I'd like to wrap up tweeting about vaccine boosters, because I prefer to provide scientific analysis in on controversial or misunderstood issues, not to repeat what's already known.

And now it's clear that boosters were/are needed and were/are useful.

A mini-thread
There were disparate reasons for anti-booster arguments, making for an odd hodgepodge of forces denying booster efficacy or need across the political spectrum. These included:

1. Denial of booster need/efficacy in the US to signal dediction to health outside the US (sadly...
...in the way it was communicated, some similarities to the playing it down by the former guy)

2. Reluctance by certain political or media favorites (not using the E word here) to be the bearer of inconvenient news, or to change a position formulated before Delta
3. A misunderstanding that people weren't getting vaccinated due to concerns about efficacy when the unvaxxed were predominantly not concerned enough about getting COVID19

4. Shocking lack of understanding of numbers by unfortunately placed FDA officials
5. Apparent forgetting by many commentators that a big reason to vaccinate is to reduce disease incidence and thereby help protect those who haven't yet gotten boosted/vaccinated.
6. Finally your standard anti-vaxxers who happily amplified arguments 1-5.
And so this week we finally have FDA approval and CDC advice to boost everyone, when we could have had this in August when Israel told us exactly what to do and why, and the upper levels of the WH understood. This is nicely discussed here.

So all the debate from poor scientific understanding feeding anti-health politics amounted to an unnecessary 3mo delay and reduced booster acceptance than what could have been achieved by a timely, unified, fact-driven, educational, and honest booster program.
And now the evidence is now abundant that:
1. there is a need in most Western countries as a seasonal surge hits the northern hemisphere and vax rates remain <90%.
2. boosters prevent deaths, and a lot of this is directly
The need is obvious — we're seeing surges in colder-weather states. 60-80% vaccination rates (among all ages) is simply not enough to stop Delta from reaching the unvaxxed or unboosted with its high contagiousness. From today's nytimes below
The efficacy of boosts is obvious too. It was obvious from just serology data, but also from the Israel MOH data in August, or the Israel NEJM paper in September (nejm.org/doi/full/10.10…) or the Pfizer Phase 3 trial in October showing 95% fewer cases in 3 shots vs 2 shots waned.
Most recently we have a Lancet study from Israel in late October comparing 2 shots waned to 3 shots on hosp and death. Boosters reduce those severe events 6-7x. So the claim that the 2 shots protected very well against severe disease even after waning is also now refuted.
I never expected to comment much on vaccines, as I figured it wouldn't be hard for the media to find knowledgeable people to explain them (or at least stop quoting people who are proven wrong). Turned out that didn't always happen, so I did my best to fill the gap.
Now that these questions are getting settled (sadly, by bad scenarios being realized) I hope to return my attention to my actual jobs: molecular engineering, chemical biology, reporter development, and (as SARSCoV2 will remain an major problem of our lifetime) coronavirus drugs.
P.S. Lancet study link: thelancet.com/journals/lance…
P.P.S. Similar confirmation in the US (from none other than Dr. Fauci) that boosters reduce hospitalizations among previously vaccinated
Just when I thought we could put the booster issue behind us. Regardless of their intentions, some doctors need to do a little reading and thinking (or ask someone to explain to them) before issuing their opinions.
As a scientist at a prestigious institution with some rather smart peers, I'd be embarrassed to make such a simple logical mistake as above, and would make sure to double-check myself before posting incorrect interpretations in the future, i.e. I'd learn.
The WH nicely summarized all the data in a succinct slidedeck


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More from @michaelzlin

26 Nov
B.1.1.529 (nu) is bad news. It has an unusually high number of mutations.

And my (and Haseltine's) stated concern about molnupiravir accelerating evolution of SARSCoV2 is being discussed now.

The former makes me even more concerned about the latter.

Merck claims there isn't a higher rate of viral mutations in molnupiravir clinical trial participants. But (1) this logically contradicts its stated mechanism of action and (2) we need to see the data to know the confidence level of this statement
edition.cnn.com/2021/11/23/hea… Image
Specifically, how could molnupiravir (Lagevrio) work by causing mutations in SARSCoV2, but when Merck sequences virus from patients taking molnupiravir they see no higher rate of mutations. Is the drug working or not?
Read 7 tweets
23 Nov
Speaking of motivated reasoning, last clause in pink box is a scientifically dubious interpretation.

Sisonke2 is a trial to give Sisonke1 participants (single-dosed J&J) another J&J dose as booster.
Gets worse after you click through. Really, no safety support? Trial organizers would actually withhold medical treatment if you have issues? I'm sure that's not what they meant, as it would be extremely unethical. So why use threatening words that imply it? Image
It's in reality a bit of a nonissue for safety, as there is *more* data in support of the safety of a Pfizer boost for J&J than of a J&J boost for J&J. So bringing it up is not scientifically valid either, and it seems to brought up only as a way to scare people away from Pfizer.
Read 4 tweets
23 Nov
One could say the ability to adapt one's beliefs in response to new evidence is 1 of 2 essential characteristics of a scientific mindset. The other one is the ability to use theory to formulate new hypotheses.
If you then think experts should have a scientific mindset (and I'd suggest you should, or you'd just have someone who's only right when they're lucky, and wrong other times), then you'd want your experts to change their position when presented with evidence that contradicts it.
Interestingly using theory to back a hypothesis and adapting beliefs to data are in tension: if you hold on to an incomplete/outdated theory too strongly, you can fail to accept new data. This is indeed a major contributing factor to scientific debate.
Read 6 tweets
5 Nov
Pfizer revealed great results for their COVID19 drug: prevention of 89% of hospitalizations if taken within 3 days of symptoms (85% if 5 days). I think you've all heard by now.

The drug blocks the coronavirus protease. As some of you know, my lab works on the same thing...
and in fact we have been testing the Pfizer drug (PF-07321332) in the lab, because it differs from our own previously revealed SARSCoV2 protease inhibitor (from September 2000) by only a few atoms, so we synthesized PF-07321332 as well.

Knowing Pfizer's compound (now called Paxlovid) works so well and was zipping through clinical trials (helps when you have $billions), we have been working on making even better protease inhibitors, hence our silence since September 2000.
Read 72 tweets
25 Oct
We can compare the UK experience to other similar countries to understand the role of public health rules in limiting disease.

Here I choose the Netherlands for comparison since it is close geographically, has similar vaccine rates, and had an initial Delta surge of similar size
As apparent from the graph above, UK doesn't come out too well. But first let's establish the conditions. Vaccination rates are similar between UK and Netherlands
Age structure is similar with the Netherlands having slightly more people in age segments >50yo
Read 22 tweets
23 Oct
Pfizer's application for the vaccine for 5-11yo is progressing well.

FDA analysis identifies no red flags.

VRBPAC meeting Tuesday to discuss risk/benefit ratio. Much will depend on the value of case suppression which I think should be considered in context of schools and families. Meeting materials at link below

Trial was too small (n ~ 1500 in vaccine group) to see myocarditis. FDA estimated benefits vs risks assuming MC rate similar to 12-17yo getting 30ug (maybe overestimate; 5-11yo get 10ug).
Read 6 tweets

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