Remember how we were told that one of the reasons mRNA vaccines were so snazzy that it would be a snap to roll out new versions to tackle Covid variants…even if getting them approved, manufactured and distributed might lead to delays.
Even though Pfizer and then other vaccine-makers said they could have a booster targeting Omicron out in three months or so, the Administration is talking down the possibility of one. That seems odd in that:
2 vaccine doses barely create a dent against Omicron, and previous infection, according to initial Imperial College data didn’t either (although some other studies suggest prior infection could blunt severity; the jury is still out on many important Omicron questions)
There is good evidence that a booster of the current vaccines reduces the odds of severe outcomes, but not to the same degree as against earlier variants. However, it’s not as clear even against the original variants whether a booster produces as long-lived immunity as the first shots did; it may be shorter, even before you get to how it behaves against Omicron. Israel is launching its fourth round of booster shots only five months after offering boosters to the highest-risk populations. In other words, given that some, perhaps many, members of the public won’t be happy about a more than twice a year vaccination regime, if one is to stay current, another reason to back an Omicron-specific booster is it might last longer against Omicron than the current vaccines, which were developed against the wild type virus.
Now one might reasonably say that the vaccine-makers didn’t rouse themselves to create a Delta version. One reason was that Delta overlapped with the older variants a bit before becoming dominant. Second is that the performance of the original vaccines didn’t fall as much in reducing risk of hospitalizations and death as it appears to when boosted for Omicron. Sadly the vaccines did do more to reduce contagion of the wild type virus than Delta, but that change doesn’t get much mention.
But as far as I can tell, the idea of developing a new vaccine targeting Delta wasn’t even seriously entertained. Our GM described an additional issue which I never saw mentioned in the press: the Delta variations were orthogonal to some other variants. So while the original vaccine was pretty effective against wild type and Delta and the “orthogonal” variants, one aimed at Delta would not do much to combat the orthogonal variants. So it made sense to stick with the original vaccine as a reasonable “good enough for all current seasons” compromise.
But as we know, Omicron is fabulously different. So it’s disconcerting to see what sure looks like official reducing of expectations regarding getting an Omicron booster around March, as Pfizer and now others have indicated. From Top regulator says need for Omicron vaccine depends on staying power of variant in STAT:
Whether Americans will need additional vaccines specifically tailored to the rapidly spreading Omicron variant of the coronavirus may depend on how long it circulates in the United States, a top regulator told STAT in an interview Wednesday.
“If it turns out that Omicron is the new variant that actually things settle into, well then of course we will probably need an Omicron-specific vaccine,” said Peter Marks, the Food and Drug Administration’s top vaccine regulator. “On the other hand, if this is just a variant that’s passing through and we get [a new variant] in a month or two, we won’t need that.”
Marks added that Omicron is “a very, very fast-moving virus” that “could pass across this country within a matter of a few weeks,” and that he does not know for sure whether Omicron-specific jabs will be needed….
All three manufacturers with vaccines authorized in the United States — Pfizer, Moderna, and Johnson & Johnson — are currently readying Omicron-specific vaccines. Pfizer has said it could begin delivering its Omicron-specific vaccine by March, pending FDA approval.
Huh? Unless you assume Omicron will be displaced by yet another variant, even those who were boosted will need a new shot in 5-6 months. And even assuming perfect compliance, 75% odds of not getting a serious infection falls to 42% if you play that game three times, as in go 15-18 months under an Omicron regime. While if an Omicron booster lowers the odds of serious infection by 90%, the risk of getting a bod case over the same time period with perfect compliance is 73%. And to the degree the risk reduction is higher than 90%, the better the long-term odds.
And you don’t have to go far into the article to see that our suspicion, that this messaging reflected an Administration preference, looks correct, particularly when contrasted with the fact that the vaccine-makers are moving ahead with Omicron products:
The Biden administration has signaled that it plans to fight the spread of Omicron through existing booster shots, which were not formulated specifically for Omicron. Early data suggest that the booster shots from Moderna and Pfizer significantly enhance protection against the Omicron variant…
Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases and the chief medical adviser of the Biden Covid-19 response, has expressed doubts about the need for Omicron-specific shots.
Even if you wonder about the wisdom of having to get repeatedly jabbed with Covid vaccines, the risk/return tradeoff is clearly better, all other things being equal, with a more effective vaccine. So if you are going to use mRNA vaccines to combat Omicron, that argues for a sure-to-be-more-potent Omicron booster against Omicron rather than a less ooomphy one designed to beat the wild type variant.
GM confirmed our downbeat take:
Two possibilities here, not mutually exclusive, in fact they may well be part of the same scenario
1. They are expecting it to just burn through the population in the next 3 months so there is no point developing a new vaccine
2. The next variant will not be derived from Omicron. Which is highly likely given the experience so far — no dominant variant has come from the previous dominant variant so far, it has all been going back to B.1. This has to change at some point — there will not be surviving ghost B.1 lineages forever — but given how long it apparently takes for a variant to be cooked up, I would expect the next one, if it is not a B.1.X again, to derive from Alpha, Beta, Gamma, P.1, or some of the others. And it will be different from both Delta and Omicron. So they be waiting for the next one which they expect to be something entirely different again.
That does not make epidemiological sense — you want people to develop as broad immunity as possible so if you give them an Omicron vaccine, that will prepare them better for future variants than another WT booster.
But it makes sense from a corporate point of view — there is not going to be demand for Omicron vaccines once Omicron has passed.
And it makes sense from narrative control point of view — the moment they start giving variant-specific vaccines, the expectation will be that the same will be done for future variants too. And we are only now going to be seeing real diversification. Then you have three problems:
First, you need to actually deliver on that expectation, which will be logistically impossible if you have to revaccinate every 3-4 months.
Second, this exposes the insanity and complete bankruptcy of the whole vaccines-only approach. So you must not go there unless you absolutely have to.
Third, a key goal has been to get people accustomed to the idea that they will be endlessly reinfect and if you condition them to expect variant-specific vaccines, then you move away from accomplishing it. The long-term objective is for people to be happy with their annual “natural booster” whether vaccinated or not.
But at some point there will be no choice.
Note that the SARS-2 vaccine does not work at all on SARS-1, not even for severe disease (this has been tested in mouse models and the vaccinated mice die just as quickly and as often as the unvaccinated ones upon SARS-CoV-1 challenge). The antigenic distance between the Wuhan WT and Omicron is a third of that between Wuhan WT and SARS-CoV-1, and there is much more divergent stuff out there (e.g. SHC014). So plenty of room for further escape and evolution.
P.S. I forgot to mention another cross-protection measurement — a SARS-1 vaccine does not work tall on WIV-1, another one of those SARS-type coronaviruses that people were studying in the pre-pandemic days
We’ve backed ourselves into a collective corner with the “vax vax vax” approach and little to no focus on treatments and non-pharmaceutical interventions or eradication. And the fact that US life expectancy fell by 1.8 years in 2020 due to Covid ought to be treated as an outrage and a call to (much better) action. Instead, the collective reaction seems to be a shrug.