Hacker News Reader

Comment by goalieca | Hacker News Reader

> Available evidence emerging from Israel and the UK shows a significant increase in protection against infection and severe disease following a booster dose in all age groups in the short term

So, I’ll admit I don’t understand the physiological mechanisms at play (is it just waning antibody concentration?) but what is the long term strategy here? Is there going to be annual boosters with vaccine passports? The governments are not exactly being transparent and I think it is time now that things are under relative control to start having adult discussions and public policy debates once more.

View on HN

> (is it just waning antibody concentration?)

Two notable mechanisms:

* The booster shot does increase antibody concentrations and recruits more memory B cells to make antibodies.

* Each booster also significantly increases the diversity of the immune response. You get more antibodies against the antigen, and you also get many more antibodies against things kind of like the antigen.

> but what is the long term strategy here? Is there going to be annual boosters

That's a really good question.

I personally believe (based on little evidence at this time) that each dose provides some small permanent increase in protection against infection, and a somewhat larger permanent increase in protection against severe illness.

So as we go through this whole exercise, a greater proportion of the population is protected and people are less likely to be carriers. In turn, it becomes easier to leave things up to individual choice, as the overall baseline risk reduces and people's choice mostly affects their own health.

> and I think it is time now that things are under relative control to start having adult discussions and public policy debates once more.

Yes. Look, I don't want to wear masks forever indoors. I think it'd be great to normalize it for when we're feeling under the weather or it's flu season, but I also want to be able to see other peoples' faces and carry on normal conversations.

> So as we go through this whole exercise, a greater proportion of the population is protected and people are less likely to be carriers.

I suspect we should also be vaccinating the wider world in order to minimize mutations which might nerf our vaccine and natural immunity. I’m of the impression that most of the world doesn’t hasn’t had even a single dose.

That said, last I checked, the US had donated more vaccine than all other countries combined and committed itself to many times more donations than it had already delivered. Further still, it was committed to building out the logistics infrastructure to make sure those vaccines get delivered and in such a way that other polities (e.g., Europe) can donate via that same infrastructure. Now we just need other polities to step up their donations.

> I’m of the impression that most of the world doesn’t hasn’t had even a single dose.

It's very unevenly distributed, but it looks like we're at ~55% with a single dose and ~43% fully vaccinated: https://www.nytimes.com/interactive/2021/world/covid-vaccina...

We don’t know the long-term strategy. We’re literally looking at the data coming out of Israel month-to-month to determine how long the boosters will be effective.

Why only Israel?

They have the highest vaccination rates the earliest.

Do you happen to know how they manage that ahead of the small northern European countries?

They paid Pfizer a lot more per dose than other countries. There were also reports that they were willing to share data on outcomes more freely (or less bureaucracy) than normal.

They are very very small, so when supplies were tight it didn't take many doses to fully vaccinate them, and then they are the lab test of the world. They are WAY smaller than even the small northern European countries.

They also have a very integrated very high tech medical data system, with complete info on each person, medical history, doses, everything in one file.

Their population is the same as ours in Sweden, the biggest Nordic country, while Belgium is only slightly bigger and Switzerland slightly smaller and we're all richer (their GDP is 200bn less than ours for example.)

We all also have a very integrated high tech medical data systems with complete info on each person, medical history, doses, everything in one file (and works anywhere in the country.)

So there must be a difference in policy.

yes, it was basically the one thing most people would agree that Netanyahu got right (at least if you're not an anti-vaxxer). He basically didn't wait for the vaccine, he went to Pfizer with a plan and worked closely with them to get it to fit their needs.

https://amp.theatlantic.com/amp/article/617780/

Basically they negotiated to be Pfizer’s testbed / data partner for full rollout of the vaccine.

I believe the answer there is military enforced/backed vaccine mandate. To my knowledge so far Israel is the only state in the world to in some cases quite literally put guns to people's heads to take the vaccine. Don't know if it is the right approach or not, but in world vaccination statistics it has been a leading approach.

that's not true. there are plenty of anti vaxxers in Israel who have not been vaccinated. With that said, people who want to work (and have to work from an office setting) would have to pay for a test every 72 hours or so out of their own pocket. Of course if work from home, less of an issue. So, they've made it difficult for people to live their lives without being vaxxed, but they haven't put a gun to anyone's head or thrown anyone in jail for the simple act of not being vaccinated.

Many Orthodox Jewish communities outrightly refused vaccines and implementing the mandates. These communities saw the largest outbreaks, nonetheless there could never be. forced vaccination mandate in Israel

From outlier to harbinger.

That’s true. There were many people, including commenters on HN, recommending people ignore Israel’s booster data and recommendations because it was an “outlier”

Annual boosters for all volunteers or annual boosters for risk patients seem to be the most likely future strategy, depending on the approach of the local health authorities and the number of infections in the future. Just like with influenza, and it's probably going to be combined with the influenza shots.

Surely the answer is: we don't know. And, we'll see. For now I feel short term is a reasonable focus.

Hundreds of million of doses have been administered and "we don't know, we'll see". Seems foolhardy.

"You can't produce a baby in one month by getting nine women pregnant."

Sometimes understanding long term effects requires long term observation.

The hundreds of millions of doses haven't been administered to the same person.

It's more .. not letting perfect be the enemy of good enough. The longevity of the vaccine has been the only real disappointment so far - the results have been otherwise fantastic.

So do we give up fantastic results while we wait to see if they'll find something with better longevity?

There are vaccines for which after a couple boosters we consider the lifetime immunity to be acceptable; there are others for which we do not. Many variables at play (including actual infection rates, mutation rates, etc), so hard to predict.

They've been saying from the beginning that vaccines only offer short term immunity and that the virus will be mutating (hence potentially making current vaccines ineffective) so that we might end up in a scenario similar to the flu.

Now, I suppose that whether large scale booster programs, vaccine passports, etc will continue will simply depend on how widespread and serious the virus remains. So no-one knows for sure.

We might end up with combined flu/covid vaccines recommended annually for the vulnerable.

coronaviruses do not mutate as quickly as influenza so it’s a bit of a different situation. The 3 dose mRNA + booster is all the same exact vaccine. That being said, maybe we will need annual boosters which we get with a combined flu shot.

> The 3 dose mRNA + booster is all the same exact vaccine

Yes, currently it is. But that may change at any time.

They mutate 2 gnomes/month.

So we already have thousands of mutations. But changes we call variants happen much slower.

Still, the vaccins are based on the 2019 variant.

The likely scenario is no one actually knows what the future will hold yet, so they're only basing policy on what they have learned thus far, and changing as the situation develops when it doesn't match their expectations. Not sure if there's anything else one can do.

Well, maybe three will actually do it. There's quite a few vaccines which require a course of three or even four shots to confer lasting long-term immunity. If you don't do the full course with repeat challenge it tends to fade after some months or years.

Reply on news.ycombinator.com