVID19 can cause severe, even long-term cases. Therefore, the potential risks of vaccination are nowhere near as risky as risking the infection with the actual pathogen. The vaccination discussion you're trying to have has already been settled. The panel was not revisiting the approved 2-dose course. It was considering the benefits and risks of a third (booster) jab for individuals aged 16 and above. If you had listened to the panel, you'd understand the vote: there is not enough data at this time to conclude that the benefits outweigh the risks for a booster in such a broad group.
WalterBright 5y ago
It also seems patently obvious that in order for the vaccinated immune system to destroy the virus, one must first have the virus in the body, i.e. be infected with the virus. This will take a non-zero amount of time. Hence, a vaccinated person can in the interim test positive for the virus, even if the vaccine protection is working perfectly fine.
- Throwawayaerlei 5y ago
  Not necessarily so from what I've read about neutralizing antibodies. You'll only have a lot of them for a while after an exposure, but if they latch onto, in this case, every spike protein on the surface of a SARS-CoV-2 virus, the virus will never get a chance to infect a cell. Antibodies latched onto surface proteins can also stick to each other and form clumps that limit or eliminate the ability to infect. Otherwise you're correct as far as I know, the other mechanisms of the adaptive immune system only come into play once cells get infected. But there might not be very many of them, perhaps not enough for a RT-PCR test to find.

heisenbit 5y ago

The immune system is a curious thing. There is e.g. a vaccine against pneumonia but you my doctor explained to me that you can only get it once in your life. There is another one which is not as good so you may get that some years later. The recommendation is - at least here in Germany - to take the vaccine only once you are older and have a higher hospitalization (and with it associated infection) risk. Clearly a booster would reduce infections but that effect probably is dwarfed by vaccinating the un-vaccinated. Rolling out a booster across a large population takes resources (and the health sector is running very, very low on resources - Idaho gave up on normal standards of care now). The question is also what is the impact of the booster on medium term development, medium term options and vaccination discipline of the general population. We also lack understanding of Pfizer vs. Moderna stats. Then the is the lack of understanding what repeated short term boosting does - it is not typically done. And last but not least the question is what is the best strategy to deal with the threat of new variants emerging. Reducing infections in the US will help reduce the chance for a concerning variant to emerge but possibly these resources are better spent fighting the virus globally as these variants tend not to stay in one place only. Pushing for a quick approval and rollout for the first vaccine was a relatively clear cut risk - benefit trade-off. There are risks with the booster (small but there are with any medicine) and the benefit is vastly smaller. The trade-off is different and we should not pressure experts to come to conclusions on a shortened timeline.

trident5000 5y ago
This is just getting ridiculous. Get everyone who wants it the vaccine and then drop the distancing measures and masks so heard immunity builds and repeat exposure keeps peoples immune system responsive to it in perpetuity. Pharma companies are going to push boosters forever as they make money on it. downvote this all you want and tremble in your basement with the blinds closed but this is how we move past this.
- jasonlaramburu 5y ago
  >Get everyone who wants it the vaccine Presumably this has already occurred. COVID daily death rates in the US are on track to meet or exceed the previous all time high. It is undeniable at this point that the vaccine effectively eliminates the possibility of death from COVID-19, so there are presumably still many Americans without protective immunity. Government should do everything to get people vaccinated and prevent needless death. >heard [sic] immunity builds and repeat exposure keeps peoples immune system responsive to it in perpetuity This does not seem to be an accurate understanding. I know of many people who contracted COVID-19 during the alpha wave, declined vaccination thinking they had protective immunity, and then contracted Delta with severe symptoms a year later. >this is how we move past this. How do you figure? If we don't get more people vaccinated, deaths will continue to accelerate. There is also no known protective immunity better than vaccine + infection.

nradov 5y ago

In March 2021 the FDA authorized the Adaptive Biotechnologies T-Detect test which assays one aspect of memory T cell responses. It's disappointing that most recent studies still aren't routinely using that test in combination with PCR and antibody tests. It could give us a more complete picture of population immunity levels and changes following infection or vaccination. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-adaptive-biotechnologies-t-detect-covid-test https://www.fda.gov/news-events/press-announcements/coronavi...

oezi 5y ago

Sometimes I wish the experts would not just talk about their desire to know more, but also considering the consequences of taking or not taking chances. For example there wasn't enough data to support giving AZ to elderly people, which made Germany not give it to elderly people, which turned out doubly bad: AZ works in older people, but is more dangerous in younger ones (well 1 in 100.000 dead dangerous). This likely cost us something like 5.000 to 10.000 of our 90.000 deaths. In hindsight waiting for phase 3 trials on the vaccines similarly cost so many lives around the world it seems crazy now. Could we have prevented some of the last fall wave? Boosters seem to be in a similar position. If you have the guts (like Israel) to take a chance as a society you might save another 1 life per 2.000 to 10.000 this fall.

arcticbull 5y ago
This is the psychology of prison reform. You don't want to be the elected official who's responsible for one released prisoner killing someone so you lock up all the prisoners forever. [edit] it's also the psychology of investing in infrastructure for your software project. It's impossible to count the set of things that didn't happen because of your work. It's much easier to count the set of negative things that did happen as a result of your not doing that work.
- oezi 5y ago
  But we want prison reform. We should demand it rather than letting politicians hide behind status quo in-action. Right? Investing software quality is a goos example because we all know the trade-off between perfect software and launching with bugs. The conversation with vaccines in the epidemic has been too much looking for perfection.
  - arcticbull 5y ago
    Agreed, it's been a lot of demanding perfection from vaccines in case there's some nebulous potential harm - a feeling we can never assuage - while allowing the virus with known, realized, actual harm run rampant. I still hear people talk about how they don't want the vaccine "because it hasn't been studied enough" when it's literally been given almost six billion times.