Thanks Dr. Rasmussen! Important points on the virology, but I believe the epidemiology is important also. We seem to agree there's a non-zero risk of strains emerging that aren't well protected against by current vaccines. We may disagree about how far from non-zero that risk is.
https://twitter.com/angie_rasmussen/status/1420024555981221897
Yes, flu mutates faster—but we haven't seen two-fold changes in flu transmissibility in one season with one strain. With so much transmission, many new variants of SARS-CoV-2 are likely to continue to emerge.
There’s debate about whether vaccine-induced immunity can result in vaccine escape. As you correctly note, it’s not analogous to antibiotics, where use clearly drives resistance.
(Although there was an early theory that immune-escape variants emerged among people with long-term carriage of the virus because of immunological deficits.)
On the other hand, we commonly see new pathogens adapt quickly as they spread widely among humans. And pertussis provides a cautionary note, with apparently decreasing vaccine efficacy because of changes in the bacteria.
On basic principles, if there are strains that can spread in a vaccinated population, they will have a survival advantage.
As immunity becomes more common, the selective pressure on the virus will increase, though this could be for strains that are of relatively low pathogenicity (or not).
We may have different perspectives—whether the virology will be a more powerful factor than the epidemiology, only time will tell. But we certainly agree vaccinating the world & tamping down spread are crucial to save lives & reduce the risk of more problematic variants emerging.
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