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Definitely a stretch but the linked studies are worth a read anyway.

I've only (cursorily) read [1] but it suggests combining different approaches for targeting immune response rather than the same approach across the populous. The risk would be assuming high levels of protection given how likely the virus is of escaping a single target through evolution. I guess that does pose a risk if people treat the current vaccines as a means to return to normal. My guess is variations on "the vaccines aren't very effective" are the biggest and most credible concerns people have though not a good reason to not receive them.

The cited papers are definitely legitimate and interesting, even though they do not support the point the commenter wished to make. It's too bad that HN flagging means the OC can't be seen at all. Most content which deserves harsh criticism does not necessarily deserve full censorship, which can easily backfire.

We do need diversified defenses, but we shouldn't forget that our natural immunity is ultimately the line of defense that actually fights the virus. Vaccines just help it develop some particular tools against the spike protein. As of yet, I don't know any reason to believe that this prevents the immune system from forming more comprehensive and diverse defenses. On the contrary, the immune response is so complex and multifaceted that the vaccine-induced antibodies can only play a small role, albeit critical in the early stages of infection.

> even though they do not support the point the commenter wished to make

They do support the general point - if you think otherwise, please articulate how they do not.

Thanks for adding this. Compulsory mass vaccination is one of the greatest medical miracles in human history, possibly the actual single greatest.

Source: https://en.wikipedia.org/wiki/Iron_lung#/media/File:Poumon_a...

According to a 2012 NEJM survey, #1 is anesthesia.

https://www.degruyter.com/document/doi/10.1016/j.sjpain.2013...

IIRC it then went X-Rays and Antibiotics, but can't find source ATM.

Second greatest. Antibiotics take the crown.

I think you got me there, but it's at least up there as a big winner.

I didn't read it as a stretch because first generation vaccines used in the campaigns all have shared targeting, and medical treatment is being discounted.

> Such a narrow molecular focus raises the specter of viral immune evasion as a potential failure mode for these biomedical interventions

This was from [1]

> Backing up a provocative claim with a snowblind of irrelevant references is a shameful misinformation tactic and you should stop doing it immediately. Doing it in a public health context is particularly dangerous and frankly disgusting.

Please, be kind.

The references were applicable but not written for the everyday consumer.

It's not valid to go from "vaccine escape may occur" to "mass vaccination is a public health risk". You can't claim B, which doesn't follow from A, and follow B up with a bunch of citations that only support A. That's misinformation about a high-stakes public issue, it's irresponsible, and it warrants harsh criticism.

> "vaccine escape may occur"

You're disregarding the nuances and evidence put forth in the cited literature - either intentionally or out of ignorance.

A much more fair representation is: "vaccine escape is exceedingly likely to occur under the conditions of mass vaccination combined with a vaccine that does not necessarily prevent infection and transmission, and which induces an immune response highly targeted toward the spike protein RBD"

In that case B absolutely follows from A. To argue otherwise is a non-sequiter.

Even if vaccine escape eventually occurs, it doesn't follow that mass vaccination itself is a bad policy. You have to weigh the consequences of the escape against the consequences of not mass vaccinating.

The consequences of not mass vaccinating are "a lot of people die that wouldn't have with the vaccine", so the consequences of escape need to be pretty dire to outweigh that. Does escape make the virus significantly more dangerous than it would have been if the vaccine were not used on such a large scale? It's unclear.

To answer that, one critical question would be whether the vaccine somehow hinders the immune system from developing a more complex and robust response to the virus. I have not seen anything that speaks to that question yet.

Antibiotic resistance don't make us regret the use of antibiotics. We just avoid using them without evidence that they are needed, and we use them in combination with other measures. Mass vaccination and a more targeted campaign are both consistent with both of those principles, and nuanced evidence and reasoning would be needed to favor one over the other.

> You have to weigh the consequences of the escape against the consequences of not mass vaccinating

Yes, agreed.

At this point we're talking in circles. It's obvious you believe that the benefits of compulsory mass vaccination outweigh the potential consequences of vaccine induced immune escape, even though you admit that "it's unclear" whether compulsory mass vaccination will make the virus even more lethal and potentially lead to even more suffering and death.

I won't continue on with the debate because no further evidence is being provided, and frankly we're in agreement that the calculus is intractable right now, and only in disagreement on whether it's acceptable to call compulsory mass vaccination a public health risk, so it's just semantics at this point.

> one critical question would be whether the vaccine somehow hinders the immune system from developing a more complex and robust response to the virus

Here is some literature that provides preliminary answers [1][2]. The summary is that natural infection induces an immune response which includes nucleocapsid protein antibodies, whereas vaccination using the current mRNA formulations does not. Compared to natural infection, vaccination induces an immune response that is more highly targeted toward the spike protein RBD. In terms of individual health outcomes, neither of these papers address whether natural infection offers better or worse immune protection compared to vaccination.

[1] Distinct SARS-CoV-2 Antibody Responses Elicited by Natural Infection and mRNA Vaccination https://www.biorxiv.org/content/10.1101/2021.04.15.440089v4

[2] Antibodies elicited by mRNA-1273 vaccination bind more broadly to the receptor binding domain than do those from SARS-CoV-2 infection https://pubmed.ncbi.nlm.nih.gov/34103407/

Not talking in circles I think - I'm happy with where we landed. Sorry I started off harsh. You sounded too close to an antivaxxer trying to pass your opinions off as authoritative, and semantics really do matter there. I'm glad to see your ideas are much more nuanced and I think we largely agree at this point. To get any clearer we probably need input from proper vaccinologists. And hopefully they are informing policy, although that's no guarantee in this bungled response we've had.

Yeah that's good feedback thanks - I'm definitely with you in praying for a healthier world supported by thoughtful and scientifically based policy.

My emphasis is on compulsory, but perhaps I should've been more clear. Obviously I've triggered some people here.

Vaccines are powerful tools that help save lives and we should use them. But if they are used indiscriminately they can actually further endanger public health. You might be familiar with antibiotic resistance - vaccines are subject to the same potential for unexpected consequences.

All of the sources I cited support this fact - it is not misinformation. Did you read any of them?

Here are some excerpts for you:

Excerpts from [1]:

> "The spike protein receptor-binding domain (RBD) of SARS-CoV-2 is the molecular target for many vaccines and antibody-based prophylactics aimed at bringing COVID-19 under control."

> "Such a narrow molecular focus raises the specter of viral immune evasion as a potential failure mode for these biomedical interventions. With the emergence of new strains of SARS-CoV-2 with altered transmissibility and immune evasion potential, a critical question is this: how easily can the virus escape neutralizing antibodies (nAbs) targeting the spike RBD?"

> "Our modeling suggests that SARS-CoV-2 mutants with one or two mildly deleterious mutations are expected to exist in high numbers due to neutral genetic variation, and consequently resistance to vaccines or other prophylactics that rely on one or two antibodies for protection can develop quickly -and repeatedly- under positive selection."

> "The speed at which nAb resistance develops in the population increases substantially as the number of infected individuals increases, suggesting that complementary strategies to prevent SARS-CoV-2 transmission that exert specific pressure on other proteins (e.g., antiviral prophylactics) or that do not exert a specific selective pressure on the virus (e.g., high-efficiency air filtration, masking, ultraviolet air purification) are key to reducing the risk of immune escape"

> "Strategies for viral elimination should therefore be diversified across molecular targets and therapeutic modalities"

Excerpts from [2]:

> As vaccines against SARS-CoV-2 are deployed across populations, it is possible to create a selection pressure for variants that can escape the vaccine-acquired immune response. Over the past few months, several variants have emerged which show a reduced susceptibility to vaccine-acquired immunity, though none appears to escape entirely. These variants largely emerged before vaccination was widespread, thus selection pressure from vaccines is unlikely to have made a significant contribution to their emergence. However, as vaccines become more widespread, the transmission advantage gained by a virus that can evade vaccine-acquired immunity will increase.

> There is no historic precedent for the mass administration of antiviral medication in the community as prophylaxis, apart from the use of anti influenza Neuraminidase Inhibitors, which were used to a limited extent in this way in the early phases of Influenza Pandemic of 2009 in the UK. The safety and efficacy profile must be extremely well established for a mass administration strategy to work and poor compliance will likely rapidly lead to the selection of drug resistant variants, rendering such a strategy short lived.

I could go on, but that fact is your comment is not a charitable or informed response to the statements I made.

[1] Risk of rapid evolutionary escape from biomedical interventions targeting SARS-CoV-2 spike protein (April 2021) https://pubmed.ncbi.nlm.nih.gov/33909660/

[2] Can we predict the limits of SARS-CoV-2 variants and their phenotypic consequences? https://www.gov.uk/government/publications/long-term-evoluti...

I stand by my post. None of this says anything remotely implying what you claimed, that the mass vaccination programs pose a serious public health risk. That is purely your speculation, vaguely inspired by the content of the papers.

Your contention that it matters whether the campaign is compulsory or not only takes you further from your supposed evidence base. It's not even in the same universe as what the papers are talking about, and is purely your own invention.

I understand that you're worried about vaccine escape, but to go from that to "compulsory mass vaccination is a serious public health risk" is a completely unwarranted leap. Your authors advocate for diversifying our defenses, not eliminating the only one we currently have.

I disagree. I think it is a serious public health risk, at a certain probability, and you've provided no sources or math to explain what the probability is. Can you enlighten us as to what the probability of vaccine escape is?

Is the risk of vaccine escape 50%? 5%? .5%? .00005%? I have no idea what the OOM of possibilities is (I am attempting to model it). I appreciate all literature that explores that.

Clearly we've seen a significant drop in VE. I think that's pretty good evidence that the possibility of full vaccine escape needs to at least be considered. And certainly if the probability is ascertained to be above a threshold, then it is a serious public health risk.

Massachusetts now is reporting ~40% of COVID deaths now in fully vaccinated individuals (https://www.mass.gov/doc/daily-covid-19-vaccine-report-augus...).

I think vaccines should be Bayesian (very good bet if over 30 and never had COVID). But there is zero precedent for mass vaccination in the midst of a pandemic, and some people think things could go wrong. I am very very curious what people who model it think the probability of that happening is.

I appreciate the links and position put forward by the commenter, and sad to see that flagged.

I'd prefer to see links to models/code/data that offers arguments to support that odds of vaccine escape are low.

To repeat what I've said several times now (how can I be more clear?), the risk of vaccine escape does not imply a particular public health policy. There is no procedure that tells us what policy we should choose based on vaccine escape risk, because it isn't the only consideration. It is irresponsible to make authoritative pronouncements on a complex public health policy issue when you're completely fixated on one particular risk. Unless you're willing to describe EVERY possible action as a public health risk, in which case you should be honest and upfront about the obscure, misleading choice of language.

> the risk of vaccine escape does not imply a particular public health policy

It does have major ramifications for public health policy - you're disagreeing with many experts in the field when you make these claims.

> There is no procedure that tells us what policy we should choose based on vaccine escape risk, because it isn't the only consideration

Of course it isn't the only consideration - no one claimed that it was. This is a straw man.

> It is irresponsible to make authoritative pronouncements on a complex public health policy issue when you're completely fixated on one particular risk.

We are in agreement on this in general, and I admit my comment could have been worded less strongly.

But again, these ideas are being espoused by experts publishing peer-reviewed literature. They are not "fixated on one particular risk", and if you take the time to read the cited literature you'll find rich discussion of many subtle nuances and tradeoffs. That is as authoritative as it gets. There is nothing irresponsible about sharing the knowledge and opinions put forth by world class researchers.

I agree that vaccine escape risk has real implications. I meant to say it doesn't determine whether mass vaccination is prudent. I explained what is missing to make that determination in another comment. Do we agree on that?

FWIW, there is precedent both in 1918 (when the Supreme Court ruled it was constitutional), and during the revolutionary war (when George Washington made history by vaccinating his troops with a new experiment technique called a vaccine)

When discussing vaccine escape (unlike antibacterial mutation pressure) I seem to usually see it described as an issue for diseases which already have many strains: https://en.m.wikipedia.org/wiki/Antigenic_escape. Which wouldn’t yet apply to COVID. And is not a problem for the mRNA technique (which can simply change the target sequence and give a new/booster shot).

Great retort BTW. I will be using the "... not eliminating the only one we currently have" line in future. Im worried that any concerns people have result in them being lumped in with conspiracy theorists/misinformants (?) but it seems irrational and dangerous to deter people from receiving some protection if the risks are more effectiveness and longevity rather than side-effects. My most lingering concern is simply that such a large number of people receiving the same few new vaccines seems like a gamble that we will all be forced to participate in. That's life though..freedom isn't always a given.

It's possible that mandatory vaccination is not the optimal strategy. But authoritatively branding it a public health risk is not something anyone is in a position to do with the info available.

These concerns and warnings are coming from the scientific literature - from experts at top institutions in the world. Your dismissal of them is completely unsupported.

I am not dismissing them. On the contrary, every post I have made takes pains to distinguish between the legitimate analysis and claims in the scientific papers you have cited (e.g. that vaccine escape is worthy of concern) and your unwarranted, irresponsible inferences from them (i.e. that mandatory vaccination is a public health risk - especially stated with such a definitive air of authority, followed by a flurry of citations that simply don't say that).

At best we can say that vaccination programs are not without risks. But this is true of many, many legitimate public health measures, and it is deeply misleading to single out one of them as a "public health risk" on this basis. If we apply such a lax standard of labeling consistently, then not doing a compulsory mass vaccination program is also a public health risk, for reasons that are now extremely obvious if they weren't already.

You have misattributed too many strawman positions to me at this point. You are either unable or unwilling to engage in good faith and this may have to be the end of my interactions with you.

It doesn't make sense to me how you can admit that "vaccine escape is worthy of concern" (which is an understatement at best), but then say it's "deeply misleading" to call it a public health risk. Yes you're right that none of the citations literally say "this is a public health risk" - but is it really an "inference" to say that viral resistance driven by mass vaccination poses a risk?

We clearly disagree so we needn't go on longer - but FWIW I can't help but feel as though you've been downplaying the significance of these risks with very little supporting evidence, other than your own logical reasoning and accusation of misinformation. I do appreciate you conveying your opinions in a respectable manner.

Thank you. I appreciate you bringing these legitimate concerns to light and I hope there is open debate about all costs and benefits of mass vaccination. The lack of public discourse from a position of humility and curiosity has led to many bad decisions during this pandemic, IMO.

That said, public health requires the analysis of all costs and benefits using a consistent, logical methodology. We need to be very clear about the inferences supported and not supported by our evidence.

Saying that mass vaccination carries the risk of vaccine escape is very different from saying that mass vaccination is a public health risk.