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Comment by elromulous | Hacker News Reader

Can someone who's more knowledgeable on the topic comment on the following: if natural immunity is more robust (as one would expect - the immune system is exposed to many spikes that way, as opposed to just the one), why don't we first immunize with the vaccine, and then expose people to the alpha variant, so as to develop a more robust (i.e. natural) response without the risk.

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You would want the exposure to be nasal, so that would require a distribution system for inhalers containing the alpha variant.

From the date of the first vaccine, until 2 weeks after the second vaccine, the immune system goes through many changes enroute to gaining protection from serious illness. It is recommended to avoid immune system stress, exposure to any pathogens (e.g. visiting hospitals), physical exertion, etc. during the 2 week period immediately after the first vaccine. If one is infected with anything earlier than 2 weeks after the 2nd vaccine, it will be recorded as an unvaccinated infection.

Anyone (vaccinated, partially vaccinated or unvaccinated) who gets infected should immediately avail themselves of early treatment options, e.g. monoclonal antibodies (free and available in some states), upcoming antiviral tablets from Pfizer and Merck (in trials) or other therapeutics on the global market. Early treatment speeds recovery. Without early treatment, the graph of outcomes becomes complex.

Actually this is sort of a thing. For example the polio vaccine has a killed vaccine (analogous to spikes) and a live attenuated vaccine. The live vaccine has higher risk of side effects but provides more robust immunity.

Vaccine schedules can be designed to give the killed version first for some immunity followed by live vaccine to provide more robust immunity.

None of the COVID vaccines so far are live attenuated vaccines as far as I'm aware.

> the immune system is exposed to many spikes that way...

Why not just develop anther vaccine or two? Wasn't the point with the mRNA vaccines that they would easily be tweaked to target another spike?

While I am a complete neophyte, from what I learned so far immunity is non-linear. Antibody dependent enhancement and original antigenic sin come to mind. We can't just pile up vaccines and expect the effects to always be positive.

https://en.wikipedia.org/wiki/Antibody-dependent_enhancement

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

Wow, the immune system is complex.

I think the best answer is that we are just beginning to understand the immune response to infection and our vaccines and that the exact pathway to create the best, most protective and longest lasting immunity is still an area of active research. We just don't know enough at this point.

One reason amongst many others is the risk of a vaccine-resistant strain emerging. There’d be a pretty enormous evolutionary pressure for that outcome under those circumstances.

I would point out fear of resistance is not a good reason to withhold vaccination or withhold care. Resistance will always eventually happen through evolution. What's important is that care is given when indicated.

No vaccine is 100% effective and it is unethical to purposefully expose people to disease.

Huh? The ethics of therapies that expose people to pathogens is complicated - many examples where exposure can be ethical as long as patient is aware of the risks. Arguably all vaccines fall into this ethical framework, and other immunizations which involve exposure.

Under what ethical framework?

10x to 100x less likely but still a distinct possibility you kill someone that would've lived if they weren't inoculated with a live virus. That's messed up by itself, but also cases like that would likely discourage the people on the fence about vaccination.

https://www.nytimes.com/interactive/2021/08/10/us/covid-brea...

Minor live infections to build immunity is called variolation, it's a tactic that was used effectively historically against smallpox, but effectively got obsoleted by vaccination, which doesn't kill as many people.

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

You linked data on breakthrough infections. Those are infections in people who have been vaccinated, some of which can still result in death. I don't believe there have been any reported deaths from the vaccine. There may be an alleged one, but the details are controversial. If you can link data suggesting that the vaccine is 10x to 100x less likely than covid to kill you but does still reliably kill you, I think we could entertain this line of rhetoric further.

Despite that, let's concede the vaccine does kill people: I'm not sure that's unethical though if more people end up dead because the population didn't quickly achieve immunity and stop the spread of the virus. There are a lot of ethical frameworks out there and in the US we are actually a majority rule so as a society we should generally be protecting the interests of the majority of people except in cases where it leads to sever oppression or breach of civil liberties. We are okay with the draft (forced risk of death) during times of war yet somehow when the enemy is unfamiliar in the form of a virus we aren't?

https://en.m.wikipedia.org/wiki/Human_challenge_study

yet this exactly what the pharma companies did during the clinical trials to confirm the vaccines' efficacy.

Wait, what? No. Just no.

To confirm efficacy they gave the vaccine to half of a population likely to develop the disease naturally. Then they compared how many people for sick in each group. That's why testing took a year instead of 2 months, they have to wait for enrollees to get sick naturally.

If we ignore ethics, I guess we could get more nuanced efficacy information out of a small sacrificial population. But that is just not done. Not even during a pandemic.

Before Chicken Pox vaccination was invented people would hold "Pox Parties" to infect and immunize their children at a young age when risk of severe infection was low.

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

I'm unclear about these muddled responses to your post that simply states two incontrovertible truths.

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