6 ms·

New Covid Shots Recommended for Americans 6 Months and Older This Fall

29 points by whack 2y ago

afavour 2y ago
It's basically the new flu shot, and probably will be for a very long time yet. I'm not so concerned about that but I do wonder when the next disease (bird flu?) will come along and we'll get another annual shot... and another...
- nknealk 2y ago
  It’s worth noting that companies are testing flu + COVID vaccines as an all in one shot. I think most people don’t want to come to their pharmacy for multiple jabs. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-data-mrna https://www.pfizer.com/news/press-release/press-release-deta...
  - seanmcdirmid 2y ago
    You can schedule two jabs at your pharmacy, so it isn't that inconvenient. It is much harder with a young child, who...you can get to take one jab but you really aren't going to get two jabs in one sitting. A combined jab would avoid an extra appointment and toy/cheeseburger bribe. Also, the COVID jab is much harder to take than the flu jab for some reason. I barely notice the flu shot, but for a COVID shot, I actually feel my muscles contracting, and my arm is a bit sore for a week (although nothing beyond a minor annoyance). I wonder what this means for a combined shot.
  - hprotagonist 2y ago
    and moderna: https://www.nature.com/articles/d41586-024-02121-1 https://www.nature.com/articles/d41586-024-02121-1
  - JohnTHaller 2y ago
    You can get two or three vaccinations at once provided they don't have any issues with each other. I just got Shingrix and TDAP earlier this week, one in each arm. Pro tip, get the one more likely to cause injection site pain (Shingrix in my case) in your non-dominant arm.
- tossandthrow 2y ago
  There is a push for restoring nature, so I think it will be less in 50 years.
- jawns 2y ago
  It is already possible to combine multiple vaccines into a single shot. This approach is used for other diseases, such as the MMR (measles, mumps, and rubella) vaccine. In the hypothetical case you're describing, I would expect that consolidation of vaccine administration would happen before we reach a point where you need to get half a dozen separate jabs at your annual well visit.
- jstummbillig 2y ago
  When something works really well and is statistically beneficial, I am not sure why you would decline any of them.
  - afavour 2y ago
    Oh, don't get me wrong, I'm not being anti-vaccine. I'm being anti-ever-growing-list-of-disease-to-worry-about.
    - jstummbillig 2y ago
      I understand, but I think I read it as the diseases-we-have-good-interventions-for-list. We can work on more efficient distribution, but it seems like a relatively minor issue.
      - worksonmine 2y ago
        You could also put it in the "diseases-we-dont-need-interventions-for-in-most-cases-list". The vaccines aren't really effective for younger people. I still remember how it was pushed as 95% effective against *transmission* in the beginning. We don't see this panic regarding the flu and they have similar mortality in the same demographics. Give it to the elderly and the sensitive and ignore it for the rest like we've always done. There's really no need to exaggerate the risks, I only caught covid twice (first and delta variants) 2 years apart while many of my vaccinated friends seem to catch every single one only months apart. Why is that? Interestingly I've never been this healthy in my life, anecdata and probably more related to social distancing than being unvaccinated but interesting nonetheless. I don't care if people choose to get vaccinated but it's seriously time to move on.
- marcuskane2 2y ago
  Honestly though, that sounds... amazing. I've spent some of my life working in undeveloped, tropical areas. Because of this, I'm vaccinated against a bunch of diseases the average Western citizen doesn't worry about- Yellow Fever, Japanese Encephalitis, Tuburculosis and have seen first-hand the afflictions of the local populations who weren't vaccinated. Working in a clinic with sick and dying people, while being safe because I myself am vaccinated against the disease is kind of a surreal experience. While obviously the ideal would be a single dose providing lifelong protection, an annual booster still would make me incredibly grateful that I get to live in this modern, almost futuristic world of preventative medicine superpowers.
- hulitu 2y ago
  >It's basically the new flu shot That says it all. There were some suckers getting the flu shot and then developing a severe flu. Reading the vaccine documentation turns out that it was developed using a variant at the other end of the world.
deleted 2y ago
[deleted]
jjtheblunt 2y ago
I wonder scientifically what goes into "recommendation" nowadays, amid all the bickering and turmoil, and i no longer feel I know, and i believe personally in vaccines, but not in profiteering, which never seemed a discussed concern till the last few years. how can an observer detect if profiteering is influencing recommendation?
- deleted 2y ago
  [deleted]
submeta 2y ago
In Germany, no one will going to get a covid vaccination again. This topic was dealth with so controversially, so polarisingly, that it divides the nation. One group even made a political program with being anti-covid measures, pretending there are dark forces limiting personal freedom etc. How‘s the situation in the US? I got 3 shots. And had severe complications after the third shot. So I don’t think I am going to have one again.
- jstummbillig 2y ago
  How could the country being divided lead to nobody getting the vaccine?
  - rightbyte 2y ago
    "Nobody is going there anymore. It is too crowded." I feel 'everyone' and 'nobody' very often can be replaced by 'a lot' and 'few'.
    - jstummbillig 2y ago
      My contention was not between "nobody" and "a few" but how a divided country (so the claim) would unite "everyone"/"a lot" on the same side of the divider.
- zamfi 2y ago
  > How‘s the situation in the US? Let me quote the illustrious submeta here: > This topic was dealth with so controversially, so polarisingly, that it divides the nation. One group even made a political program with being anti-covid measures, pretending there are dark forces limiting personal freedom etc. That just about covers it.
- bun_terminator 2y ago
  Wait, there was incredibly limited freedom - with unthinkable, dystopian severity. And those responsible are still alive (and free)
- deleted 2y ago
arjie 2y ago
My personal theory is what I call Low Dose, Frequent Exposure https://wiki.roshangeorge.dev/index.php/Low_Dose,_Frequent_Exposure https://wiki.roshangeorge.dev/index.php/Low_Dose,_Frequent_E... I’m not against the vaccine. I just don’t think I need it. Sure, some people talk about chronic inflammation. But I think I trust my generally normative immune system to handle this. Nebula says that my genome is at the 99th percentile for serious illness and hospitalization with COVID-19 so this will be fun to see. But I’m going to stick to it.
- nusl 2y ago
  Careful. You don't get second chances with some things.
  - arjie 2y ago
    Fair warning. I just have a different outlook on these things.
    - nusl 2y ago
      Yeah, that's fine. I've found throughout life that an outlook can drastically change for the worse after an event occurs. Hindsight is 20-20.
taxicabjesus 2y ago
[flagged]
slashtom 2y ago
People become statisticians and scientists overnight when it comes to COVID-19 Vaccines. The science is very simple, get the shot and you reduce the likelihood of hospitalization or death. It's more effective for those with co-morbidities or those older in the age brackets. I am not sure why this was politicized to death the way it has been. The mandates early on were to curb the hospitalizations / deaths that was occurring. Really the mandate should have been for people with co-morbidities or in the upper age bracket but you know what, people are stupid and everyone thinks they're healthy, so instead of being nuanced they applied it to everyone.
- robcohen 2y ago
  I think the issue is that most people don't have co-morbidities and most people aren't old. So when you're told to get the vaccine, and it turns out you're actually worse off due to potential heart complications, it feels like a betrayal. By the way, it is. Part of this, I believe, was hedging bets in the fog of war that was a global pandemic. Part of it was just raw incompetence. I am genuinely curious as someone who got every shot and booster. Do I actually benefit from this one? My understanding is the last one I did not statistically benefit from.
- Krssst 2y ago
  > The mandates early on were to curb the hospitalizations / deaths that was occurring. The first vaccine was very efficient against infection by the original variants. So it was not useful only for people with co-morbidities. Then we got Omicron and a loss of efficacy against infection (but still useful to reduce severeness).
  - micah94 2y ago
    My issue is that it was already known that you can't vaccinate against a corona virus. Why we were convinced this time would be different was insane to me. They used to call them "mutations". But they came up with a new word "variants". Plus there were past attempts to come up with vaccines for SARS and MERS which all failed. This was no different. I wished they had leveled with everyone about this rather than scare the shit out of people.
ghusto 2y ago
Most of Europe (i.e. the parts of Europe that I know) acknowledged that "mistakes were made", and moved on. Nobody really expected an apology from officials for the shit-show, because everybody understood that they were doing the best they could given their situation, and it would be political suicide to admit they acted in error. What's weird about the U.S.A. though, is that it's still a thing _now_?
- slouch 2y ago
  Oh, simple: they called it a vaccine when they knew it wasn't & did generational damage to the concept of vaccines.
guyzero 2y ago
This is basically the new flu shot and we'll get the usual litany of anecdotal reports that someone still got the flu/covid, but statistically these shots reduce the number of infections and the severity of infections with few side effects, so I'll keep getting them.
- stuaxo 2y ago
  Thanks, I've been thinking this for a while, I've also been slack and had neither for a couple of years and need to sort that out.
- hprotagonist 2y ago
  https://www.nature.com/articles/d41586-024-02121-1 https://www.nature.com/articles/d41586-024-02121-1 Indeed!
- ifyoubuildit 2y ago
  Will it actually reduce the number of infections?
  - guyzero 2y ago
    "during 2019-2020, the last flu season prior to the COVID-19 pandemic, flu vaccination prevented an estimated 7 million influenza illnesses, 3 million influenza-associated medical visits, 100,000 influenza-associated hospitalizations, and 7,000 influenza-associated deaths." https://www.cdc.gov/flu/about/qa/vaccineeffect.htm https://www.cdc.gov/flu/about/qa/vaccineeffect.htm Time will tell how effective covid vaccines are when it's mutating as rapidly as it is. The covid vaccine will definitely reduce zero infections if people do not get it.
    - ifyoubuildit 2y ago
      Yeah, sorry I wasn't clear, I was talking about the covid shots. There are studies suggesting negative efficacy against infection after the initial period°. So while I think for hospitalizations and death there is a stronger argument, for infections it's not terribly clear. ° from chat gpt (with all the standard caveats): Source: "Vaccine effectiveness against SARS-CoV-2 infection with the Omicron or Delta variants following a two-dose or booster BNT162b2 or mRNA-1273 vaccination series: a Danish cohort study" (Published in The Lancet). Source: "Efficacy of a Fourth Dose of Covid-19 mRNA Vaccine against Omicron" (Published in NEJM). Source: UKHSA COVID-19 vaccine surveillance reports.
timonoko 2y ago
[flagged]
nikolay 2y ago
Turn this into a SARS/MERS - it would be highly profitable. I'm not an anti-vaxxer - I have all vaccines, and I made the mistake of getting the first Pfizer, which I regretted a lot after I damaged my health due to side effects that were downplayed and ignored by both Pfizer and CDC! Geert Vanden Bossche [0] has been predicting a vaccine-induced massive die-off this summer! We need antivirals, not vaccines! Just look at this [1] and shit in your pants!!! [0]: https://x.com/GVDBossche https://x.com/GVDBossche [1]: https://nextstrain.org/ncov/gisaid/global/6m https://nextstrain.org/ncov/gisaid/global/6m
Shorel 2y ago
Part of the problem is to just group all Covid-19 shots as if they were the same thing. They are very different technologies. I got a Pfizer–BioNTech booster, and it was of course fine. I don't want and would not get the Sinovac booster.
ifyoubuildit 2y ago
Let's assume for the sake of argument that these new shots will be perfectly safe and effective (won't catch it, won't spread it, won't have any side effects, etc). Given current sentiment and uptake rates, how many people are actually going to get these (or make their 6 month old get them)? And how low does that number have to be before you are just training people to be comfortable ignoring your recommendations?
dkekenflxlf 2y ago
attack!!! near to a cinema next to you!! ;-)
randm_sequence 2y ago
The disappointing thing that no one talks about is that all of the vaccines target the spike, which is the part of the virus that evolves most quickly (the spike is also an immunotoxin). Alternatively, vaccines could have targeted the nucleocapsid protein. This would have had the dual benefit of not being as immunogenic/immunotoxin and also likely being a one and done shot with long term effective immunity. Why do you think the folks at Big pharma decided to choose a vaccine against the spike protein? Can anyone say "recurring revenue?"
- tripletao 2y ago
  Vaccines designed at a genomic level target the spike because that's the protein at the surface of the virus, and thus believed to be the most effective target for your immune system. That belief seems to have been correct (at least as to infection), since mRNA vaccines against the spike had the highest efficacy. The spike is unfortunately also under heavy selective pressure for that same reason, leading to the rapid evolution that you note; but that's the inherent and unavoidable tradeoff. Inactivated virus vaccines (like Sinovac) don't target the spike, since they don't target anything. They do induce anti-nucleocapsid immunity, but there's no evidence that corresponds to any clinical benefit. I don't think the word "immunogenic" means what you think it does. Vaccines are supposed to be immunogenic (i.e., to generate an immune response); if they weren't then they wouldn't do anything. I've seen papers proposing that the spike protein is toxic in certain cases, but no evidence that the exposure from the vaccine minus the exposure from averted infections is net harmful.

29 points by whack 2y ago

It's basically the new flu shot, and probably will be for a very long time yet. I'm not so concerned about that but I do wonder when the next disease (bird flu?) will come along and we'll get another annual shot... and another...

nknealk 2y ago
It’s worth noting that companies are testing flu + COVID vaccines as an all in one shot. I think most people don’t want to come to their pharmacy for multiple jabs. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-data-mrna https://www.pfizer.com/news/press-release/press-release-deta...
- seanmcdirmid 2y ago
  You can schedule two jabs at your pharmacy, so it isn't that inconvenient. It is much harder with a young child, who...you can get to take one jab but you really aren't going to get two jabs in one sitting. A combined jab would avoid an extra appointment and toy/cheeseburger bribe. Also, the COVID jab is much harder to take than the flu jab for some reason. I barely notice the flu shot, but for a COVID shot, I actually feel my muscles contracting, and my arm is a bit sore for a week (although nothing beyond a minor annoyance). I wonder what this means for a combined shot.
- hprotagonist 2y ago
  and moderna: https://www.nature.com/articles/d41586-024-02121-1 https://www.nature.com/articles/d41586-024-02121-1
- JohnTHaller 2y ago
  You can get two or three vaccinations at once provided they don't have any issues with each other. I just got Shingrix and TDAP earlier this week, one in each arm. Pro tip, get the one more likely to cause injection site pain (Shingrix in my case) in your non-dominant arm.
tossandthrow 2y ago
There is a push for restoring nature, so I think it will be less in 50 years.
jawns 2y ago
It is already possible to combine multiple vaccines into a single shot. This approach is used for other diseases, such as the MMR (measles, mumps, and rubella) vaccine. In the hypothetical case you're describing, I would expect that consolidation of vaccine administration would happen before we reach a point where you need to get half a dozen separate jabs at your annual well visit.
jstummbillig 2y ago
When something works really well and is statistically beneficial, I am not sure why you would decline any of them.
- afavour 2y ago
  Oh, don't get me wrong, I'm not being anti-vaccine. I'm being anti-ever-growing-list-of-disease-to-worry-about.
  - jstummbillig 2y ago
    I understand, but I think I read it as the diseases-we-have-good-interventions-for-list. We can work on more efficient distribution, but it seems like a relatively minor issue.
    - worksonmine 2y ago
      You could also put it in the "diseases-we-dont-need-interventions-for-in-most-cases-list". The vaccines aren't really effective for younger people. I still remember how it was pushed as 95% effective against *transmission* in the beginning. We don't see this panic regarding the flu and they have similar mortality in the same demographics. Give it to the elderly and the sensitive and ignore it for the rest like we've always done. There's really no need to exaggerate the risks, I only caught covid twice (first and delta variants) 2 years apart while many of my vaccinated friends seem to catch every single one only months apart. Why is that? Interestingly I've never been this healthy in my life, anecdata and probably more related to social distancing than being unvaccinated but interesting nonetheless. I don't care if people choose to get vaccinated but it's seriously time to move on.
marcuskane2 2y ago
Honestly though, that sounds... amazing. I've spent some of my life working in undeveloped, tropical areas. Because of this, I'm vaccinated against a bunch of diseases the average Western citizen doesn't worry about- Yellow Fever, Japanese Encephalitis, Tuburculosis and have seen first-hand the afflictions of the local populations who weren't vaccinated. Working in a clinic with sick and dying people, while being safe because I myself am vaccinated against the disease is kind of a surreal experience. While obviously the ideal would be a single dose providing lifelong protection, an annual booster still would make me incredibly grateful that I get to live in this modern, almost futuristic world of preventative medicine superpowers.
hulitu 2y ago
>It's basically the new flu shot That says it all. There were some suckers getting the flu shot and then developing a severe flu. Reading the vaccine documentation turns out that it was developed using a variant at the other end of the world.

deleted 2y ago

[deleted]

jjtheblunt 2y ago

I wonder scientifically what goes into "recommendation" nowadays, amid all the bickering and turmoil, and i no longer feel I know, and i believe personally in vaccines, but not in profiteering, which never seemed a discussed concern till the last few years. how can an observer detect if profiteering is influencing recommendation?

deleted 2y ago
[deleted]

submeta 2y ago

In Germany, no one will going to get a covid vaccination again. This topic was dealth with so controversially, so polarisingly, that it divides the nation. One group even made a political program with being anti-covid measures, pretending there are dark forces limiting personal freedom etc. How‘s the situation in the US? I got 3 shots. And had severe complications after the third shot. So I don’t think I am going to have one again.

jstummbillig 2y ago
How could the country being divided lead to nobody getting the vaccine?
- rightbyte 2y ago
  "Nobody is going there anymore. It is too crowded." I feel 'everyone' and 'nobody' very often can be replaced by 'a lot' and 'few'.
  - jstummbillig 2y ago
    My contention was not between "nobody" and "a few" but how a divided country (so the claim) would unite "everyone"/"a lot" on the same side of the divider.
zamfi 2y ago
> How‘s the situation in the US? Let me quote the illustrious submeta here: > This topic was dealth with so controversially, so polarisingly, that it divides the nation. One group even made a political program with being anti-covid measures, pretending there are dark forces limiting personal freedom etc. That just about covers it.
bun_terminator 2y ago
Wait, there was incredibly limited freedom - with unthinkable, dystopian severity. And those responsible are still alive (and free)
deleted 2y ago

arjie 2y ago

My personal theory is what I call Low Dose, Frequent Exposure https://wiki.roshangeorge.dev/index.php/Low_Dose,_Frequent_Exposure https://wiki.roshangeorge.dev/index.php/Low_Dose,_Frequent_E... I’m not against the vaccine. I just don’t think I need it. Sure, some people talk about chronic inflammation. But I think I trust my generally normative immune system to handle this. Nebula says that my genome is at the 99th percentile for serious illness and hospitalization with COVID-19 so this will be fun to see. But I’m going to stick to it.

nusl 2y ago
Careful. You don't get second chances with some things.
- arjie 2y ago
  Fair warning. I just have a different outlook on these things.
  - nusl 2y ago
    Yeah, that's fine. I've found throughout life that an outlook can drastically change for the worse after an event occurs. Hindsight is 20-20.

taxicabjesus 2y ago

[flagged]

slashtom 2y ago

People become statisticians and scientists overnight when it comes to COVID-19 Vaccines. The science is very simple, get the shot and you reduce the likelihood of hospitalization or death. It's more effective for those with co-morbidities or those older in the age brackets. I am not sure why this was politicized to death the way it has been. The mandates early on were to curb the hospitalizations / deaths that was occurring. Really the mandate should have been for people with co-morbidities or in the upper age bracket but you know what, people are stupid and everyone thinks they're healthy, so instead of being nuanced they applied it to everyone.

robcohen 2y ago
I think the issue is that most people don't have co-morbidities and most people aren't old. So when you're told to get the vaccine, and it turns out you're actually worse off due to potential heart complications, it feels like a betrayal. By the way, it is. Part of this, I believe, was hedging bets in the fog of war that was a global pandemic. Part of it was just raw incompetence. I am genuinely curious as someone who got every shot and booster. Do I actually benefit from this one? My understanding is the last one I did not statistically benefit from.
Krssst 2y ago
> The mandates early on were to curb the hospitalizations / deaths that was occurring. The first vaccine was very efficient against infection by the original variants. So it was not useful only for people with co-morbidities. Then we got Omicron and a loss of efficacy against infection (but still useful to reduce severeness).
- micah94 2y ago
  My issue is that it was already known that you can't vaccinate against a corona virus. Why we were convinced this time would be different was insane to me. They used to call them "mutations". But they came up with a new word "variants". Plus there were past attempts to come up with vaccines for SARS and MERS which all failed. This was no different. I wished they had leveled with everyone about this rather than scare the shit out of people.

ghusto 2y ago

Most of Europe (i.e. the parts of Europe that I know) acknowledged that "mistakes were made", and moved on. Nobody really expected an apology from officials for the shit-show, because everybody understood that they were doing the best they could given their situation, and it would be political suicide to admit they acted in error. What's weird about the U.S.A. though, is that it's still a thing _now_?

slouch 2y ago
Oh, simple: they called it a vaccine when they knew it wasn't & did generational damage to the concept of vaccines.

guyzero 2y ago

This is basically the new flu shot and we'll get the usual litany of anecdotal reports that someone still got the flu/covid, but statistically these shots reduce the number of infections and the severity of infections with few side effects, so I'll keep getting them.

stuaxo 2y ago
Thanks, I've been thinking this for a while, I've also been slack and had neither for a couple of years and need to sort that out.
hprotagonist 2y ago
https://www.nature.com/articles/d41586-024-02121-1 https://www.nature.com/articles/d41586-024-02121-1 Indeed!
ifyoubuildit 2y ago
Will it actually reduce the number of infections?
- guyzero 2y ago
  "during 2019-2020, the last flu season prior to the COVID-19 pandemic, flu vaccination prevented an estimated 7 million influenza illnesses, 3 million influenza-associated medical visits, 100,000 influenza-associated hospitalizations, and 7,000 influenza-associated deaths." https://www.cdc.gov/flu/about/qa/vaccineeffect.htm https://www.cdc.gov/flu/about/qa/vaccineeffect.htm Time will tell how effective covid vaccines are when it's mutating as rapidly as it is. The covid vaccine will definitely reduce zero infections if people do not get it.
  - ifyoubuildit 2y ago
    Yeah, sorry I wasn't clear, I was talking about the covid shots. There are studies suggesting negative efficacy against infection after the initial period°. So while I think for hospitalizations and death there is a stronger argument, for infections it's not terribly clear. ° from chat gpt (with all the standard caveats): Source: "Vaccine effectiveness against SARS-CoV-2 infection with the Omicron or Delta variants following a two-dose or booster BNT162b2 or mRNA-1273 vaccination series: a Danish cohort study" (Published in The Lancet). Source: "Efficacy of a Fourth Dose of Covid-19 mRNA Vaccine against Omicron" (Published in NEJM). Source: UKHSA COVID-19 vaccine surveillance reports.

timonoko 2y ago

[flagged]

nikolay 2y ago

Turn this into a SARS/MERS - it would be highly profitable. I'm not an anti-vaxxer - I have all vaccines, and I made the mistake of getting the first Pfizer, which I regretted a lot after I damaged my health due to side effects that were downplayed and ignored by both Pfizer and CDC! Geert Vanden Bossche [0] has been predicting a vaccine-induced massive die-off this summer! We need antivirals, not vaccines! Just look at this [1] and shit in your pants!!! [0]: https://x.com/GVDBossche https://x.com/GVDBossche [1]: https://nextstrain.org/ncov/gisaid/global/6m https://nextstrain.org/ncov/gisaid/global/6m

Shorel 2y ago

Part of the problem is to just group all Covid-19 shots as if they were the same thing. They are very different technologies. I got a Pfizer–BioNTech booster, and it was of course fine. I don't want and would not get the Sinovac booster.

ifyoubuildit 2y ago

Let's assume for the sake of argument that these new shots will be perfectly safe and effective (won't catch it, won't spread it, won't have any side effects, etc). Given current sentiment and uptake rates, how many people are actually going to get these (or make their 6 month old get them)? And how low does that number have to be before you are just training people to be comfortable ignoring your recommendations?

dkekenflxlf 2y ago

attack!!! near to a cinema next to you!! ;-)

randm_sequence 2y ago

The disappointing thing that no one talks about is that all of the vaccines target the spike, which is the part of the virus that evolves most quickly (the spike is also an immunotoxin). Alternatively, vaccines could have targeted the nucleocapsid protein. This would have had the dual benefit of not being as immunogenic/immunotoxin and also likely being a one and done shot with long term effective immunity. Why do you think the folks at Big pharma decided to choose a vaccine against the spike protein? Can anyone say "recurring revenue?"

tripletao 2y ago
Vaccines designed at a genomic level target the spike because that's the protein at the surface of the virus, and thus believed to be the most effective target for your immune system. That belief seems to have been correct (at least as to infection), since mRNA vaccines against the spike had the highest efficacy. The spike is unfortunately also under heavy selective pressure for that same reason, leading to the rapid evolution that you note; but that's the inherent and unavoidable tradeoff. Inactivated virus vaccines (like Sinovac) don't target the spike, since they don't target anything. They do induce anti-nucleocapsid immunity, but there's no evidence that corresponds to any clinical benefit. I don't think the word "immunogenic" means what you think it does. Vaccines are supposed to be immunogenic (i.e., to generate an immune response); if they weren't then they wouldn't do anything. I've seen papers proposing that the spike protein is toxic in certain cases, but no evidence that the exposure from the vaccine minus the exposure from averted infections is net harmful.