On May 18, in response to a May 16 post by Igor Chudov titled “’Vaccine Against Variants’ is Impossible and Will Endanger the Naturally Immune,” my friend and co-author Charley Hooper wrote:
Chudov presented two main points. First, creating a vaccine to address many of the SARS-CoV-2 variants will be difficult, if not impossible. Second, there’s some evidence that a pan-SARS-CoV-2 vaccine could harm those who were originally unvaccinated but now have immunity due to natural infection. If his two points are correct, then any mass vaccination campaigns could hurt many people.
But here’s why I’m not concerned:
(1) The technical difficulties of developing a pan-SARS-CoV-2 vaccine will be overwhelming. Igor Chudov describes this issue.
(2) The pandemic is over.
I live in a lightly populated area of Northern California. Except in medical facilities, it is rare for me to see anyone with a mask and it’s been that way for a month or two. Life has gotten back to normal: crowded bars and restaurants, in-person meetings, parties, travel, gyms, sports, etc. Combine that with a lot of “vaccine hesitancy” in my town and we should be primary candidates for SARS-CoV-2 infections and fatalities. But the sky hasn’t fallen because the virus has mutated into highly contagious but relatively benign forms. The new variants are almost as contagious as the all-time record holder, measles. Which means that, unless you’ve been living in a cave, you’ve probably been exposed many times to people capable of infecting you. Whether you’ve been vaccinated or not, you probably have good immunity at this point. And, if you do become infected and have symptoms, your illness probably won’t be bad.
For a quick point about how contagious the measles virus is, if no one in the whole world had any immunity to measles and you, and you alone, were infected, you could infect the whole planet in 25 days. This assumes an infection factor of 18 (every infected person can infect 18 others), three days for an infection to manifest, and adequate mixing (via travel, public events, etc.). The number for the SARS-CoV-2 variants is almost the same: 28 days.
People aren’t getting measles once a month. People aren’t getting COVID once a month. The only conclusion we can draw is that most of us have substantial immunity to SARS-CoV-2.
(3) Most of the new vaccines won’t be developed.
Why? In addition to Point 1, because people like me [Charley consults to pharmaceutical companies] will inform the vaccine developers that there won’t be much of a market for their new vaccines. The demand is just not there. Plus, the FDA was incredibly permissive with giving emergency use authorizations to the Pfizer/BioNTech and Moderna vaccines. Don’t expect a repeat anytime soon. With the FDA back to its normal habits, vaccines might take years to develop. Consider the Novavax vaccine, which still hasn’t been approved by the FDA. Drug companies won’t see a way to make money on the new vaccines. Most will be abandoned.
(4) Even if the new vaccines are developed, few will use them. Unpopular vaccines won’t be mandated.
The demand just isn’t there. People are ready to move on. They aren’t afraid of COVID anymore. Will governments require vaccinations? Other than some authoritarian governments, I don’t think so. People, including me, lined up to get the original vaccines. They will stay away in droves for the new ones in an act of civil disobedience.
Any government that relies on popular support will quickly see the new vaccines as a losing proposition.
I have two points to add.
First, on Charley’s statement in point (3) above:
Plus, the FDA was incredibly permissive with giving emergency use authorizations to the Pfizer/BioNTech and Moderna vaccines. Don’t expect a repeat anytime soon. With the FDA back to its normal habits, vaccines might take years to develop.
Note that Charley is describing, not recommending. He and I both think that the FDA should be extremely permissive, at a minimum. He has written a whole book recently, Should the FDA Reject Itself?, that makes that case in some detail.
Second, I want to add a point made by co-blogger Scott Sumner: we now have a cure for COVID-19: Paxlovid. A cure beats a vaccine.
READER COMMENTS
Thomas Lee Hutcheson
Jun 12 2022 at 4:53pm
A pan-corona virus vaccine seems like a good idea (net benefits>0) even if it come too late to be of much help with this pandemic, which is still killing around 400 people a day, because of the proof of concept. We may need to have a pan-some other family of viruses.
Charley Hooper
Jun 12 2022 at 8:19pm
In clinical trials of about 7,000 patients, Paxlovid was 64% effective in preventing death from COVID-19. That’s good, but I don’t think 64% is a cure.
https://c19early.com/pl
David Henderson
Jun 12 2022 at 10:05pm
Thanks. Good point.
Scott Sumner
Jun 13 2022 at 12:11am
The study I saw said 89% effective.
https://www.bmj.com/content/375/bmj.n2713
Charley Hooper
Jun 13 2022 at 3:02pm
Paxlovid (nirmatrelvir) has been studied for its benefit against mortality in COVID-19 patients in a few different studies:
Hammond et al., NEJM, April 14, 2022, studied Paxlovid + Norvir (ritonavir)
Group 1 (≤3 days after onset of symptoms): risk of death 96% lower than placebo
Group 2 (≤5 days after onset of symptoms): risk of death 94.8% lower than placebo
The 89% result that you referenced was based on an interim analysis of the Hammond et al. study and it blended the benefits of preventing death and hospitalizations.
Arbel et al., Research Square, June 1, 2022, studied Paxlovid alone
Group 1 (age 65+): risk of death 81% lower than controls
Group 2 (age 40-64): risk of death 64% higher than controls
Wong et al., Medrxiv, May 20, 2022, studied Paxlovid + Norvir
Risk of death was 68% lower than controls
Across all studies, the benefit is 64%
Todd Moodey
Jun 13 2022 at 3:08pm
Charley–
I assume “64% higher…” in Group 2 of the Arbel study is a typo, and should read “64% lower…”?
Regards,
Todd
David Henderson
Jun 13 2022 at 7:00pm
I just asked Charley. No, he did mean “64% higher.”
Todd Moodey
Jun 13 2022 at 7:12pm
Wow, 64% higher for that group (which I’m in!) is striking given the direction and magnitude of all the other results.
Thanks for confirming that David.
Regards,
Todd
Charley Hooper
Jun 13 2022 at 10:11pm
Note that the Arbel study looked at Paxlovid alone, without Norvir.
These results just show why multiple clinical trials are useful to show what’s really going on.
Matthias
Jun 13 2022 at 3:27am
Why would a cure beat a vaccines?
The logistics for a vaccines are much better: you can vaccinate whenever it’s convenient. Eg you can vaccinate kids when they then five. That’s a steady flow of demand.
For a cure, you have to have a system in place exactly when it’s needed. And demand will be extremely variable, based on whenever you have a major outbreak.
(Of course, cures and treatments can be better than vaccines. Details depend on circumstances.)
Charley Hooper
Jun 13 2022 at 3:07pm
Good points!
David Henderson
Jun 13 2022 at 6:57pm
Charley beat me to it. I agree.
Butch Howard
Jun 13 2022 at 1:42pm
Is measles the best comparison here? Don’t we all, or nearly all, get vaccinated for measles? Is there anything for which we behave the same with respect to vaccinations for something that is as contagious as measles and SARS-CoV-2 (i.e. something as contagious which we don’t bother with vaccines)?
Charley Hooper
Jun 13 2022 at 3:07pm
Nothing is as contagious as measles. As far as I’m aware, SARS-CoV-2 has come the closest.
As an aside, this is why China’s zero-infection policy is hopeless and is bound to be futile.
Kevin Dick
Jun 13 2022 at 3:19pm
While you explicitly use measles as a comparison for contagiousness, it’s important to remember that measles is a poor comparison in terms of immunity. So everyone should be careful in making inferences about covid dynamics or economics based on measles immunity. Flu is the better comparison.
Apparently, it was known among certain infectious diseases specialists, but not the general medical community, that durable sterilizing immunity to covid was very unlikely. So all that talk about herd immunity (from either infection or vaccination) was misguided, at least herd immunity in the classic sense as usually described in articles at the time.
This paper explains how all the respiratory viruses with durable sterlizing immunity (e.g., smallpox, measles, mumps) also exploit lymph/blood dissemination for transmission.
https://journals.plos.org/plospathogens/article?id=10.1371%2Fjournal.ppat.1009509
Viruses that are in some sense “purely” respiratory do not have durable sterilizing immunity from either vaccination or infection.
Interestingly, you can get a purely respiratory infection of both smallpox and measles even if you are immune! It just doesn’t go anywhere.
This fact has a number of implications.
First, it means that efforts to limit exposure by the general public (as opposed to those at unusually high risk) are even more misguided now that we have vaccines. Nearly everybody is going to get a strain of SARS-CoV-2 on a periodic basis and it’s not at all clear that delay does more good than harm.
Second it means that seasonal covid vaccinations _might_ make economic sense. I’m not sure what the economics of seasonal flu vaccines are but lots of people do get them every year and companies continue to make them. Personally, I’ve determined that the expected work and leisure productivity saved by seasonal flu vaccination is a bargain relative to the cash cost. It could be the same with covid.
So I think your conclusion that the demand won’t be there is premature. The FDA should provide a streamlined process for seasonal covid vaccines, then we should let the market decide.
David Henderson
Jun 13 2022 at 6:57pm
I have zero doubt that Charley would agree with you that the government should let the market (i.e., people) decide.
Kevin Dick
Jun 13 2022 at 10:36pm
Apologies, I parsed “co-author” quickly, thinking that you meant in this instance, but I see that is incorrect.
Charley Hooper
Jun 14 2022 at 12:19am
You’ve given me some things to think about. I hope to respond in a day or two.
Comments are closed.