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Comment by omginternets | Hacker News Reader

I'm not clear on how "the vaccine does not effectively prevent transmission" translates into "vaccinate everyone and give booster shots at once".

I realize these vaccines reduce transmission rates, but ~25% is still alarmingly high. From my meager understanding of epidemiology, this is orders of magnitude above what is needed to stop an epidemic. I also realize that they reduce hospitalization and death rates, both of which are extremely valuable, especially to certain populations.

But there's also a real ethical dilemma, here. The various approvals for the vaccines (especially with young children) hinge on its purported efficacy; this is what was supposed to offset the known-risks and Knightian uncertainties [0].

I realize this has become a terribly politicized issue, and I also realize there are a disappointing number of pig-headed, foolish anti-vaxxers, but it also seems like there's room for informed debate around mass inoculation with these vaccines in particular.

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

EDIT: I must admit that I am pleasantly surprised by the level-headedness and respect with which you all have responded to this comment. Thank you so much, I really appreciate it.

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Vaccine efficacy is against severe COVID illness, not against transmission. The vaccine is still effective, although recent studies indicate that after 6 months it may only be 50% effective against severe illness (this will vary tremendously for each individual).

This is a non-sterilizing vaccine. It was never designed to stop transmission. It did surprisingly block transmission pretty well before the Delta variant. The theory presented here is that the vaccine effect takes time and kicks in on around day 5. With Delta the virus has already become highly transmissive by then. Pre-delta that probably was not the case.

That is really just rewriting history (see my comment below about some of the original studies from the trials). Vaccines were presented as having an efficiency of around 90% after the second dose - meaning that only around 8% of people (for Pfizer) in the trials actually got sick, all the graphs and charts from the beginning of the year were about this. The fact that now we are rewriting the history books will not help at all in the trust of the public, especially the ones that still didn't get it.

That was certainly the case for the original strain, and shortly after the vaccine. What you see today is how the vaccine interacts with newer strains compounded with the effects of time. It’s not rewriting history at all, in fact you can still access all of the original information, it’s just out of date. As it turns out, most people don’t commit the level of critical thought required to process this.

The only way that we would not be dealing with COVID today is if it was taken seriously early on. China seriously dropped the ball. I don’t believe that the resulting quarantines and lockdowns in other nations (which were for the most part necessary to reduce death tolls pre-vaccine) could have gone any better than they did, as people simply do not care.

The 'rewriting history' thing is probably a reference to this:

> Vaccine efficacy is against severe COVID illness, not against transmission

That is not and never has been - up until literally a few months ago - the definition of vaccine efficacy, nor was it the definition being used for COVID vaccines up until it turned out they can't prevent disease.

Trying to assert what vaccine efficacy is without acknowledging that this is an entirely novel use of the term is going to come across as an attempt to confuse people/make them forget that it was only recently that high efficacy was being proudly announced in terms of "preventing COVID-19".

Also bear in mind that this new definition has no real metrics or science behind it. What exactly is "severe" illness. Don't say hospitalizations because people have to choose to go to hospital and are being told that taking the vaccine means they won't have to go to hospital. That's a massive, massive confounder, and none of the public health agencies suddenly making claims about "severe" disease even recognize it exists, let alone control for it.

> That is not and never has been - up until literally a few months ago - the definition of vaccine efficacy

I remember something else. At least where I live, since the very beginning of the vaccination programme, people were advised to not wait for Pfizer and Moderna vacinnes that were in short supply, but use already widely available AstraZeneca and Johnson & Johnson vaccines because even though their efficacy against transmission was significantly lower, they still provided very good protection against severe illness; and that protection was always being explicitly stressed out as the most important.

e.g. https://www.publichealthontario.ca/-/media/documents/ncov/co...

"All of the COVID-19 vaccines approved for use in Canada are effective at preventing symptomatic SARS-CoV infection and COVID-19 related hospitalizations and death."

Because the phrase vaccine efficacy just means how good is a vaccine at something it can be defined relative to any endpoint you want. Nonetheless, both the way the term "vaccine" has been used historically and the way "vaccine efficacy" was being used as recently as this spring were in terms of, it will prevent you from getting infected and sick.

The original claim was that "vaccine efficacy is NOT against transmission" and that this is merely updated information, not an attempt to rewrite history. But it certainly looks that way to a lot of us because to truly accept that the previously distributed information was wrong would imply a major screwup and thus some sort of investigation and accountability. At minimum it means trial failure, for one thing. The pharma companies claimed the trials showed they could prevent COVID-19. They were wrong. That implies other claims made by the trials could be wrong, which implies the government should suspend the rollout until the true facts about what the vaccines actually do can be established.

Obviously no such logic is appearing anywhere in public health. Instead the message has simply shifted to be, vaccines prevent "severe illness and death" and that's why they're awesome and always were. The Pfizer trial at least, didn't actually show that however.

As long as 'severe' covid efficiency rates are in the same ballpark as covid deaths rates, I'm willing to accept the ballpark even if the details may be marginally off. Another credible metric is ICU utilization, because it's an expensive scarce resource, people are not sent there willy nilly.

depends what you read when vaccines came out. I dod not see any claims from scientific sources that vaccines stopped transmissions. Those claims came from the politicians and corporate media

Actually they kind of did (see "BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6) below":

"A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups." https://www.nejm.org/doi/full/10.1056/nejmoa2034577

Maybe this is legalese, but I am pretty sure your average Joe online, that reads all kind of weird things on Facebook or other places, won't understand the subtleties of this language.

This quote doesn't say anything about whether the vaccine reduces transmission of the virus. Even large phase-3 studies like the ones done for the COVID vaccines don't have anywhere near the statistical power to determine this. Now we have epidemiological data that shows a clear reduction in transmission, but not as much as the vaccines protect against serious disease.

Here is another quote from the same paper [1]: "This report includes 2 months of follow-up after the second dose of vaccine for half the trial participants and up to 14 weeks’ maximum follow-up for a smaller subset. Therefore, both the occurrence of adverse events more than 2 to 3.5 months after the second dose and more comprehensive information on the duration of protection remain to be determined."

[1] https://www.nejm.org/doi/full/10.1056/nejmoa2034577

Flowchart:

Person A >Transmission> Person B >Transmission> Person C

Person A >Transmission> Person B (Prevention)

This flowchart would be correct if "prevention" referred to "covid infection", but unfortunately it refers to "covid infection with symptoms". Transmission is not prevented, in this case.

well, a vaccinated person supposed to have a 2x shorter interval to spread covid before recovering from it.

The study that you are referring to took place "Between July 27, 2020, and November 14, 2020". The delta variant started in India in late 2020 and wasn't spreading widely within the United States until 2021. It was listed as a variant-of-concern by the WHO on May 31, 2021.

So the research you are referring to is in regards to other variants of sars-cov2

From September 12, 2020:

"A COVID-19 Vaccine May Be Only 50% Effective. Is That Good Enough?"

https://www.npr.org/sections/health-shots/2020/09/12/9119879...

August 7, 2020:

"Fauci says COVID-19 vaccine may only be 50 percent effective"

https://nypost.com/2020/08/07/fauci-says-covid-19-vaccine-ma...

There is nothing about stopping transmission in there.

prevent: to stop something from happening or someone from doing something

https://dictionary.cambridge.org/dictionary/english/prevent?...

In this case the appropriate definition of "prevention" and "what is prevented" is to be found in the protocol of the trial [1], not in a dictionary of the English language.

If I am reading correctly (but do correct me if I am wrong because I am not 100% certain), only symptomatic cases are counted. Hence, it is quite possible for the vaccine to stop the symptoms, but not the transmission between individuals.

[1] https://www.nejm.org/doi/suppl/10.1056/NEJMoa2034577/suppl_f...

Wasn't that the pre-Delta variant(s)?

Science is constantly "rewriting history." It's called learning.

Unfortunately it's a major source of public distrust in science since when someone changes their mind it's perceived as weakness or deception. A dogmatic idiot who never learns anything looks like a stronger person of greater integrity.

The fact that we got any form of vaccine at all in one year is absolutely incredible. That it doesn't work quite as well as we originally thought isn't surprising given that it wasn't out long enough to observe long term efficacy in the wild. Original numbers were based on limited clinical tests and models.

Science is a process that will get things wrong and is full of experimentation. Unfortunately, this is lost on people, surprisingly some very smart people who should know better.

When you have people screaming at the top of their lungs: The Science is Settled!!111 They are Science Deniers!!! Science does not care about your opinion!!! Etc.

And then scientific learning happens, all those people who were screaming look like dogmatic idiots to those who they were screaming at. It doesn't matter they the ones screaming adopted the new position. I will pull out the old and tired mask issue; when this first started, the people on the "side of science" were screaming that the masks did not help and they trotted out all sorts of scientific studies to back this up, from virus size vs mask to saying ti would be harmful due to keeping more virus at your face. Those who thought masks were important all looked around and said "If masks are such a bad idea, then why are the doctors all wearing them". Now we know it was a stupid and harmful lie.

It is incredible what we accomplished in a year but it is also very frustrating to see how stupidly political and how unnecessarily opaque everyone is being. From the mask lie to the vaccination tempo(we pushed for a shorter amount of time between both shots because we were worried about followup, now we need a third shot?). No-one is willing to sit down and frankly state what we know and what we doesn't know. Our media isn't willing to accept it either. Trust is a two way street but We are all so afraid that uncertainty will breed fear that we take strong positions and end up killing trust.

What was mentioned in the original comment is not learning, it is rewriting history. It's one thing to say, we now have the data to say that we need boosters, because after a while people are at risk again, and another thing to change the original story and say, we never said the vaccine prevents infection, we said it only prevents severe cases.

I think calling people "dogmatic idiots" is exactly what actually drives people away from these discussions.

I think the "rewriting history" part is:

> It was never designed to stop transmission.

I can't find any source confirming or denying that claim, but I can say it's absolutely not the impression I got from governments and the media. Does anyone have a source saying these vaccines were designed as non-sterilizing?

this is a bizarre narrative that i'm seeing multiple times ITT

science and history are two distinct things

it's ok to rewrite science

it's not ok to rewrite history

> Original numbers were based on limited clinical tests and models.

Exactly! Those initial numbers were based on limited clinical trials because time was not on our side. We needed to get something out fast, so we didn't go through all trial options.

> only around 8% of people (for Pfizer) in the trials actually got sick

With which variant alpha or delta? and how much time after the vaccination?

It is you rewriting history.

> Vaccine efficacy is against severe COVID illness, not against transmission.

Since children have very little chance of a severe COVID infection, why the push to vaccinate them then?

Children can still suffer under long COVID[1] and other complications that can occur with COVID.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927578/

Sure, but now we're talking about the rate of complications from the vaccine vs. COVID among younger populations, and how deadly those complications are. Have you heard any of this nuanced debate, or have you just heard screaming to get everyone vaccinated with no nuance at all?

Which nuance do you think is missing for example from them FDA press release about the EUA for the BioNTech/Pfizer vaccine for children? https://www.fda.gov/news-events/press-announcements/fda-auth...

Nuance: Touting high effectiveness agains infection, which degrades over time. This has been explained elsewhere in this thread, the original vaccine claims were similar and later morphed into "but the vaccine was always designed to protect against severe infection".

Nuance: Not mentioning that their own full application estimates saving one in a million children, under the best circumstances. See Table 14 on page 34.

The difficult ethical question: on one hand there is 1 child you may save given the information available today. On the other hand you don't know which one ahead of time, you need to inoculate 1 million children with a vaccine for which you don't have any longterm data on.

https://www.fda.gov/media/153447/download

Ok, let's have a look what the vaccine manufacturers claimed in their phase 3 study papers about the durability of the protection:

BioNTech/Pfizer [1]: "This report includes 2 months of follow-up after the second dose of vaccine for half the trial participants and up to 14 weeks’ maximum follow-up for a smaller subset. Therefore, both the occurrence of adverse events more than 2 to 3.5 months after the second dose and more comprehensive information on the duration of protection remain to be determined."

Moderna [2]: "Another limitation is the lack of an identified correlate of protection, a critical tool for future bridging studies. As of the data cutoff, 11 cases of Covid-19 had occurred in the mRNA-1273 group, a finding that limits our ability to detect a correlate of protection. As cases accrue and immunity wanes, it may become possible to determine such a correlate."

AstraZeneca [3]: "In this interim analysis, we have not been able to assess duration of protection, since the first trials were initiated in April, 2020, such that all disease episodes have accrued within 6 months of the first dose being administered. Further evidence will be required to determine duration of protection and the need for additional booster doses of vaccine."

Johnson & Johnson [4]: "A limitation of the trial is the relatively short follow-up, which was necessitated, as in other Covid-19 vaccine trials, by the urgent need for vaccine. The data do not suggest a waning of protection."

[1] https://www.nejm.org/doi/full/10.1056/nejmoa2034577 [2] https://www.nejm.org/doi/full/10.1056/nejmoa2035389 [3] https://www.thelancet.com/journals/lancet/article/PIIS0140-6... [4] https://www.nejm.org/doi/full/10.1056/NEJMoa2101544

Speaking of protection (vaccine effectiveness against infection) durability, I have to admit there is a certain level of disappointment seeing charts like Figure 1 in a US veteran study, which flat out contradicts the J&J claims (VEaI 3%) and partly invalidates the Pfizer claims (VEaI 56%). Or a Qatar study. Or a Sweden study.

There is also the official reaction. Aug 18, 2021: "CDC Director Says Coronavirus Vaccines Less Effective For Delta But Still Prevent Severe Infection".

Possible all of these studies are flawed. And perhaps I'm accidentally misquoting Rachel Walensky. Given that the original trials were closed by vaccinating the control arm of the studies, not even sure where to look for credible longterm tracking of VE against infection data.

On the other hand, possibly the manufacturer original studies were flawed. Or the virus evolved, Delta, duh. These conversations are difficult to carry partly because we are supposed to take the original studies, created with (acceptable) conflict of interest as gold standard, and summarily dismiss any independent verification thereof.

https://www.medrxiv.org/content/10.1101/2021.10.13.21264966v...

https://www.nejm.org/doi/full/10.1056/NEJMoa2114114

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3949410

https://www.forbes.com/sites/andrewsolender/2021/08/18/cdc-d...

PS. One more recent VE study picked from the comments, https://www.nature.com/articles/s41591-021-01548-7/tables/3

UK, VE vs delta over 90 days

  days  VEaPCRI  VEaSI
  after
  2nd
  dose

  14    85%      93%
  30    83%      92%
  60    80%      86%
  90    75%      78%

The trend makes me fairly intrigued to see the follow up at 180, 270 etc. days after 2nd dose.

Watch this till the end : https://www.youtube.com/watch?v=TSZMtSPX3iE

To be fair, before we get carried away, VE against severe infection persists much better given the limited data we have and considering the in-the-field hospitalization & death rates. For adults, especially older, the vaccine is a big net positive.

I don't get what point you are trying to make. Yes, the vaccine efficacy drops over time. This is expected since the antibody levels in the blood drop over time. The manufacturers have pointed out from the beginning that this drop and the potential need for a third shot have to be determined from real-world data, as was done in many studies.

Now the picture seems to be that vaccine effectiveness does indeed drop over time, but protection against severe disease remains pretty strong, with the possible exception of old people who tend to have a weak immune response. Most governments have reacted by recommending third shots to this group in order to further improve the protection.

I really can't see any controversy here. This is precisely the procedure one expects when a new vaccine is introduced.

It is also worth pointing out, that even without boosters the vaccines vastly outperform any medication tested against COVID so far. And they do that much cheaper and with lower side effects.

"Yes, the vaccine efficacy drops over time." That's it. Pfizer made their core of their argument to FDA for 5-11 age group based on VE against infection numbers that we agree do not hold over time. They should take their time to conduct a real study and demonstrate real clinical benefits. There is no rush.

Is the chance of long covid higher than the chance of myocarditis? Is one more dangerous than the other?

Myocarditis is very serious. Any child with it will need cardiology visits for most of their life.

Covid can also case myocarditis and at a higher rate[1] than after the vaccine.

[1] https://www.newscientist.com/article/mg25133462-800-myocardi...

Yes, but I thought we were talking about the push to vaccinate children, which is under say 14 years old. The younger you are, the less likely you are to have symptoms from COVID, so of the numbers listed in that article it's not clear what proportion of those complications from COVID came from the upper age brackets rather than the 12-15 year olds.

And how stupid is it that these articles talk about studies but still don't actually link to them?

> And how stupid is it that these articles talk about studies but still don't actually link to them?

Well, the middle-man doesn't want you going to the source. What's his job gonna be if you do?

As I understand it, precisely because they may then pass the infection on to those who may then end up with a severe illness (either because they're unvaccinated or because their protection is waning).

> As I understand it, precisely because they may then pass the infection on to those who may then end up with a severe illness

But we've already established that the vaccine doesn't prevent transmission. It may slightly attenuate transmission, but nowhere near enough to stop the spread. Given these facts, the vaccine is mainly so the vulnerable populations can protect themselves, but most children aren't among those populations (obviously immunocompromised children are).

If the vaccine isn’t very effective in stopping transmission then how does the vaccine address this?

I don't think I've seen anyone suggest that there is absolutely no impact on transmission. Teenagers were previously a population in which the virus could freely circulate where now there's at least some limited curtailment.

It wasn't my point, but others in this thread have also noted with sources that the level of impact on that younger population (and even small children), including long covid, also appears to be generally underestimated by the general population.

I've heard other people say this and in addition to the common response of helping to reduce spread, I wonder: won't those children grow up to become adults who might experience more serious infection/symptoms? Isn't this like the Chicken Pox vaccine that is commonly given to infants because the disease can be more severe when contracted as an adult?

> I've heard other people say this and in addition to the common response of helping to reduce spread, I wonder: won't those children grow up to become adults who might experience more serious infection/symptoms?

Children exposed to COVID develop strong immunity even if they have no symptoms [1], so the vaccine likely wouldn't convey any more protection than they've already developed.

[1] https://pediatrics.duke.edu/news/children-mild-or-asymptomat...

>Study authors said the findings suggest vaccinating young children against COVID-19 could also elicit a similar or greater degree of protection than that of adults.

>Given similarities in the response to natural infection in children and adults, it is likely that vaccination against SARS-CoV-2 will also elicit a similar degree of protection across the full spectrum of age, as has recently been reported for the Pfizer-BioNTech vaccine in children 12–15 years of age (42). Though we cannot directly compare our results to the neutralizing antibody titers reported in vaccine trial studies, both the vaccine trial data and our results suggest that younger age may be associated with greater neutralizing antibody responses.

I'm not a doctor, but doesn't this actually suggest that the younger the age we can administer COVID-19 vaccines, the stronger the antibody response is likely to be?

First, those claims are speculative as they admit. Second, you cannot generalize from one or two small studies; for instance, other studies (the much-touted Israeli study) have found that natural immunity actually provides much greater protection.

We'll only figure out the truth long after it matters, so the question being debated is the risk of complications from the vaccine compared to the risk of complications from COVID. Given younger populations have very, very low risk from COVID, this is a subtle and complicated question to answer.

> Given younger populations have very, very low risk from COVID, this is a subtle and complicated question to answer.

Shouldn't we apply the precautionary principle to that question then ? From my primitive understanding of medical ethics there is duty of care versus do no harm.

As such, considering the slim percentages at play, there is IMHO no duty to administer preventive treatments children which are not infected, while harm may be caused.

It's getting ugly... The choice of newspaper section is telling...

"San Francisco says children 5 to 11 will have to comply with proof-of-vaccination mandate"

https://www.sfgate.com/bay-area-politics/article/San-Francis...

Ugly is the correct word indeed. Just imagine what attitudes this conditions for at such an age...

The vaccine develops a single antibody against a single spike protein. Natural immunity develops not only a spike protein antibody, but also antibodies against a bunch of other parts of the virus.

If the virus alters the spike protein (eg, the A.30 variant which is pretty much immune to the vaccine), all those other antibodies against the unchanged parts are likely still effective at slowing the virus while new antibodies are developed.

This appears to be changing with Delta, which is causing unprecedented pediatric ICU admission.

https://www.contagionlive.com/view/delta-variant-icauses-unp...

That article you linked (like literally every other one I've read) makes no mention of the numbers that recovered just fine. If they all made a recovery then this vaccine push is pointless.

While the risk of severe covid infection is lower in childred, it still exists and we would like to make it even smaller.

Children's deaths are tragic but extremely low risk for covid. 558 children under 18 died have died in the US, out of a population of 73 Million. How low of risk do you need it to be?

Here in Brazil we've had over 3500 deaths from people under 18, including over 320 babies under 1 year old. There have been cities where sick children were not able to get medical treatment because the pediatric ICU was over capacity. Most of these deaths could have been prevented if a vaccine were available.

At the other end of the spectrum, in British Columbia (population 5 million), there have been 0 deaths in age group 10-19 and 2 deaths in age group <10.

To further confound the issue, mortality rates in infants is significantly larger than in older kids, for US something like 500/100k vs 20/100k, reflecting a number of infants with congenital issues. Some of those end up counted as "death with covid", even if they were not going to make it either way. It is better to search for epi data for kids excluding 0-1 age group, if at all available.

http://www.bccdc.ca/Health-Info-Site/Documents/Week_41_2021_...

>This is a non-sterilizing vaccine.

Unfortunately, it was being sold to the public like it was.

>Herd immunity against COVID-19 should be achieved by protecting people through vaccination, not by exposing them to the pathogen that causes the disease. Read the Director-General’s 12 October media briefing speech for more detail.

>Vaccines train our immune systems to create proteins that fight disease, known as ‘antibodies’, just as would happen when we are exposed to a disease but – crucially – vaccines work without making us sick. Vaccinated people are protected from getting the disease in question and passing on the pathogen, breaking any chains of transmission. Visit our webpage on COVID-19 and vaccines for more detail.

>To safely achieve herd immunity against COVID-19, a substantial proportion of a population would need to be vaccinated, lowering the overall amount of virus able to spread in the whole population. One of the aims with working towards herd immunity is to keep vulnerable groups who cannot get vaccinated (e.g. due to health conditions like allergic reactions to the vaccine) safe and protected from the disease. Read our Q&A on vaccines and immunization for more information.

https://www.who.int/news-room/q-a-detail/herd-immunity-lockd...

To nit-pick, it is not the vaccine effect take 5 days to kick in but that the vaccine trained immune response takes 5 days to kick in.

I would be interested in seeing how long it takes for natural trained immune response for someone who had Covid previously.

Maybe the best strategy for herd immunity would be to get double vaccinated to prevent serious effects then contract Covid to gain superior antibody response.

>> Maybe the best strategy for herd immunity would be to get double vaccinated to prevent serious effects then contract Covid to gain superior antibody response.

From reading about Covid, I thought the virus had a couple of genes that make it more deadly, one of which tends to suppress the immune system for example. Why not create another variant that is a full virus without those genes and use that as a live vaccine? Sure it might escape, but so what it's less lethal than the one out there right? Obviously this raises a bunch of ethical issues, but they are similar to the issues around forced vaccination.

What you are talking about is actually a type of vaccine.

https://en.wikipedia.org/wiki/Attenuated_vaccine

My guess is that such a vaccine would take longer to develop, but I'm not sure about that.

Wiki also lists the following drawbacks:

In rare cases, particularly when there is inadequate vaccination of the population, natural mutations during viral replication, or interference by related viruses, can cause an attenuated virus to revert to its wild-type form or mutate to a new strain, potentially resulting in the new virus being infectious or pathogenic.[34][39]

Often not recommended for immunocompromised patients due to the risk of potentially severe complications.[34][40][41]

Live strains typically require advanced maintenance, such as refrigeration and fresh media, making transport to remote areas difficult and costly.[34][42]

> This is a non-sterilizing vaccine. It was never designed to stop transmission.

Nobody really knew in precise terms what the vaccines were going to do because there was initially no long-term data about their efficacy or studies about transmission.

But it's simply a fact that the vaccines were sold to the public as The Way to end the pandemic and return to normalcy. Did you completely miss all of the talk about "herd immunity"? Are you not aware of all of the places, like California, that ended their mask mandates and told vaccinated individuals they could gather indoors together?

If the vaccines were never intended or thought to significantly reduce if not stop transmission, why was "herd immunity" ever in our pandemic vocabulary? Why did the mask requirements get lifted? Why were vaccinated individuals told they could basically resume normal activities in the company of other vaccinated individuals? And why are some places pushing so hard on vaccine passports?

It's okay that the vaccines haven't proven to be as effective as we had hoped in ending the pandemic. But there is a real issue with the way the vaccines were sold to the public. The messaging that was used to encourage people to get vaccinated was way ahead of what we knew in terms of the science and unfortunately, this is likely going to cause long-term issues. Specifically, I think it's going to be harder and harder to get people to take boosters. I'm predicting that each successive round of boosters will see fewer and fewer takers.

You got it before I could edit :)

But this is very much my point: we were sold a benefit-risk ratio that assumed the vaccines effectively curb transmission.

And the vaccine _did_ curb transmission of the original variant. Variant Delta came later.

I don't recall the exact figures, but I believe it wasn't spectacular.

Moreover, now that Delta is a thing, aren't the ethical issues nonetheless present.

From [0]

> A recent study found that vaccinated people infected with the delta variant are 63 per cent less likely to infect people who are unvaccinated. [1]

> This is only slightly lower than with the alpha variant, says Brechje de Gier at the National Institute for Public Health and the Environment in the Netherlands, who led the study. Her team had previously found that vaccinated people infected with alpha were 73 per cent less likely to infect unvaccinated people. [2]

> What is important to realise, de Gier says, is that the full effect of vaccines on reducing transmission is even higher than 63 per cent, because most vaccinated people don’t become infected in the first place.

[0] https://www.newscientist.com/article/2294250-how-much-less-l...

[1] https://www.medrxiv.org/content/10.1101/2021.10.14.21264959v...

[2] https://www.newscientist.com/definition/uk-covid-19-variant-...

delta completely out competed the original variant, but for the sake of due diligence it would be nice to see data on how effective the vaccine is against the original variant

What we were sold, specifically? One of the challenges to the way this has been been politicized is that the original claims (high efficacy against serious cases, imprecise but substantial efficacy against spread, both of which have held up quite well) were often drowned out by people making much stronger claims for political reasons such as they didn't work at all, or that failing to instantaneously stop the pandemic even at vaccination rates far below the target threshold meant the approach had failed.

"Summer of freedom"

"Here we regain our freedom"

"There will not be a 4th wave"

That's what we were sold. Anyone who questioned it was called an antivax conspiracy theorist.

And the worst part is, the namecallers still think they're on the right/smart side even after miles of backpedaling.

Who specifically said that and when? What I heard was medical professionals saying we could have those things when people got vaccinated. When political posturing caused large numbers of people to refuse vaccinations, masks, and other public health precautions, those ambitions weren't met but I don't blame the people who said it was possible as much as I blame the Republican leaders who personally got vaccinated but told millions of their followers not to.

It's like saying that flossing and tooth brushing were a lie because you had cavities after only doing either half of the month.

Countries with very high vaccination rates such as Portugal or Singapore show quite clearly that all of these statements have been correct. At this point, antivaxers are the only reason why the pandemic is still an issue in industrialized countries.

Singapore may have been a poor choice of example.

In late August it was announced that 80% of the Singapore population was now vaccinated against COVID-19.[1] However, in September and October there has been a dramatic surge in cases and deaths in that country.[2]

[1] https://www.reuters.com/world/asia-pacific/singapore-fully-v...

[2] https://www.worldometers.info/coronavirus/country/singapore/

It's true that it's a dramatic increase, but the death rate still seems to be considerably lower, which is what you'd expect from a vaccine which is not sterilizing. The big question I'd have is what this would look like adjusted for age since American vaccination rates for the highest-risk age groups were also pretty high.

https://ourworldindata.org/explorers/coronavirus-data-explor...

Nit. CFR may not be the best measure, as it is very sensitive to the level of testing, which I expect is higher in a small homogenous country like Singapore. Alternatively, raw deaths per million shows closer numbers, though unclear if Singapore peaked yet.

https://ourworldindata.org/explorers/coronavirus-data-explor...

Yeah, I definitely would want a professional analyst to compare things. The main one I’d be interested in is age-matched rates since as we saw with the Israeli data it’s easy to hit confounds like Simpson’s paradox.

And if what we were/are being sold is reduced severe illness then that seems like a personal issue and the mandates don't make sense.

I get it, if beds are in use by severely ill Covid patients that means less beds for others... then let the bed owners decide how they wish to allocate bed usage, just like some doctors are refusing to see non vaccinated patients.

Yes, and rather than admit this plainly observable fact, incorporate this new information, then base policy choices on what we now know, we still have "health officials" and politicians from one side of the aisle sticking their fingers in their ears, closing their eyes, and shouting "Nah nah nah I can't hear you!" as they push illogical (and arguably wildly immoral) policies like vaccine mandates and perpetual masking and an overall unending bizarro world. I don't know how else to describe COVID anymore other than it's become the world's largest secular religion.

This is how the lead author of the study we are discussing interprets the new information: “Our paper, which had a global impact within 24 hours of publication, provides important support for the following crucial public health actions: vaccinate the unvaccinated ASAP; give boosters to all those who are eligible ASAP; maintain social and public health measures despite vaccination.” (This is the fifth paragraph the linked article).

Even if the vaccines don't entirely curb transmission, they reduce it and reduce the risk of severe illness. While for an individual this might impact their decision making framework, I don't see how it should change the framework for public health officials.

> politicians from one side of the aisle sticking their fingers in their ears, closing their eyes, and shouting "Nah nah nah I can't hear you!"

Politicians on the other side of the aisle are attempting to ban any COVID prevention measures at all. I agree that vaccine mandates aren't the only tool available to us, but it's hard to argue with the mandates when there are people fighting against mandatory testing, mask wearing, and social distancing.

Oh vaccines reduce it by some vague amount, if at all, to vaccinated people whom you admit are at far less risk having been vaccinated? Oh well then go nuts, put in whatever draconian rules you want if it may or may not reduce some spread by some minor amount and means that someone gets COVID in 2023 instead of 2022. That's all the justification we need! Quarantine the kids. Fire police. Make everyone hate each other. Sounds totally worth it!! Yay!!

This is the cult of safetyism. A total inability to process risk/reward and tradeoffs, and eschewing basic logic for "protection" whether real or imagined no matter the cost. All I sincerely ask to people such as yourself is, "What is your long-term plan? Is this forever for you?" Usually, I watch as their brains simply break down on the side of the highway. They have no answer because their logic is so bad they get stuck in an eddy with no way to get out. Welcome to the Church of COVID.

And no, conservatives aren't banning prevention measures. Everyone alive is free to get vaccinated (and wear a mask) as most have even in places like Florida. They're banning punitive rules, and whether it's Florida or Texas or all of Scandinavia, they've demonstrated that there are no worse outcomes from simply allowing people to make their own health choices without figuratively putting a gun to their heads (mandates) or making them do anything they don't want to (masks). Meanwhile, half the world upon seeing this: "Nah nah nah I can't hear you!"

>Fire police.

Really?

Most crime-ridden city in America is vehemently trying to put in a policy which would cause potentially almost a third of their police fired. Again, cult of safetyism run amok. This is what fatally flawed logic gets you.

https://abc7chicago.com/chicago-police-fop-john-catanzara-ma...

If a third of an underperforming police force doesn't respect either public safety or the law, the logic of replacing them seems impeccable to me...

Behold, an Orthodox Covidian! So righteous! So caring! So noble! So educated!

Incorporating this new information would lead to policies that support vaccine mandates and masking.

But then again, that's always been what I thought the policies should be since there was never any strong claims to vaccines preventing transmission.

How is one supposed to debate with someone who thinks the sun rises in the west? If you can't even process the basic facts about vaccines - they don't reduce spread but reduce risk of complication - that logically make mandates and masks useless (which is now also being proven in real-world data), I mean, there's no point in discussion. You can say the sky is red as many times as you want, that doesn't make it true. Besides the fact that by your logic this is a new ridiculous equilibrium for life, with PERPETUAL quarantines, testing, masks, employer enforcement of personal medical choices, passports to do anything, and more broadly everyone hating each other's guts. Sounds fun!!! Totally worth it!!! Places like Sweden and Florida don't count!!!

You're replying to a thread devoted to discuss evidence the efficacy with which vaccines reduce spread, in which they note that the transmission rate is much lower in doubly vaccinated households than unvaccinated household, and also comment that they were a little surprised and disappointed that the vaccine was not more efficient in reducing transmission, as other vaccines often are.

I don't think you're in a position to lecture people about inability to process basic facts if your partisan screed depends on ignoring this to insist that "they don't reduce spread" is an established fact about vaccines. How is one supposed to debate with someone who insists the sun rises in the west, indeed?

The only person with a reality perception issue is you. Your posts are extremely ironic.

That is not what was sold.

50% effective against transmission, severe illness, or both?

Another angle is the redefinition of the term vaccine (https://www.miamiherald.com/news/coronavirus/article25411126...). The CDC claims they redefined it away from the word “immunity” towards the word “protection” because no vaccine grants perfect immunity. Personally I find that to be a bad answer. By taking a weighty word like “vaccine” and redefining it, the expectations of risks and benefits the public holds were exploited. For the majority of the public, those who are under 50 and healthy, COVID poses little risk - it’s not much different from a typical seasonal flu. Personally I think getting an mRNA vaccine is a reasonable low-risk action but the risk of undergoing any medical intervention is nonzero, and it is higher for a novel technology. I bet that if the COVID vaccines were not called a vaccine, people would evaluate the risk reward trade off differently.

The redefinition game seems to be quite frequent in American politics these days. It comes up in culture war activism (definitions for “man”, “woman”, etc) as it has for many years, but it is more disturbing to see it come from public agencies and trusted institutions like universities or hospitals or the CDC. Apart from the word “vaccine”, there is the controversial issue of COVID’s origins. Anthony Fauci repeatedly denied that the NIH was involved with Gain of Function research but they later admitted what was obvious all along, that they had indeed funded GoF (https://www.vanityfair.com/news/2021/10/nih-admits-funding-r...). One claim I’ve seen in articles is that the NIH and/or NIAID (the agency Fauci leads) basically came up with a private, narrow definition for GoF that excludes the GoF they were conducting. This is why it is important that definitions remain static unless accepted by an overwhelming majority of the public - it undermines basic communication.

> I'm not clear on how "the vaccine does not effectively prevent transmission" translates into "vaccinate everyone and give booster shots at once".

It translates into "vaccinate everyone" because the fact that transmission can't be eliminated means that it's likely that nearly every person will eventually be exposed to live virus, so we'd better hope everyone is vaccinated so the effects of that exposure are lessened.

If it were more effective at reducing spread, vaccinating everyone would be less critical, since we might achieve heard immunity with a smaller vaccinated percentage.

This reasoning completely ignores the reality that COVID does not pose a significant risk to most people. Why not vaccinate those who are at risk, on a voluntary basis?

To reiterate: I am not opposed to vaccines, but concerned about the general push towards mandatory vaccination for everyone.

Hospital Capacity.

I live in North Texas, our Trauma Service region has 4m people in it, at one point during the Delta wave we had less than 70 free ICU beds - and we have more hospital capacity than much (if not all) of the state per capita (and indeed, much of the country as well). During the Delta wave, the hospitals here were full of unvaccinated 20 and 30 somethings without complicating health issues, with serious COVID, most of which would have been prevented had they been vaccinated.

Unless the social contract is changed so those who are unvaccinated can be denied treatment (meaning limited to palliative care) during periods of capacity required rationing for serious (read, requires an ICU bed) cases of COVID, mandatory vaccinations are effectively a requirement.

Is it fair to the person who was vaccinated, then gets in a car accident (or has a stroke, or some other issue) and dies waiting for an ICU bed, because all the beds are full of folks who could have been vaccinated (and probably wouldn't have needed an ICU bed if they had) but decided not to be?

I'm pretty libertarian, and I loathe making these choices - but as long as hospital capacity is a shared resource, your choice as an individual effects others, and in times of crisis society sometimes has a right to decide some things for you, whether you like it or not, remove that linkage, and then folks should be able to do as they please.

> During the Delta wave, the hospitals here were full of unvaccinated 20 and 30 somethings without complicating health issues, with serious COVID, most of which would have been prevented had they been vaccinated

Source?

https://tulsaworld.com/news/local/new-surge-of-covid-patient...

https://www.utsouthwestern.edu/covid-19/assets/modeling.pdf

See the graphs on Slide 11.

Thank you!

I've seen the current state analysis before, but imo, it's hard to tell how many unvaccinated 20-30 year olds (with/without comorbidities) were affected (slide 11 combines ages 18-49).

The article mentions that "it’s now commonplace for previously healthy, younger adults with decades of life expectancy on the line to be among the sickest of the sick" but shows no data.

I've seen it enough from enough from enough different diverse sources for it to count as something resembling data - the thing is, the two crunch periods for COVID, are the times the data gets the blurriest, because the people who collect it are so busy.

It is frustrating that anti-mandate crowd ignores this comment, in my mind this is the singular reason that strict measures should still be required.

A functioning health care system is a cornerstone of any modern society. Until we get to a point where subsequent covid waves aren't overloading the healthcare system, then we need to keep fighting this thing.

I think the better solution is allowing denial of treatment over mandatory COVID vaccinations.

"Mandatory COVID vaccinations" has other aspects to it. Who makes it mandatory? Employers who may have a reason beyond public health for mandating, namely that they don't want a bunch of employees falling seriously ill at roughly the same time.

Touche.

*I think the better solution is allowing denial of treatment over government mandated COVID vaccinations.

>I think the better solution is allowing denial of treatment over government mandated COVID vaccinations.

I hope you are being sarcastic, that is a horrible policy because it can easily lead to: *I think it is better to allow denial of treatment to drug addicts because they knew what they were signing up for when they started using.

or worse.

There is no mandatory denial of treatment.

Those that want to treat drug addicts are still allowed and free to do so.

Edit: Just like those that want to treat unvaccinated COVID patients are still allowed and free to do so. And if they want to charge more money (due to shortage of supply or high demand) so be it.

That argument is a very slippery slope. There are a lot of other health issues which stem from either active at-risk behavior or lifestyle choices.

I don't believe medical ethics should be reformed in a way to open such a door. It might be Pandora's.

I'd also be much more sympathetic to vaccine evangelism if the damn things got nationalized/opensourced at some point and didn't translate to pure pharma profit.

> COVID does not pose a significant risk to most people.

True, but this is not the deciding factor. What matters is the ability of the healthcare system to take care of the sick during outbreaks.

If it doesn’t make sense from a public health or human behaviour standpoint, what other factors should we consider before financial motives?

The only people who say this are those who don't consider long covid. Which is a terrible outcome and seems to indiscriminately chose who to effect (in the pool of non-hospitalized people) and not be rare at all (10-30%).

It's misleading to transfix on the died:"recovered" dichotomy. Recovered just means "not dead, not testing positive".

And there is a good chance that this virus is sowing the seeds of a massive wave of Parkinson's in the future. There is good evidence of some forms of Parkinsons having viral origin. COVID has mirrored most of the traits these suspect viruses have (gut, vagus nerve, lewy bodies)

>not be rare at all (10-30%)

>this virus is sowing the seeds of a massive wave of Parkinson's in the future

Do you have a source for any of this? On the face of it, this is outrageous fear-mongering.

Sure

Long haul prevalence:

https://health.ucdavis.edu/health-news/newsroom/studies-show...

For Parkinson's just google "Parkinson's viral etiology" There are dozens of legitimate published studies. None focus specifically on COVID, because its so new and the timeframes so long. But there is a link between infection with serious viruses (including coronaviruses) and later neural degeneration.

>None focus specifically on COVID

All I needed to know. Thank you for editing your previous comment. Even so, saying there is a "good chance" is still a massive over-statement of what is currently known.

The study on "long-haul" prevalence did not paint the same picture of a terrifying "Long Covid". The reported symptoms seemed quite mild - "fatigue and shortness of breath". Thanks to a combination of increased unhealthiness thanks to lockdowns, and the now endless cycles of diseases being passed around, that sound like my every day life. The published evidence around "Long Covid" certainly does not match the popular and widely-circulated (generally online) stories and dire admonitions.

The Parkinsons link with COVID isn't far fetched

https://www.webmd.com/lung/news/20201106/covid-19-linked-to-...

Also fatigue and shortness of breath are about as "mild" as chronic back pain, i.e. you don't want it. It really isn't something people should dismiss in the same way you shouldn't dismiss moving a piano by yourself. You'll likely be fine, but if you tweak your back you'll live with a constant reminder that you should not have done that.

It's been a year since that article, so I assume the "mounting evidence" didn't come to much.

On the other hand, recent reports show some much more disturbing possible side effects:

https://www.forbes.com/sites/brucelee/2021/10/01/restless-an...

One rationale I've seen is that uncontrolled spread and too many unvaccinated people overwhelms the hospital system, thus causing dramatic harm to people who need non-COVID related treatments. This dynamic played out in the US just a few weeks ago. That last wave had a larger proportion of hospitalized people who were younger and, in theory, less at risk because that group was less vaccinated as a whole.

The vaccines do reduce spread some, but they also keep people out of the hospitals.

Your reasoning also completely ignores the reality that the vaccines do not pose _any_ risk to most people.

> general push towards mandatory vaccination for everyone.

So you don't have your measles etc childhood vaccines?

Long Covid is a gamble.

It translates into "offer vaccine to everyone" but it also significantly diminishes the justification for forcing people to get vaccinated - it's usually presented as "do it for others" a.k.a. "herd immunity" but currently it seems we won't be able to achieve that even with 100% vaccination rate.

'we might achieve heard immunity with a smaller vaccinated percentage.'

It is crossing back and forth between humans and animals such as cats and deer. Therefore, there can never be herd immunity because it mutates and crosses back to humans. The possibility of herd immunity is not fact based. Some would call the continued presumption of a possible herd immunity to be anti-science, as it can not work.

What about people that have already had it? Should/do they need to get vaccinated/boosters?

Comments like this are antivaxx because they attempt to use a misinterpretation of "science" to negate the benefits of vaccination.

You also have no idea what the FDA or CDC considers or why. Instead you posit your own interpretation of what an approval is or should be.

I'm not clear on how "the vaccine does not effectively prevent transmission" translates into "vaccinate everyone and give booster shots at once".

Because the vaccination reduces the severity of disease so you don't want the unvaccinated getting very ill, and you don't want people with waning vaccine-induced immunity getting ill.

Lower hospitalization rates also reduces the issue of not being able to get treatment for non-covid issues when the hospitals are full of covid patients [1].

[1] https://www.cbsnews.com/news/icu-non-covid-patients-wait/

Agreed. However, once we've vaccinated all the at-risk populations, isn't the benefit of vaccinating everyone else marginal?

No because vaccination still reduces the risk of severe disease and hospitalizations.

But those were already marginal in children, for example. Aren't you concerned about the risks to children? What benefit do they obtain in exchange for that risk?

Has there been any data suggesting that the vaccines present a significant risk to children?

On note is that they say their numbers to too small to note differences between the vaccines, but being a UK study it would seem likely to be predominantly the AZ vaccine which seems to have some potentially significant differences in effectiveness than the Pfizer/Moderna vaccine.

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