Medical Ethicist at UC Irvine on leave for challenging vaccine mandate | Hacker News Reader

Medical Ethicist at UC Irvine on leave for challenging vaccine mandate

aaronkheriaty.substack.com

79 pointsagomez314110 comments

I think it's crazy and dogmatic when authorities know that natural immunity is as good as induced immunity[1] via vaccines but never the less remain steadfast in the face of evidence with their dogmatism that only vaccine immunity is acceptable. It's an argument we might expect from someone who is ignorant, for example, but not from people who should know better.

If they were to remain consistent then they would also invalidate J&J vaccines given those are viral vector vaccines.

Note: I am vaccinated and favor vaccination for those not exposed or unvaxxed, but I also believe that if you have had Covid19 you do not need MOAR immunity. You already have it.

[1]https://www.science.org/content/article/having-sars-cov-2-on...

Had a discussion with a buddy and his doc wife Monday. She pointed out that the immune system might learn some weird protein on the variant X particle. Which leaves you open to variant Y which doesn’t have that protein. But the spike protein the current generation of vaxes target is common to all of the variants.

I’ve read something different, which is that natural immunity likely comes with recognition of multiple markers, not just the spike protein, and therefore gives you the ability to respond to a wider range of variants. Now I’m not sure what to believe. But in the absence of definitive and absolute evidence, I lean in favor of individual freedoms and civil liberties rather than mandates.

The Science article's[1] subheading quotes: "Israelis who had an infection were more protected against the Delta coronavirus variant than those who had an already highly effective COVID-19 vaccine"

[1]https://www.science.org/content/article/having-sars-cov-2-on...

https://ncrc.jhsph.edu/research/comparing-sars-cov-2-natural...

"In addition, individuals who were previously infected who received one dose of the Pfizer vaccine were even more protected from breakthrough infection than the naturally infected group. There were no deaths in any of the groups examined. Given that previously infected individuals may have had multiple infections prior to the study period, the overall applicability of the study to all populations needs more clarification. Lastly, these findings should not be taken as an endorsement that getting infected is a better overall option for protection than the highly effective vaccines that are available as only those who survived initial infection were eligible for analysis."

Isn't that apples and oranges comparisons? They're not talking effective rates only relative rates. They could also claim having mRNA + adenovirus vaccines improve efficacy (not sure if there is such a study) but that does not say anything about mRNA vs adenovirus by themselves.

Is this backed by actual evidence? It seems like you can come up with plausible sounding reasons for both sides (edit: see sibling comment), so your anecdote isn't really convincing.

That is nonsensical. For that argument to be sound, you'd have to assume simultaneously: (a) that not all COVID variants have spike proteins so they don't all induce antibodies to it; and (b) that all COVID variants have spike proteins so the antibodies from the mRNA vaccines are widely applicable.

No, you only have to assume there are other proteins for the immune system to attack other than the spike. Which we already know is true, though it isn't clear if attacking them works, we know there is more than the spike protein in the virus.

False. That logic does not hold unless you also assume that the presence of protein B means no antibodies to protein A will be developed. There is zero evidence of such a phenomenon. Indeed, that's why many high-specificity antibody tests require an immunoassay — the infection causes antibodies to each of the envelope proteins. If antibody development were an either-or proposition as is required by your argument, immunoassays would not — could not — work.

I did not assume no other proteins.

> the infection causes antibodies to each of the envelope proteins.

That's interesting, I was not aware of that there was always antibodies to all envelope proteins. Do you have links to more information on the topic?

How does this work when some of the envelope proteins are common, ones that occur in other non-viral sources?

There aren't always antibodies to all envelope proteins. That's too strong of a claim. Sometimes antibodies to early stage precursors fade before antibodies to others are developed.

I'd recommend reading about the HIV virion as an example with multiple proteins and needing multiple detected antibodies for a positive diagnosis. It's a good virus to read about due to the immense amount of research put into it.

Doesn't that contradict your statement above - "There is zero evidence of such a phenomenon" ?

No...? No rational person could draw that conclusion.

Where exactly are you seeing evidence that the presence of protein A means antibodies to protein B will not be developed?

> the spike protein the current generation of vaxes target is common to all of the variants.

Until it wanes, which you don’t know when it does, so you take a booster until you get a breakthrough case because you aren’t immunized, you got a biological shortcut.

> you got a biological shortcut

What do you mean by this?

In traditional vaccines a weakened or dead virus is placed in the human. In a way it’s playing with fire but there’s enough experience using them that it’s built a reasonable safety record.

With mRNA some cells in your body are tricked into growing so they have some unique but supposedly harmless aspect of the virus, like the spikes. [0] The immune system encounters these cells, recognizes them as not right, terminates and communicates to the larger system to be on the lookout for the molecular markers it found. If traditional vaccine is a trial by fire, then mRNA is trial by flashlight. It simulates some aspects of the fire but not others.

Immunization by mRNA may be better, sufficient or worse than the traditional immunity from actual virus material. I don’t think anyone knows for sure yet but I do know enough big money is riding on mRNA that it may be made to look like the only right approach even if it is only one of several good approaches.

0. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different...

Jesus people, I just passed on what an actual doc told me. There was no anecdote, no evidence, just what she told me. Calm the fuck down.

California has instituted state-wide vaccine mandates for kids in schools. LA has instituted vaccine mandates for restaurants, gyms and malls. The long term safety and efficacy of the vaccines is yet to be proven. Literally, since not enough time has passed since the vaccines were conceived. Authorities are significantly overreaching. This is a crisis. Perhaps people have all the reasons to be touchy.

For comparison, Norway just lifted covid restrictions. Apparently they have access to a different science than US West coast authorities.

Or when countries like Denmark and Sweden halt moderna for under 30's citing inflammation reactions. As much as there is a crusade to dismiss the VAERS database it does pretty obviously suggest that there is quite a bit more risk here than in traditional vaccines.

The 'traditional' i.e. non-RNA Oxford vaccine has somewhat greater risk profile than Moderna.

> As much as there is a crusade to dismiss the VAERS database

there is not a "crusade to dismiss" VAERS data. There is a push to correctly remind people about the shortcomings of VAERS reports for which that has been the case (and made known[1]) for as long as it has existed. The "crusade" is to use VAERS to misinform people.

[1]https://vaers.hhs.gov/data/dataguide.html

From what I understand, the immune response from natural infection varies dependent on the individual and circumstance, so some may have tested positive with their immune system not eliciting as robust a response as someone who was vaccinated (or infected under different circumstances). So you could have person A who tests positive but with very low viral load and was asymptomatic (for example) and their immune response is much less robust than person B who was symptomatic. When they encounter the same variant in the future, person A may have much less protection (or none at all[1]) compared to person B. I'm not sure if we have nailed down what tests tell us the robustness of someones immunity accurately to be able to rely on them for something like health passes.

Another factor I have come across is that it may be that natural immunity is more variant specific while the vaccine results in a immune response to a wider array of variants. This seems like it may be valid considering the situation in Brazil[2] and with our understanding of the flu, but I am not sure the mechanism for this.

Lastly (as mentioned in another comment) it can create perverse incentives where people will do something like "covid parties" to gain natural immunity which would make things worse.

The vaccine on the other hand has a dose which is of a known quantity and the response from that dose is well understood across many demographics. So it may come down to the fact that we understand the vaccine response better than natural responses.

I'm not saying whether or not any of this is a good enough reason not to allow for natural immunity to be just as valid, but it's what I have come to understand (which may be incorrect) based on the data we have.

[1] https://wwwnc.cdc.gov/eid/article/27/9/21-1042_article

[2] https://www.bmj.com/content/372/bmj.n394

Let's suppose the above is true (I think that's not settled, but let's say it is), then what do we do about people who took less effective (approved) vaccines? That will also allow for infection. What do we do about them?

it seems like the current logic is to mix vaccines to create the most robust vaccine immune response, but depending on availability that may be easier said than done.

The J&J vaccine in the US was evaluated at 67% efficacy, vs ~95% for the mRNA counterparts.

Are those people then supposed to take the mRNA vaccines in addition, if not, why are people with natural immunity required to get an additional vaccine (among them J&J)?

it seems like J&J has high efficacy against serious outcomes for delta (71% effective against hospitalization and 95% effective against death[1]) so it may be pretty comparable to the main alternatives. However, for options like Sinovac it may be a different story.

[1]https://www.aamc.org/news-insights/so-you-got-jj-vaccine-her...

> From what I understand, the immune response from natural infection varies dependent on the individual and circumstance, so some may have tested positive with their immune system not eliciting as robust a response as someone who was vaccinated (or infected under different circumstances).

Can you explain why you don't believe the same would apply to the immune response elicited by vaccines?

There are breakthrough cases in people who are just a couple of months out from their second dose of even Pfizer and Moderna, and not all of these people are in age and risk groups where one would expect a poor immune response. So clearly YMMV with the vaccines as well.

> Another factor I have come across is that it may be that natural immunity is more variant specific while the vaccine results in a immune response to a wider array of variants.

The science actually indicates the opposite of what you suggest. See https://www.nature.com/articles/s41586-021-04060-7

> While individual memory antibodies selected over time by natural infection have greater potency and breadth than antibodies elicited by vaccination, the overall neutralizing potency of plasma is greater following vaccination.

So basically, if you recovered from natural infection, your memory B cells will be "better" than those generated by vaccination in terms of their potency and breadth (which speaks to the potential to deal with variants), but people who have been vaccinated have more potent neutralizing antibodies immediately following vaccination.

The problem, which can be seen in places like Israel, is that the neutralizing antibodies don't stick around forever. In fact, the latest data[1] suggests these antibodies wane quite rapidly (in as little as a couple of months) in those vaccinated with Pfizer. This is discouraging but not surprising. It doesn't make sense for the body to keep high levels of neutralizing antibodies circulating indefinitely every time you're exposed to a new pathogen.

The question: is the world prepared to boost everyone every 2-3 months to keep our veins flowing with high levels of neutralizing antibodies?

[1] https://www.cnn.com/2021/10/06/health/pfizer-vaccine-waning-...

Unless you're a virologist, I don't want you opinion on the efficacy and reasons for vaccination. If I wanted to know if I can trust a bridge I'd ask people intimate with the details. Anyone else speaking in their place is muddying the waters.

Lol. University administrators are not virologists.

No, but if their policy is based on real expertise and evidence, and not joe bob "whos a doctor", then I trust that knowledge far more. Everyone of every background has tried to comment on the efficacy and reasoning of vaccines, they do this by being intellectually dishonest and citing papers they don't understand, ignoring that medical science is a science like any other - there's a lot of published material and specific expertise necessary to grok it. At most people will look at the graphs pictured and think they understand how that graph works. Case in point the israel study.

While in principle it sounds good, recognizing the substantial level of immunity of individuals with past COVID-19 infections, and would probably be fine in a sane world, I feel that this creates some risky incentives.

Many anti-vax and conspiracy-oriented people unfortunately have the false belief that COVID-19 infection is a trivial matter or a hoax. Consequently, some may resort to pox parties [0] as a way to avoid vaccination. And yes, people have tried this:

> And this was no ordinary party–it was a “COVID party”, where guests tried to intentionally get the virus to “build up natural immunity” without getting vaccinated. [1]

If people were to intentionally try to gain immunity through exposure, at least 5% of them (and their subsequent infected contacts) will end up in the hospital, consuming healthcare resources. That seems a foolish risk to take, politically. The aforementioned people who tried it in Alberta ended up filling several beds in the hospital:

> A party west of Edmonton has landed several people in the hospital with COVID-19, sources have confirmed to CityNews. [1]

In reality, if you've already had COVID it is a trivial act to get vaccinated. That vaccination will help boost your immune response to the disease and may even help to limit your risk of breakthrough infection. I can't see a serious, legitimate reason to not get the vaccine in such cases. And to allow otherwise creates dangerous incentives.

[0] : https://en.wikipedia.org/wiki/Pox_party

[1]: https://www.660citynews.com/2021/09/23/alberta-covid-party-h...

So let's just keep firing natural-immunity only people? Surely they won't lose all faith in government and corporate institutions when they're being fired for negligible benefit...

> they're being fired for negligible benefit

You are only measuring "benefit" to the individual. They're mandated to do something with zero cost and minimal risk. And it comes with massive benefit to the group and to the public as a whole.

They're being mandated because there is a huge cost to infection. The Canadian government pays an average of $23,000 for every person that gets hospitalized by COVID. [0] Roughly 5% of those infected require hospitalization. And we have already seen numerous people blocked from timely access to healthcare due to hospitals being filled with COVID patients.

It's good public policy to require vaccination. Providing incentive to get infected is a really bad idea because it will result in healthcare resources being massively oversubscribed. Besides, infection-acquired immunity is not permanent. The virus mutates and it is likely that additional vaccination will eventually be required for subsequent variants.

[0] : https://www.cihi.ca/en/covid-19-hospital-stays-cost-3-times-...

I think people should think less about incentives and more about realistic assessment of dangers of the disease. You are not talking to pupils and you are not a teacher.

I am vaccinated but by some sloppy internet dictionaries an "anti-vaxxer" because I oppose mandatory vaccination. This shifting in policy was predicted by a lot of the more crazier groups, which makes their statements true. You may not want to give people false incentives...

That’s a false premise, vaccination still has value after an infection.

https://www.cdc.gov/media/releases/2021/s0806-vaccination-pr...

“In today’s MMWR, a study of COVID-19 infections in Kentucky among people who were previously infected with SAR-CoV-2 shows that unvaccinated individuals are more than twice as likely to be reinfected with COVID-19 than those who were fully vaccinated after initially contracting the virus. These data further indicate that COVID-19 vaccines offer better protection than natural immunity alone and that vaccines, even after prior infection, help prevent reinfections.”

Ok. mRNAs are evaluated to have an efficacy of ~95%; J&J (adenovirus) at 67%. Are then the J&J recipients mandated to get an mRNA too, so that they not get infected at higher rates than their mRNA recipients?

Pfizer was recently downgraded to 39% efficacy after a few months: https://link.springer.com/article/10.1007/s10654-021-00808-7. So unless you'd like IaaS to mean "immunity as a service" and pay Pfizer in perpetuity every 3 months or so, vaccines merely prepare you to tolerate the real thing a little better making this novel virus not so novel. You can't "stop covid" with them, and why the authorities continue to lie about this, I can't even fathom at this point.

Not to put too fine a point on this, but make no mistake, vaccine or no vaccine, you _will_ get COVID. You'll just be 10x less likely to die from it, although that's being called into question as well by now. Be that as it may if you're on the older side and/or obese, you should get vaccinated if you haven't had COVID yet. I did. I've also lost 15 kilos so far, and I don't intend to take any "boosters".

The CDC press release you link to is misinformation. Its title is "New CDC Study: Vaccination Offers Higher Protection than Previous COVID-19 Infection". But that is not what the study demonstrates. It demonstrates instead that getting vaccinated in addition to having had COVID-19 previously improves immunity. It does not demonstrate that people who are only vaccinated (not previously infected) have higher immunity than people who were prevously infected (and not vaccinated).

I completely agree with all of that. The press release is misleading, it was probably drafted in bad faith with the intent to mislead, and its title as stated is factually inaccurate and directly contradicts the balance of the available evidence from other research. I condemn all of that.

However, it's worth emphasizing that none of that invalidates the parent commenter's claim that vaccination provides significant additional protection against reinfection for people who've already had COVID, as the study linked in the press release finds.

CDC has tainted epidemiological data by issuing guidance to exempt vaccinated people from testing unless symptomatic. Vaccinated asymptomatic cases were simply not counted for a period of time ending in late June 2021. I can't find the date when they issued the faulty guidance for a precise time interval, but any study comparing vaccinated / unvaccinated cases relying on US epidemiological data including May/June 2021 must sadly be considered tainted.

https://www.nytimes.com/live/2021/07/28/world/covid-delta-va...

It’s hardly hiding what’s being described, the very first sentence clarifies: In today’s MMWR, a study of COVID-19 infections in Kentucky among people who were previously infected with SAR-CoV-2 shows that unvaccinated individuals are more than twice as likely to be reinfected with COVID-19 than those who were fully vaccinated after initially contracting the virus.

As to which is better, there are studies showing higher protection from vaccination alone than prior infection, and other showing the opposite. It’s complicated in part because the pandemic has been around for significant periods so the timing of infection vs vaccination matters. Further, infection doesn’t provide a uniform level of protection and of course the details get deep. https://www.cell.com/cell/fulltext/S0092-8674(20)31235-6?_re...

And of course from a public health standpoint a positive Covid test isn’t guaranteed to represent an actual infection.

> there are studies showing higher protection from vaccination alone than prior infection, and other showing the opposite.

So you admit to listing one small study that states A while knowingly ignoring the other studies that argue the opposite? The NIH-funded study and Israel’s data are relevant counterpoints in this discussion.

It’s not just one small study for example here’s: Not all persons recovering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection develop SARS-CoV-2–specific antibodies. https://wwwnc.cdc.gov/eid/article/27/9/21-1042_article

I granted severe infections do result in a strong immune response, but simply having a positive test result isn’t the sign of long term immunity people assume. That said, surviving COVID also implies a healthy immune system which is a rather morbid example of survivorship bias.

> but simply having a positive test result isn’t the sign of long term immunity people assume

You were overly dismissive in your first mention of this. Do you have data behind the tests being false positive? Multiple positive tests + symptoms are surely sufficient

That really depends on the tests and time period. False positive rates depend not just in the test but also the percentage of population infected. Unfortunately many people where diagnosed based on symptoms or a single test which was inaccurate. At the time telling someone to self isolate based on an inaccurate test and only preforming more accurate testing if they got really sick was considered acceptable.

In a study of 14 of the approved tests, one of the tests gave false positives more than 15% of the time, and three others gave false positives more than 10% of the time. https://www.sfgate.com/coronavirus/article/which-COVID-19-te...

People may want to read the section of that study in terms of its limitations. Holy shit.

” The findings in this report are subject to at least five limitations. First, reinfection was not confirmed through whole genome sequencing, which would be necessary to definitively prove that the reinfection was caused from a distinct virus relative to the first infection.…”

That wouldn't significantly affect the conclusion though, right? They compared the reinfection rate for people with previous infection + vaccine to people with previous infection + no vaccine. Since both groups previously had COVID, shouldn't that cause (in expectation) the same false positive rate for both groups when testing for reinfection?

Edited to add: The authors cite [0] to support their claim that it's not significant, it basically seems consistent with their claim that it's really unlikely to still have viral shedding at the duration that they tested at.

Also worth mentioning that adding an equal proportion of false positives to both groups would cause the study to understate the effect size (i.e. the magnitude of the additional protection conferred by vaccines) by biasing the odds ratio in the direction of 1.

[0] https://www.thelancet.com/journals/lanmic/article/PIIS2666-5...

Sure, getting vaccinated after one recovers from an infection imparts the highest level of protection by that wasn't the GP's point. A prior infection imparts a much higher level of protection against future infections than any vaccine that we currently have.

Possibly, though positive Covid tests aren’t a guarantee of an actual infection which might be why some studies showed vaccination was more effective.

Alternatively, having survived the first infection says more about the individual than getting a vaccination. Which is yet another way this stuff gets tricky.

> some studies showed vaccination was more effective

Could you point me to them? I'm unable to find any.

Here’s one showing prior infections or at least prior positive test results failing to result in long term immunity.

https://wwwnc.cdc.gov/eid/article/27/9/21-1042_article

The linked article does not study long term reinfection rates, it studies systemic antibody response. Unfortunately, the topic of long-term covid antibody research is a difficult area: both exponential antibody decay and antibody location are relevant. Extrapolating epidemiological conclusions from small population antibody studies is reaching.

Population studies run into different issues you want both. I recall an early study showing vaccination being significantly more effective, but that’s before current variants showed up etc.

Really you can’t draw accurate conclusions from any one study but multiple studies give you a better picture of what’s going on. Large numbers of people falsely believe they had COVID, people who survived COVID are healthier than the general population because the other option is death, the most common infection doesn’t get a strong immune response, vaccine recipients tend to be older and in worse health etc.

That said, an otherwise healthy person who got very sick from COVID and got multiple high quality tests verifying exposure likely does have a significantly better long term protection. But, that’s not representative of the general population that had COVID.

Andrew Gelman has a blog post about this misleading report: https://statmodeling.stat.columbia.edu/2021/10/01/cdc-as-bad...

He’s just complaining about the title as misleading when the very first sentence provides full clarification.

However even the other interpretation is supported by evidence like this. https://wwwnc.cdc.gov/eid/article/27/9/21-1042_article Though critically surviving COVID says good things about the immune system even if you didn’t develop an immunity you may still be better off than the average vaccination recipient who tends to be older and in worse health. Which further confuses the issue at the population level.

Is this a joke? CDC issues guidance that vaccinated persons should not get tested anymore unless symptomatic, then collects data showing that, lo and behold, vaccinated people have lower rates of reinfection. Duh, you just stopped measuring infection rates for vaccinated asymptomatic cases, which are the majority of covid infections.

You'd think that CDC employees would disclose CDC guidance that might be invalidating the core premise of their study... Consider finding an alternative to CDC. FWIW, UK has pretty good data.

> This report details the findings of a case-control evaluation of the association between vaccination and SARS-CoV-2 reinfection in Kentucky during May–June 2021 [...] Second, persons who have been vaccinated are possibly less likely to get tested. Therefore, the association of reinfection and lack of vaccination might be overestimated.

https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm

> July 28, 2021. Anyone who has been potentially exposed to the virus should get tested, the C.D.C. now says. Previous guidance recommended testing only for fully vaccinated people who were symptomatic.

https://www.nytimes.com/live/2021/07/28/world/covid-delta-va...

That was controlled for in the study because these people aren’t idiots.

If you really don’t trust US data there is another study out of Israel again showing a single vaccine dose after infection significantly reduces reinfection risks.

Unless there is a technical explanation on how exactly the study 'controlled' for the data bias they failed to disclose, the study is tainted, sorry. This is a technical audience, we can double check the math. They should retract it, but this is 2021 US with too much politics everywhere, so probably they won't.

The substantive discussion is a separate topic. Given all the facts we know so far, including exponential antibody decay and the obvious need for boosters, looks like the vaccines temporarily raise the antibody levels, and then peter out. Note, I'm not making any claims which immune system stimulus is better long term, vaccines or covid infection. We simply don't understand the long term interplay of the human immune system, the vaccines and the virus. Short term studies amount to 'we put a drop of ink into the ocean, measured the water color 1 second later, yay, the ocean is now black'. Hard to credibly extrapolate them 20 years in the future.

So far we assumed a static virus. The largest risk with the current vaccination campaign is that it is using a monoculture vaccine, teaching the immune system to eliminate a grand total of 1 protein. Even a cursory familiarity with how evolution works in large monoculture populations should raise some red flags. https://www.canr.msu.edu/grapes/integrated_pest_management/h.... Long term the virus is likely to figure out a way to do its thing while escaping the vaccine protection. (It so happens that Pfizer CEO publicly agrees with this position, so there).

Given that it is fundamentally impossible to predict the long term evolution of the pandemic absent a time machine, it is highly unethical to force people take the vaccine using universally reviled tactics like state enforced segregation and discrimination.

(Disclaimer: I am vaccinated and hope for the best).

> exponential antibody decay

Antibodies are part of the adaptive immune system but are only produced when the body thinks there is an active infection. To simply greatly long term immunity is maintained via memory B cells because constantly producing antibodies to every disease encountered is untenable. https://en.wikipedia.org/wiki/Memory_B_cell

> grand total of 1 protein

That’s not how these vaccines work. A vaccination covers a huge range of mutations in that spike protein as the immune system memorizes multiple targets. Again simplifying it’s like memorizing 4 of your ten fingerprints, lose a finger and you still match the other 3. The protein target is chosen because it is part of the mechanism of infection, without that a simple COVID variant can’t infect you. Of course given enough time it could evolve around this issue but we are not talking about a single mutation.

> A vaccination covers a huge range of mutations in that spike protein as the immune system memorizes multiple targets.

This is an excellent technical point. Trouble is we already know that we are 'a few mutations away' from a covid variant evading vaccines, which is 'likely' to emerge. A recent Japanese preprint nailed it down to just 4: K417N, N439K, E484K and N501Y.

https://www.deseret.com/coronavirus/2021/8/26/22642809/delta...

https://www.biorxiv.org/content/10.1101/2021.08.22.457114v1

Rachel Walensky, CDC boss, July 2021: "the largest concern that we in public health and science are worried about is that the virus…[becomes] a very transmissible virus that has the potential to evade our vaccines in terms of how it protects us from severe disease and death". A new, more elusive variant could be "just a few mutations away," she said.

https://www.webmd.com/vaccines/covid-19-vaccine/news/2021073...

Albert Bourla, Pfizer CEO, Aug 2021: "Every time that a variant appears in the world, our scientists are getting their hands around it. And they are researching to see if this variant can escape the protection of our vaccine. We haven't identified any yet, but we believe that it is likely that one day, one of them will emerge."

https://www.insider.com/pfizer-ceo-vaccine-resistant-coronav...

Nature, March 2021: "Our study and the new clinical trial data show that the virus is traveling in a direction that is causing it to escape from our current vaccines and therapies that are directed against the viral spike,” says Ho, the director of the Aaron Diamond AIDS Research Center and the Clyde’56 and Helen Wu Professor of Medicine at Columbia University Vagelos College of Physicians and Surgeons.

https://www.cuimc.columbia.edu/news/new-study-coronavirus-va...

https://www.nature.com/articles/s41586-021-03398-2

=====

> long term immunity is maintained via memory B cells because constantly producing antibodies to every disease encountered is untenable

You are reading this backwards. I am not making any claims of what the appropriate level of antibodies ought be for long term immunity. I find "using tainted data we found 2x increase of antibody levels in post-infection + vax compared to just post-infection" studies ridiculous. The people pushing vaccines on people with prior infection, the people pushing boosters, the cottage industry of antigen studies making bold immunity extrapolations are making such claims. Perhaps you should spend some time educating them of basic immune system functions?

I wouldn't mind that much, everybody is free to chose their own risk profile. Right? Then they throw away the democratic norms and practices of past 200 years because they don't get the buyin levels (100%) they were hoping for. That is evil.

This is problematic for a few reasons:

1) There are varying levels of infection and immunity, and we really don't know how that bell curve works in the population at large.

2) We can't effectively test in order to objectively assess who is naturally protected.

3) From a public policy perspective, it's a total disaster: if we 'require' immunity, a unbelievably large portion of the population will opt to get COVID instead of the vaccine. This is the real kicker right here. If the population acted in any way reasonably, I think that some kind of antibody test, or even declaration from a doctor might work fine. But we are, as a general population, still in the illiterate dark ages.

I spent a day at a family members house where he had his FB profile videos playing out loud - it was the most insane stuff I've ever heard, I thought it was satire, it was not. It was video after video of completely insane conspiracy theorists, most of them total nobodies but trying to gain an audience, extolling unbelievable things. My family member believes that he has access to special 'privileged information' (even though it's just random videos on Facebook) and he utterly will not believe anything that he hears on the news.

The doctors on TV are all liars, the vaccine is a big scam. He's a 'Wolf' while the rest of us are 'Sheep'. Etc..

I would not have believed this new social phenomenon (it's new at least at this scale) until I witnessed it myself - fake information has turned a material portion of the population into zombies.

4) It's moot - the vaccine is safe and effective. So people can just take it and that's that. Conscientious objectors are fine, they just can't work in hospitals, at least for now.

> We can't effectively test in order to objectively assess who is naturally protected.

There are over 43 million Americans who have already survived a lab-confirmed SARS-CoV-2 infection. You don't need to test them. Their status can be verified just as easily as a person who has a CDC vaccination card.

Oh but it's "protection" you want to talk about?

The reality is that you can't measure real-world protection in any given individual with natural immunity or vaccine-based immunity. The vast majority of people who have been vaccinated don't test their antibody titers (ever, and over time) and even if they did, there are no validated models for correlating antibody titers to real-world protection. Antibodies aren't the end-all and be-all of immunity. Immunity is complex, and there are a variety of factors (memory T and B cell responses, your overall immune health, the viral loads you're exposed to, etc.) that determine how your body will respond to a pathogen.

Moving away from family anecdotes, here's an actual case: https://www.taiwannews.com.tw/en/news/4307460

A pilot in her 40s who received her second dose of Moderna in early August had a breakthrough infection in October. Data suggests that Moderna is the most effective vaccine and a person in her 40s is not in the age group (65+) where we see vaccine efficacy waning most quickly.

So a person who got the most effective vaccine, who is healthy enough to be a commercial airline pilot, who is not 65+, and who was fully vaccinated for less than 2 months, when her antibody titers would be expected to be very high, can still catch a breakthrough case.

I don't think I will get any boosters, the behavior of authorities is atrocious and irresponsible on this matter. We wouldn't even have had a problem when we had fewer people out for the evil anti-vaxxers. I think authority needs a clear bump on their ideas. They already got enough, but they seem to learn quite slowly.

> I am vaccinated and favor vaccination

Me too, but that doesn't matter. That should be nobodies business from now on.

If immunity is what people cared about, shouldn't we just do antibodies test instead of a blanket vaccine on all? Some people double vaxxed still present low antibodies. Everyone's biology is going to react differently.

Worth mentioning that "challenging" here means suing his employer in federal court! In any context, it seems pretty reasonable to place an employee on paid leave while that employee is in the process of suing you!

Separately, from the earlier linked Substack post, this seems to be the context of the lawsuit:

> Natural immunity following Covid infection is equal to (indeed, superior to) vaccine-mediated immunity. Thus, forcing those with natural immunity to be vaccinated introduces unnecessary risks without commensurate benefits—either to individuals or to the population as a whole—and violates their equal protection rights guaranteed under the Constitution’s 14th Amendment.

Are state-run university systems generally held to be subject to the 14th Amendment under the law? It seems like public K12 schools are [0] but I'm not a lawyer and a quick search didn't turn up anything that explicitly states one way or the other.

Also, the benefits of getting vaccinated are clearly significant even for people who've already had COVID. Whether the risks are "unnecessary" and whether the benefits are commensurate with those risks varies on a case by case basis. But even when they are, that certainly doesn't follow trivially from the fact that "natural immunity following Covid infection is equal to (indeed, superior to) vaccine-mediated immunity," as the author's usage of "thus" suggests.

[0] https://www.concordlawschool.edu/blog/constitutional-law/14t...

> In any context, it seems pretty reasonable to place an employee on paid leave while that employee is in the process of suing you!

It doesn't seem reasonable to me at all.

from a business prospective it seems like a "reasonable" course of action, but of course not all business decisions are "reasonable" from an ethical perspective.

Are you expecting people who sue companies for harassment, etc., to be put on reduced salary paid leave?

That seems like a nice tool to have to suppress suits.

No, they should get their full salary, as the author is. The overtime complicates things, I'd personally lean toward including the overtime pay they were projected to have earned to avoid creating the chilling effect you describe (either in perception or reality), but I can see the case for excluding it too.

It's more than overtime, see:

"since half of my income from the University comes from clinical revenues generated from seeing my patients, supervising resident clinics, and engaging in weekend and holiday on-call duties. So while on leave my salary is significantly cut. Furthermore, my contract stipulates that I am not able to conduct any patient care outside the University..."

> Are state-run university systems generally held to be subject to the 14th Amendment under the law?

Yes. See Bakke, Grutter, Gratz, etc.

What's "right" and what's "wrong" are such subjective things. All I really care about is the science and the science as far as I can tell is overwhelmingly in favor of the idea that you should still get a vaccine even if you have natural immunity.

Be careful not to conflate what the science says and what scientists say. The position you articulate is certainly in vogue at the moment but I'm not aware of any study that supports it, let alone one that's methodologically sound.

> Be careful not to conflate what the science says and what scientists say.

Could you elaborate on that cryptic statement? What is the science saying, and what are the scientists saying? What is the difference and why does it matter here?

It's not so much Science as it is Public Health Policy informed by the Science.

The distinction is important because were dealing with masses of people here, not some kind of simple objective reality.

If we all acted very rationally and conscientiously, the world would be a totally different place.

Where did you get that science?

"being unvaccinated was associated with 2.34 times the odds of reinfection compared with being fully vaccinated"[1]

[1] https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm?s_cid=mm...

https://statmodeling.stat.columbia.edu/2021/10/01/cdc-as-bad...

that correction is not relevant to this thread. The title is misleading when talking about vaccines alone vs infection alone, but it is not misleading in regards to this discussion - "you should still get a vaccine even if you have natural immunity". The study DID show that vaccine + infection is better than just infection.

Here is more evidence:

https://www.nbcnews.com/health/health-news/hybrid-immunity-p...

Lol. This is not a reason for mandate.

this comment thread was not about the legitimacy of mandates but feel free to pivot

So what happens in a year or two if, however unlikely it may seem now, bad medium-to-long term effects of the vaccines start to show up?

After spending this much political capital, no one could ever afford to admit that the unvaccinated, especially those who already had COVID, had a point. So would there just be a huge cover-up, or would They (with a capital T) push propaganda that says "The science has changed, but the people who didn't follow the previous science were lucky and unpatriotic!"?

There are already all sorts of demonstrable long term effects of COVID. No speculation necessary.

How much time must pass without long term effects materializing before unvaccinated people admit that the vaccinated had a point?

People are about to be coerced into an injection against their will and could suffer ill effects, with no legal recourse. If it turns out they were right, then they were screaming the truth the whole time and nobody listened. Are you okay with all that?

People are already catching a devastating disease against their will, and are already suffering ill effects. Are you beginning to see how all of your speculation about hypotheticals has real world analogs that are already occuring?

Many of the people in my speculation about hypotheticals already had COVID. It's not an exclusive-or.

> If it turns out that the world _was_ flat, then they were screaming the truth the whole time and nobody listened. Are you okay with all that?

If.

I mean, yes? It all depends on how plausible the original proposition is. So the proposition under test here is "are COVID vaccines preferable to COVID"? The data from the real world is here and it's not even close.

> How much time must pass without long term effects materializing before unvaccinated people admit that the vaccinated had a point?

Rhetorical question, but:

Given what we know about long term effects of vaccination, about 3-4 months without "long term effects".

Needless to say, this mark has been passed more than once - in trials in 2020, and then again in mass vaccination programs in 2021.

> So what happens in a year or two if, however unlikely it may seem now, bad medium-to-long term effects of the vaccines start to show up?

I am not going to say that's impossible.

I am going to suggest that there would be Nobel prize in medicine waiting for the people who can explain the novel mechanism for _how_ those supposed much delayed side effects are possible.

Vaccine side effects occur shortly afterwards (1). They do not surface a year later - and it would have to be a year later, not 6 months, given when mass vaccination programs started & what we haven't seen happen in the real world. And vaccine side effect also do not surface 6 months later, FWIW.

Why do you feel invested in fantasising about "vindication, propaganda, cover-up". Is this heathy? You're nearly there with "could not ever afford to admit being wrong"

1) "In virtually all cases, vaccine side effects are seen within the first two months after rollout."

https://www.uab.edu/news/health/item/12143-three-things-to-k...

> I have nothing personal to gain by this lawsuit and a lot to lose professionally…

>Many of you have asked how you can support me and my efforts to challenge coercive mandates. My first answer is to consider becoming a paid subscriber to this newsletter

This bit is hilarious

so are they being put on leave for "challenging their vaccine mandate on behalf of Covid-recovered individuals with natural immunity" or because they refuse to get vaccinated in accordance with mandates?

> I have no intention at this time of resigning, withdrawing my lawsuit, or having an unnecessary medical intervention forced on me

Based on this line, I think he refused to get vaccinated and they took measures that had been clearly spelled out to him beforehand. Seems a bit theatrical considering this was all entirely foreseeable.

yea considering the post opens with how he is representing people fighting for natural immunity legitimacy and how it is never stated if he has had a previous infection, it seems purposefully written to make it sound like the repercussions are from "speaking out" vs. "not following the rules" which is a common narrative from those claiming to be "silenced"

There is no way he wasn't aware this would happen, it's laid out very clearly in the policy:

> If an employee fails to submit proof of Full Vaccination ... the employee will receive a Notice of Continued Non-Compliance stating that the Department will commence a period of progressive corrective action/discipline, up to and including termination/dismissal, against the employee. [1]

[1] https://policy.ucop.edu/doc/5000695/SARS-CoV-2_Covid-19

Is this cognitive dissonance or can there be real disagreement between "experts"? Just a few weeks ago ACLU said it was unethical and freedom restricting to not get the vaccine. Who do I listen to?

Your common sense. No one can be an "expert" on Corona. They don't even know what it is! Certainly this was true by the first lockdown.

There is no such thing as common sense in immunology.

Claiming "common sense" is about as empirically useful and valid as claiming "street smarts".

No, thanks, I'll stick to the people that would rather peruse evidence and draw limited conclusions and admit that educated guesses are still far better than uneducated guesses.

Pitting arguments by authority against one another, in most of the EU, vaccination is considered equivalent to documented proof of recovery from COVID within the past 6 months

Given the Dr Kheriaty was infected last year, wouldn't that mean that even by EU standards, he would be considered the same as a Covid-naive individual?

Yes. And honestly, he probably should be, using the precautionary principle? I don't think there's great data showing that people infected with the ancestral variant have good immunity to Delta. Certainly, a lot of people who'd had the ancestral variant were re-infected with Beta, when there were big outbreaks of that in South America.

This person works from home and their job is to look at big picture when SHTF scenarios are happening.

Fucked move.

I won't comment on the particular case, but this is in general how public policy works, no? There's a rule set for everyone that, hopefully, makes sense for most people, but it is enforced for everyone.

Take speed limits for example. I'm sure a top driver, paying extra attention, can safely drive much faster, and probably still be safer than a lousy driver within the speed limit. But the rule's the rule and you have to abide by it.

It's a nice analogy in a few ways I think. Speeding by 20-30% mostly doesn't kill anyone, it's overall rare, but when it goes wrong, you're likely to kill yourself and others, and involve rescue services, at a cost and some risk to them - a bit like refusing a vaccine. Driving slowly also induces some risks to the individual - cardiovascular from sitting down for longer, respiratory for being stuck in traffic fumes, less time to relax, whatever. These are probably very minor, but so is the risk of vaccine complications.

Also, speed limits are kind of crude. Why do they go in round values of 10 kph/mph? Why not fine-tuned to the conditions - "here the curvature and visibility permits a max speed of 74 kph". They're not meant to be exact, they are meant to be roughly correct, easy to set sensibly and to police.

There's also the aspect of "one rule for everyone". If I'm a legal, but not exceptional driver, and see better drivers drive faster on the roads, that erodes my obedience of the speed limit too, which for me, and most people, is actually a good speed limit. If I follow suit with the better, faster drivers, that ends badly. The message is clear: "everyone go below speed limit, anyone going faster is getting a ticket".

I think vaccines are really the same. The novelty is that car driving evolved as an opt-in thing (even though it often isn't anymore, if you need a car to get around), whereas we're saying vaccines are kind-of mandatory. So while with cars, "meh you can walk if you don't like speed limits" (which often you can't), but with vaccines, "meh if you don't want this thing injected into you, you can't participate fully in public life". With driving, some people think they know better, can drive faster, and that the open road, and free fast lane, is a personal right - yet we don't make exceptions for them.

Vaccinations are testable and enforceable, via pieces of paper - the means public policy is optimised on and honed for many decades. They do protect other people, to a debated, but certainly meaningful extent. They have an effect, apparently, even for people who did have the disease. It's crude but it works at scale. It's not exact, maybe some people had Covid and are immune, maybe some paper (peer-reviewed so definitely correct) shows that some gene makes people immune, but these are not great exceptions for public policy to deal with.

I'm sure my analogy fails at some level of scrutiny, but overall I think it's decent.

My spin on your analogy would be that we are applying one speed limit to all roads.

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