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This is a really good article on the immune system. One thing I can't help but notice though is that it only barely skirts the fact that essentially no viral v

This is a really good article on the immune system. One thing I can't help but notice though is that it only barely skirts the fact that essentially no viral vaccine prevents infection, with the possible exception of the HPV vaccine. The vast majority of the vaccines we currently use allow infection but give the body the ability to quickly respond to and end the infection before it leads to severe disease (eg paralysis in Polio or B-cell destruction in Measles). For slowly developing viruses you may see no symptoms at all because the body is able to clear the infection but for viruses like flu and Sars-CoV-2 that attack the respiratory system it's much more difficult to prevent symptomatic disease. Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease but that is an incredibly high bar that no respiratory viral vaccine has ever met. The benefit of the vaccines is that they greatly reduce severe disease, almost eliminate death, and shorten the amount of time the virus has to reproduce so transmission and variant generation are also reduced.

nsxwolf 5y ago
Chicken pox vaccine works so well that no one gets a single sore.
Jtype 5y ago
So then no other vaccines have led to or provided herd immunity?
- gameswithgo 5y ago
  It is just a nuanced semantic distinction. You are immune in the sense that you never notice the virus (in some cases) or have no severe impacts (in others). But you are (never?) immune in the sense that you literally never have the virus replicate in you at all. I am reminded of the recent twitter thread posted here by Dan Luu about how communicating nuance at scale is impossible.
  - rich_sasha 5y ago
    I thought a big part of the tragedy of the measles vaccine rates dropping is precisely that we’re losing herd immunity. At 95%+ immunised outbreaks ought not occur because herd immunity, even for the remaining unvaccinated, whereas at the lower levels, outbreaks will likely happen. Is that not right?
    - Retric 5y ago
      Herd immunity is a function of transmission not individual infection. Faster and stronger immune responses reduce the number of viruses produced inside someone over an infection. That directly means they are less likely to infect other people. Herd immunity is effectively a function of how infections something is. 1 case leading to 2 cases on average means you need to cut transmission in 50%. 1 case leading to 10 cases and you need to block 90% of new cases. Critically this means vaccinated people can still be infectious as long as they infect less than 1 person on average you can reach herd immunity.
    - stonemetal12 5y ago
      That is right. It is just immunity as a term in the medical community vs average joe use of the word. Medical community immunity means your immune system fights off the invaders before anything medically interesting happens, not that you have a magical force field that prevents entry. Not sure why people are trying to twist that into some sort of insidious plot. If you have the measles vaccine and you get exposed to measles, measles will be in your body for a short time in low quantities, but your immune system will quickly destroy it. That means you are unlikely to pass it on or develop symptoms.
      - rich_sasha 5y ago
        Ok makes sense. But is that different then to vaccines against bacterial diseases? If some bacteria enter my body, surely they don’t magically disappear either, maybe split a few times but eventually die off.
  - rhino369 5y ago
    I would say this distinction is often just a semantics argument designed to calm the public. In common usage, it means you won't have a significant infection that becomes contagious. The vast majority of vaccines are successful at preventing that type of infection for a long time. Though there are exceptions. By defining "infection" so broadly it loses all meaning, some officials are trying lump to the covid vaccines (which are no longer very good at preventing contagious infections) with vaccines that prevent contagious infection for decades. Obviously, the effectiveness of vaccines is nuanced and their effectiveness at preventing contagious spread is a spectrum--not a binary. Public health officials should just be straight with us. The vaccines aren't as good as some of the vaccines we all get--like measles--but they do provide a great deal of protection. It's still basically a miracle that we got the protection we did in about a year after the virus appeared. It's a huge success.
- monocasa 5y ago
  If it can't replicate as well in you, you significantly reduce the ability for it to spread via you typically. Herd immunity fro that perspective is about reducing spread to the point that outbreaks don't spread from local groups because the R value is low enough, even taking into account the few people who can't be immunized.
- kaitai 5y ago
  Evaluate the statements above with respect to measles or polio, as the parent poster points out. It is clear that measles and polio vaccines can lead to "herd immunity", while preventing severe side effects of these diseases in the majority of cases. The point is there is a range of infection mechanisms for viruses (respiratory vs other, for starters) and vaccines thus provide benefit at different points in the infection process. This leads to heterogeneity in "infection level" and symptomaticity in the vaccinated population.
- deleted 5y ago
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superkuh 5y ago
>an incredibly high bar that no respiratory viral vaccine has ever met. An incredibly high bar that no intramuscular (humoral) respiratory viral vaccine has met. Mostly because injecting into the muscle does not lead to tissue resident immune cells in the upper respiratory mucosa because it's a separate immune compartment from the body serum. But there are options like intranasal boosters after intramuscular vaccination that can prevent infection and do significantly reduce shedding and spread. And it's been driving me crazy the entire pandemic that intranasal spray vaccine boosters are not being heavily funded and persued. It would save the world so many lives, time, and incalculable money.
- qzw 5y ago
  Any idea (or sources) why they are not being pursued? And why are flu vaccines not commonly given as intranasal spray?
  - inglor_cz 5y ago
    I think there is some concern of intranasally applied substances getting into the brain. Even plain water infested with certain amoebas can give you a fatal brain disease if you use it for nasal irrigation. It is perfectly safe for drinking, though. https://www.healthywa.wa.gov.au/Articles/N_R/Nasal-irrigation-is-it-safe https://www.healthywa.wa.gov.au/Articles/N_R/Nasal-irrigatio... We do not have that amoeba here, but I still boil the water and cool it down before using it to flush my nose. (Works great against mild common colds.) One of the worst outbreaks in the world actually happened in Czechoslovakia 60 years ago - 16 people died after being infected in a public swimming pool.
    - maxerickson 5y ago
      There's an approved nasal vaccine in the United States (FluMist). It's use was not encouraged for a while because it didn't vaccinate against H1N1 (recent years have included H1N1). It doesn't look to be particularly more effective than the shot (marketing focuses on no shot, not on it working better; the CDC says the effectiveness is similar). There's multiple candidate intranasal SARS-CoV-2 vaccines, just none that have concluded trials.
cloutchaser 5y ago
I think we should thank whatever god that so far it seems we didn't end up with a Marek's disease type situation. I don't know how much of a guarantee there was about this with covid, but if the vaccine would have promoted a much more aggressive virus we could have ended up in a situation where any unvaccinated human will basically die (this happens in chickens, see: https://en.wikipedia.org/wiki/Marek%27s_disease https://en.wikipedia.org/wiki/Marek%27s_disease). I sincerely hope the people who devised this vaccine know what they are doing. As far as I know (according to a Katalin Kariko inteview), the Sars-Cov-2 spike protein can't mutate too much without limiting it's effectiveness, so therefore this vaccine should theoretically work in the future. But that Marek's disease issue is very very scary to me.
- r00fus 5y ago
  DOesn't the problem with Marek's disease have more do do with the horrendous conditions of poultry handling worldwide (mainly close confines)? I don't think that's generally transferrable situation unless you consider humans to be under similar conditions.
- isoprophlex 5y ago
  Well... that was an unsettling read. > The evolution of Marek's disease due to vaccination has had a profound effect on the poultry industry. All chickens across the globe are now vaccinated against Marek's disease (birds hatched in private flocks for laying or exhibition are rarely vaccinated). Highly virulent strains have been selected to the point that any chicken that is unvaccinated will die if infected.[14] Other leaky vaccines are commonly used in agriculture. One vaccine in particular is the vaccine for avian influenza. Leaky vaccine use for avian influenza can select for virulent strains.[15] Wonderful. Like H5N1, which has a 60% mortality in humans.
  - collegeburner 5y ago
    I remember it was discussed months ago on HN when early on in vaccines roll out, somebody raised this concern but the consensus was the vaccines mostly prevented infection so not a big worry ¯\_(ツ)_/¯
rbancroft 5y ago
The bar is being set high for these vaccines because they are being pushed and mandated with very exaggerated justification, that they will end the pandemic. Rational people will agree that there are significant benefits to the vaccine, but I don't believe there is any evidence to suggest that these vaccines will get us to an end state where the virus is no longer circulating. If you want people to go along with a medical intervention, state clearly the expected outcome and don't move the goalposts when the data changes. If the data is strong, you most likely wouldn't need mandates to convince people.
- amanaplanacanal 5y ago
  Where I live, the goalposts are exactly the same as they were two years ago: don’t let the health care system get overwhelmed. I have no idea what your politicians have been telling you.
  - JacobThreeThree 5y ago
    >the goalposts are exactly the same as they were two years ago Shouldn't the politicians have made progress on this issue over the course of two years? At what point is it incompetence or corruption, if the billions being spent to fight the pandemic make zero discernable impact on the most critical issue?
    - thfuran 5y ago
      >Shouldn't the politicians have made progress on this issue over the course of two years? What do you mean? Should they should magically cause the number of doctors and hospitals to double inside two years? >if the billions being spent to fight the pandemic make zero discernable impact on the most critical issue? What leads you to believe that measures such as pushing vaccination haven't been having tremendous impact on that issue?
      - JacobThreeThree 5y ago
        >What leads you to believe that measures such as pushing vaccination haven't been having tremendous impact on that issue? Do you believe that health care systems are currently overwhelmed by COVID?
pibechorro 5y ago
All true, but this was not what was sold to the general public. Had people been informed that the latest vaccines against COVID-19 behaved similarly to rhe seasonal shots people get for regular flue season, a vast majority of the public would have opted out, as they do with the seasonal versions. This was further compounded by the aggressive dismissal and censorship of natural immunity and preventive care (good diet, exercise, vitamins, etc). We are here today because the obvious was politicized.
- jahnu 5y ago
  > the aggressive dismissal and censorship of natural immunity who agressively dismissed this?
  - twofornone 5y ago
    Your friendly neighborhood fact checkers who suppress virtually anything which could justify opposition to vaccine mandates. Including news media.
  - HWR_14 5y ago
    I angrily dismiss it. It's a nonverifiable bullshit excuse to avoid a needle prick. Tests have some error, it's unclear if you got a sufficient dose, spaced exposures are better, the vaccine has shown better variant resilience, choose your reasons. If you haven't gotten a vaccine, I don't care if you've had COVID or not. Either way you should get a shot. It might be different if there were any cost to it. But there isn't. So invariably the people bitching about natural immunity are just doing it to make a point, usually political.
    - jahnu 5y ago
      I agree people should get the shot. It's so amazingly clear that it's effective at helping your immune system to fight the virus quicker. But the CDC did announce that since delta people who recovered from an infection have better immune response than those who are only vaccinated. I asked the OP to clarify because there is false information out there that this fact is being suppressed "aggressively" when in fact the CDC announced it!
lamontcg 5y ago
> This is a really good article on the immune system. I still don't particularly like it that much. None of this should be all that new. There were plenty of knowledgeable people saying all along that sterilizing nutralizing immunity in the mucosa was unlikely to be achievable for a vaccine against a respiratory virus that most commonly had no viremic phase, particularly as a shot given in the arm. They were also saying that T-cells were the important thing to prevent disease and death and we shouldn't be focusing on preventing infection. Some other people who debated or disagreed with that perspective are now suddenly learning novel new things about the immune system. There's a good chunk of experts out there that were saying this all along though (if you were listening to them and not the headlines and blogs and twitter).
- Vrondi 5y ago
  You are quite right, but the media, the government, and many public health agencies have been ignoring this, focusing solely on antibody levels, and trying to keep them constantly high through ever more panicky calls for more and more boosters. For everyone, regardless of prior infection.
  - f6v 5y ago
    Because some times you have to make a call. Some studies are now revealing that booster shots might be less effective in those who recovered (watched a guy present his unpublished data the other day). But it’s not that obvious.
  - kurthr 5y ago
    This is for two reasons: One, measuring antibodies is MUCH easier than measuring T or B cell response. This is especially true early on in the pandemic, if you want to measure representative numbers of people, and you don't know when/whether they will be exposed or catch COVID (due to masking/lockdowns etc). Two, when your problem is that the hospitals are filling up and you're facing a labor shortage for some essential workers for a a few months... then boosting antibodies for 4-6 months to reduce retransmission rates and minimizing symptomatic cases makes a lot of sense.
deleted 5y ago
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dbroockman 5y ago
This is a rewriting of history. Before we ever had results from the COVID vaccine trials, the FDA declared that the primary goal of the trials was to prevent any symptomatic infection in the first place. From June 2020: https://www.fda.gov/media/139638/download https://www.fda.gov/media/139638/download.
- standardUser 5y ago
  Sure, and Viagra was developed to treat hypertension. The fact that efficacy data changes with the completion of new studies or advent of new strains should be viewed as normal, not as a surprise or some kind of bait and switch.
- notahacker 5y ago
  I'm not sure linking to a document with phrases like "As it is possible that a COVID-19 vaccine might be much more effective in preventing severe versus mild COVID-19" really proves that it's "rewriting history" to suggest that preventing all infections or symptomats of a respiratory diseases is an very high bar to set, or that the medical profession hasn't been cognizant of that from the start...
tomp 5y ago
> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease but that is an incredibly high bar that no respiratory viral vaccine has ever met. So what you're saying that Fauci, Pfizer etc. weren't just wrong about the vaccine ("if you get it you won't get sick" a.k.a. "science has changed as we've learned more facts") but actively lied about it (after all, they of all people should know that no other vaccine succeeded in that for respiratory viruses).
- kodah 5y ago
  I don't think we can use terms like "lie" with respect to the pandemic yet, because full post-facto analysis is not done yet. That analysis isn't just on people's words, it's on their relationships to other people, entities, etc... You also have to determine what they "know" during a given time. I'm fully supportive of holding government officials accountable, especially if they've enacted their own agenda, but there's a time and place for such things as well as a path to proving them.
- nradov 5y ago
  If you look back at the actual press releases and research studies that Pfizer and BioNTech published about their Comirnaty vaccine, they never specifically claimed that it would reliably prevent infection. It was the politicians like Fauci who made false claims not backed by reliable science. (And to be clear, I still recommend that everyone eligible get vaccinated as it's fairly effective at preventing severe symptoms.)
toolz 5y ago
> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease There's a laundry list of public health officials (including the CDC director, to give a sense of the authority on this list) that said it would prevent infection and transmission. So it really shouldn't surprise anyone that there were expectations that the vaccine would do what public health authorities said it would do.
- thatguy0900 5y ago
  It's kind of funny how fast people forget what was originally talked about when the goalposts moved.
  - toolz 5y ago
    Yep, I find it quite reprehensible how quickly politicians (the ones in public health and elected leaders) pivoted from "the vaccine will end the pandemic" into "this is the un-vaccinated peoples fault". I guess politically they had to throw the minority group under the buss to keep the attention off of their own failures. It worked though, I have had people tell me I'm disgusting more than once for not being vaccinated. Nevermind that I've had covid twice, am young and in very good health, have been taking vitamin A/D since 2020 and have high levels of sufficiency of both. It appears I'm the bad guy because I would rather a 75 year old in a poor country have my doses of vaccines than take it just because I'm being pressured into it. I'm not sure many liberals survived this pandemic, at least not vocally. I feel truly bad for any minorities that really shouldn't take the vaccine for medical conditions. I know for a fact there are doctors who have recommended against taking the vaccine because of preexisting conditions but wouldn't write a doctors note for fear of losing their license. I'm actually missing out on a vacation in Cali right now with the partners family because I'm afraid I'll get a positive PCR test and ruin it for them (since they require tests or vaccine cards most places, as I understand it)
    - clairity 5y ago
      > "I'm afraid I'll get a positive PCR test and ruin it for them (since they require tests or vaccine cards most places, as I understand it)" CA is batshit crazy over covid for mediopolitical reasons, but at least here in LA, you can easily flash anything in front of most restaurant/retail workers and they won't even read it if it looks even halfway legit (there's too much variation in vaccine cards and test results for them to be experts anyway). some places, like disneyland, will be a little more diligent though. so while folks still wear masks outdoors like cargo culters, most people don't care enough to do more than go through the motions.
draw_down 5y ago
jmckib 5y ago
I'm confused. Weren't covid mRNA vaccines very effective at preventing infection, even asymptomatic infection, against delta and earlier variants? Only with omicron has the effectiveness been significantly reduce, but not to zero. And once we come up with a variant-specific vaccine, I would expect the effectiveness to go up again.
- jdrc 5y ago
  The efficiency of vaccines for infection fell by 50% in 4 monts even for delta and other variants. Their effectiveness with omicron infection is very little. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02183-8/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
  - jmckib 5y ago
    50% effectiveness against infection is still pretty significant. And note that OP said "essentially no viral vaccine prevents infection." I think we can agree that is not the case.
  - r2_pilot 5y ago
    I've been exposed twice with known-omicron and have not gotten sick yet. YMMV.
- Izkata 5y ago
  No, they were very effective at preventing symptomatic covid. This can mean either preventing infection or not preventing infection but just stopping symptoms. The trials that came up with that 94% efficacy never tested for which of these two outcomes it was, and it turns out it was mostly the second one, which allows for asymptomatic spreading.
  - jmckib 5y ago
    No, the vaccines were very effective at preventing any infection, both symptomatic and asymptomatic. There were studies done by giving the participants regular covid tests, usually once a week, so they would catch asympomatic cases as well. Here are the conclusions from a meta-study from July 2021: > In fully vaccinated individuals, VE against symptomatic and asymptomatic infections was 80–90% in nearly all studies. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8284046/ https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8284046/
ls15 5y ago
> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease but that is an incredibly high bar that no respiratory viral vaccine has ever met. This is only an incredibly high bar if all you ask for is a tool to mitigate personal risk. If you want to make the use of that tool mandatory, then it is a reasonable bar, and there are additional other bars that are also very high.
sgustard 5y ago
> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection The original announcements from Pfizer et al touted the 90-95% effectiveness of the vaccines against infection (and 95-100% against severe infection). The idea that vaccines prevented most infection was literally part of their testing and marketing from the start. The wild card was Delta & Omicron not complying with those numbers, not that people shared some mass delusion.
- nsxwolf 5y ago
  I was very enthusiastic about the vaccine and couldn’t wait to get it. I didn’t believe I had any real chance of dying, I just didn’t want to get sick with it and was ecstatic about not having to wear masks. If the vaccine had come out of the gates as something to just prevent death, I would not have been so enthusiastic or motivated.
- maxdj 5y ago
  None of the phase 3 trials measured protection against infection, and none of the press releases mention infection, see Pfizer’s original results: https://www.businesswire.com/news/home/20201118005595/en/ https://www.businesswire.com/news/home/20201118005595/en/ I think confusion comes from the use of “COVID-19” which is not a virus or infection specifically but a disease caused by sars-ncov2 infection. If you have an asymptomaic infection, you don’t have COVID-19.
  - defaultname 5y ago
    The trials would have had to have tested every participant daily to qualify protection against infection. However it was most certainly presumed, and the entire narrative around the vaccine push was achieving herd immunity: when enough people were unlikely to shed viruses in any likely transmissive volume because of achieved immunity (whether via vaccine or previous infection), transmission would trickle to an almost halt and life would return to normal. This wouldn't require 100% coverage, nor a 100% effective vaccine (no vaccine has ever been 100% effective, or so-called "sterilizing") to accomplish. There is a bit of rewriting now that is happening that is a bit disturbing and seems like gaslighting. A notion that the vaccine never sought to prevent infection (and thus viral transmission). That is obviously and easily proven as completely wrong. But then protection faded maybe quicker than expected, and variants broke expectations and some protections. It sucks, but it's where we're at. The vaccines still have the enormous benefit of reducing case severity, but they certainly did fail in some of the goals. Sidenote: If you are infected and thus replicating SARS-CoV-2 viruses, you have COVID-19 even if entirely asymptomatic. As with the prior points, this is trivial to verify. The "COVID-19 is only severe cases" claim is a part of the prior bit of gaslighting where we're redefining everything to somehow make early proclamations (e.g. "prevents covid-19") fit the unfortunate situation today. Cheers!
max49 5y ago
>Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease but that is an incredibly high bar that no respiratory viral vaccine has ever met. This might have something to do with the fact that "experts" (ei. the CDC, vaccine makers, and politicians in charge of health organisations around the world) explicitly told us in no uncertain terms it would prevent infection. It was one of the main argument for getting it and we were never allowed to question it when a significant amount of vaccinated people started testing positive. We were also told it was dangerous misinformation to question it publicly and it was career suicide for any expert to contradict it. The goalpost has been moving gradually from "complete immunity" to "reducing the risk of severe symptoms". one of the most interesting thing about covid was to watch people and politician rewrite history. I thought it would be difficult to do in the 2020s but I was so wrong and I wish I had saved screenshots of tweets from health officials and politicians. It's always interesting to watch the face of someone who claim that something is pure misinformation when they realise the CDC themselves were promoting the idea just weeks ago.
wrp 5y ago
There seems to have been no attempt to educate the public on what you should expect from different types of vaccine. When most people think of vaccines, they have in mind the one-shot-and-immune-for-life that you sometimes get with live-attenuated vaccines. Early articles on SARS-CoV-2 being developed clearly explained what to expect. I submitted an article (https://news.ycombinator.com/item?id=30162097 https://news.ycombinator.com/item?id=30162097) but there may be better ones.
pdog 5y ago
> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease but that is an incredibly high bar that no respiratory viral vaccine has ever met. In the U.S., health experts explicitly said the vaccines totally prevent symptoms and infection. The health experts said the vaccines were 100% efficacious, and this fact was repeated in the media and by leadership for months. As recently as seven months ago, they were still saying this.
zby 5y ago
I tried to google for a list of sterilising and non-sterilising vaccines - but I could not find any. Could you provide sources for your claim that "essentially no viral vaccine prevents infection, with the possible exception of the HPV vaccine"?

nsxwolf 5y ago

Chicken pox vaccine works so well that no one gets a single sore.

Jtype 5y ago

So then no other vaccines have led to or provided herd immunity?

gameswithgo 5y ago
It is just a nuanced semantic distinction. You are immune in the sense that you never notice the virus (in some cases) or have no severe impacts (in others). But you are (never?) immune in the sense that you literally never have the virus replicate in you at all. I am reminded of the recent twitter thread posted here by Dan Luu about how communicating nuance at scale is impossible.
- rich_sasha 5y ago
  I thought a big part of the tragedy of the measles vaccine rates dropping is precisely that we’re losing herd immunity. At 95%+ immunised outbreaks ought not occur because herd immunity, even for the remaining unvaccinated, whereas at the lower levels, outbreaks will likely happen. Is that not right?
  - Retric 5y ago
    Herd immunity is a function of transmission not individual infection. Faster and stronger immune responses reduce the number of viruses produced inside someone over an infection. That directly means they are less likely to infect other people. Herd immunity is effectively a function of how infections something is. 1 case leading to 2 cases on average means you need to cut transmission in 50%. 1 case leading to 10 cases and you need to block 90% of new cases. Critically this means vaccinated people can still be infectious as long as they infect less than 1 person on average you can reach herd immunity.
  - stonemetal12 5y ago
    That is right. It is just immunity as a term in the medical community vs average joe use of the word. Medical community immunity means your immune system fights off the invaders before anything medically interesting happens, not that you have a magical force field that prevents entry. Not sure why people are trying to twist that into some sort of insidious plot. If you have the measles vaccine and you get exposed to measles, measles will be in your body for a short time in low quantities, but your immune system will quickly destroy it. That means you are unlikely to pass it on or develop symptoms.
    - rich_sasha 5y ago
      Ok makes sense. But is that different then to vaccines against bacterial diseases? If some bacteria enter my body, surely they don’t magically disappear either, maybe split a few times but eventually die off.
- rhino369 5y ago
  I would say this distinction is often just a semantics argument designed to calm the public. In common usage, it means you won't have a significant infection that becomes contagious. The vast majority of vaccines are successful at preventing that type of infection for a long time. Though there are exceptions. By defining "infection" so broadly it loses all meaning, some officials are trying lump to the covid vaccines (which are no longer very good at preventing contagious infections) with vaccines that prevent contagious infection for decades. Obviously, the effectiveness of vaccines is nuanced and their effectiveness at preventing contagious spread is a spectrum--not a binary. Public health officials should just be straight with us. The vaccines aren't as good as some of the vaccines we all get--like measles--but they do provide a great deal of protection. It's still basically a miracle that we got the protection we did in about a year after the virus appeared. It's a huge success.
monocasa 5y ago
If it can't replicate as well in you, you significantly reduce the ability for it to spread via you typically. Herd immunity fro that perspective is about reducing spread to the point that outbreaks don't spread from local groups because the R value is low enough, even taking into account the few people who can't be immunized.
kaitai 5y ago
Evaluate the statements above with respect to measles or polio, as the parent poster points out. It is clear that measles and polio vaccines can lead to "herd immunity", while preventing severe side effects of these diseases in the majority of cases. The point is there is a range of infection mechanisms for viruses (respiratory vs other, for starters) and vaccines thus provide benefit at different points in the infection process. This leads to heterogeneity in "infection level" and symptomaticity in the vaccinated population.
deleted 5y ago
[deleted]

superkuh 5y ago

>an incredibly high bar that no respiratory viral vaccine has ever met. An incredibly high bar that no intramuscular (humoral) respiratory viral vaccine has met. Mostly because injecting into the muscle does not lead to tissue resident immune cells in the upper respiratory mucosa because it's a separate immune compartment from the body serum. But there are options like intranasal boosters after intramuscular vaccination that can prevent infection and do significantly reduce shedding and spread. And it's been driving me crazy the entire pandemic that intranasal spray vaccine boosters are not being heavily funded and persued. It would save the world so many lives, time, and incalculable money.

qzw 5y ago
Any idea (or sources) why they are not being pursued? And why are flu vaccines not commonly given as intranasal spray?
- inglor_cz 5y ago
  I think there is some concern of intranasally applied substances getting into the brain. Even plain water infested with certain amoebas can give you a fatal brain disease if you use it for nasal irrigation. It is perfectly safe for drinking, though. https://www.healthywa.wa.gov.au/Articles/N_R/Nasal-irrigation-is-it-safe https://www.healthywa.wa.gov.au/Articles/N_R/Nasal-irrigatio... We do not have that amoeba here, but I still boil the water and cool it down before using it to flush my nose. (Works great against mild common colds.) One of the worst outbreaks in the world actually happened in Czechoslovakia 60 years ago - 16 people died after being infected in a public swimming pool.
  - maxerickson 5y ago
    There's an approved nasal vaccine in the United States (FluMist). It's use was not encouraged for a while because it didn't vaccinate against H1N1 (recent years have included H1N1). It doesn't look to be particularly more effective than the shot (marketing focuses on no shot, not on it working better; the CDC says the effectiveness is similar). There's multiple candidate intranasal SARS-CoV-2 vaccines, just none that have concluded trials.

cloutchaser 5y ago

I think we should thank whatever god that so far it seems we didn't end up with a Marek's disease type situation. I don't know how much of a guarantee there was about this with covid, but if the vaccine would have promoted a much more aggressive virus we could have ended up in a situation where any unvaccinated human will basically die (this happens in chickens, see: https://en.wikipedia.org/wiki/Marek%27s_disease https://en.wikipedia.org/wiki/Marek%27s_disease). I sincerely hope the people who devised this vaccine know what they are doing. As far as I know (according to a Katalin Kariko inteview), the Sars-Cov-2 spike protein can't mutate too much without limiting it's effectiveness, so therefore this vaccine should theoretically work in the future. But that Marek's disease issue is very very scary to me.

r00fus 5y ago
DOesn't the problem with Marek's disease have more do do with the horrendous conditions of poultry handling worldwide (mainly close confines)? I don't think that's generally transferrable situation unless you consider humans to be under similar conditions.
isoprophlex 5y ago
Well... that was an unsettling read. > The evolution of Marek's disease due to vaccination has had a profound effect on the poultry industry. All chickens across the globe are now vaccinated against Marek's disease (birds hatched in private flocks for laying or exhibition are rarely vaccinated). Highly virulent strains have been selected to the point that any chicken that is unvaccinated will die if infected.[14] Other leaky vaccines are commonly used in agriculture. One vaccine in particular is the vaccine for avian influenza. Leaky vaccine use for avian influenza can select for virulent strains.[15] Wonderful. Like H5N1, which has a 60% mortality in humans.
- collegeburner 5y ago
  I remember it was discussed months ago on HN when early on in vaccines roll out, somebody raised this concern but the consensus was the vaccines mostly prevented infection so not a big worry ¯\_(ツ)_/¯

rbancroft 5y ago

The bar is being set high for these vaccines because they are being pushed and mandated with very exaggerated justification, that they will end the pandemic. Rational people will agree that there are significant benefits to the vaccine, but I don't believe there is any evidence to suggest that these vaccines will get us to an end state where the virus is no longer circulating. If you want people to go along with a medical intervention, state clearly the expected outcome and don't move the goalposts when the data changes. If the data is strong, you most likely wouldn't need mandates to convince people.

amanaplanacanal 5y ago
Where I live, the goalposts are exactly the same as they were two years ago: don’t let the health care system get overwhelmed. I have no idea what your politicians have been telling you.
- JacobThreeThree 5y ago
  >the goalposts are exactly the same as they were two years ago Shouldn't the politicians have made progress on this issue over the course of two years? At what point is it incompetence or corruption, if the billions being spent to fight the pandemic make zero discernable impact on the most critical issue?
  - thfuran 5y ago
    >Shouldn't the politicians have made progress on this issue over the course of two years? What do you mean? Should they should magically cause the number of doctors and hospitals to double inside two years? >if the billions being spent to fight the pandemic make zero discernable impact on the most critical issue? What leads you to believe that measures such as pushing vaccination haven't been having tremendous impact on that issue?
    - JacobThreeThree 5y ago
      >What leads you to believe that measures such as pushing vaccination haven't been having tremendous impact on that issue? Do you believe that health care systems are currently overwhelmed by COVID?

pibechorro 5y ago

All true, but this was not what was sold to the general public. Had people been informed that the latest vaccines against COVID-19 behaved similarly to rhe seasonal shots people get for regular flue season, a vast majority of the public would have opted out, as they do with the seasonal versions. This was further compounded by the aggressive dismissal and censorship of natural immunity and preventive care (good diet, exercise, vitamins, etc). We are here today because the obvious was politicized.

jahnu 5y ago
> the aggressive dismissal and censorship of natural immunity who agressively dismissed this?
- twofornone 5y ago
  Your friendly neighborhood fact checkers who suppress virtually anything which could justify opposition to vaccine mandates. Including news media.
- HWR_14 5y ago
  I angrily dismiss it. It's a nonverifiable bullshit excuse to avoid a needle prick. Tests have some error, it's unclear if you got a sufficient dose, spaced exposures are better, the vaccine has shown better variant resilience, choose your reasons. If you haven't gotten a vaccine, I don't care if you've had COVID or not. Either way you should get a shot. It might be different if there were any cost to it. But there isn't. So invariably the people bitching about natural immunity are just doing it to make a point, usually political.
  - jahnu 5y ago
    I agree people should get the shot. It's so amazingly clear that it's effective at helping your immune system to fight the virus quicker. But the CDC did announce that since delta people who recovered from an infection have better immune response than those who are only vaccinated. I asked the OP to clarify because there is false information out there that this fact is being suppressed "aggressively" when in fact the CDC announced it!

lamontcg 5y ago

> This is a really good article on the immune system. I still don't particularly like it that much. None of this should be all that new. There were plenty of knowledgeable people saying all along that sterilizing nutralizing immunity in the mucosa was unlikely to be achievable for a vaccine against a respiratory virus that most commonly had no viremic phase, particularly as a shot given in the arm. They were also saying that T-cells were the important thing to prevent disease and death and we shouldn't be focusing on preventing infection. Some other people who debated or disagreed with that perspective are now suddenly learning novel new things about the immune system. There's a good chunk of experts out there that were saying this all along though (if you were listening to them and not the headlines and blogs and twitter).

Vrondi 5y ago
You are quite right, but the media, the government, and many public health agencies have been ignoring this, focusing solely on antibody levels, and trying to keep them constantly high through ever more panicky calls for more and more boosters. For everyone, regardless of prior infection.
- f6v 5y ago
  Because some times you have to make a call. Some studies are now revealing that booster shots might be less effective in those who recovered (watched a guy present his unpublished data the other day). But it’s not that obvious.
- kurthr 5y ago
  This is for two reasons: One, measuring antibodies is MUCH easier than measuring T or B cell response. This is especially true early on in the pandemic, if you want to measure representative numbers of people, and you don't know when/whether they will be exposed or catch COVID (due to masking/lockdowns etc). Two, when your problem is that the hospitals are filling up and you're facing a labor shortage for some essential workers for a a few months... then boosting antibodies for 4-6 months to reduce retransmission rates and minimizing symptomatic cases makes a lot of sense.

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dbroockman 5y ago

This is a rewriting of history. Before we ever had results from the COVID vaccine trials, the FDA declared that the primary goal of the trials was to prevent any symptomatic infection in the first place. From June 2020: https://www.fda.gov/media/139638/download https://www.fda.gov/media/139638/download.

standardUser 5y ago
Sure, and Viagra was developed to treat hypertension. The fact that efficacy data changes with the completion of new studies or advent of new strains should be viewed as normal, not as a surprise or some kind of bait and switch.
notahacker 5y ago
I'm not sure linking to a document with phrases like "As it is possible that a COVID-19 vaccine might be much more effective in preventing severe versus mild COVID-19" really proves that it's "rewriting history" to suggest that preventing all infections or symptomats of a respiratory diseases is an very high bar to set, or that the medical profession hasn't been cognizant of that from the start...

tomp 5y ago

> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease but that is an incredibly high bar that no respiratory viral vaccine has ever met. So what you're saying that Fauci, Pfizer etc. weren't just wrong about the vaccine ("if you get it you won't get sick" a.k.a. "science has changed as we've learned more facts") but actively lied about it (after all, they of all people should know that no other vaccine succeeded in that for respiratory viruses).

kodah 5y ago
I don't think we can use terms like "lie" with respect to the pandemic yet, because full post-facto analysis is not done yet. That analysis isn't just on people's words, it's on their relationships to other people, entities, etc... You also have to determine what they "know" during a given time. I'm fully supportive of holding government officials accountable, especially if they've enacted their own agenda, but there's a time and place for such things as well as a path to proving them.
nradov 5y ago
If you look back at the actual press releases and research studies that Pfizer and BioNTech published about their Comirnaty vaccine, they never specifically claimed that it would reliably prevent infection. It was the politicians like Fauci who made false claims not backed by reliable science. (And to be clear, I still recommend that everyone eligible get vaccinated as it's fairly effective at preventing severe symptoms.)

toolz 5y ago

> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease There's a laundry list of public health officials (including the CDC director, to give a sense of the authority on this list) that said it would prevent infection and transmission. So it really shouldn't surprise anyone that there were expectations that the vaccine would do what public health authorities said it would do.

thatguy0900 5y ago
It's kind of funny how fast people forget what was originally talked about when the goalposts moved.
- toolz 5y ago
  Yep, I find it quite reprehensible how quickly politicians (the ones in public health and elected leaders) pivoted from "the vaccine will end the pandemic" into "this is the un-vaccinated peoples fault". I guess politically they had to throw the minority group under the buss to keep the attention off of their own failures. It worked though, I have had people tell me I'm disgusting more than once for not being vaccinated. Nevermind that I've had covid twice, am young and in very good health, have been taking vitamin A/D since 2020 and have high levels of sufficiency of both. It appears I'm the bad guy because I would rather a 75 year old in a poor country have my doses of vaccines than take it just because I'm being pressured into it. I'm not sure many liberals survived this pandemic, at least not vocally. I feel truly bad for any minorities that really shouldn't take the vaccine for medical conditions. I know for a fact there are doctors who have recommended against taking the vaccine because of preexisting conditions but wouldn't write a doctors note for fear of losing their license. I'm actually missing out on a vacation in Cali right now with the partners family because I'm afraid I'll get a positive PCR test and ruin it for them (since they require tests or vaccine cards most places, as I understand it)
  - clairity 5y ago
    > "I'm afraid I'll get a positive PCR test and ruin it for them (since they require tests or vaccine cards most places, as I understand it)" CA is batshit crazy over covid for mediopolitical reasons, but at least here in LA, you can easily flash anything in front of most restaurant/retail workers and they won't even read it if it looks even halfway legit (there's too much variation in vaccine cards and test results for them to be experts anyway). some places, like disneyland, will be a little more diligent though. so while folks still wear masks outdoors like cargo culters, most people don't care enough to do more than go through the motions.

draw_down 5y ago

jmckib 5y ago

I'm confused. Weren't covid mRNA vaccines very effective at preventing infection, even asymptomatic infection, against delta and earlier variants? Only with omicron has the effectiveness been significantly reduce, but not to zero. And once we come up with a variant-specific vaccine, I would expect the effectiveness to go up again.

jdrc 5y ago
The efficiency of vaccines for infection fell by 50% in 4 monts even for delta and other variants. Their effectiveness with omicron infection is very little. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02183-8/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- jmckib 5y ago
  50% effectiveness against infection is still pretty significant. And note that OP said "essentially no viral vaccine prevents infection." I think we can agree that is not the case.
- r2_pilot 5y ago
  I've been exposed twice with known-omicron and have not gotten sick yet. YMMV.
Izkata 5y ago
No, they were very effective at preventing symptomatic covid. This can mean either preventing infection or not preventing infection but just stopping symptoms. The trials that came up with that 94% efficacy never tested for which of these two outcomes it was, and it turns out it was mostly the second one, which allows for asymptomatic spreading.
- jmckib 5y ago
  No, the vaccines were very effective at preventing any infection, both symptomatic and asymptomatic. There were studies done by giving the participants regular covid tests, usually once a week, so they would catch asympomatic cases as well. Here are the conclusions from a meta-study from July 2021: > In fully vaccinated individuals, VE against symptomatic and asymptomatic infections was 80–90% in nearly all studies. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8284046/ https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8284046/

ls15 5y ago

> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease but that is an incredibly high bar that no respiratory viral vaccine has ever met. This is only an incredibly high bar if all you ask for is a tool to mitigate personal risk. If you want to make the use of that tool mandatory, then it is a reasonable bar, and there are additional other bars that are also very high.

sgustard 5y ago

> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection The original announcements from Pfizer et al touted the 90-95% effectiveness of the vaccines against infection (and 95-100% against severe infection). The idea that vaccines prevented most infection was literally part of their testing and marketing from the start. The wild card was Delta & Omicron not complying with those numbers, not that people shared some mass delusion.

nsxwolf 5y ago
I was very enthusiastic about the vaccine and couldn’t wait to get it. I didn’t believe I had any real chance of dying, I just didn’t want to get sick with it and was ecstatic about not having to wear masks. If the vaccine had come out of the gates as something to just prevent death, I would not have been so enthusiastic or motivated.
maxdj 5y ago
None of the phase 3 trials measured protection against infection, and none of the press releases mention infection, see Pfizer’s original results: https://www.businesswire.com/news/home/20201118005595/en/ https://www.businesswire.com/news/home/20201118005595/en/ I think confusion comes from the use of “COVID-19” which is not a virus or infection specifically but a disease caused by sars-ncov2 infection. If you have an asymptomaic infection, you don’t have COVID-19.
- defaultname 5y ago
  The trials would have had to have tested every participant daily to qualify protection against infection. However it was most certainly presumed, and the entire narrative around the vaccine push was achieving herd immunity: when enough people were unlikely to shed viruses in any likely transmissive volume because of achieved immunity (whether via vaccine or previous infection), transmission would trickle to an almost halt and life would return to normal. This wouldn't require 100% coverage, nor a 100% effective vaccine (no vaccine has ever been 100% effective, or so-called "sterilizing") to accomplish. There is a bit of rewriting now that is happening that is a bit disturbing and seems like gaslighting. A notion that the vaccine never sought to prevent infection (and thus viral transmission). That is obviously and easily proven as completely wrong. But then protection faded maybe quicker than expected, and variants broke expectations and some protections. It sucks, but it's where we're at. The vaccines still have the enormous benefit of reducing case severity, but they certainly did fail in some of the goals. Sidenote: If you are infected and thus replicating SARS-CoV-2 viruses, you have COVID-19 even if entirely asymptomatic. As with the prior points, this is trivial to verify. The "COVID-19 is only severe cases" claim is a part of the prior bit of gaslighting where we're redefining everything to somehow make early proclamations (e.g. "prevents covid-19") fit the unfortunate situation today. Cheers!

max49 5y ago

>Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease but that is an incredibly high bar that no respiratory viral vaccine has ever met. This might have something to do with the fact that "experts" (ei. the CDC, vaccine makers, and politicians in charge of health organisations around the world) explicitly told us in no uncertain terms it would prevent infection. It was one of the main argument for getting it and we were never allowed to question it when a significant amount of vaccinated people started testing positive. We were also told it was dangerous misinformation to question it publicly and it was career suicide for any expert to contradict it. The goalpost has been moving gradually from "complete immunity" to "reducing the risk of severe symptoms". one of the most interesting thing about covid was to watch people and politician rewrite history. I thought it would be difficult to do in the 2020s but I was so wrong and I wish I had saved screenshots of tweets from health officials and politicians. It's always interesting to watch the face of someone who claim that something is pure misinformation when they realise the CDC themselves were promoting the idea just weeks ago.

wrp 5y ago

There seems to have been no attempt to educate the public on what you should expect from different types of vaccine. When most people think of vaccines, they have in mind the one-shot-and-immune-for-life that you sometimes get with live-attenuated vaccines. Early articles on SARS-CoV-2 being developed clearly explained what to expect. I submitted an article (https://news.ycombinator.com/item?id=30162097 https://news.ycombinator.com/item?id=30162097) but there may be better ones.

pdog 5y ago

> Somehow there's this idea that the Sars-CoV-2 vaccines need to prevent infection or symptomatic disease but that is an incredibly high bar that no respiratory viral vaccine has ever met. In the U.S., health experts explicitly said the vaccines totally prevent symptoms and infection. The health experts said the vaccines were 100% efficacious, and this fact was repeated in the media and by leadership for months. As recently as seven months ago, they were still saying this.

zby 5y ago

I tried to google for a list of sterilising and non-sterilising vaccines - but I could not find any. Could you provide sources for your claim that "essentially no viral vaccine prevents infection, with the possible exception of the HPV vaccine"?