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Comment by bingohbangoh | Hacker News Reader

Won’t there always be a variant popping up somewhere in some part of the world though?

The idea that “if we all got vaccinated, we could have zero variants” reeks of “zero COVID” thinking

More unvaccinated people -> more people getting covid -> more chances for mutation into variants

It's really that simple. We want as few active infections as possible globally so that existing vaccinations can work for the variants they were made in mind with. Otherwise we will be at the disadvantage in a perpetual arms race trying to quickly stamp out the global "fires" of new variants.

In a world where the delta variant can infect fully vaccinated people fairly easily, aren’t the vaccinated the real problem? The unvaccinated aren’t putting any particular pressure on the virus when it comes to evolving around the vaccines, but the vaccinated are.

Unless we could magically get the cases to zero this problem isn’t going away. Mask mandates will slow things, but eventually you’ll need enough people to actually get infected to drop the replication rate.

Variants occur in both unvaccinated and the vaccinated.

Given enough time, a virus will tend evolve to become more infectious period.

Somebody else could confirm this, but it seems to me that the current known variants of concern are not responses to vaccination.

Only the vaccinated will preferentially evolve variants that are resistant to the vaccine. The vaccines are leaky, as evidenced by the recent outbreak in the Northeast. A saner strategy with leaky vaccines is to vaccinate the small population that is vulnerable and let the rest of the population of develop a natural herd immunity. Otherwise you are creating a fitness advantage to resistant strains.

This is not how it works, and "natural" herd immunity has never been a real concept in epidemiology - which it is clear you are speculating on without bothering to read about but should also be trivially obvious from the fact that until vaccines none of the vaccine preventable diseases ever went extinct on their own.

Or how the flu hits every single year.

> Herd immunity is a form of indirect protection from infectious disease that can occur with some diseases when a sufficient percentage of a population has become immune to an infection, whether through vaccination or previous infections, thereby reducing the likelihood of infection for individuals who lack immunity.

Right from wikipedia.

It is misleading though, since this definition is merely ‘flattening the curve’ for the rest of human life, and accepting the increased death rate every year. By contrast, a successful vaccination effort also ‘flattens the curve,’ but additionally substantially reduces the rate of deaths. The latter is what we have observed happen with high confidence in the vaccinated population for COVID: deaths of vaccinated individuals is much less common than for unvaccinated (back of napkin math seems to currently be somewhere between 100-1000 to 1 across most age ranges)

Yes, and wikipedia is not the study of epidemiology.

Epidemiology as a field did not publish papers or study the idea of "natural" herd immunity till last year when politicians started throwing the term around and a whole lot of researcher's scrambled to see whether this insanity had any merit.

Of which the answer is what we already knew just spelled out more specifically: no, this doesn't actually happen in the wild without vaccines, because it's literally just spreading the virus. Viruses burn themselves out after infecting basically everyone, provided immunity is long lasting.

I don't think when people talked about herd immunity they meant that the coronavirus would be wiped out, just that it'd get the replication rate down to a manageable level. Just like those diseases that vaccines wiped out, the young would always be at risk of being infected. In this case though, the young (babies excepted) are also fairly protected from it getting serious.

This is incredibly wrong.

Evolution is incremental. To become vaccine evading, the virus has to have a host it can replicate it, and a host that is a resistant target.

In fact it needs a big pool of them, since once infected develop immunity they no longer produce trial mutations.

So you need a pool of the unvaccinated, coming into frequently, regular contact with the vaccinated in order for any specific vaccine escape to evolve.

This is because, any incremental improvement needs to become a population dominant strain within the unvaccinated population: that you survived in a vaccinated person for a little bit is irrelevant if at the end of the day every virus with that trait dies without spreading.

Even if you successfully do spread from a vaccinated host, you need to either land in another vaccinated host (who then spreads you around: so isolation measures are effective), and while you're doing this you need to develop a better escape system: not guaranteed, because if overall viral loading or time to immunity is shorter, that's less time to generate variants.

But...a good way to optimize this, is to just spread to a pool of unvaccinated people. With luck you retain the vaccine-escape mutations, become dominant within the unvaccinated pool, and then get lots of opportunities to try and infect vaccinated people and get a little further.

This, incidentally, why viral evolution tends to consist of "the virus jumped between species several times" - because crossing a species barrier requires ongoing persistent contact between a host you can replicate it, and one you're trying to cross over into.

> To become vaccine evading, the virus has to have a host it can replicate it, and a host that is a resistant target.

Can you please explain more?

Why can't both hosts A and B both be vaccinated folks?

Is'nt there a 3rd category - those who have immunity via past infection? How do it work in that case?

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If what you say above is correct, then why do we see new strains in flu?

Has'nt pretty much every person on earth been exposed to flu or vaccinated against it?

If host A and B are both vaccinated, then either the virus has achieved vaccine escape (it is spreading amongst the vaccinated population effectively), or if it hasn't then it still dies out.

If 1 vaccinated person infects another say 3, but then those people fail to infect anyone else - then it doesn't actually matter what selective advantages that viral strain had - 100% of the virus has died out.

But if the same chain terminates in the vaccinated people then infecting an unvaccinated person...then the new mutation escapes and potentially becomes dominant within the reservoir (unvaccinated people) and a failure to spread through the vaccinated population doesn't lead to the destruction of the mutant strain.

thank you for explaining this. Is there some literature that provides a reasonably clear explanation ( ELI5) around this.

the next question is what happens to those with acquired immunity, and why are they being forced to be vaccinated?

I see many studies that show that their levels of antibodies seem to be even better than ones from the vaccines.

Right, but aren't you assuming that the delta variant can't go from vaccinated to vaccinated effectively? I don't think we really have solid data on this yet but it seems possible, at the very least.

If that is happening, and the R0 from vaccinated to vaccinated is above 1, aren't we creating immense evolutionary pressure to defeat the current vaccines?

If you actually want that, then you need some kind of megaproject to build vaccine factories to supply the entire world and to distribute them to the whole world's population. This virus doesn't respect borders.

Yes in fact, that's the core of what a lot of people have been wanting by trying to get an IP waiver from the WTO. You don't even need new factories, as there's tons of factories out there that are itching to make the various vaccines.

It was my understanding that the developing world doesn’t have the required infrastructure nor qualified workers to manufacture the complex covid vaccines. So the whole patent point is moot.

Your understanding is incorrect, hence the ongoing process for the WTO waiver. Even the mRNA vaccines aren't that crazy, it's a culture of e. coli that's been genetically engineered to produce the vaccines; the manufacturing steps themselves are pretty run of the mill bio reactor stuff with slightly more stringent temperature controls on the tail end. The non mRNA vaccines are pretty much equivalent to any other standard vaccine.

With an IP waiver, you make it less likely you'll have a vaccine for the next one, defeating the entire purpose.

No you don't; the vaccines were funded almost entirely with public money anyway.

Their manufacture was. The mRNA research was a huge private bet (after some companies had given up).

The largest source of Moderna's R&D funding was nearly $1B in grants from the US Government.

This has already happened. There's a world organization distributing millions of vaccines, and soon billions.

the dynamic is a feedback loop in either direction. More vaccinations means slowdown of spread which means slower rate of mutation and in turn easier ways to control the virus. Faster transmission means faster rate of mutations and having a harder time controlling the virus.

'Zero covid' or near-zero covid anyway does not 'reek' because it is perfectly attainable. The virus could be squashed pretty much completely. The fact that we cannot do it is the result of institutionalized failure, resignation and normalization of dysfunction, not actually a matter of fact.

We have in fact eradicated one highly transmittable, airborne virus through a global vaccination effort already, namely smallpox. And that was almost half a century ago.

Haven’t we seen several recent papers suggesting animal reservoirs for the virus? If those papers are correct, it seems that elimination from the Earth is never going to happen (well, it’ll happen when the sun turns into a red giant).

> We have in fact eradicated one highly transmittable, airborne virus through a global vaccination effort already, namely smallpox. And that was almost half a century ago.

Exactly. It was half a century ago when the global population was half what it is today and travel (especially international) was massively lower as well. Also Smallpox had a much lower mutation rate than COVID does, and it's not transmissable until obvious symptoms develop (much different than COVID). Thinking the same strategy would work today is kind of a pipe dream.

>The virus could be squashed pretty much completely.

In Korea, we tried, succeeded for a couple of weeks, then failed.

A core difference is the smallpox vaccine had/has sterilizing immunity while the covid vaccines do not. I think given non-sterilizing immunity and the rate and scale of global vaccine roll outs, zero covid is virtually impossible.

Think about the end game here - we have evidence of ~4 covid viruses that have adapted to humans, one of which may have been responsible for an epidemic a couple of 100 years ago. Now days they are relatively benign, they make up part of what we call "the common cold".

This is historical evidences that covid viruses in humans evolve to become relatively benign, likely this happens faster if we let it kill more people more quickly, but, well, modern medicine. So what will it take for the current covid variant to reach this state - we'll need it to evolve a benign version that out competes the current covid-delta .

A benign version of a virus that out competes its more lethal cousins is something that we also call a "live vaccine".

So why shouldn't we help it along? if we know it's going to happen naturally why not make it happen faster? past attempts to generate live vaccines have mostly worked but have not always gone well, but they were made with technologies that essentially consisted of whacking them with a mallet and hoping they would stay dead - the mRNA vaccines are much more like engineering. Why not take an existing relatively benign vaccine and fit it out with a protein coat similar enough to C19 and release that?

Obviously this is not something one would do blindly, it would require lots of testing, especially with immunocompromised people. And testing (without releasing it early) would be hard - tested people would need to remain in lockdown.

Of course the crazy anti-vaxxers would scream bloody blue murder - but given that their current propaganda already paints the current vaccines as "live vaccines" and warns people to stay away from the vaccinated that horse would seem to have already bolted

This point needs to be stated more loudly.

People here pretend that if only USA was 100% vaccinated, then there will not be another variant.

There will always be another part of the world where a variant will arise, and eventually make its way here to the US.

OTOH, the USA is unique in the freedom it offers compared to any other country in the world, and a key ingredient in my opinion to its success.

One of the most shocking aspects to me is how the US citizens have changed to so nonchalantly willing to give away their freedoms and those of their neighbours.

I would not have believed if someone told me this 2 years ago.

And in the past years, I had often wondered about the 'good' Germans during the time of the Nazis, and why they did'nt first lift a finger when the atrocities against the Jews started, and later, a good number of them actively participated in elimination of the Jews.

the last year has been quite an eye opener. My hope is that more US citizens, regardless of their political persuasions and belief about the vaccines step back and think about the uniqueness of the freedoms they enjoy, and their willingness to throw it all away.

Most people's moral framework isn't deontological, fortunately for everyone.

And that's why governments managed to kill over a hundred million people in the past century, because they convinced people it was for some "Greater good".

Are you comparing vaccines and masks to genocide?

Are you intentionally missing the point?

The mindset of fear that is inculcated that pits one group against another is the similarity that starts it off.

1940s Germany: Germans were convinced that Jews were the outer, not deserving of protection

20th century communism, too many examples - China, Russia, Cambodia, etc : Different classes - writers, teachers, scientists were identified as the outer group, and hate was inculcated

Today's scenario: the 'unvaccinated' are made as the other group.

That’s not a particularly good analogy. The persecution of the Jews by Nazis was based on immutable characteristics (such as whether or not one’s grandparents were Jewish). Likewise, if you had built a career as an intellectual, teacher or urban professional in Phnom Penh in the 1970s, you couldn’t suddenly turn around and pretend to be a peasant to avoid persecution. Even being short-sighted and wearing glasses was enough to be marked as an enemy of the Khmer Rouge regime.

Choosing not to be vaccinated is not an immutable characteristic. It’s a behavioural choice and a better analogy would be choosing to drink and drive – behaviour that is rightly frowned upon by most of society.

'Drinking and driving' is not a good analogy either.

There is no one that argues that 'drinking and driving' is good for anyone at all.

OTOH, regarding vaccines, there are so many different human conditions, side effects and issues seen with vaccines that it is fair to be skeptical.

The other big factor is the time that has elapsed, and different folks have different levels of comfort.

All of this being brushed aside - to identify a group of folks to crush -- is the evil being discussed.

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that they are immutable or not is quibbling, in my opinion.

Using the Khmer Rouge, the system decapitated the intellectuals not because they are learned, but because they had the ability to think and decide for themselves.

Now, in the US, I argue, that people who chose to think differently are being targeted, with the carrot being provided that they can change...

Is this not coercion? There is a line between persuasion and coercion, and very clearly, it has been crossed.

A completely separate problem. If you're not grounded in reality, it doesn't matter if you're operating in a deontological or consequentialist mode. You can justify bad outcomes with either.

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