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Comment by nsxwolf | Hacker News Reader

Why haven’t they updated the vaccine? I thought one of the major benefits of this technology was the ease with which you can modify them.

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Pfizer are on it (1). They estimate that it takes around 3 months. Which actually is really easy.

And the others are following suit in similar timeframes (2)

The hard part is deciding if this variant is the one that you're going to vaccinate against for a year or more. That takes data, which also takes time.

1) https://www.theguardian.com/society/2021/nov/26/biontech-say...

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

https://www.independent.co.uk/news/uk/omicron-oxford-covid-a...

Each successful varient tends to be the ancestor of the next successful varient.

That means if you develop a vaccine against any successful varient today, it will be a closer match than one made last year.

As I understand it, none of the existing major variants is an ancestor of Omicron - their closest common ancestor is quite a way back in the pandemic. Alpha and Delta weren't particularly closely related either.

Is there a good reason that they haven't updated their vaccine for Delta, which has been out for much longer than 3 months? Over 99% of cases in the US are Delta now, which the original jab wasn't designed for.

Boosting with the original vaccine was effective for delta.

We do have a Delta-specific jab though that has gone through trials. Why not release it for sale? Just to save the government money on all the older jobs they already bought and haven't used?

Not just that, but distribution and whether or not you are ready to push for every person to get the updated one or not. People will fatigue from having to keep up, especially if only a month after their last shot there is a “new” one for a new variant, and then omicron comes out and a “new” one for that. You could end up with far more boosters than actually needed at which point people will get confused or mentally burnt out on it.

I think there are some sound reasons for not jumping on updated vaccines for every variant and only ones that the original doesn’t appear sufficient for.

> Delta now, which the original jab wasn't designed for.

Current vaccines have still been "highly effective" against Delta, so I think that's why this hasn't been done: there's no point in using the big guns now when the existing weapon works well, and you might really need the big gun soon (and you can't know when).

So it's better to keep it in reserve. The question now is, is Omicron "it" ?

By their own data, it’s less effective against Delta than the targeted strain. And the massive spike in excess deaths within heavily vaccinated states/countries this past fall was a pretty good sign we would have benefitted from an updated vaccine.

"Once Delta became the dominant strain, VE went from 91% to 78% against COVID-19 infection, 92% to 90% against hospitalization, and 94% to 91% against death."[1]

[1] https://www.cidrap.umn.edu/news-perspective/2021/09/covid-19...

(Fairly) effective at preventing serious disease/hospitalization. It seems to me the original plan on the vaccines was to reduce r0 below 1 in the population as a whole, but when Delta came along we changed the metrics the vaccines were to be judged by.

Over 90% is more than fairly effective.

All vaccines are judged by preventing serious disease and death. Not meeting higher hopes doesn't change that.

The justification for a vaccine mandate is based on preventing infection and transmission (aka r0), not just disease or death. That is probably on a lot of people's minds.

How long does it take to ramp up production? I'm at 6 months and a few days since my 2nd shot. Do I get a booster now or wait a few months in hope of an updated one?

Get a booster when you can, it is worth it.

I had mine last week.

We don't know if and when there will be an omicron-specific jab, and a mRNA 3rd dose cuts your chances of bad outcome (severe illness, hospitalisation) from omicron or previous variants to a lot lower than 2 doses ever did.

https://twitter.com/PaulMainwood/status/1458020957457731585

https://twitter.com/PaulMainwood/status/1460191035531878405

I'll likely do that. For what it's worth I was not eligible for a booster where I live until very recently.

> Get a booster when you can, it is worth it.

If you are under 65 and not immune compromised, there's essentially no evidence for this claim.

If you are either of those things, there's some evidence that it takes your risk of severe illness (already low after vaccination), and divides it by another factor of ~20 [0]. That's great, but it's a tiny absolute effect, and we shouldn't over-sell it.

If you're under 65, there's essentially no evidence supporting widespread use of boosters, and the CDC ACIP was against recommending it for all people [1] (but was ignored by politicians). The WHO continues to ask rich countries not to give boosters to healthy young people, given lack of evidence and supply constraints. [2]

Not incidentally: your two tweets discuss infection, not severe illness. All current evidence is that you're well-protected against severe disease after two shots. Paper in the lancet as of last week found that boosters had a marginal impact on cellular immunity, with the primary benefit being antibody response. [3] Again, fine, but we know that antibody response wanes over time. It's completely unsurprising that you'd have more antibodies two weeks after vaccination. You'll have far lower antibodies 9 months from your third dose, too.

[0] https://www.nejm.org/doi/full/10.1056/NEJMoa2114255

[1] https://www.cdc.gov/mmwr/volumes/70/wr/mm7044e2.htm

[2] https://www.who.int/news/item/04-10-2021-interim-statement-o...

[3]https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

> a mRNA 3rd dose cuts your chances of bad outcome (severe illness, hospitalisation) from omicron or previous variants to a lot lower than 2 doses ever did.

Literally no evidence for this statement. We simply don't know anything about Omicron and boosters. This is why this press release from Pfizer is on the front page of HN right now.

If you are in that group (under 65 and no co-morbids) two shots should be fine. Getting infected, using early treatments (even controversial ones) and recovering with a dose of natural immunity is probably better as the SA study from yesterday showed.

> Getting infected, using early treatments (even controversial ones) and recovering with a dose of natural immunity is probably better

Citation needed, as you appear to be saying that a COVID infection is preferable to a vaccination, and that is an extraordinary claim. Bonus points for using " natural immunity", a loaded term.

There's good evidence that natural infection is more robust than vaccination alone, and that a combination of infection + a booster is best overall:

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

That may be a silver lining, but the statement was "is COVID infection preferable to a vaccination".

COVID infection, if you're not aware, also can have downsides. This evidence does not make "lets get COVID" a good idea on balance.

For low risk groups I think it's preferable to let your immune system have a go at it. Training it on only a portion of the spike with an alpha based vax will get you into the endless booster game. Especially if you have things like ivermectin and vitamins at your disposal.

> I think it's preferable to let your immune system have a go at it.

Again, citation needed, as you appear to be saying that a COVID infection is preferable to a vaccination.

> Especially if you have things like ivermectin and vitamins at your disposal.

Are you joking? I can't tell if this is supposed to a serious suggestion for discredited quack remedies, or sarcasm.

No I am not joking. Ivermectin worked for me. Cured me of long covid rapidly after three months of suffering through it this past spring.

Quackery it is.

Well I hope you never get as desperate as I was because this inability to see and evaluate alternatives would hurt you.

I'm not suggesting that people should run out and get infected in lieu of getting a vaccine.

I am suggesting that this mad rush toward boosters-for-all is unscientific and driven by hysteria.

That still doesn't sound like a strong argument against it to me. Getting the booster might help or might not help as much as was said. Not getting it does nothing for or against you. It sounds to me like getting a booster is a safe, reasoned choice that has a good chance at offering additional protection, zero financial cost for almost everybody, and typically very mild side effects. "Don't get it because there's a chance that it might not help and almost no risk of harm" doesn't sound compelling.

> It sounds to me like getting a booster is a safe...and typically very mild side effects.

Based on what, exactly? Also, you can drive a truck through the gap left by "typically", here. People with two doses of the vaccines will "typically" never become seriously ill.

We don't prescribe (let alone, mandate) medications because "it might help and people are scared". You have to show the benefits exceed the costs for everyone for whom you are making the recommendation. And the "costs" here don't just include things like heart inflammation (which is a real risk amongst young boys, in particular), but also the societal cost of otherwise healthy people being vaccine-sick for 1-3 days post-booster. Why do that, if it isn't going to provide a real benefit?

Also, I don't know if you noticed this in what I wrote, but the WHO is practically begging rich western nations to stop hoarding vaccines for healthy people, so that poor nations can get first doses.

Meanwhile, we have a new variant...plausibly out of a poor, under-vaccinated nation. Just a coincidence, though!

The article's main point was 3 doses of the original vaccine is more effective than 2 for omicron. They expect to have an omicron vaccine available by March if 3 doses of the original vaccine isn't enough.

I totally agree with that assessment. What I am weighing, though, is that I would not be eligible for any potential omicron-specific booster for several months if I get a booster now. It's a risk/reward calculation.

Previously it wasn't deemed necessary (i.e. the original design was good and universal enough), for Omicron as far as I know tests are running, depending on how that goes and how countries decide to treat the regulatory part of updating it we might see an adjusted one now. (EDIT: "universal enough": we don't want a vaccine extremely optimized for a variant, but one that has a good chance to work well against other/new variants too, so there's a balance if a improvement against one variant makes it worse overall)

EDIT 2: apparently some small trials for modified variants are also running for Delta, so I guess this statement needs to be modified and it wasn't considered justified to rush out a new anti-delta variant, but testing is done so the findings can be used for upgrades.

That page says they are working on it and expect to have it ready for use in 100 days including the design and manufacturing but not approval.

Not an expert, but I think the problem is in the testing and distribution. Just from a public health POV, it's hard enough tracking who is getting doses of what and all the public communication about what to do that it really needs and deal with hate tweets from Rand Paul. Synthesizing the vaccine could possibly be done in a week.

In the case of the mRNA vaccines (e.g. Pfizer) it is the spike protein targeted, and that has a hard time effectively mutating because most changes to it make it less infectious. Other aspects of the virus may change but the spike so far has been relatively stable.

They can definitely update the vaccine but it's not easy as 1 2 3 then good to go.

I thin an appropriate analogy to your question is the question "Why haven't you written your masterpiece novel? I thought one of the major benefits of a computer is the ease with which you can write and publish anything."

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