You shared the last article about the Delta Variant so much that over 350,000 people read it. Thanks for spreading the word on something so important. You then asked so many good questions that I decided to answer as many as I could. So here are the most frequently asked questions along with my answer.
Whether booster shots should be allowed is the wrong question. We should be asking whether they should be offered in highly vaccinated populations while there are still so many countries with low or no access to vaccines at all. For pharmaceutical companies, selling boosters in developed countries offers greater profits faster than selling first and second doses in developing countries. Global public health policy should not be dictated by the pharmaceutical investors' desire for greater dividends, but by global public health considerations.
There simply does not appear to be a pressing public health need for booster shots. Easily detectable T-cells and antibodies reduce over time, but there is no reason to believe that immune response (whcih is to say immune memory) disappears along with them. Meanwhile, in many countries, vaccination rates are still so low that capacity does not even meet the needs of front line health workers treating COVID patients, let alone vaccinating at-risk groups.
This is not only a moral failure, it also provides perfect condidtions for the emergence of new variants. Instead of deepening protection in highly vaccinated countries by diverting capacity to booster doses, we should we widening coverage to more countries in order to run as fast as we can towards global herd immunity. Only then will we really be able to learn to live with the virus.
This comment is so spot on. I’m even more intrigued by our collective inability to address global challenges than I am by viral disease spread. Sometimes it seems our whole neighborhood is on fire and we are watering our lawn.
Me asombra que el aumento de casos en Israel lo quieran resolver con una tercera dosis y sigan sin inmunizar a los palestinos que necesitan a diario para hacer los trabajos que ellos no quieren y por lo tanto entran y salen de Israel y pueden contagiar. No he visto recientemente ningún artículo que hable de esto ni el porcentaje de vacunados entre la población palestina. Creo, aunque puede que me equivoque, que aunque nos pongan 10 dosis si llegan personas sin vacunar a nuestro entorno, voveremos a contagiarnos. Gracias por el artículo y los enlaces y referencias. Interesante para mi la vacuna Novavax
When writing about long covid, consider the broader consequences. Noone has started thinking about it yet. I feel like a Cassandra trying to raise awareness and failing.
What will it do to partisan divides in the US? We have one party whose more extreme supporters are irrational enough to refuse a free and safe vaccine during a plague. What happens to their rationality when they get a bit of covid induced brain damage? What happens to the healthcare debate when 10% of Republicans get long covid? By my back of the envelope calculations, it doesnt look like long covid is big enough to influence elections, but it could make a large chunk of the Republican electorate less likely to vote because they become disabled by long covid.
What happens to inequality if we take the poorest workers, who are often from minority backgrounds, and subject them to long covid. This could further deeply entrench inequalities, especially without adequate support or treatment for the disabled.
Similar to Jose's comment: There must be massive financial complications for pharma companies whether their drugs get approved/effectiveness/etc. Also we see that some countries administer different vaccines.
Whats your take on the effect of lobbyism on the global vaccine market? Are there any truly independent studies done between the different vaccines, and if so, why dont countries adhere to these studies?
Whats your take on a global vaccine strategy after we reach the maximum potential vaccinations (everyone that wants to, is vaccinated)? Should we leave this up to individual countries, buying from big pharma?
In the UK, the ONS is an independent body responsible for producing and checking statistics about events in the nation. Once every week they test a large number of people and produce a figure of "N in 100,000 people have COVID today".
To the best of my knowledge, at the present time these figures are confirming the approximate number of reported cases.
Therefore the reason for a reduction in the number of reported cases is unlikely to be due to a reduction in the number of tests. Obviously, there could be something about the way UK people decide to get tested, but so long as the ONS is producing the statistic, you can use it as being indicative of the true situation.
The majority of people around the world who have been vaccinated received shots manufactured in China. Can you share more data about their efficacy against Delta?
Here are my questions, as a Southern Californian. I’m concerned about waning protection of the vaccine (in my case Pfizer) after six months amid constant reports about breakthrough infections. Why isn’t the CDC collecting data on breakthrough infections? The official pronouncements say they are exceedingly rare, but if that’s true, why do I hear so many anecdotes about them from people I know? What’s more, I get the impression that we’re being prepared to accept the inevitability of catching COVID. Even the New York Times the other day advised, “Hey, if you get a breakthrough case, your immunity will improve! So goody!” This seems crazy to me - every infection poses risks to others and is an occasion for further mutation. Can this really be the posture of our national, or world, leaders?
In Argentina, where I am from, we are mixing Sputnik with Moderna/AstraZeneca, and Sputnik with Sinopharm. There are good and massive studies carried out here that show they are safe and work better. These vaccines (Sputnik/Sinopharm) are not approved by many European countries (actually they won’t let you travel with these) purely because geopolitical reasons. This is another interesting point at this stage, how geopolitical issues affect the vaccination strategies worldwide
Thanks a lot for your common sense and great capacity of analysis. A side note on mix and matching. I fully agree with “Mix-and-match is probably not more dangerous.
It’s probably slightly better for immunity.”
However, it is likely that some mix and match, such as one mRNA vaccine with another, does offer very little in terms of protection and may increase, even a little bit, the risks of immune-related adverse effects. This, I advise mixing after Astra or Janssen but not Pfizer after Moderna or Moderna after Pfizer.
A small point regarding mix-and-match. At some point, right or wrong, we will all be living in a world of 'Vaccine Passports'. As I see it, the only way to define whether or not someone has qualified to hold one is on the basis of completing a recommended course of vaccines: Two Pfizer, Two AZ, one J&J etc. Even if mix and match is medically sound, it will make the issuance of Vaccine Passports problematic: I had one Pfizer in April 21 and one Sinovac in July 21 (for example). Do I get one?
For the ones you listed, the simple rule "at least two shots" would be sufficient by current standards. If things get more complicated, simple apps could help to figure that out. I really hope thst this wouldn't be a show stopper.
Just to clarify, I am talking about the rule that would be needed to verify if a given mix should qualify (at least two shots of any of the three vaccines you named). For J&J, current standards require only one shot, but this exception is _not_ due to mixing and would not be required for mixes as mixes involve at least two shots.
New Zealand is taking the lock down approach, slowly moving to 80%+ vaccinated (my small community is 83% now). I think the Govt will slowly open up to vaccinated travelers in 2022. Businesses and conservatives are pushing for opening sooner and not so limitedly. Any advice for New Zealand? I think some ministers are reading your pieces.
Ponerle retos sencillos al virus (transmisión entre humanos) en su millonaria replicación lo reforzará (mutación + peligrosa). Ponerle retos más difíciles (transmisión entre especies) y que además lo supere lo transformará siendo casi invencible.
Just a minor correction: in your first footnote, you wrote: "[assuming] that vaccination and previous infection are independent". I understand that you are referring to their respective protective effect, but the sentence sounds like it is suggesting that having been vaccinated and having been previously infected are independent events. But since the occurrence of one clearly affects the probability of occurrence of the other, of course, having been vaccinated and having been previously infected are dependent events.
Overlapping categories does not necessarily suggest independence (certainly not in this case). For example, law-school attendees and lawyers are two overlapping—and certainly dependent—categories.
The footnote probably means "[assuming] that the protection conferred by vaccination and previous infection aren't *cumulative* " instead of that the two categories are independent (they really aren't).
Whether booster shots should be allowed is the wrong question. We should be asking whether they should be offered in highly vaccinated populations while there are still so many countries with low or no access to vaccines at all. For pharmaceutical companies, selling boosters in developed countries offers greater profits faster than selling first and second doses in developing countries. Global public health policy should not be dictated by the pharmaceutical investors' desire for greater dividends, but by global public health considerations.
There simply does not appear to be a pressing public health need for booster shots. Easily detectable T-cells and antibodies reduce over time, but there is no reason to believe that immune response (whcih is to say immune memory) disappears along with them. Meanwhile, in many countries, vaccination rates are still so low that capacity does not even meet the needs of front line health workers treating COVID patients, let alone vaccinating at-risk groups.
This is not only a moral failure, it also provides perfect condidtions for the emergence of new variants. Instead of deepening protection in highly vaccinated countries by diverting capacity to booster doses, we should we widening coverage to more countries in order to run as fast as we can towards global herd immunity. Only then will we really be able to learn to live with the virus.
This comment is so spot on. I’m even more intrigued by our collective inability to address global challenges than I am by viral disease spread. Sometimes it seems our whole neighborhood is on fire and we are watering our lawn.
Israel offered boosters to the elderly because they were set to expire anyway. Pfizer is working on a booster tailored to delta.
Me asombra que el aumento de casos en Israel lo quieran resolver con una tercera dosis y sigan sin inmunizar a los palestinos que necesitan a diario para hacer los trabajos que ellos no quieren y por lo tanto entran y salen de Israel y pueden contagiar. No he visto recientemente ningún artículo que hable de esto ni el porcentaje de vacunados entre la población palestina. Creo, aunque puede que me equivoque, que aunque nos pongan 10 dosis si llegan personas sin vacunar a nuestro entorno, voveremos a contagiarnos. Gracias por el artículo y los enlaces y referencias. Interesante para mi la vacuna Novavax
When writing about long covid, consider the broader consequences. Noone has started thinking about it yet. I feel like a Cassandra trying to raise awareness and failing.
I've calculated that long covid could do similar amount of long term damage to the US employment market as the Great Recession (https://obscurata.wordpress.com/2021/06/17/is-long-covid-about-to-block-the-economic-recovery/). The post also contains a lot of analysis on the true prevalence of long covid, you might find it helpful.
What will it do to partisan divides in the US? We have one party whose more extreme supporters are irrational enough to refuse a free and safe vaccine during a plague. What happens to their rationality when they get a bit of covid induced brain damage? What happens to the healthcare debate when 10% of Republicans get long covid? By my back of the envelope calculations, it doesnt look like long covid is big enough to influence elections, but it could make a large chunk of the Republican electorate less likely to vote because they become disabled by long covid.
What happens to inequality if we take the poorest workers, who are often from minority backgrounds, and subject them to long covid. This could further deeply entrench inequalities, especially without adequate support or treatment for the disabled.
When writing about Long-COVID, consider reading https://sciencebasedmedicine.org/neurological-manifestations-of-covid/?utm_source=rss&utm_medium=rss&utm_campaign=neurological-manifestations-of-covid (also contains lots of interesting references). There may be neurological damage even in persons who do not realize it. This is imho a serious concern, especially when policy makers seem to be okay with the virus spreading among children simply due to the fact that they rarely need to be hospitalized.
Similar to Jose's comment: There must be massive financial complications for pharma companies whether their drugs get approved/effectiveness/etc. Also we see that some countries administer different vaccines.
Whats your take on the effect of lobbyism on the global vaccine market? Are there any truly independent studies done between the different vaccines, and if so, why dont countries adhere to these studies?
Whats your take on a global vaccine strategy after we reach the maximum potential vaccinations (everyone that wants to, is vaccinated)? Should we leave this up to individual countries, buying from big pharma?
We have made pharma billionaires. Per Reuters, this years projected sales figures. Pfizer $33 billion, Moderna $19 billion, & J&J $2.5 billion.
In the UK, the ONS is an independent body responsible for producing and checking statistics about events in the nation. Once every week they test a large number of people and produce a figure of "N in 100,000 people have COVID today".
To the best of my knowledge, at the present time these figures are confirming the approximate number of reported cases.
Therefore the reason for a reduction in the number of reported cases is unlikely to be due to a reduction in the number of tests. Obviously, there could be something about the way UK people decide to get tested, but so long as the ONS is producing the statistic, you can use it as being indicative of the true situation.
The majority of people around the world who have been vaccinated received shots manufactured in China. Can you share more data about their efficacy against Delta?
Here are my questions, as a Southern Californian. I’m concerned about waning protection of the vaccine (in my case Pfizer) after six months amid constant reports about breakthrough infections. Why isn’t the CDC collecting data on breakthrough infections? The official pronouncements say they are exceedingly rare, but if that’s true, why do I hear so many anecdotes about them from people I know? What’s more, I get the impression that we’re being prepared to accept the inevitability of catching COVID. Even the New York Times the other day advised, “Hey, if you get a breakthrough case, your immunity will improve! So goody!” This seems crazy to me - every infection poses risks to others and is an occasion for further mutation. Can this really be the posture of our national, or world, leaders?
In Argentina, where I am from, we are mixing Sputnik with Moderna/AstraZeneca, and Sputnik with Sinopharm. There are good and massive studies carried out here that show they are safe and work better. These vaccines (Sputnik/Sinopharm) are not approved by many European countries (actually they won’t let you travel with these) purely because geopolitical reasons. This is another interesting point at this stage, how geopolitical issues affect the vaccination strategies worldwide
Thanks a lot for your common sense and great capacity of analysis. A side note on mix and matching. I fully agree with “Mix-and-match is probably not more dangerous.
It’s probably slightly better for immunity.”
However, it is likely that some mix and match, such as one mRNA vaccine with another, does offer very little in terms of protection and may increase, even a little bit, the risks of immune-related adverse effects. This, I advise mixing after Astra or Janssen but not Pfizer after Moderna or Moderna after Pfizer.
Yeah so the rule there should be "if you didn't get an mRNA before, get one now". The opposite is unclear to me.
Yes, exactly. Thanks again.
Hi Tomas. I've been enjoying your analyses.
A small point regarding mix-and-match. At some point, right or wrong, we will all be living in a world of 'Vaccine Passports'. As I see it, the only way to define whether or not someone has qualified to hold one is on the basis of completing a recommended course of vaccines: Two Pfizer, Two AZ, one J&J etc. Even if mix and match is medically sound, it will make the issuance of Vaccine Passports problematic: I had one Pfizer in April 21 and one Sinovac in July 21 (for example). Do I get one?
For the ones you listed, the simple rule "at least two shots" would be sufficient by current standards. If things get more complicated, simple apps could help to figure that out. I really hope thst this wouldn't be a show stopper.
Just to clarify, I am talking about the rule that would be needed to verify if a given mix should qualify (at least two shots of any of the three vaccines you named). For J&J, current standards require only one shot, but this exception is _not_ due to mixing and would not be required for mixes as mixes involve at least two shots.
Tomas.
What about side effects? The toll of side effects need to be factored in. https://www.virginiastoner.com/writing/2021/8/10/update-on-the-deadly-covid-vaccine-coverup-plus-how-to-estimate-risk-better-than-the-cdc
New Zealand is taking the lock down approach, slowly moving to 80%+ vaccinated (my small community is 83% now). I think the Govt will slowly open up to vaccinated travelers in 2022. Businesses and conservatives are pushing for opening sooner and not so limitedly. Any advice for New Zealand? I think some ministers are reading your pieces.
Ponerle retos sencillos al virus (transmisión entre humanos) en su millonaria replicación lo reforzará (mutación + peligrosa). Ponerle retos más difíciles (transmisión entre especies) y que además lo supere lo transformará siendo casi invencible.
What is your profession?
Thanks for another excellent article.
Just a minor correction: in your first footnote, you wrote: "[assuming] that vaccination and previous infection are independent". I understand that you are referring to their respective protective effect, but the sentence sounds like it is suggesting that having been vaccinated and having been previously infected are independent events. But since the occurrence of one clearly affects the probability of occurrence of the other, of course, having been vaccinated and having been previously infected are dependent events.
I assume he means because some previously infected & recovered people were also vaccinated. Those two categories overlap somewhat.
Overlapping categories does not necessarily suggest independence (certainly not in this case). For example, law-school attendees and lawyers are two overlapping—and certainly dependent—categories.
The footnote probably means "[assuming] that the protection conferred by vaccination and previous infection aren't *cumulative* " instead of that the two categories are independent (they really aren't).