It’s OK to talk about the biological limitations of vaccines without being anti-vax


Just bc we wish vaccines stop transmission, doesn’t make it so. Vax limit spread a bit, but we’ve known for months that breakthroughs are not rare and spread among vax is common

Does this mean that COVID vaccines don’t work? Absolutely not. They work great… for what they were measured and authorized to do - stop disease.

They weren’t authorized for their ability to stop spread. Vaccines work! Let’s be open both about what they do and don’t do well

The more we try to toe the line and not quite be open w the limitations of vaccines - often suppressing messaging about their limitations - the more those limitations come back to haunt us in the form of loss in confidence across the population in the whole vaccine program.

“Breakthroughs” are common. Spread among vaccinated is common

What is much much less common? Severe disease among vaccinated! This is not common bc vaccines do work.

But let’s not pretend vaccines are doing so well to stop transmission that other efforts are tossed.

Vaccinate-or-test policies assume some level of equivalency in reducing transmission.

The two strategies are complimentary and should be used together when the goal is to both cut disease (vaccine) and greatly limit spread (test before entering)

This is a very nice study that shows that vax have limited ability to stop transmission

Among positive index cases, vaccination among the index cases had no measurable benefot to reduce transmission to household contacts vs unvaccinated index cases

There was however some measurable benefit for contacts of being vaccinated vs not, when exposed. The secondary attack rate was 38% among unvax’d contacts and 25% among vax’d.

So there is some benefit

But calling it rare is a symptom of scientific censorship in my view

A bit more information in a different thread regarding transmission is here:

This is a really nice breakdown of that @TheLancetInfDis paper referenced above in this thread by @jeremyfaust…

I agree with most of it. Though I less confident that a more rapid clearance of RNA is actually having a substantial benefit

Worth the read!

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More from @michaelmina_lab

28 Oct

This new piece in @nytimes shows great benefits of vax to reduce disease

BUT the evaluation of Vax to reduce cases (ie: 6x higher cases in unvax’d) relies on data that is fundamentally flawed by the @CDCgov’s policies - to not test if vax’d

If we have a National test policy that differs by vaccination status - such that the CDC put out stating to not test once vaccinated, then regardless of the biology, policy will drive detected cases down among vaccinated, regardless of whether they are truly lower.

This immediately makes interpretation of reported cases between the two groups uninterpretable.

Instead, what we need in the US is a robust mechanism to do ongoing random surveillance testing to actually identify vax effects to cut virus acquisition and transmission

Read 11 tweets
21 Oct

Remarkably IMPORTANT letter from Senator Durbin - Majority whip - urging FDA to recognize testing for PUBLIC HEALTH as distinct from medical diagnosis & rapid Ag tests should not be compared to PCR for EUA, but rather another rapid Ag test

Why is this important?

Because the US still is in need of greater access to inexpensive rapid tests

One of the main barriers preventing Americans from accessing many high quality tests used successfully around the world is a high regulatory burden for public health tests

The regulation of these tests by the FDA is 100% appropriate for MEDICAL devices used by doctors to diagnose individuals.

But for Public health tests, we need regulation that focuses on what these tests are meant to do. Answer the question "Am I Infectious Right Now?"

Read 5 tweets
6 Oct
THREAD: Some thoughts on this White House Report on Testing...


The extra $1B towards purchasing rapid tests is a great step forward. It is a strong signal that the WH and the Federal government is recognizing that American's are demanding to be able to know if they are infectious in real time.

So I'm fully supportive of the WH support

A question was just asked to @CDCDirector about whether roll out of rapid tests will limit the public health reporting

This is an important question and a good reason the federal government should simultaneously prop up efforts to make these tests verifiable and reported.

Read 7 tweets
6 Oct
HUGE News!

White House finally recognizing crucial need for rapid tests as we get through this most recent wave of COVID (& after 700K lives lost)

This is good news & a show of support for public health from the White House and the FDA


We Should be careful to take this in stride. We've seen similar announcements in the past. FDA press release, media attention, WH remarks and then little to no change.

The FDA EUA for ACON rapid tests is a terrific step forward!!

But is it enough...?
I would argue that it is not enough. There are many many many very high quality tests out in the world that simply do not exist in the US market bc of the approach we take to regulating these tests.

As I've mentioned in the past...

Read 8 tweets
1 Oct
1/ Thread

While vaccines are most effective tool to protect us all from severe disease

#RapidTests answering “Am I Infectious Now?” are an answer to society *living* with Covid-19

New @NYTOpinion @nytimes by me and Steven Philips @TheCOVIDCollab…
@nytopinion @nytimes @TheCOVIDCollab 2/

FINALLY Americans are seeing the value of at-home rapid tests, and demanding them to help keep their families, friends, neighbors safe and schools and businesses running.

But now the US govt needs to make more highly accurate rapid tests available to meet that demand.
@nytopinion @nytimes @TheCOVIDCollab 3/

In many parts of world, rapid testing is commonplace. Policymakers recognized early that rapid tests could blunt the pandemic by scuttling transmission chains. They created special regulatory pathways to evaluate these tests, quickly & effectively….
Read 11 tweets
24 Sep
Thread On tests and the media

It is almost universal that any piece discussing Rapid Ag tests says “PCR is more accurate but…”

But even this isn’t true. It simply depends what you want to detect.

If wanting to identify ppl who are contagious, PCR is much less accurate.

If your goal is to detect ppl are infectious, a rapid Ag test is highly sensitive AND specific for this.

PCR is not specific for this. It will read positive even when not infectious. So… it’s less accurate for the public health question at hand “am I infectious”

You might say… well PCR is much more sensitive. But even that is not true. A bit more, yes, but if wanting to catch infectious ppl, it’s really but that much more sensitive and, if that’s your goal, then PCR is massively LESS effective than a rapid test.

Read 7 tweets

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