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Comment by tombert | Hacker News Reader

I've been saying for roughly a year now that if nothing else good can come from Covid, we at the very least are dumping a ton of time and resources and research into mRNA vaccines.

I know basically nothing about virology, but I remember hearing a podcast a million years ago talking about mRNA vaccines, and I remember after it was over thinking "if this is even half as cool as it sounds to a lay person, the implications of this are huge". It appears that it's substantially more than half as cool as it sounded, and the fact that we are even having discussions about being able to wipe out malaria is mind-boggling to me (in a good way).

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We developed several working vaccines, and in record time. A triumph of scientific engineering.

I too am very hopeful for mRNA vaccines, although I don't know how much I should temper my expectations. The idea of curing certain cancers, not just preventing them, is wild.

I haven't even heard about the curing cancer part, that's awesome if it's true.

I think I'm going to temper my expectations to "faster and more vaccines increasingly exotic diseases" for now. I would absolutely love to be proven wrong though.

Chimeric antigen receptor (CAR) T-cell therapy is a way to get immune cells called T cells (a type of white blood cell) to fight cancer by changing them in the lab so they can find and destroy cancer cells. CAR T-cell therapy is also sometimes talked about as a type of cell-based gene therapy, because it involves altering the genes inside T cells to help them attack the cancer.

...

In CAR T-cell therapies, T cells are taken from the patient's blood and are changed in the lab by adding a gene for a man-made receptor (called a chimeric antigen receptor or CAR). This helps them better identify specific cancer cell antigens. The CAR T cells are then given back to the patient.

https://www.cancer.org/treatment/treatments-and-side-effects...

Right now this is done in a very personalized and labor intensive way. I think the thought is mRNA is potentially a gigafactory compared to artisanal methods.

They also can only target cancers that have specific markers that are unique to the cancer and not normal cells, lest the treatment kill non cancer cells. Early experiments here did lead to patient deaths (in advanced already going to die cancer patients). Not all cancers have these unique markers so this therapy only works on a few types,m.

Fantastic podcast covering topic by interviewing the father of these therapies:

https://youtu.be/pVMl0LgdnOU

Podcast available on Apple podcasts etc. The Drive episode 177.

can't recommend enough.

Except we had to change the definition of “working vaccine” to fit these new therapies.

Traditionally a vaccine has to keep efficacy for a year. We haven’t got a year of data but the efficacy has dropped significantly

I call bullshit. Antibodies wane but the memory cell response is robust and holds up over what looks to be a pretty long period (studied intensively for 6 months but with no sign of decline). Here's a new paper that shows that in detail (paper itself is dense but Twitter thread is fairly accessible):

https://twitter.com/rishirajgoel/status/1448711946010710023

By basically all measures, these vaccines work better than the flu vaccine, which for some reason doesn't attract the same sort of criticism.

Great link, summarizing recent research showing strong post-vaccination long-term B cell response.

Then Twitter surfaces a recent breakthrough infection study among 620k US veterans in the "More Tweets" section: https://twitter.com/EricTopol/status/1448815262522773520 After six months from initial vaccination (Mar-Aug) the J&J vaccine appears to have zero (!) VE against infection. Pfizer is holding at a modest 53% against infection. Worse, the curve has the same shape as J&J, merely 2 months delayed.

In spite of very promising cellular and molecular studies, I am left scratching my head: are the vaccines any good at preventing infection in the long term, where we define long term as a few years down the road? The question is somewhat rhetorical, as we don't have epi studies from 2025 yet.

PS. I am more than happy to make a distinction between infection and severe infection. The main reason I pay attention to VE against infection are vaccine mandates and the whole stigma buildup against unvaccinated people.

PS2. > the flu vaccine, which for some reason doesn't attract the same sort of criticism.

People are free to get or not get a flu vaccine. Not getting a covid vaccine means loss of livelihood, loss of basic liberties and social ostracism.

COVID-19 vaccines aren't sterilizing to any meaningful extent. They provide only limited and temporary protection against infection. The real benefit is in protection against severe symptoms.

https://www.nature.com/articles/d41586-021-02689-y

https://www.businessinsider.com/delta-variant-made-herd-immu...

> People are free to get or not get a flu vaccine. Not getting a covid vaccine means loss of livelihood, loss of basic liberties and social ostracism.

Gee, I wonder if something happened recently that made stopping Covid more pressing than making everyone get a flu shot? Sure seems like there’s some reason, maybe a few hundred thousand reasons, why as a society we’re taking Covid and vaccination against it more seriously than the flu.

It’s weird to be so focused on infection, when efficacy against severe disease is more practically relevant. And the latter remains high, around 92% or higher, even against Delta.

Vaccine protection isn’t binary. Even if you end up infected your disease will be less severe AND you will be less contagious.

I call bullshit. Your source doesn’t address the efficacy decrease at all.

Yes, there are lasting changes from the vaccine, no that doesn’t indicate much about level of protection.

I definitely would never get a flu shot with its ridiculous efficacy numbers. If you forced me to get it to remain a part of society it would require my resistance by any means.

If you didn’t respond like an asshole id give you a couple sources. But, bullshit and all.

I don't know enough about vaccines to dispute what you're saying (though I feel like I have heard contrary data on this), but even if it's only fully effective for 8-9 months, isn't the fact that we had a vaccine that accomplished at least some of its goals safely designed and tested in record time a really cool thing?

Even if it's only effective for 6 months, that's still 6 months of slowing the spread, and conceivably we can extend the efficacy by administering booster shots.

It's efficacy as measured as "chances of getting sick" declines significantly, but it's still pretty effective.

But the protection against hospitalization and death is still very robust even after almost a year.

My understanding is that all vaccines have similar "effectiveness curves", in that they are highly effective in the first weeks, and effectiveness degrades over time down to some low base level of immunity, where your body is no longer actively producing antibodies, but it has the ability to restart production quickly if necessary.

It's not as though the concept of a vaccine booster is new, after all we get annual flu shots. It's also a question of efficacy of the vaccine versus the new predominate variant. Delta didn't exist when the vaccines were finalized.

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