Thread by @ASlavitt

COVID Update: Vaccines wane because they’re supposed to.

Millions won’t access the vaccine & billions can’t. That’s a bigger problem.

Report from talking to 3 scientists about what we’ve recently learned and what it means. 1/

The worst is not behind us. Thousands are dying each day in the US and in Africa & many remote areas of the world, they remain highly vulnerable.

Until the global situation is made top priority & the US population does better, we remain vulnerable to ongoing suffering.2/

A powerful variant upended 2021 & falling short of our vaccination goals in 2021 could preview the same challenge for 2022. 3/

In 2021 we learned a lot about the vaccine that we didn’t know going in. These are very good vaccines but subject to the same properties as others.

Against a slower spreading COVID, they would have performed better. But Delta threw a curve.

What we know… 4/

The vaccines durability— lessening effectiveness by 6%/month— is new information.

Vaccines wane for very appropriate reasons as @KatherineJWu reminds me. If they didn’t, imagine our blood viscous with antibodies. 5/

The cycle— We get sick w something. We get an immune response. We produce antibodies. Those antibodies provide our quickest response to the virus.

Imagine if each time we get sick we add antibodies to our blood & they never subsided. 6/

The antibody response is supposed to wane. One way to think about it is seeing the response recede and hide out in our cells— with a memory of the illness (b cells) & killers (t cells) in our cells & bone marrow.

The whole thing is pretty clever & elegant. 7/

There are 2 factors to consider here.

1) This happens in a well-functioning immune system. Add a condition which weakens our immune system or simply age the immune system & the response is worse. 8/

2) how the virus behaves itself. Those that take a reasonably long time to attack us can be defeated without so much as a sniffle. But a quicker attack like the one from Delta means our slower trigger can allow for nasal infection before being pushed back. 9/

What we know about the vaccines is like many they don’t prevent cold like symptoms except after the initial vaccine antibody response. There’s no vaccine for the common cold.

But the vaccines do prevent the virus from taking hold in the lungs where the damage is greater. 10/

Of course this is why vaccinated people can also occasionally spread the virus through the nose, particularly as the vaccine wanes. 11/

We also learned that vaccine doses are best spread out longer than the initial 3-4 weeks. Six months acts as a great reminder to our bodies of what this virus looks like.

Some are frustrated that we are learning things like this as we go. Maybe think about it like this…12/

If in 2020 we wanted to test how the immune response would improve if we waited 6 months between shots, it would have taken us … another 6 months. 13/

As I discuss with @drsanjaygupta on @inthebubblepod today, some people get resentful that we learned something new about the vaccine. They get stuck. Feel lied to. Believe the communication is too confusing. That scientists don’t know what they’re taking about. 14/

https://twitter.com/inthebubblepod/status/1442469508707459073

Sanjay and I put forward a suggestion for people who find themselves stuck by advice that differs from earlier advice.

“Last January Dr Fauci said x. Now he said y.”

Two potential conclusions. Maybe consider the other one besides Dr Fauci being a moron. 15/

Of course one reason people need more protection from a third shot is the many who will get no protection from a first.

In that sense it’s a self-fulfilling prophecy. Vaccines only work as well as how many people use them. 16/

The many who won’t are sadly, slowly, inefficiently and often dangerously acquiring some immunity by getting infected.

Some deploy this as a strategy as they mock the scientists who advise against this as being constantly wrong. 17/

My view is that scientists are part of the problem because in their minds, they are never wrong & have never been wrong. It’s just “how science works” or “what we knew at the time.”

In a distrusting culture I put a premium on straight talk & this often sounds like an excuse. 18/

How about “We were wrong in February. We didn’t take the 6 months needed to study boosters so we guessed. And we were wrong. Now we know better.”

People may follow new scientific advice better with a drop of humility from those who give it. 19/

We don’t really have time to dwell on past errors.

Take a minute to acknowledge that neither the science nor the scientist are perfect. Then move on. 20/

Now many who refuse the vaccine in the US have watched the country slowly become a global hot spot.

The other places in the globe are hot less by choice than the vaccine supply hasn’t caught up with them. 21/

Vaccine production is scaled. COVAX and the US and the IMF have all stepped up to create enough doses. India will be exporting again in October.

Now we need an effort to go from airports to arms in the next 6 months in developing countries. 22/

Whether in the US or abroad, viruses that find places to replicate find places to mutate.

If the immune response is low because of prior or current illness, the replication process is unchecked. More chance for mutation. 23/

The crowd that promotes “natural immunity” should really be called “pro virus” as they give the next variant a greater chance to emerge. 24/

If we face our challenges & adapt to emerging truths, scientists believe we have a chance to turn the corner.

It’s not the virus that haunts us now. It’s almost entirely the human response. Fix that and the suffering will subside more quickly. /end