I generally like this article but I think "But current vaccines do not stop you from transmitting Delta to others" is problematic enough that you should IMO change it.
1) The study in Eric's tweet is about AZ which is not available in the US and there seems to be good evidence that it's less effective against Delta than the mRNA vaccines.
2) You probably already know this and it's mostly hedging against anti-vaxxers (and potentially compatible with your sentence) but the vaccines reduce your chance of being infected in the first place so that reduces transmission.
3) There's decent emerging evidence that infected vaccinated people have less infectious virus (even though viral loads may be high) and that the period during which they are infectious is shorter.
I know you don't want to hear it but you should have left this question to experts. You and I absolutely don't know whether it would be medically useful or not. I suppose it depends on the minutiae of how differently the variants behave.
I am skeptical as I have not seen evidence of severe disease among the vaxed except among severely immunocompromised. If boosters are not medically useful and are merely a political project to make the vaxed feel better during an epidemic among the vaxed, that would be a waste and distraction from the real problem of getting more people vaxed.
But I'd pay attention to an expert making this recommendation. There just isn't any value in you weighing in here.
If you don’t actually know what you are talking about, then maybe you should stay in your damn lane.
It is really easy to make random guesses that the consensus opinion is wrong, and occasionally by chance you are going to be right. Early in the pandemic everyone and their dog at some point wondered if masks would in fact help. But it wasn’t the endless tweets by armchair epidemiologists that discovered the problem, it was a bunch of actual scientists that did the work.
Delta specific covid shots seems like a good idea. It probably seems like a good idea to the army of people who have probably been working on the problem since delta emerged. You even link to a report that says that Pfizer is working on the problem.
How hard is it to understand that building a new vaccine, testing it, and making sure that it is safe and effective is an insanely difficult problem that takes a staggering amount of time, resources, work, and money? Do you actually think we can just tweak the sequence, and get the new dose into arms by the end of the week?
Are you actually implying that the constraints on vaccine production are due to artificial political scarcity, and not because we are running up against real physical limits?
What I find infuriating is your assumption that the roadblocks are political, rather than practical, and therefore the CDC et al must be incompetent or corrupt or playing larger political games. You have no evidence of any of that.
People don't complain about Nate Silver, Alex Taborek, and others because they 'don't stay in their lane', but because they can be insufferable arrogant at times. They have posted half baked critiques, created straw men, and not acknowledged errors. They also claim as their own brilliant insights, facts and ideas that have been well known by other experts.
Does anyone really believe that vaccine developers aren't attempting to improve the vaccine to tackle variants, as has been the standard practice for flu vaccines for years, as Alex T implies?
Has Alex T considered that the problem is that the challenges are greater than what he is aware of, instead of the researchers and public health people having only half his intellect?
President Biden got the Pfizer shot very early. He is almost 79 year old and is exposed to a lot of people. It is only a matter of time before Delta meets him and he is hardly protected at that phase. Deadly breakthrough cases at that age after 8-9 months are not rare at all as you could see in Israel before the booster campaign. Prime minister Bennet even said that those old people who got two shots but didn't get the booster shot are most at risk since they have the illusion of immunity. It is a matter of national security to start booster shots ASAP and to vaccinate the president first.
Regarding variant based shots, their approval and manufacturing will take some months. We need boosters now.
Pfizer's own positions are that any reduced effectiveness is due to waning immunity over time rather than lesser effectiveness against the Delta variant, and that Delta-specific boosters "almost certainly" won't be necessary:
I think the variant-specific boosters would be put into play if the vaccines had significantly reduced effectiveness against a dominant variant, but the people who would actually be marketing these boosters don't think that's the case here. Delta is more contagious across the board than original coronavirus, but that's a different issue.
You have a misunderstand of vaccine production complexities. Simply throwing more resources at it isn't a problem. The problem is spool-up time and expertise base - vaccine manufaturing is peak high-technology manufacturing. It requires very good specialists, perfect quality assurance, clean rooms, etc.
A major missing piece is not being able to rapidly trial for safety and efficacy. Any country with the means to do it could have started this already, coordinating a roll out in order to best learn from it. Recommending to press ahead with boosters (variant specific or otherwise) without a more experimental approach is like advancing oblivious to leaving enemy positions at your back. Same problem can be seen with childhood vaccination issues. It's a recurring problem of lacking the political will and organisation to move forward both rapidly and cautiously.
TLDR, Noah how should we roll out boosters while also learning if they work and are safe, in a short time scale?
I'm not sure the Delta mutations necessarily introduce new targetable epitopes, or that it's clear what these might be. It's like telling someone to target someone wearing an invisibility cloak. Sure, the cloak is unique but it's not easy to target.
The breakthrough we need now is in scaling up manufacturing while we figure out how to fine tune using the mRNA tech.
I think Delta is unique b/c of its speed, I am not sure just configuring it to search for a different protein wins this race, we need to take a different approach to counter the speed of Delta, I think we need a vaccine targeted at nasal and lung tissues, like a spray vaccine.
The idea is sound and we certainly should be working on it. However, two points should be kept in mind: First, the current vaccines offer a beautiful "template" allowing the same strategy for variants. However, without (at least) years of empirical experience, it would be dangerous to actually release one of these novel vaccines without substantial testing to verify efficacy and safety.
Second, the current vaccines do a great job of activating the B cell/IgG antibody system. However, they do a poor job of stimulating IgA, the primary immune molecule in the upper respiratory tract. That likely explains why they're more effective at preventing death than preventing infection or reducing viral load. Accordingly (though the point is consistent with your essay) it remains important to design new vaccine delivery systems, perhaps inhaled or subcutaneous mRNA.
One aspect to account for is supply chain issues. You will need separate production and distribution lines. For a company, it's easier to keep making loads of the same, rather than custom versions.
The pharma community used insanely advanced technology to create covid vaccines in under 18 months.
Any sufficiently advanced technology is indistinguishable from magic.
Magic in fantasy novels is wielded by either good wizards or evil wizards.
Good wizards in fantasy novels give the protagonist everything they want: advice, support, and the occasional magic sword.
Everyone thinks they are the protagonist.
Therefore, if the pharma community isn’t giving you exactly what you want, they must be evil. They have powerful magic and can do anything. Anything bad that happens must be deliberate on their part.
I generally like this article but I think "But current vaccines do not stop you from transmitting Delta to others" is problematic enough that you should IMO change it.
1) The study in Eric's tweet is about AZ which is not available in the US and there seems to be good evidence that it's less effective against Delta than the mRNA vaccines.
2) You probably already know this and it's mostly hedging against anti-vaxxers (and potentially compatible with your sentence) but the vaccines reduce your chance of being infected in the first place so that reduces transmission.
3) There's decent emerging evidence that infected vaccinated people have less infectious virus (even though viral loads may be high) and that the period during which they are infectious is shorter.
I know you don't want to hear it but you should have left this question to experts. You and I absolutely don't know whether it would be medically useful or not. I suppose it depends on the minutiae of how differently the variants behave.
I am skeptical as I have not seen evidence of severe disease among the vaxed except among severely immunocompromised. If boosters are not medically useful and are merely a political project to make the vaxed feel better during an epidemic among the vaxed, that would be a waste and distraction from the real problem of getting more people vaxed.
But I'd pay attention to an expert making this recommendation. There just isn't any value in you weighing in here.
About
If you don’t actually know what you are talking about, then maybe you should stay in your damn lane.
It is really easy to make random guesses that the consensus opinion is wrong, and occasionally by chance you are going to be right. Early in the pandemic everyone and their dog at some point wondered if masks would in fact help. But it wasn’t the endless tweets by armchair epidemiologists that discovered the problem, it was a bunch of actual scientists that did the work.
Delta specific covid shots seems like a good idea. It probably seems like a good idea to the army of people who have probably been working on the problem since delta emerged. You even link to a report that says that Pfizer is working on the problem.
How hard is it to understand that building a new vaccine, testing it, and making sure that it is safe and effective is an insanely difficult problem that takes a staggering amount of time, resources, work, and money? Do you actually think we can just tweak the sequence, and get the new dose into arms by the end of the week?
Are you actually implying that the constraints on vaccine production are due to artificial political scarcity, and not because we are running up against real physical limits?
What I find infuriating is your assumption that the roadblocks are political, rather than practical, and therefore the CDC et al must be incompetent or corrupt or playing larger political games. You have no evidence of any of that.
People don't complain about Nate Silver, Alex Taborek, and others because they 'don't stay in their lane', but because they can be insufferable arrogant at times. They have posted half baked critiques, created straw men, and not acknowledged errors. They also claim as their own brilliant insights, facts and ideas that have been well known by other experts.
Does anyone really believe that vaccine developers aren't attempting to improve the vaccine to tackle variants, as has been the standard practice for flu vaccines for years, as Alex T implies?
Has Alex T considered that the problem is that the challenges are greater than what he is aware of, instead of the researchers and public health people having only half his intellect?
President Biden got the Pfizer shot very early. He is almost 79 year old and is exposed to a lot of people. It is only a matter of time before Delta meets him and he is hardly protected at that phase. Deadly breakthrough cases at that age after 8-9 months are not rare at all as you could see in Israel before the booster campaign. Prime minister Bennet even said that those old people who got two shots but didn't get the booster shot are most at risk since they have the illusion of immunity. It is a matter of national security to start booster shots ASAP and to vaccinate the president first.
Regarding variant based shots, their approval and manufacturing will take some months. We need boosters now.
Pfizer's own positions are that any reduced effectiveness is due to waning immunity over time rather than lesser effectiveness against the Delta variant, and that Delta-specific boosters "almost certainly" won't be necessary:
https://www.bloomberg.com/news/articles/2021-09-15/pfizer-says-covid-19-vaccine-efficacy-erodes-over-time
https://www.washingtoninformer.com/pfizer-updating-vaccine-for-delta-but-doesnt-anticipate-needing-it/
I think the variant-specific boosters would be put into play if the vaccines had significantly reduced effectiveness against a dominant variant, but the people who would actually be marketing these boosters don't think that's the case here. Delta is more contagious across the board than original coronavirus, but that's a different issue.
Noah please read this: https://www.science.org/content/blog-post/myths-vaccine-manufacturing
You have a misunderstand of vaccine production complexities. Simply throwing more resources at it isn't a problem. The problem is spool-up time and expertise base - vaccine manufaturing is peak high-technology manufacturing. It requires very good specialists, perfect quality assurance, clean rooms, etc.
You seem to believe that the FDA can and will approve the variant specific boosters quickly.
This seems quite optimistic if by quickly you mean as quickly as new variants pop up and spread, a few weeks or months...
They are good people but are imbeded in a very risk adverse organization
Appreciate your booster for boosters.
A major missing piece is not being able to rapidly trial for safety and efficacy. Any country with the means to do it could have started this already, coordinating a roll out in order to best learn from it. Recommending to press ahead with boosters (variant specific or otherwise) without a more experimental approach is like advancing oblivious to leaving enemy positions at your back. Same problem can be seen with childhood vaccination issues. It's a recurring problem of lacking the political will and organisation to move forward both rapidly and cautiously.
TLDR, Noah how should we roll out boosters while also learning if they work and are safe, in a short time scale?
I'm not sure the Delta mutations necessarily introduce new targetable epitopes, or that it's clear what these might be. It's like telling someone to target someone wearing an invisibility cloak. Sure, the cloak is unique but it's not easy to target.
The breakthrough we need now is in scaling up manufacturing while we figure out how to fine tune using the mRNA tech.
Shouldn't we be laser-focused on the nasal-spray options . . . ?
I think Delta is unique b/c of its speed, I am not sure just configuring it to search for a different protein wins this race, we need to take a different approach to counter the speed of Delta, I think we need a vaccine targeted at nasal and lung tissues, like a spray vaccine.
I’m not sure that we could get variant Booster is out in time. I suspect broad spectrum vaccines will be more effective.
I’m working in Argentina and a week before I came here I went and got a Moderna Booster. I had Pfizer Mar/Apr.
The idea is sound and we certainly should be working on it. However, two points should be kept in mind: First, the current vaccines offer a beautiful "template" allowing the same strategy for variants. However, without (at least) years of empirical experience, it would be dangerous to actually release one of these novel vaccines without substantial testing to verify efficacy and safety.
Second, the current vaccines do a great job of activating the B cell/IgG antibody system. However, they do a poor job of stimulating IgA, the primary immune molecule in the upper respiratory tract. That likely explains why they're more effective at preventing death than preventing infection or reducing viral load. Accordingly (though the point is consistent with your essay) it remains important to design new vaccine delivery systems, perhaps inhaled or subcutaneous mRNA.
One aspect to account for is supply chain issues. You will need separate production and distribution lines. For a company, it's easier to keep making loads of the same, rather than custom versions.
The pharma community used insanely advanced technology to create covid vaccines in under 18 months.
Any sufficiently advanced technology is indistinguishable from magic.
Magic in fantasy novels is wielded by either good wizards or evil wizards.
Good wizards in fantasy novels give the protagonist everything they want: advice, support, and the occasional magic sword.
Everyone thinks they are the protagonist.
Therefore, if the pharma community isn’t giving you exactly what you want, they must be evil. They have powerful magic and can do anything. Anything bad that happens must be deliberate on their part.