Pfizer and Moderna vaccines may produce lasting immunity • Hacker News Board

Re: Pfizer and Moderna vaccines may produce lasting immunity

#321

Post by incrudible » Tue, Jun 29, 2021, 9:40 PM UTC

baq wrote: post #311

incrudible wrote: post #309

Earlier quoted context omitted.

How is that relevant? The question is: How effective are these vaccines really against that variant? In the real world, not in the lab. If half the cases are in vaccinated individuals and only half the people are vaccinated, how can the vaccine be 80%-90% effective? That's a mathematical impossibility. In the case of the deaths, it might be possible because the vaccinated are far older on average and likely over-coun…

i disagree fundamentally about the question. for me, the question is: how can we prevent the virus from mutating enough to escape vaccine- and covid-based immunity with another variant? the answer is to stop the virus from infecting a host in which it can mutate freely and from which it can escape. we don't know these people, so we should aim to vaccinate as many as possible before it finds another person who walks a…

> i disagree fundamentally about the question.

Maybe you're in the wrong thread, then?

> for me, the question is: how can we prevent the virus from mutating enough to escape vaccine

Probably not with a vaccine that is not quite strong enough to prevent spread, but simultaneously strong enough to put selection pressure on the virus.

> the answer is to stop the virus from infecting a host in which it can mutate freely and from which it can escape. we don't know these people, so we should aim to vaccinate as many as possible before it finds another person who walks around with the virus for multiple months with no symptoms, accelerating natural selection thousandfold.

The scenario you are describing is the immunocompromised person whose body can't quite kill the virus, but also puts selection pressure on it. Such cases have been described, but whatever mutation would come out of that is not necessarily going to be much more effective at overcoming the defenses of a normal immune system.

The Sars-CoV2 virus will almost certainly stick around and it will keep mutating, even with the best of vaccination efforts. Nature finds a way. We'll have to get used to it.

Re: Pfizer and Moderna vaccines may produce lasting immunity

#322

Post by timr » Tue, Jun 29, 2021, 9:40 PM UTC

Pyramus wrote: post #259

timr wrote: post #232

Earlier quoted context omitted.

> You would see side effects for a vaccine within six months, and we have been administering it for much longer than that. We have now had two separate rare-but-serious side effects of different Covid vaccines: the CVT issue with J&J, and the myocarditis issue with the mRNA vaccines in children. It's disingenuous to suggest that the vaccines are "safe" merely because they've been widely administered; even the questio…

I don't think anyone is ignoring these issues - on the contrary, even in these very rare cases of side effects vaccination efforts were halted immediately. Safe is always relative. If you don't think the vaccines are safe enough, then please also be consistent and don't engage in equally unsafe activities, e.g. don't drive a car, exercise regularly, eat healthily, don't encourage your girlfriend/wife/daughter/friend…

> Again, from what we know today, it is safer to vaccinate your kids then driving them around in a car.

...and if it were choice between vaccinating kids and driving them places, then this example would be relevant.

We don't approve drugs simply because they're less risky for a target population than some other selection of risky things.

> Even when the risk/benefit profile is even/negative, absolute risk is super low.

Yes. So is the benefit.

Re: Pfizer and Moderna vaccines may produce lasting immunity

#323

Post by timr » Tue, Jun 29, 2021, 9:43 PM UTC

superkuh wrote: post #319

timr wrote: post #178

Earlier quoted context omitted.

> Is 12 to 15 weeks (3-4 months) really "long lasting" antibody mediated immunity? It's perfectly normal for an antibody response to decay over time. We don't keep making antibodies in perpetuity for every antigen we've ever seen, or our blood would turn into peanut butter. The B-cell and T-cell mediated responses to previous infection are also proving to be robust, and the B-cell response, in particular, primes the…

Yes. But we only get one influenza vaccine per year. The expectation has been for antibody neutralization coverage (not just T-cell mediated infected cell killing) lasting that long. 15 weeks is rather short. Additionally, it's not really 15 weeks. The study time scale starts at the 1st vaccine dose (week 1). Then it's 3 weeks until the 2nd dose and 2 more weeks till full protection. So the actual protective coverage…

> 15 weeks is rather short. Additionally, it's not really 15 weeks.

You're right. It's the lower bound, based on the duration of the experiment.

There have now been many, many studies all pointing in the same direction. A small selection:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Natural infection protects against Covid (incl. Alpha variant). Adjusted incidence rate ratio for covid infection - 0.159 (84% protection) and symptomatic covid - 0.074 - (93% protection) - 7 month follow up

https://jamanetwork.com/journals/jamainternalmedicine/fullar...

Patients who had 1 PCR positive tests had Hazard ratio 0.06 of further positive PCR - 94% protection - 12 month follow up.

https://academic.oup.com/cid/advance-article/doi/10.1093/cid...

After 1 positive PCR, Protection against any COVID - 81.8%, symptomatic COVID - 84.5% - 6 month follow up - protection increased over time.

https://academic.oup.com/cid/advance-article/doi/10.1093/cid...

seropositive patients had 94% reduction in hazard of testing positive - 8 month follow up

https://www.nejm.org/doi/full/10.1056/NEJMoa2034545

Adjusted risk ratio of covid infection for antibody positive healthcare workers was 0.11 (89% less likely) - 7 month follow up period. All reinfections were asymptomatic.

At this point, claiming that immunity to Covid (even against "the variants") is less than a year is an extraordinary claim. There is no reason, prima facie to presume that the results will be different for vaccines.

Re: Pfizer and Moderna vaccines may produce lasting immunity

#324

Post by sjwalter » Tue, Jun 29, 2021, 9:49 PM UTC

mrj wrote: post #301

sjwalter wrote: post #298

Earlier quoted context omitted.

One of the foundational, bedrock principles of bioethics is "informed consent". It is extremely, practically diabolically, unethical to lie to people about medical treatments prior to gaining their consent. This is literally bioethics 101. You are saying that I am putting people, or society, at risk simply by stating the simple, 100% true fact that these vaccines are not through FDA Phase 3 trials. The implication of…

I'm not arguing against consent, of course. The data is out there but you are misinterpreting it. I just think you're taking issue with silly things, overblowing the risks and trying to make other people scared. That's seriously messed up. Be truthful. You've decided not to take it no matter what. Now you're back-filling reasons not to. If you truly were about your ethics, you'd stop trying to make others afraid beca…

You said I was spreading doubt about vaccines during a deadly pandemic.

I have said zero about the safety of the vaccines. I have only stated the unassailable fact that they have not completed phase 3 trials.

How is telling the facts about the status of the vaccines spreading doubt?

I have taken plenty more vaccines than you, I'm sure, I'm not some anti-vaccine nutcase. I love medical technology, I love vaccines. I also love bioethics. I wish more people, like you, did too.

You say I'm afraid, and you couldn't be further from the truth. I'm more well-informed about covid than most people I interact with on a daily basis, and I live in a state that values individual autonomy, so we've experienced basically zero impact on our daily lives because of covid. Some folks used to wear masks, most folks didn't. Everything remained open, save a brief closure of our bowling alley, now thankfully back open.

I walk around without any fear whatsoever and all my local fellows seem to as well. Nobody talks about covid or really cares much about it all. Very few are vaccinated.

Life is fine.

Others are more scared. Others, like you, are trying to hide information about the vaccines. That sucks.

I hope your life improves, friend!

Re: Pfizer and Moderna vaccines may produce lasting immunity

#325

Post by superkuh » Tue, Jun 29, 2021, 9:53 PM UTC

timr wrote: post #323

superkuh wrote: post #319

Earlier quoted context omitted.

Yes. But we only get one influenza vaccine per year. The expectation has been for antibody neutralization coverage (not just T-cell mediated infected cell killing) lasting that long. 15 weeks is rather short. Additionally, it's not really 15 weeks. The study time scale starts at the 1st vaccine dose (week 1). Then it's 3 weeks until the 2nd dose and 2 more weeks till full protection. So the actual protective coverage…

> 15 weeks is rather short. Additionally, it's not really 15 weeks. You're right. It's the lower bound, based on the duration of the experiment. There have now been many, many studies all pointing in the same direction. A small selection: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Natural infection protects against Covid (incl. Alpha variant). Adjusted incidence rate ratio for covid infection - 0…

Right. The experiment was far too short to make any claims about long term B cell mediated antibody levels. Establishing 7 weeks post fully vaccinated being good is not a "lasting immunity".

I'm not sure I agree with just assuming protection will last that long as a default. This study does not establish it but it is a good stepping stone to proving that theory.

re: your edits, the tangential bit from this paper about sars-cov-2 positive cases wasn't the main thrust and from the graphs it looks like their neutralizing antibody levels actually are multiple logs below mRNA vaccinated people at the same 15 week point. I'm not sure what all these citations about naturally infected people add to the topic being debated.

Re: Pfizer and Moderna vaccines may produce lasting immunity

#326

Post by Pyramus » Tue, Jun 29, 2021, 9:59 PM UTC

incrudible wrote: post #303

Pyramus wrote: post #269

Earlier quoted context omitted.

Again, that is false. It's not even close, for women age 20-29 the risk of fatal thrombosis is 1:250k, while Covid is somewhere around 1:25k [1]. That's a whole order of magnitude. The risk/benefit ratio of AZ vaccine is only poor when the risk of exposure is very low [2]. [1] https://www.nature.com/articles/s41586-020-2918-0/figures/2 [2] https://assets.publishing.service.gov.uk/government/uploads/...

> It's not even close, for women age 20-29 the risk of fatal thrombosis is 1:250k I have yet to find a source that gives the risk for that cohort. > ...while Covid is somewhere around 1:25k Even if it's an order of magnitude higher, the risk of a actually getting a PCR-confirmed infection is an order of magnitude lower. Again, Germany: 28 deaths of women in that age group over the course of the pandemic[1], including…

> I have yet to find a source that gives the risk for that cohort.

The data is publicly available for many countries, e.g. here for the UK:

[1] Report on adverse reactions until 16 Jun 2021 https://www.gov.uk/government/publications/coronavirus-covid...

[2] Vaccination statistics https://www.england.nhs.uk/statistics/statistical-work-areas...

Check the table with reports and fatalities by age, and the paragraph interpreting the data. Together with [2] you can calculate the fatality rate for the 20-29 group. In the end you'll end up with a fatality rate for women age 20-19 in the range of 1:150k-300k (quick back of the envelope calculation).

> Even if it's an order of magnitude higher, the risk of a actually getting a PCR-confirmed infection is an order of magnitude lower.

The source I posted is a metastudy, computing IFR based on seroprevalence from many different countries, so PCR tests have nothing to do with it.

Re: Pfizer and Moderna vaccines may produce lasting immunity

#327

Post by timr » Tue, Jun 29, 2021, 10:01 PM UTC

superkuh wrote: post #325

timr wrote: post #323

Earlier quoted context omitted.

> 15 weeks is rather short. Additionally, it's not really 15 weeks. You're right. It's the lower bound, based on the duration of the experiment. There have now been many, many studies all pointing in the same direction. A small selection: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Natural infection protects against Covid (incl. Alpha variant). Adjusted incidence rate ratio for covid infection - 0…

Right. The experiment was far too short to make any claims about long term B cell mediated antibody levels. Establishing 7 weeks post fully vaccinated being good is not a "lasting immunity". I'm not sure I agree with just assuming protection will last that long as a default. This study does not establish it but it is a good stepping stone to proving that theory. re: your edits, the tangential bit from this paper abou…

> re: your edits, the tangential bit from this paper about sars-cov-2 positive cases wasn't the main thrust and from the graphs it looks like their neutralizing antibody levels actually are multiple logs below mRNA vaccinated people at the same 15 week point. I'm not sure what all these citations about naturally infected people add to the topic being debated.

These are all real-world studies of actual duration of immunity. They trump any theoretical concerns based on lab measurements of neutralizing antibody levels.

Observing that the vaccines induce responses lasting as long as 15 weeks is completely unsurprising, based on what we already know from real-world observation of natural infection. Ignoring contextual evidence and concluding that this specific paper didn't provide reasonable evidence is losing the forest for the trees.

Could it be possible that the vaccines don't confer immunity lasting as long as what we're observing from natural infection? Sure, I guess.

Is it likely? No.

Re: Pfizer and Moderna vaccines may produce lasting immunity

#328

Post by peter422 » Tue, Jun 29, 2021, 10:46 PM UTC

sjwalter wrote: post #320

peter422 wrote: post #293

Earlier quoted context omitted.

How do the ethical calculations stack up when we account for the hundreds of thousands of lives saved? Regardless of whether you think the vaccines are safe, they are quite clearly effective.

I'm having a hard time understanding your question because the only way I can interpret it seems to imply that you think it is better to lie to people about the status of a medical treatment than it is to be honest, in a gambit to ensure more people accept administration of the treatment. Is that what you're implying? To directly answer your question: I do not think the ethical calculations change one single iota bas…

You are the one who is calling something that is obviously safe, not safe.

You think you are smarter and more thoughtful about this than the experts who debated it in the open for hours upon hours to decide it was safe and should be available to everybody.

You said earlier you were safe because of your vitamin D levels. The science on the protective nature of vitamin D to COVID is not clear at all. But you claimed it as fact because you want it to be true. You want the vaccines not to be safe so you make up thresholds and then tell us you are being honest by saying the vaccine doesn’t cross them. Why do you trust all the other vaccines the FDA has approved, but not this one that the FDA says is safe and effective. Do you trust them or not? Or do they lie sometimes when you disagree and tell the truth when you agree?

Re: Pfizer and Moderna vaccines may produce lasting immunity

#329

Post by nradov » Tue, Jun 29, 2021, 10:47 PM UTC

peter422 wrote: post #293

sjwalter wrote: post #283

Earlier quoted context omitted.

I'm guessing you didn't read the link you pasted as well. Note the correction at the top of the page. It is clear that I'm correct. The vaccines are still in phase 3 clinical trials, as reported by clinicaltrials.gov, the source of truth for such questions. Estimated Study Completion Date literally means the date that the Phase 3 trial study is estimated to be completed, at which point FDA goes through the process of…

How do the ethical calculations stack up when we account for the hundreds of thousands of lives saved? Regardless of whether you think the vaccines are safe, they are quite clearly effective.

Forcing people to undergo medical procedures against their will cannot be ethically justified by any number of hypothetical lives saved. Everyone who can safely get vaccinated should do so, but it can't be coerced.

Re: Pfizer and Moderna vaccines may produce lasting immunity

#330

Post by nradov » Tue, Jun 29, 2021, 10:49 PM UTC

peter422 wrote: post #328

sjwalter wrote: post #320

Earlier quoted context omitted.

I'm having a hard time understanding your question because the only way I can interpret it seems to imply that you think it is better to lie to people about the status of a medical treatment than it is to be honest, in a gambit to ensure more people accept administration of the treatment. Is that what you're implying? To directly answer your question: I do not think the ethical calculations change one single iota bas…

You are the one who is calling something that is obviously safe, not safe. You think you are smarter and more thoughtful about this than the experts who debated it in the open for hours upon hours to decide it was safe and should be available to everybody. You said earlier you were safe because of your vitamin D levels. The science on the protective nature of vitamin D to COVID is not clear at all. But you claimed it…

The science on hypovitaminosis D being a serious risk factor for bad COVID-19 outcomes is now quite clear. This site has a fairly comprehensive index of the studies.

https://vitamin-d-covid.shotwell.ca/