The ‘Figure it Out Yourself’ Phase of COVID
With the government throwing its hands up, it's now up to the citizenry.
At The Conversation (via YahooNews), University of South Carolina immunologists Prakash Nagarkatti
and Mitzi Nagarkatti answer the question “Should you get a COVID-19 booster shot now or wait until fall?” The reason it’s even a question is that vaccines that protect against newer strains better and last longer are in the pipeline.
Moderna and Pfizer-BioNTech, the two companies whose mRNA vaccines have been the primary options for COVID-19 vaccination across all age groups, both have new vaccine formulations on the way. An advisory committee of the Food and Drug Administration is set to meet on June 28, 2022, to evaluate the newest versions and to decide on which are likely to be recommended for use in this fall’s booster shots.
Moderna’s new bivalent vaccine mixes mRNA that encodes for the spike proteins of the original SARS-CoV-2 virus as well as the slightly different spike protein of the more infectious omicron variant. In early June 2022, Moderna said that in clinical trials, its bivalent vaccine outcompetes the original vaccine strain, inducing a stronger immune response and longer protection against the original SARS-CoV-2 and its variants, including omicron. Moderna later announced that its newest formulation also performs well against the newest omicron subvariants, BA.4 and BA.5, which are quickly becoming the dominant strains in the U.S. Because of the significantly stronger immune response that the new shot induces, Moderna predicts that such protection may last a year and plans to introduce its new vaccine in August.
And most recently, on June 25, Pfizer-BioNTech also announced results for its two new COVID-19 vaccine formulations: a bivalent formulation consisting of mRNA that encodes for the spike proteins of the original SARS-CoV-2 strain and the original BA.1 omicron subvariant, and a “monovalent” version that is only directed at the spike protein of BA.1. The company’s preliminary studies demonstrated that both the monovalent and the bivalent vaccines triggered antibodies that neutralized the newer omicron BA.4 and BA.5 subvariants, although to a lesser degree than the BA.1 subvariant. However, Pfizer’s monovalent vaccine triggered better virus-neutralizing antibodies against the omicron BA.1 subvariant than did the bivalent vaccine.
Even more interestingly,
Another vaccine formulation that is working its way toward authorization is Novavax, a vaccine built using the spike protein of the original SARS-CoV-2 virus. The Novavax vaccine has the advantage of being similar to traditional vaccines, such as the DTaP vaccines against diphtheria, tetanus and pertussis, or the vaccines against other viral infections such as hepatitis and shingles. The Novavax vaccine has been clinically tested in South Africa, the United Kingdom and the U.S. and found to be safe and highly effective with 90% efficacy against mild, moderate and severe forms of COVID-19.
An advisory committee to the Food and Drug Administration endorsed the Novavax vaccine in early June 2022. Now, the FDA is reviewing changes that Novavax made during its manufacturing process before making its decision to authorize the shot.
In Australia, the Novavax vaccine was recently registered provisionally as a booster for individuals aged 18 years and over. The company is performing phase 3 clinical trials to determine if its vaccine can be used safely and effectively as a booster in people who have previously taken mRNA vaccines.
When these new vaccines become available in the coming months, people will have significantly more options for mixing and matching vaccines in order to enhance the duration and quality of their immune protection against COVID-19.
That’s all good news, obviously. But the obvious counter is that one could get a second booster whenever one is available and then get one of the new vaccines down the line. After all, we seem to be getting these every few months now.
Strangely, however, the Nagarkattis don’t even mention that option. Nor, incidentally, do they answer the titular question. The reader is simply left to decide for themselves whether waiting makes sense.
This is becoming an increasingly common phenomenon. As Ed Yong, The Atlantic‘s Pulitizer Prize-winning health reporter notes, America has entered the “Figure it out yourself” phase of the pandemic.
Across the country, almost all government efforts to curtail the coronavirus have evaporated. Mask mandates have been lifted on public transit. Conservative lawmakers have hamstrung what public-health departments can do in emergencies. COVID funding remains stalled in Congress, jeopardizing supplies of tests, treatments, and vaccines. The White House and the CDC have framed COVID as a problem for individuals to act upon—but action is hard when cases and hospitalizations are underestimated, many testing sites have closed, and rose-tinted CDC guidelines downplay the coronavirus’s unchecked spread. Many policy makers have moved on: “We’re heading into the midterms, and I think there’s a real desire to show confidence that they’ve solved this,” Céline Gounder, an infectious-disease specialist and the editor at large for public health at Kaiser Health News, told me.
But COVID is far from solved. The coronavirus is still mutating. Even at one of the lowest death rates of the pandemic, it still claims the lives of hundreds of Americans daily, killing more than twice as many people as die, on average, in car accidents.
Regardless, as we’ve noted multiple times here in recent months, most of us have more or less decided to just get on with our lives as though the pandemic were over. Some did so all along. Others of us did so once we were vaccinated and boosted and, more importantly, the CDC simply changed its guidelines so that most of the country was suddenly marked safe.
I fully understand President Biden and state and local leaders who were criticized for mandating masking and vaccines during early phases of the pandemic changing their stance in response both to a better-contained virus and a population that’s mostly just done with it. Indeed, the alternative was likely to be mass non-compliance.
Still, it’s rather bizarre that we’ve mostly stopped even bothering to dispense advice as to appropriate risk mitigation behaviors. Then again, we may simply be at the point where only the most at-risk and most cautious will bother to heed it.
Many sensible policies—say, mask mandates that toggle on in grocery stores, public transport, and other essential spaces when community transmission is high—seem unlikely in this political climate. What, then, is still on the table? Right now, “I feel like I’m screaming into the wind,” Matifadza Hlatshwayo Davis, the health director for St. Louis, told me. But while others get to simply say “We’re screwed” and move on, she said, “I have to drive into work and figure it out.” Débrouillez-vous, indeed.
I have interviewed dozens of other local officials, community organizers, and grassroots groups who are also swimming furiously against the tide of governmental apathy to push some pandemic response forward, even if incrementally.
As with everything else, our extreme polarization is hurting us:
In America, trust is in short supply, and accordingly, the country has underperformed throughout the pandemic despite its considerable resources. This problem is getting worse: A poll from January found that only 44 percent of respondents trusted the CDC’s statements on COVID, down from 55 percent in 2020—a decline that spanned the political spectrum.
Honestly, that’s not a huge decline considering the very real hits the CDC has taken to its credibility. And many of its pronouncements, including the changing guidelines, are clearly as much about political calculations as what “the science” shows. But that lack of trust, filtered through a partisan lens in which Democrats bent over backward to take the vaccine seriously (even if occasionally over-reacting) while Republicans wanted to pretend it was nothing more than a seasonal flu, has certainly hampered our response.
Yong puts in a long pitch for enlisting the health of “community health workers” who are “hired for their empathy, their strong local ties, and their personal experience with hardship” as well as nationally-organized advocacy groups. Essentially, with government only able to reach so many people, an alternative is needed.