Vaccines

 The current conflicts over vaccines in my opinion were a direct result as to how the Government handled the pandemic. The thesis of the Government leaders was that mRNA vaccine was a sine qua non, it worked, prevented getting the virus and prevented the spread. Unfortunately that was based upon literally no clinical evidence,

mRNA vaccines were new, elegant and did have a modicum of effectiveness. Namely they may have reduced persons getting "infected", qua getting sick. It may not have stopped people from getting infected and being a carrier, I cannot find any trials demonstrating that. It did not stop transmission. Frankly we still do not really understand the transmission path. My guess it by aerosols and into the tear ducts. But that is at best an educated guess. Yes, there was no time for clinical trials but frankly the CDC should have been collecting data and making it publicly available, There is a mass of people who could be examining it.

Instead, one relied at best on shaky State data. In New Jersey for example the head of Dept Health was a politically connected RN. It was never clear to me that this individual had a modicum of confidence.

The major problem was the Government stating things which frankly were far from provable. Vaccines did not stop infection nor did they stop transmission. Once the public started to discover this there was a gross collapse of confidence. The CDC was never on top of the issue. 

Vaccines play a major role in health care. I had my small pox vaccine in 1944, and suspect it may very well still be effective. I had Polio vaccines, Rabies, Yellow Fever, and the list goes on. Flu vaccines are good for at most 6 months, COVID likewise. Neither is fool proof. They are mitigators. Polio and Small Pox seem to be effective and long lasting. 

But it is essential that the public be informed even if is a limited amount and that must be stated. Telling the people and absolute when their own eyes show otherwise destroys trust. No trust and you get what we see today.  

Vaccines

 In a recent note in Science they discussed the facts that COVID vaccines have limited effectiveness as compared to other vaccines. They note:

Neither vaccinations nor immunity from infections seem to thwart SARS-CoV-2 for long. The frequency of new infections within a few months of a previous bout or a shot is one of COVID-19’s most vexing puzzles. Now, scientists have learned that a little-known type of immune cell in the bone marrow may play a major role in this failure. The study, which appeared last month in Nature Medicine, found that people who received repeated doses of vaccine, and in some cases also became infected with SARS-CoV-2, largely failed to make special antibody-producing cells called long-lived plasma cells (LLPCs). “That’s really, really interesting,” says Mark Slifka, an immunologist at the Oregon Health & Science University who was not involved with the work. The study authors say their finding may indicate a way to make better COVID-19 vaccines: by altering how they present the spike surface protein of SARS-CoV-2 to a person’s immune cells. Durability is an age-old bugaboo of vaccine designers. Some vaccines, particularly ones made from weakened versions of viruses, can protect people for decades, even life. Yet others lose effectiveness within months. “We really haven’t overcome this challenge,” says Akiko Iwasaki, a Yale University immunologist who is developing a nasal COVID-19 vaccine she hopes can be given often enough to get around the durability problem.

 My 1944 smallpox immunity still works as does my 1953 polio. However my mRNA COVID kind of lasts six months at best. The observation noted above about immune cell surface proteins, receptors, has merit. However the flu shots last about six months. Perhaps the mutation rate of single stranded mRNA viruses is at fault.

One suspects dramatic changes in vaccines now that we have a window to their operations.

Vaccines

 Last year was a year of small miracles regarding vaccine development. The mRNA vaccines are well targeted and well tolerated. The slow uptake, however, combined with uncontrolled inward migration with infected individuals creates a petri dish for mutations and variants. This becomes a direct threat to even those who were vaccinated.

Now we also fortunately know that the spike protein is an excellent target for the immune system. It works and is highly efficacious. However if we have more variants we need more updates to the vaccine. The mRNA should not include all of the dominant variants. Like flu shots, we can track the variants and modify and update the vaccines.

However the current administrations sees grossly deficit in performing this task. We are skimming along with the vaccine success of the past administration while the current appear lax in what is now a simple and necessary update.

The focus on masks distracts from the real solution, updated vaccines. The FDA without any form of aggressive and assertive leadership is at fault for not approving the current vaccine, a year after its trials and hundreds of millions already immunized.

We need three simple things from Government:

1. FDA approval of the mRNA vaccine, especially as it effects the deployment of variant based mRNAs

2. The aggressive testing and tracking of mRNA vaccine variants, now, not to wait!

3. The focus on vaccination and let the mask issue play itself out. 

It is necessary for some leadership in the current administration and less pandering to egos. There is a small window of opportunity before we find ourselves back to ground zero. We must get variant based mRNA vaccines out now.

Interesting Response

 In a paper from a Dutch group, they report:

The mRNA-based BNT162b2 vaccine from Pfizer/BioNTech was the first registered COVID-19 vaccine and has been shown to be up to 95% effective in preventing SARS-CoV-2 infections. Little is known about the broad effects of the new class of mRNA vaccines, especially whether they have combined effects on innate and adaptive immune responses. Here we confirmed that BNT162b2 vaccination of healthy individuals induced effective humoral and cellular immunity against several SARS-CoV-2 variants. Interestingly, however, the BNT162b2 vaccine also modulated the production of inflammatory cytokines by innate immune cells upon stimulation with both specific (SARS-CoV-2) and non-specific (viral, fungal and bacterial) stimuli. The response of innate immune cells to TLR4 and TLR7/8 ligands was lower after BNT162b2 vaccination, while fungi-induced cytokine responses were stronger. In conclusion, the mRNA BNT162b2 vaccine induces complex functional reprogramming of innate immune responses, which should be considered in the development and use of this new class of vaccines.

 The TLR, Toll Like Receptors, play a significant role in the innate system. For example, TLR-6 is on an endosome and it enhances IL-6 and the cytokine storm reaction. Now actual modification of TLR responses is quite dramatic and one suspects this will require extensive further study.