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Comment by roody15 | Hacker News Reader

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...)

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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."

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 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.

> 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.

"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.

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.

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.

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...

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)"

"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).

>"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

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...

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.

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?

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

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

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.

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).

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

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