Do we need Omicron-specific vaccines?

I’d say so.  So does Yglesias.  But, as he points out, don’t listen to him, listen to Michael Mina. Yglesias:

Omicron has weakened our vaccines

Hannah Kuchler, Donato Paolo Mancini, and Oliver Barnes at the Financial Times did a write-up of data from the UK Health Security Agency that I think really clarifies the vaccine situation.

I’m going to steal their chart because it’s good. The key points are that vaccination works against both Delta and Omicron, but it works significantly less well against Omicron. Boosters work against both variants, but again less well against Omicron. A boosted person has similar protection against Omicron as a non-boosted person has against Delta.

So I’m boosted, you should boost, we all should boost. At the same time, this is telling us we should expect a lot of symptomatic infections even among boosted people.

Pfizer, optimistically, is telling us that its vaccine still offers a 70% reduction in the risk of severe (i.e., you end up in the hospital) Covid-19. And unless something really weird is happening, that should also mean at least a 70% reduction in the risk of death. But while 70% is pretty good, South African health journalist Mia Malan notes it is far less than the 93% protection provided against Delta. Most people naturally tend toward absolutism, so they’ll hear about a large reduction in relative risk and figure “okay, I’m safe.” Then they’ll hear anecdotes about severe breakthroughs and ask, “is it all a lie and nothing works?”

We live in a big country (and a bigger world), so even though a 70% reduction in severe disease is significant, we’re still going to see a lot of vaccinated people end up in the hospital — including some relatively young people with no clear comorbidities.

Variant-specific vaccines

Everybody wants to reassure people that the existing vaccines are still useful against Omicron and that everyone who can take them, should take them. That said, they are clearly less effective than they were against Delta. And they were less effective against Delta than they were against the original strain.

With the flu, we have an established process for creating variant-specific shots for each new flu season and approving them very rapidly. We could set up a process like that for variant-specific boosters, but so far we have not. And that, in turn, has made it unclear to pharmaceutical companies whether developing variant-specific boosters is likely to be lucrative. There’s a good case to be made that we should not be so heavily reliant on the profit motive when it comes to pharmaceutical development. But the fact is that we are dependent. Right now, Pfizer and Moderna are selling every dose of mRNA they can make, so it’s not obvious that there is a super-strong business case for developing new vaccines. If we want to see that happen, we need to put money into it and we need regulatory clarity.

I’m just going to quote an email that Harvard’s Michael Mina sent to Holden Karnofsky, because it’s very smart and also because maybe people will trust a Harvard epidemiologist rather than a “contrarian” on Substack.

Enjoy:

We should do the least necessary checks of the new variant vaccines. Put them into 20 people and make sure they elicit the desired immune responses. Do NOT do any sort of efficacy study and these vaccines should be fast tracked like flu shots.

Unfortunately FDA has essentially no ability to balance the cost of slowness and the cost of inaction with the benefit of action. The FDA viewpoint is that inaction and whatever cost comes from that is not on them. They are used to a system where it’s better to do nothing than act with any uncertainty. But that’s Bc the FDA is not designed for emergencies. It just isn’t. It is horribly inefficient and unable to effectively make calculations around public health vs medicine.

To this day we still do not have a regulatory framework for products that have as a base use one of public health. Vaccines elicit ideas of public health but ultimately are evaluated and regulated as medicine. As far as safety this is important. But as far as efficacy and the regulatory approaches and data required, it’s entirely around individual benefit. Which at this point I hope everyone recognizes that’s the wrong angle in a pandemic.

For example, we knew that a single dose vaccine would yield 90% or more protection from severe disease for at least a few months, yet we withheld first doses in order to give people second doses and importantly we have those second doses in a suboptimal manner just Bc that’s the hard data we had. But the soft data (the data from decades of immunology research across the world) allowed us to know that spacing the vaccines months apart would have been better both for individuals and for public health. We didn’t do that.

At this point, we can’t get optimized vaccines off the ground in time to head off an Omicron wave. But we will still be vaccinating (and boosting) people next summer, by which time Omicron will still be kicking around everywhere, so it still helps. More to the point, we’re in a world where different variants are going to be popping up for a while, so we need to be ready to optimize.

There is so much uncertainty about what to expect with Omicron.  Two things are pretty clear, though. 1) There’s going to be an Omicron wave. 2) A 3rd dose is far and away the best thing we can do against this coming wave.  The difference in preventing a symptomatic Omicron infection between two doses (especially waning doses) and a third dose is simply massive and we are crazy not to make this change our public policy.

As for the actual title of this post, though, any vaccine changes are going to be much too late for the coming wave.  But there’s a good enough chance that Omicron is not going to be outcompeted for a good while and it’s kind of nuts that at this point we’re still basing our vaccines off the original Wuhan strain when we know we could get so much of a better immune response with a vaccine much more appropriately targeted to the dominant strain.  

The honesty asymmetry

Presumably the most important asymmetry going these days is the fact that Democrats have a commitment to liberal democracy and the rule of law and Republicans, increasingly do not.  Presumably something that goes along with this is Republican politicians” tenuous connection to facts and empirical reality.  The NYT did some heroic work reading thousands of politicians’ emails for misinformation.  And, unsurprisingly, Republicans lie and lie.  And participate in a coordinated ecosystem of dishonesty and misinformation.  Of course, many people just take the “well, all politicians lie” approach.  But, just a vast difference in the matter of scope.  NYT:

A few weeks ago, Representative Dan Crenshaw, a Texas Republican, falsely claimed that the centerpiece of President Biden’s domestic agenda, a $1.75 trillion bill to battle climate change and extend the nation’s social safety net, would include Medicare for all.

It doesn’t, and never has. But few noticed Mr. Crenshaw’s lie because he didn’t say it on Facebook, or on Fox News. Instead, he sent the false message directly to the inboxes of his constituents and supporters in a fund-raising email.

Lawmakers’ statements on social media and cable news are now routinely fact-checked and scrutinized. But email — one of the most powerful communication tools available to politicians, reaching up to hundreds of thousands of people — teems with unfounded claims and largely escapes notice.

The New York Times signed up in August for the campaign lists of the 390 senators and representatives running for re-election in 2022 whose websites offered that option, and read more than 2,500 emails from those campaigns to track how widely false and misleading statements were being used to help fill political coffers. [emphases mine]

But Republicans included misinformation far more often: in about 15 percent of their messages, compared with about 2 percent for Democrats. In addition, multiple Republicans often spread the same unfounded claims, whereas Democrats rarely repeated one another’s.

At least eight Republican lawmakers sent fund-raising emails containing a brazen distortion of a potential settlement with migrants separated from their families during the Trump administration. One of them, Senator John Kennedy, Republican of Louisiana, falsely claimed that President Biden was “giving every illegal immigrant that comes into our country $450,000.”

Those claims were grounded in news that the Justice Department was negotiating payments to settle lawsuits filed on behalf of immigrant families whom the Trump administration had separated, some of whom have not been reunited. But the payments, which are not final and could end up being smaller, would be limited to that small fraction of migrants.

The relatively small number of false statements from Democrats were mostly about abortion. For instance, an email from Representative Carolyn Maloney of New York said the Mississippi law before the Supreme Court was “nearly identical to the one in Texas, banning abortions after 6 weeks,” but Mississippi’s law bans abortion after 15 weeks and does not include the vigilante enforcement mechanism that is a defining characteristic of Texas’ law

The emails reviewed by The Times illuminate how ubiquitous misinformation has become among Republicans, fueled in large part by former President Donald J. Trump. And the misinformation is not coming only, or even primarily, from the handful who get national attention for it.

The people behind campaign emails have “realized the more extreme the claim, the better the response,” said Frank Luntz, a Republican pollster. “The more that it elicits red-hot anger, the more likely people donate. And it just contributes to the perversion of our democratic process. It contributes to the incivility and indecency of political behavior.”

The messages also underscore how, for all the efforts to compel platforms like Facebook and Twitter to address falsehoods, many of the same claims are flowing through other powerful channels with little notice.

Hyperbole?  Sure.  But blatant, outright falsehoods.  Especially consistently and widely shared within the same party, just have no place in a democracy. 

Of course, this also speaks to a larger problem in that the Republican Party is increasingly unconcerned about basic principles of democracy and completely in thrall to literally one of the most dishonest politicians in American history.  This is pretty, pretty bad and there’s no sign of it getting better or how to make it get better.  

%d bloggers like this: