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Comment by endisneigh | Hacker News Reader

Assuming it's only as effective as the original two-dose shot and prevents for the same duration, it seems like COVID will never go away. Assuming the current trend and a 9 month prevention, that pretty much aligns to what happened last year. So we'd need no new significant variants to develop or any outbreaks. Seems unlikely given that there are many countries with vaccination rates under 50%

Probably better to focus on the minimum number of vaccinations necessary to make hospitalization/death unlikely and move on from there. Preventing infection might be too high a bar to meet now.

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[edit] this is in response to the earlier version of your post where you wonder if the virus will ever go away:

That I think is a given. Even if we had a bullet proof vaccine, you have such a large reserve of unvaccinated people across the world, plus animals, that the virus is endemic at this stage.

Which isn't a problem. If once vaccinated the virus is mostly harmless, then it is just one more of the many endemic diseases we live with without worrying about.

We might also see the first batch of medicines appear in 2022, if we can successfully prevent ICU visits with effective medicines for starters, that would mean a lot to healthcare professionals worldwide.

Is there any actual development here? It's definitely not a given that we can do this.

There actually is!

Two studies in Brazil have shown a pretty significant reduction in hospitalizations in a RCT of fluvoxamine. More data obviously required.

Plus there has been more work on other treatments, but most are pretty expensive.

https://www.vox.com/future-perfect/22619137/fluvoxamine-covi...

While obviously complicated, Pfizer is working on a promising medication and I know of a dutch trial using antibodies that’s starting a next phase.

I am not a virologist, but based on my reading, in 100 years COVID will still be with us. At worst it will be the flu, and at best it will be just another strain of a cold.

COVID has the very helpful quality of being least impactful on the very young. As new children are born they will be exposed to COVID multiple times over their lives, to the point when they are at ages we now consider vulnerable, they likely will have developed as much resistance as one can have.

"If once vaccinated the virus is mostly harmless"

Note that even not vaccinated, the ultra large majority of people either are asymptomatic or don't get anything worst than a flu (which doesn't mean covid = flu in general)

We seem to have forgotten that the original concern with the virus was the fact that it saturated intensive care units in hospitals, and thus prevented people from getting proper care.

Which, unfortunately, is still relevant - as seen in Louisiana and Florida. A frank and honest admission by one of the physicians on Reddit was that most people who stay in ventilator for weeks have no path to recovery but families don’t let them go. Essentially COVID patients hold up the beds for a long time as well.

That’s the original acute concern. Long run we still don’t know if it will have effects on brain function etc. There are some disturbing lines of evidence on this front. For example the UK biobank showing grey matter loss post infection including in mild cases:

https://www.medrxiv.org/content/10.1101/2021.06.11.21258690v...

i remember this study, but i'm surprised we don't have more papers on the same topic since. It seemed like a pretty big news, and yet i don't hear people recommending mass-vaccination mention it.

Any idea why ?

I recommend mass vax and this point is one of the main points I use. But I agree with you that sadly, this danger is not well known.

My guess is it takes a while to do this sort of study. UK biobank was unusual in having such a large database of scans.

Vaccination should reduce the risks. But there was a nurses study that 19% of the breakthrough cases had lasting effects. So I would not expect vaccination to eliminate the risk if a breakthrough happens.

In places with high vaccination rates, to some extent, tracking new cases as positive test rates is fighting the last war.

>Which isn't a problem. If once vaccinated the virus is mostly harmless, then it is just one more of the many endemic diseases we live with without worrying about.

It's a problem if you're one of the many people who, for whatever reason, can't be safely vaccinated.

> as effective as the original two-dose shot and prevents for the same duration

We're giving boosters of a vaccine developed against the Beta variant. That's better than nothing. But it's inefficient against Delta.

Pfizer/BioNTech are working on a Delta-specific booster [1]. If we can get approvals rolling faster without compromising safety, it might mean being able to release variant-specific boosters earlier in their transmission cycle.

[1] https://investors.biontech.de/news-releases/news-release-det...

> If we can get approvals rolling faster without compromising safety, it might mean being able to release variant-specific boosters earlier in their transmission cycle.

This is basically it. We'd need an approval process similar to what exists for flu shots today. I'm not versed on what that process is, but if that can happen with covid, it'll be the biggest batch of red tape cut.

pfizer and moderna have essentially filed for rolling submissions. the biggest impediment to vaccines stopping the virus is morons not getting the vaccine.

Yeah, dang morons not getting the not-yet-available booster shot!

I mean, those dang morons not getting the available vaccine which does nothing for transmission of the current viral variant! Eesh, well that doesn’t hold water either...

Ugh this is too complicated, let’s just blame the unvaccinated anyways mmkay?

As to whether the current batch of mRNA vaccines are "inefficient" against delta, the science is far from settled.

There are no changes to the mRNA vaccines composition in the booster. Moderna has been testing a lower "dosage" of the booster at 50 mcg vs. 100mcg for the current vaccine, but other than that it's the same stuff it's always been.

The question is how useful variant-specific boosters are at this point in time, though. As I understand it there are two things working against them. Firstly, one of the main ways Delta seems to beat vaccination is by replicating more efficiency before the immune system can respond, and tailoring the vaccine more specifically to it won't really help with that. Secondly, a booster for a very similar variant might just boost the existing immune response for the previous variant rather than creating new, more specific antibodies ("original antigenic sin") - this is apparently one factor limiting the effectiveness of flu vaccines.

A few vaccines are 3 doses at 0,1,6-12 months and offer a decade of protection if you don't miss the last dose..

wow, wasn't aware of this development. which COVID vaccine is this? is it one of the nasal ones?

I think they're saying that other vaccines, not COVID vaccines, have this property. We can't assess decadal resistance yet for COVID vaccines.

If so, I'm not sure how that's relevant to COVID at the present. Per the article we're discussing it's unclear how long a 3rd dose will be effective for, hence my comment to begin with.

If we were to pre-suppose you gain a decade of prevention then yeah, that'd be great.

We don't know how the protections in the current vaccines are going to play out until we investigate them more.

Agreed, but we already know how 2-dose plays out with respect to Delta. The article in question is investigating how a 3rd dose fares against delta. There are also delta-specific boosters coming out soon.

I think they're saying that we can hope that three shots gives long term resistance, as it happens for other vaccines. We can only hope, and it's not a totally unrealistic hope given how other vaccines work.

What are these other vaccines? are the vaccinations for other coronaviruses? I'm not a biologist so I'm not seeing the connection. Is there reason to believe adding more doses would make the prevention jump from less than a year to a decade?

You can see the recommended vaccine schedule here. Several include 3+ doses.

https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolesc...

I'm aware of the 3 dose vaccines - what I'm asking is if there's any connection between the duration and the type of vaccine and the type of underlying virus.

The flu, for example as existed longer than COVID and we do not have a "3 dose" vaccine that prevents the flu for a decade. Why would we expect this for COVID as opposed to an annual booster?

HPV is a 3-dose vaccination in most cases. I believe Hep A and Hep B vaccines also have 3-dose versions, but I'm not sure if the 2 or 3 dose schedule is standard.

this wouldn't be covid-19 vaccine, rather a vaccine for another disease. We absolutely do not have any data on the efficacy of any covid-19 vaccine after a decade (or more than 18 months or so) yet.

I assume this is snark, but misguided if so. I believe the parent comment was simply stating there are some vaccines generally with this trait, so perhaps the covid vaccines would similarly improve from a 3rd dose

it was an honest question. what about it came across as snarky?

Expecting that we would be aware of vaccines that provide a decade long protection against a disease that has been around for less than 3 years. I mean we could have those vaccines already, but we couldn't possibly know that we have them until they've been around for a decade or more.

Per the article we already know 3-dose of Pfizer does not offer a decade of prevention. What the article states is that it offers a level of protection similar to when one first completes the two-dose regimen, so we don't have to wait a decade to know.

All we know is that an additional dose does increase your protection, but it doesn't necessarily give you a decade of protection since there were people who got the 3rd dose and still got COVID.

> All we know is that an additional dose does increase your protection, but it doesn't necessarily give you a decade of protection since there were people who got the 3rd dose and still got COVID.

That doesn't mean anything regarding protection longevity. There will always be instances of individuals who fail to receive immune protection from a vaccine. The vast majority of people could potentially receive years of protection with a 3rd dose, while a small group doesn't get any protection at all. That isn't specific to covid.

Sure, but if you like at the data in the article it's virtually identical to the 2nd dose data.

Do they decay in a few months if you do miss the 3rd dose though?

My hepatitis vaccine was like that, and I delayed the last dose, and apparently they say it doesn't matter how long you delay the last one, it just can't be taken earlier.

It's why I'm more interested in companies that can treat the symptoms effectively than only the vaccines right now. IMO the only way this ever truly gets better is if the effects can be mitigated quickly.

Whoever figures that out is going to make a lot of money.

Good luck with that in 2021, someone is already making a lot of money, and ostensibly weaponizing big tech into preventing anyone from even talking about alternatives.

"CBD and its metabolite, 7-OH-CBD, but not congeneric cannabinoids, potently block SARS-CoV-2 replication in lung epithelial cells. CBD induces interferon expression and up-regulates its antiviral signaling pathway. A cohort of human patients previously taking CBD had significantly lower SARSCoV-2 infection incidence of up to an order of magnitude relative to matched pairs or the general population. This study highlights CBD, and its active metabolite, 7-OH-CBD, as potential preventative agents and therapeutic treatments for SARS-CoV-2 at early stages of infection."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987002/

I am not saying anything, JUST SAYIN'

It's been figured out, but we're waiting on Pfizer to bring it's protease inhibitor to market before we acknowledge existing, out of patent medications that do the same thing.

I wonder if this is really the case. It seems like the original vaccines trained everyone's immune system on the spike protein specifically because this is exposed and highly conserved by the virus, such that it's hard to change and still leave an effective virus. Delta, however, found such a mutation that made it more virulent and it escaped.

If we vaccinate against the modified spike, it's not clear how many more mutations exist like Delta. Maybe we can still get ahead of it, but I don't think anyone knows yet.

I do wonder if we'll see reformulated boosters against Delta's spikes, though.

I wonder how accurately we can run mutation simulations updated based on best current data to correct the best guess optimization function(s). It would be a breakthrough if we can predict the likeliest mutation. I'm aware of the enormous number of variables making this tremendously difficult...

We don't have the technology to stimulate that accurately in software. It would have to be done using transgenic animal models and/or human tissue cultures. Essentially it would be a form of gain-of-function research, and there are concerns that a lab accident could result in an even more dangerous variant escaping into the wild.

With ML-assisted drug discovery in, say, kinase inhibitors we search the molecule variation space for test candidates. What stops us from applying this to the protein scale by folding binding sites to discover variant candidates that would be more virulent? I'd like to understand this better.

Sure you can explore the solution space in software to identify candidates but at some point you have to create a live virus and see how it actually performs.

Is there any reason not to increase vaccine production rates so we have the capacity to vaccinate the world population faster than every 9 months?

nope - as you allude to, ideally we could spit out these vaccines and just give people 6-month boosters until everyone is vaccinated and we're good.

I believe the issue is that too many people fail to get vaccinated so it's challenging. Requiring boosters might also convert small numbers of people who got a vaccine one to not get it subsequent times.

In the first world there is an issue of take up. But around much of the rest of the world, the issues is they haven’t received nearly enough vaccine.

If we don’t significantly vaccinate much of the rest of the world, my expectation is a continued high rate of variant creation as well as continued economic instability due to logistics disruption.

> Is there any reason not to increase vaccine production rates

Intellectual property rights.

It's not a "good" reason. But it's a reality that needs to be overcome.

https://www.reuters.com/business/healthcare-pharmaceuticals/...

https://www.democracynow.org/2021/6/22/headlines/south_afric...

Germany doesn't want the Pfizer vaccine made freely: https://www.reuters.com/business/healthcare-pharmaceuticals/...

and by some co-incidence, this is good for German money: https://www.reuters.com/article/us-germany-economy-biontech-...

> Is there any reason not to increase vaccine production rates so we have the capacity to vaccinate the world population faster than every 9 months?

Capital constraints. Most specifically, human capital. mRNA production methods, including for critical precursors, are complicated. There is a limited number of people who can build and monitor the productions systems.

There are countries filled with idiots,like my lovely Romania where 70% of people don't want to get vaccinated, and we have to sell/donate millions and millions of doses.

Well, that's only partially true. Romania has preordered 120M doses for (at best) 15M eligible people. So either way, we'll have to donate tens of millions of doses.

The Irish population (including myself) are very grateful for this :) Kinda sucks for Romania though.

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