Jonathan Ball Profile picture
Feb 9 16 tweets 3 min read
I don't know why I (and many colleagues) have to keep saying this but #COVID19 vaccines do not prevent infection and therefore do not prevent emergence of variants. Sub-sterilising immunity through infection or vaccination will drive emergence of variants.
Please don't use this line of argument to underpin vaccine equity statements. Vaccine equity is important. Very important. But it should not be argued that fairer vaccine access will protect the world from future infections or variants.
It is possible to generate sterilising immunity but incredibly difficult to maintain. Therefore, we need to accept that infections will continue in future, variants may well emerge.
Current vaccines won't prevent this. BUT they do prevent disease...
The tweet above should be read in context of related tweets about vaccine inequities and emergence of variants.
We know that some vaccines may generate sterilising immunity and prevent immunity. But for existing covid vaccines there is a body of evidence to show that reinfections can occur in a significant proportion of people, and this is most likely due to waning levels of circulating Ab
I.e., the ability to provide sterilising immunity is short-lived. That doesn't mean you are not immune from disease. Your memory population will protect you BUT it will take a few days to kick in.
During that interval the virus will replicate. As antibody levels rise, that replication will occur in the face of rising antibody (and cellular) immunity. This is true for immunity through natural infection or vaccination.
If some of the mutations provide antibody escape and that virus is transmitted to someone else lacking sterilising immunity but has some immunity then that will favour that variant.
Other variants will arise in immunocompromised people, possibly during long-term infection. It is unlikely that vaccines will long-term prevent this from happening
Is sterilising immunity possible. We saw it in many people after vaccines were rolled out. But long-term? Maybe, especially if the virus hasn't mutated.
So maybe emergence of vaccine escape variants can be controlled by vaccinating the global population. Yes, so long as everyone receives sufficient vaccine to provide sterilising immunity and we don't have partially immune populations to incubate variants.
We think 2 doses gave reasonable levels of sterilising immunity for a few months after second dose. So if we had suppressed virus spread in every country, whilst we rolled out and administered two doses of vaccine to nearly every living person in the world...
(or ~75% of the population if R0=3) then it was achievable. But was this feasible? I would argue that targeting vulnerable people to protect against disease would be more achievable.
So was providing boosters to less vulnerable people during the UK omicron wave a waste of time. I'm sure it reduced some infection and transmission, but we don't know how much - reduction in symptomatic infection was ~75%.
But I was a big fan of boosting vulnerable people. I was less certain about all adults and probably still am...
Other views always to be found on twitter...

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More from @JonathanKBall

Feb 9
I posted a comment earlier about #covid19 #vaccines, #SterilisingImmunity and emergence of #variants and it's been pointed out to me (@bealelab @SwaledaleMutton et al.) that some of the points, well the header really, isn't factually correct and/or could be used mischievously.
Therefore I will append a clarification that my comments were able the status quo and covid vaccines alone and any other points I thought relevant to ensure my musing can't be misconstrued. The overall point about global vaccine inequities and emergence of variants remains, but
My comments hopefully can't be taken out of context and used nefariously by others with an anti-vaaxx agenda or similar. I have always been and remain a staunch believe proponent for vaccines. However, we need to understand what they do.
Read 5 tweets
Feb 9
So, to expand further. The programme (ably assembled by @BBCFergusWalsh) highlighted issues of global vaccine inequity. This is undoubtedly a major challenge and will continue to be so.
However, we need to adopt a new model of production and distribution. As the programme wonderfully illustrates. GMP manufacturing capability is incredibly imbalanced, with a few places (like US, UK, Europe, China, India) having the lion's share.
This means that too many low- and middle-income countries are reliant on those places 'doing the right thing' and providing equitable access. But there is a different way.
'Teach me to fish and I will eat for a lifetime...'
Read 8 tweets
Feb 8
It's great to see that the important role of #technicians in teaching and research is being acknowledged and that measures and policy are being put in play to support them into the future.
However, I still think that research councils, universities and research institutions are still ignoring the elephant in the room that is the thousands or short-term contracted research staff, without whom UK research really wood collapse...
Career pathways for these guys really hasn't changed throughout my career, and it really needs to. Even permanency of employment rules don't seem to have teeth, as their roles are still all-too-often tied to duration of research grants...
Read 4 tweets
Apr 9, 2021
Didnt get chance to answer a great Q on @sarahjulianotts show on @BBCNottingham about having #COVID19 #vaccine the starting #immunotherapy. If the therapy is designed to dampen down your immunity, then it might reduce the overall level of immunity that the vaccine produces.
But in this case, the therapy will start 14 days after vaccine, by which time immunity has often peaked (with Pfizer, maybe slight increase with AZ after this time). Therefore, the therapy will have very little, if any, impact.
And if you are currently on immunotherapy, then the vaccine committee have not precluded you from having the vaccine. Even if the overall response is reduced, I think in most people it will still offer some protection. Worried or unsure - ask your clinical orvaccination team👍
Read 5 tweets
Sep 2, 2020
@Psynian 1/n
Not sure I align to his views.
The virus is mutating, there is evidence/suggestion that some of those might change virus behaviour. There’s a spike change (amino acid 614) that increases infectivity of virus when grown in the lab.
@Psynian 2/n
But we don’t know if this increases infectivity, disease severity or transmissibility in humans.
@Psynian 3/n
There’s also a deletion that removes one of the non-structural genes (ORF8), which is thought to down regulate antigen presentation.
nature.com/articles/s4157…
Read 11 tweets
May 17, 2020
Thanks to @JanetDaly5 for flagging this. First animal data from #chadox1 #SARSCoV2 vaccine. Not sterilising immunity, but reduced viral load and pathogenesis, with half dose, BUT very quick challenge 4 week. (recall questioning this previously):
biorxiv.org/content/10.110…
1/n
worth considering these data in detail; and what they might or might not mean
2/n
Firstly, the challenge dose. This was a relatively large amount of virus, BUT for people exposed to virus for considerable periods of time and/or large amounts (household member or healthcare worker) then protection against higher viral load exposure is relevant.
Read 8 tweets

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