Harvard mandates the bivalent Omicron-specific Covid-19 booster | Hacker News Reader

Harvard mandates the bivalent Omicron-specific Covid-19 booster

harvard.edu

47 pointssfusato134 comments

Interesting...meanwhile in Norway they don't recommend anyone aged 12-64 to get a booster unless they have "Severe underlying conditions"

Booster doses

The Norwegian Institute of Public Health (NIPH) recommends that the following groups should take a booster dose of coronavirus vaccine before the coming autumn/ winter season:

    adults aged 65 years and above
    adults aged 18-64 years with underlying risk of a severe disease course
    adolescents aged 12-17 years with severe underlying conditions
    pregnant women in their second and third trimesters

(https://www.fhi.no/en/id/vaccines/coronavirus-immunisation-p...)

Denmark has the same policy, maybe Sweden too?

Sweden is still recommending it. https://www.folkhalsomyndigheten.se/publikationer-och-materi...

Anecdotally, I have 2 friends who are doctors in the kommun and both said the hospitals are short staffed, beds are filling up and they're seeing much more of the RSV/flu/Covid mix coming to the ER from people that are not in the listed "at risk groups". This matches what my best friends wife, who is a pulmonologist in the US, is saying.

Same for Canada RSV especially but also influenza. I'm not sure about covid. And beds filling with those is bad since that doesn't even include the usual emergencies heart attack, cancer, car crash, births.

The provincial and federal governments here encourage all to get the bivalent vaccine.

"National Advisory Committee on Immunization (NACI) continues to recommend that bivalent Omicron-containing mRNA COVID-19 vaccines are the preferred booster products for the authorized age groups. (Strong NACI recommendation)"

Sweeden seems to be recommending further boosters to 65+. For those under 65, if you fall in certain categories.

People aged 18–64 who are medically at-risk due to:

- chronic cardiovascular disease, including stroke and high blood pressure (hypertension)

- chronic lung disease such as COPD, and brittle asthma

- other conditions that impair lung function or the ability to cough and clear mucus (for example, extreme obesity, neuromuscular disorders or multiple disabilities)

- chronic liver and kidney failure

- diabetes types 1 and 2

- conditions that severely weaken the immune system as a result of illness or treatment

- Down’s syndrome

- those who are pregnant with pregnancy-related risk factors such as being older than 35, high blood pressure (hypertension), diabetes, a BMI over 30 or other factor following individual assessment.

English link: https://www.folkhalsomyndigheten.se/the-public-health-agency...

ECDC/EMA seem to have similar guidelines:

https://www.ema.europa.eu/en/news/ecdc-ema-update-recommenda...

e.g. "At the moment, there is no clear evidence to support giving a second booster dose to people below 60 years of age who are not at higher risk of severe disease. Neither is there clear evidence to support giving early second boosters to healthcare workers or those working in long-term care homes unless they are at high risk."

"don't recommend" isn't the same as "recommend don't." They clearly state other people in those age ranges can get it. This makes the recommendation much closer than what you seem to be suggesting. (I'm not actually sure why you are bringing up Norwegian vaccine guidance, unless it's to suggest getting the booster is a bad idea for everyone else or maybe you are Norweigan).

They don't recommend because they don't see clear evidence in outcomes. See my EMA link below. This doesn't make the recommendation any closer than recommending not to.

No, "not having evidence" isn't the same as having evidence against. They clearly state in that website that it's ok for people outside of there recommendations to get the booster.

> At the moment, there is no clear evidence to support giving a second booster dose to people below 60 years of age who are not at higher risk of severe disease.[1]

The booster is an approved and safe procedure, but it confers no benefit unless you have risk factors.

[1] https://www.ema.europa.eu/en/news/ecdc-ema-update-recommenda...

No, "not having evidence" isn't the same as having evidence against.

That is exactly the point that I made above.

And where does it so clearly state in the website that second part? And of course it's ok, but that doesn't make it a recommendation.

I’m not antivax or anti-medicine in any way but shouldn’t the null position be don’t inject things into your body and then it takes at least some evidence to overcome that?

It is, hence tests and clinical trials.

Clinical trials gets a drug approved for use. It proves that the drug meets certain safety requirements.

Just because a drug is approved doesn't mean you should take it indiscriminately. It is "safe" to drink NyQuil every night. Doesn't mean you should. If it confers no benefit to you in your unique circumstance, you shouldn't take it. Hence, the booster is not recommended for certain groups - because it is not needed and provides no benefit.

Safety is half of it. Clinical trials also gather evidence of beneficial effects.

https://www.fda.gov/drugs/information-consumers-and-patients...

> If the Phase 2 trials indicate that the drug may be effective--and the risks are considered acceptable, given the observed efficacy and the severity of the disease--the drug moves to Phase 3.

Yeah but the FDA is famous for approving expensive drugs that have no/little effect. So at least in the USA if a drug is approved it doesn’t mean it does anything useful

They're famous for it? How many total drugs have they approved and how many were later found to have issues?

This year it appears they've approved 30 and last year they approved 50. That's quite a few.

Fame is about one spectacular thing not usally a body of work. There are lots of drugs they routinely approve but it’s how they handle the big controversial ones that shape the public image

Well, there are plenty of approved drugs with tests and clinical trials that were later withdrawn from the market for being dangerous. What I'm saying is that the process is not infallible and in some cases it proved to be susceptible to corruption. We need to improve the process and that's not going to happen by blindly trusting Big Pharma.

Of course it's not infallible but you have to "put up or shut up". Saying the FDA is fallible is not evidence that vaccination recommendations are in error. A country not recommending a vaccine is not evidence that the vaccine doesn't work or is dangerous. What data did they use to make that decision?

Suppose the FDA, as opposed to Norwegian authorities, approved the vaccine with an indication of over 65, pregnant women, and those with serious underlying conditions. It could be taken off label by others but that was the approval. Would you then say healthy 18-22 year old should not take it?

Shouldn't "having evidence for" be a requirement before something is mandated?

>"don't recommend" isn't the same as "recommend don't." They clearly state other people in those age ranges can get it.

Come on. This is not how medical recommendations work. It's either recommended, or it's not. If the medical community thinks people should get it, they would recommend it. Besides that, Harvard is mandating the vaccine.

>I'm not actually sure why you are bringing up Norwegian vaccine guidance, unless it's to suggest getting the booster is a bad idea for everyone else or maybe you are Norweigan

Why not? Are Norwegians some mutant species with different abilities to research and/or needs of their populace? Why are some bodies requiring it, and others are mostly indifferent? Who's right?

> This is not how medical recommendations work. It's either recommended, or it's not.

That's not how this works at all. For instance there is no recommendation for flu vaccine except for at-risk groups by the EMA, yet there is a request to achieve a 75% vaccination coverage by countries which clearly implies that people should be vaccinated for whom there is no recommendation.

This is not true. The Norwegians clearly state they are ok with people outside their recommendations getting the vaccine, which contradicts what your saying based off of that guidance. Either follow their guidance or don't, but don't do so selectively if you are using this as the foundation of your argument

However, "don't recommend" is very different from "mandate", which is what is happening in the US.

If this was literally any other medical procedure, the "trust the experts" crowd would be protesting the US ignoring what the rest of the world thinks.

“Mandate” has never even come close to happening in “the US”

See for example: https://news.ycombinator.com/item?id=33786471

Recommendation is an established concept when it comes to vaccines. When you travel to country X then it's recommended to get vaccines for A, B, C. Or when you have age N and gender G you are recommended to get vaccines D, E, F. And so on. In many instances, whether your insurance pays or not depends on whether the vaccine is recommended for you by official authorities. At least in Germany, a doctor if they deem it useful for your health is still authorized to order the vaccine and put it into your arm, but you have to pay the bill for that. Sometimes insurances also pay for non-recommended vaccinations.

The same goes for therapies for diseases. Each disease has a list of therapies/drugs available that are officially recommended by authorities, and usually what insurances pay for is based on that, but exceptions exist (in both directions).

It sounds like they are saying no need to take one now for many groups. Does this mean they suggest taking one later in the year? Annually? Or are they just blanketly saying they don’t recommend getting a booster for these groups from this point on, pending further evidence?

It's recommended (not mandated) to 65+ cohort and under-65 with certain underlying risk conditions, but they won't stop you from getting it if you so wish.

It is also possible for people in the 18-64 year age group without underlying risk conditions can choose to take a new booster dose if they wish.

That is not quite the whole story. They are making it available for anyone in Oslo, at least. [1] I live in Oslo and have an appointment to get a booster tomorrow. I have multiple friends and family members in the healthcare sector, and they are all warning me that we are likely to see a significant spike in the winter. At the same time we are seeing more and more sign that each repeated infection has increased risks. [2]

- [1] https://www.oslo.kommune.no/english/coronavirus/corona-vacci...

- [2] https://time.com/6232103/covid-19-reinfections-effects/

That's not what the paper cited by Time says. It is a study in the US veteran population, whose health condition is much poorer than the general population. Secondly, the study is set up to pick up bad outcomes. Third, the people compared are those with 1 and 2 infections after the second infection, rather than seeing the effect of each infection. Fourth, the paper is pre-Omicron.

There is also far more than that. The press spun it quite a bit, in a different way.

Personally, all my family members and myself have had a contact with SARS-CoV-2 within the past months. It wasn't particularly pleasant, but certainly not a "deadly virus" (prior vaccination helps, but I'm not a person at risk anyway). It will be the first of many. I stopped caring after I got my second dose, and there's no way I will care now.

> It wasn't particularly pleasant, but certainly not a "deadly virus"

I know somebody who contracted Malaria and lived. It wasn't particularly pleasant but certainly not a "deadly disease".

Malaria is not an infection by a coronavirus (I do know one person too, FTR, my grandfather during the Albanian campaign in WWII). And it is not age stratified like a SARS-CoV-2 infection. And there's no 95% seroprevalence like with SARS-CoV-2 in most regions that had surges.

It might not be a deadly virus now but it certainly was in mid 2020. And things mutate. Flu is harmless as well, except for the years when it isn’t. Minimizing risk for others is a positive human trait.

Flu is not harmless. Not at all. It is a bad disease when symptomatic (30-40% cases may be asymptomatic). In particular for young children and the elderly.

Flu for me was way worse than a SARS-CoV-2 infection (think 40C fever).

SARS-CoV-2 was deadly for a specific part of an immuno naive population (60+). The age stratification was known since February 2020 (first Chinese paper on that from the Wuhan data). My country had zero excess deaths in the 0-50 range since the start of the pandemic.

EDIT: Anti-SARS-CoV-2 vaccines do not block transmission, certainly not now. And as thus, their protection is primarily for one's own benefit.

"making it available" and "mandate" are not the same thing.

I would drop out of Harvard if I was young and was being told to get this vaccine knowing the risks/benefit of the vaccine in young men.

According to a preprint from the Harvard (!) Center for Virology and Vaccine Research [1], there seems to be no difference in BA.5 antibody responses between the old/monovalent and new/bivalent vaccines.

Also worth mentioning that BA.5 is not the dominant strain in the US anymore [2].

Mandating the bivalent Omicron-specific COVID-19 booster seems highly questionable.

[1] https://www.biorxiv.org/content/10.1101/2022.10.24.513619v1....

[2] https://www.cnbc.com/2022/11/25/covid-omicron-bq-variants-do...

First thing I thought was that the administration instituted this based on the news without expert opinion. This couldn’t be more ironic

I received my first booster at the end of 2021, and then I got Covid (presumably Omicron) over the summer. I'm certainly not anti-vax, but I'd be annoyed if I were mandated to get the bivalent booster after recently getting Covid. For both my 2nd and 3rd shots my reactions were pretty strong (was down for the count for 48 hours with high fever, headache and chills), so I wouldn't be looking forward to wasting a weekend feeling miserable for exceedingly marginal benefit.

Why? Do they mandate flu shots too? By this point everyone I know is just living their life as normal and has accepted there's a new seasonal disease. It's not the end of the world, doubly so since students tend to be young obviously.

The amount of people with multiple boosters etc. that have gotten COVID I know is also insane. The efficacy cannot be anywhere near what was claimed, or has deteriorated since for sure. I'm not just misunderstand statistics, there's just _too many_ people I know like that for that to be the case.

As an anecdotal data point though: I got COVID once a year ago and have been perfectly fine otherwise. No long term condition, nothing. Just 3 days of flu like symptoms, but worse. Without the vaccine.

Because they're safe and proven effective at reducing death and severity of the disease. Yes your anecdotal data is one thing, this still kills way more people than flu ever did, on a yearly basis.

Now it would be interesting if they mandated this vaccine but not N95 mask wearing, that kinda baffles me.

Remember when the message they were safe and proven to prevent you from getting COVID?

No, I remember the scientists being “it’s amazing, we managed 90% effectiveness at preventing infections, and we would still have gone forward with this if it had only been 50%”.

Which scientists stated that? The vaccine clinical trials only measured rates of severe symptoms and death, and they did well at reducing those. But the initial trials didn't even look at infection rates as an endpoint.

Professor Jennifer Rogers. Here's the transcript of the podcast I listened to: https://www.numberphile.com/s/Statistics-and-Saving-Lives-wi...

Though I had misremembered, it was 95% effective and they would've been happy with 30% (the 50% was a slightly different claim right next to 30%).

There’s no death and severity for healthy young people. Only mild symptoms.

"no" deaths is definitely an overstatement (not hard to find deaths of healthy young people by Googling), but the overall point is valid. Severe consequences of Covid are very rare in the young, and many Western health authorities have found that booster vaccinations aren't warranted for young healthy people because the cost/benefit isn't there.

They can still transmit it. So, still a bad idea if the "healthy young person" has older relatives such as parents.

COVID is a problem for entire societies, tackling it in an individualised, atomised way is going to be super-ineffective.

Yes, they mandate the flu shot as well.

More colleges are mandating an assortment of vaccines, most have already mandated vaccines against things like Pertussis in order to reduce the amount of harm it can cause on campus.

No Harvard does NOT mandate the flu shot:

"Noncompliance with the flu requirement will not impact your ability to register for classes for the summer or fall semester. "

Still wrong.

https://news.ycombinator.com/item?id=33787054

Yes, they do. On the same page you're quoting they mention that they mandate it for spring quarter registration. They mandate it that way because the flu is seasonal. By the time you need to register it will be shortly before flu season kicks in.

Note that the flu mandate is a very new policy.

I'm not sure when Harvard started, but Massachusetts only started in 2020 after Covid started.

> Do they mandate flu shots too?

Yes[0]. As well as MMR, TDAP, Hep B, and Chickenpox.

[0] https://huhs.harvard.edu/immunizations#gsc.tab=0

Harvard does not mandate flu shots.

Flu

"Noncompliance with the flu requirement will not impact your ability to register for classes for the summer or fall semester. "

vs COVID:

"Students who are not up-to-date on their COVID vaccine, or other required vaccinations, will have a hold placed on their enrollment."

Incorrect. Read the whole page.

Flu is mandated is mandated for (only) spring term, because it's a seasonal disease and the vaccine is administered in the fall term.

> Students must be compliant with all vaccine requirements in order to register for the spring term.

I am glad they are consistent at least. I personally find the idea of an institution mandating yearly injections of any kind to be an overreach of power. Universities tend to do that kind of stuff, though.

(No, I don't have a problem with MMR/TDAP etc., these are vaccines with a long history that protect against diseases which I'm a lot more scared of than COVID. If there was a new strain of Polio tomorrow and a vaccine for it, I would be the first in line.)

Why are you afraid of the old polio strain? 70% of those who contract it are asymptomatic, and the death rate in the decades before the vaccine was under 1 in 100000… not altogether different from sars-cov-2. To be more scared of polio than Covid seems contradictory.

Paralysis is scary.

> The efficacy cannot be anywhere near what was claimed, or has deteriorated since for sure.

It has deteriorated as the virus mutated. I had thought this was widely reported, but now I guess not.

As others said the booster doesnt seem to be much different than previous vaccines, and overall they are all low efficacy against infection.

https://www.ecdc.europa.eu/en/publications-data/interim-anal...

https://www.science.org/doi/10.1126/science.abq1841

However, there is a worrying stream of research indicating that covid outcomes are worse than we generally think they are, even in mild infections.

https://onlinelibrary.wiley.com/doi/10.1002/jmv.28187

https://www.nature.com/articles/s41590-021-01113-x

https://publications.aap.org/pediatrics/article/150/5/e20220...?

And every reinfection seems to make it worse, so this thing should not be allowed to become 'endemic'

https://www.nature.com/articles/s41591-022-02051-3

So it seems like other, more effective measures to reduce infections are more likely to keep people healthy rather than trying to reduce the severity of symptoms (which is what vaccines do atm)

"And every reinfection seems to make it worse, so this thing should not be allowed to become 'endemic'"

Is there any reliable data on how this works in the vaccinated vs (increasingly scarce) natural immunity populations? i.e Am I more at risk of a severe reinfection third time fighting it off with my own adaptive immune response vs someone fighting it off for the third time with a full set of (5+) boosters?

Too late, it's already endemic and can never be eradicated. All of us can expect to be occasionally reinfected (unless we take extreme and unrealistic protective measures).

But as for sequelae from reinfection, there's no evidence that SARS-CoV-2 is any worse than other endemic coronaviruses such as HCoV-OC43 which we have been coexisting with for centuries. I mean it could be worse, but no one has ever done a direct apples-to-apples comparison.

I'm gonna be doing everything to avoid re-infection. I am lucky to work mostly at home and try to minimize crowded spaces during winter, going to gym when it's empty, using google to find the least busy hours everywhere.

> there's no evidence that SARS-CoV-2 is any worse than other endemic coronaviruses

Au contraire, look at the last link

Au contraire, the last link doesn't support your point. There is no evidence that SARS-CoV-2 reinfections cause any worse effects than other endemic coronaviruses. The study didn't attempt to address that at all. Read it again. It's possible that SARS-CoV-2 reinfections are worse than, let's say, HCoV-OC43 reinfections but for now we don't have any direct, reliable evidence for that.

Rearranging your whole life around avoiding a minor respiratory virus sounds absolutely exhausting.

Not gonna argue with such absolutist positions

> I'm gonna be doing everything to avoid re-infection. I am lucky to work mostly at home and try to minimize crowded spaces during winter, going to gym when it's empty, using google to find the least busy hours everywhere.

To each their own. I definitely think everyone should be free to make their own risk assessments, but living in constant fear and isolation is absolutely not worth it to me even if (and I think this is a big if) the worst news about covid is true.

For me it's easy. Winter is short, and there is very little i need to worry about. Christmas is a bit of a challenge, but thanks to older relatives we are already taking some precautions

> Individuals are eligible for the booster 2 months after their last booster or 3 months after their most recent COVID infection.

Folks trying to avoid the vaccine are simply going to produce recent COVID +ve test reports, right? I wonder if some will actively seek out getting infected by the actual virus (!) to bypass this.

EDIT: Worse, imagine seeking out someone already infected, catching the virus from them, then getting COVID -ve reports from all labs because some unique strains aren't caught? That'd be a story.

No one ever said the original vax prevented against transmission. This has always been a pandemic of the unvaccinated. The effectiveness of the original is augmented by ongoing boosters, it is not an indication that the original didn't prevent severe illness. The saddest part is that these anti-science people are the most at risk. Myocarditis and other side effects are extremely rare. In 90% cases people will experience no symptoms, but getting the ouchie protects those at most at risk. https://www.rollingstone.com/culture/culture-news/justin-bie... https://www.msn.com/en-us/health/medical/cdc-director-covid-... https://www.news.com.au/technology/science/human-body/yes-th...

Fortunately college students are at virtually zero risk from COVID-19 (unless they have some severe pre-existing conditions).

Isn't prevention of transmission what vaccine effacacy measures?

Ah, but you see, we live in the age of "words can simply be redefined to mean whatever the elites want them to mean." Stability of language is a relic from the past.

Yes, though, You're going to have poor quality arguments if the terms are poorly defined, as above.

Does vaccinating against Covid-19 prevent _some_ transmissions - yes, obviously. efficacy measures that percentage.

Does vaccinating against Covid-19 prevent _all_ transmissions - obviously not.

Watch out for the people conflating these two statements, rhetorically shifting from one the other when it suits them.

e.g. the (wrong) statement that "vaccinating against COVID-19 doesn't prevent transmission so it's useless" uses the (true) first sense for the first half, then draws a conclusion as though it's the second sense.

    > No one ever said the original vax prevented against transmission.

CDC Director Rochelle Wolensky said: "Our data from the CDC today suggests that vaccinated people do not carry the virus, don't get sick, and that it's not just in the clinical trials, but it's also in real-world data."[1].

President Biden said, “If you’re vaccinated, you’re not going to be hospitalized, you’re not going to be in the ICU unit and you’re not going to die.” He then went on to says: “You’re not going to get Covid if you have these vaccinations.”[2]

    > This has always been a pandemic of the unvaccinated.

"Fifty-eight percent of coronavirus deaths in August were people who were vaccinated or boosted, according to an analysis conducted for The Health 202 by Cynthia Cox, vice president at the Kaiser Family Foundation. We can no longer say this is a pandemic of the unvaccinated.."[3]

[1] https://www.businessinsider.com/cdc-director-data-vaccinated...

[2] https://www.cnn.com/2021/07/22/politics/fact-check-biden-cnn...

[3] https://www.washingtonpost.com/politics/2022/11/23/vaccinate...

I've had 4 vaccinations and 2 confirmed infections, the most recent one only a couple months ago now.

I think I'm good.

Wow, I find this surprising…I wonder if students will challenge it’s merits?

Do they typically?

Not at Harvard, that's for sure.

> Vaccines and boosters are the best defense against severe illness from COVID-19...

Is there any evidence that suggests vaccines and boosters are a better defense than maintaining a healthy body mass index, exercising regularly, eating a balanced diet, and spending time outdoors?

Yeah check out Dr Eric Ding on twitter he has a lot of data.

Eric Feigl-Ding is probably the worst reference you can have: he's been spreading alarmist news, spun research in the worst possible way, and even more than that. And he's not an infectious disease epidemiologist (he's an epidemiologist, but in the field of nutrition).

There are plenty, more nuanced people you can check on Twitter for more centrist views.

Why is centrist correct? That's Overton arbitrary.

Because while SARS-CoV-2 used to cause a severe disease in people at risk, it was at the same time not the end of times (and didn't warrant the widespread violation of civil liberties throughout the world, mostly ineffective anyway).

I don't know, are you saying our ancestors that died of mass disease didn't work out or spend time outdoors? Presumably if what you mentioned helped prevent disease better than vaccines then they clearly should've been protected.

The question was, if you only choose one, which would you choose.

Well, it’s safe to say I won’t be going to Harvard.

I wonder when this madness will end.

Intellectuals, Yet Idiots...

I’ll add this to the shortlist for the Accidental HN Slogan of the Year award.

HN is clearly filled with only one of the two.

it’s never too early to set a goal for 2023

>One has to belong to the intelligentsia to believe things like that: no ordinary man could be such a fool.

—George Orwell

I can't help thinking that Harvard read the room wrong there. Unvaccinated workers just got re-instated in NY. This looks like a lawsuit waiting to happen for Harvard.

Doesnt Harvard receive $m of gifts per annum. Could that influence them??. Such as ... https://www.gatesfoundation.org/about/committed-grants/2019/... hmmm https://www.nytimes.com/2009/03/04/business/04pfizer.html

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