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Michael Lin, MD PhD 🧬 Profile picture
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Mar 15 • 7 tweets • 3 min read
Great news for SA. They relied heavily on J&J and provide much knowledge about J&J's lower efficacy vs other vaccines. They've now joined most of the world in recommending 2 boosters after J&J.

Meanwhile the USA is still stuck on 1 booster only for JnJers.
And despite having been one of J&J's most vocal supporters, South Africa's health ministry is allowing heterologous boosting. That heterologous boosting works better than homologous boosting for J&J is now common knowledge.
In case we needed another reminder, a paper just came out last week (one I had analyzed as a preprint) showing J&J + 1xPfizer was much better than J&J + J&J, and similar to 2xPfizer, finally
sciencedirect.com/science/articl…
And regarding CDC data that JnJers in the US got Omicron at lower frequency than RNA recipients: such data are uninterpretable without splitting the groups by history of COVID and boosters. AFAIK boosted/infected/unboosted/naive were all grouped together.
It's exceedingly unlikely that unboosted uninfected 1xJ&J can more effective than unboosted uninfected 2xRNA vs Omicron because all the evidence is their nAbs are far lower. I covered this earlier
And in the controlled setting of monkey studies, a J&J booster clearly produces lower anti-Omicron Abs than a RNA booster, when added to either a 1xJ&J or 2xRNA primary series.

Thus serology predicts J&J blocks Omicron infection worse than RNA per dose

biorxiv.org/content/10.110…
Not to mention, as we knew, that JNJ x1 (Ad26 here) as an initial "vaccine" is far inferior in anti-Omicron antibodies to RNA x2 (BNT2x here), regardless of whether you boost with another RNA or a JNJ dose later.

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More from @michaelzlin

Michael Lin, MD PhD 🧬 Profile picture
Mar 14
In a recent thread, I analyzed Novavax vax data and hypothesized it might elicit broader antibodies than the RNA vaccines and thus be more protective vs. variants.

Now we'll explore differences between Novavax and RNA vaccines that could account for this

Novavax is S protein assembled with lipids in viral-like nanoparticles. These are taken up by APCs (DCs, macrophages), and S fragments presented on MHC2 to activate CD4+ T cells. B cells with surface Ig recognizing S and coactivation by CD4+ T cells via MHC2 then get expanded.
RNA vax deliver RNA to cells to express S. Some cells die with S at the ER-Golgi and surface. S-containing membranes are digested by APCs and S fragments presented on MHC2 to activate CD4+ T cells. B cells bind S on cells to get their 1st signal.
(Pic: doi.org/10.1038/s41541…)
Read 15 tweets
Michael Lin, MD PhD 🧬 Profile picture
Mar 8
Huge issue with Test2Treat is it's unknown if antiviral drugs is any use for vaxxed or previously infected, which is 90% of everyone now.

But Test2Treat is advertised as if for everyone. That encourages bad medicine. Topol should be against, not for, it.

washingtonpost.com/health/2022/03…
As I've said before, antivirals are merited in vaxxed cases of high-risk conditions or advanced age, who have more severe and longer-lasting breakthroughs. But this program is being promoted without those qualifications (they're not mentioned in the article for example)
About Topol's concerns that supply won't meet demand: would certainly be a problem if a bunch of people who didn't need it demanded it and answered questionnaires in a way to get it.

Thus worried by govt pushing this without better education. Could create unneeded run on drugs.
Read 5 tweets
Michael Lin, MD PhD 🧬 Profile picture
Mar 7
HK saw 1 in 23 people get COVID19 in the last 2 weeks. Death rates are higher than they were at the peak of the pandemic in Italy, when COVID19 decimated the elderly population. How can this be?

Two words: Vaccine hesitancy
It's not the case rate that's the problem but the death rate. New Zealand has a similar case rate over the same period of time, but so far almost undetectable deaths.
The problem is a simple one: In HK, "at the start of this year, just 25% of people age 80 or over had been vaccinated." That's amazingly bad.

In NZ, it's >90%.

The reason was widespread word-of-mouth fears about vaccine side effects among the elderly.

cnn.com/2022/03/05/asi…
Read 5 tweets
Michael Lin, MD PhD 🧬 Profile picture
Mar 4
Not surprised that FDA rejected the inactivated vaccine Covaxin (produced by Bharat, marketed by Ocugen) for 2-18yo. Bharat-Ocugen presented data that their vaccine produced higher antibody levels than adults, and applied for EUA based on that:
ir.ocugen.com/news-releases/…
The data were only collected in late 2021. Impressive Ocugen was able to complete a EUA application so quickly, but they apparently did so without feedback from FDA as to the sufficiency of the data (or ignored such feedback). Data are below
medrxiv.org/content/10.110…
The problem is that among 2-5yo, whom we don't have a vaccine for, we don't know the relationship between antibody titers and VE in terms of protection from infection or symptomatic cases, at least not publicly. The only people measuring those outcomes are Pfizer and Moderna.
Read 10 tweets
Michael Lin, MD PhD 🧬 Profile picture
Mar 3
Not a big fan of test-to-treat. It just codifies what HCWs should do anyway. Plus it gives in to expensive pills and gives up on the more efficacious vaccines.

Disappointing when 35% = 115M are still not fully vaxxed.

usafacts.org/visualizations… Image
Since certain internet trolls like to ask me about COIs when I talk about pills, I'm developing protease inhibitors that function similarly to Paxlovid, the drug Biden mentioned (and we had ours first, so we're not copying Pfizer). But I tend to call things as I see it.
Vaccination prevents hospitalizations by ~90%, the same as Paxlovid, and you can carry that benefit with you 24/7; you don't need to run to get tested with every sniffle.
Read 9 tweets
Michael Lin, MD PhD 🧬 Profile picture
Mar 2
Started tweeting to discuss protein engineering and biosensor development. Interrupted by COVID, an unexpected societal threat that called upon scientists to address. COVID tweets now interrupted by an even more urgent threat, one that we all must learn about and assess.
There's a role for everyone in educating themselves using knowledgeable sources, people with a track record of honesty and accuracy, and rejecting the biased or bought ones. Then we can move forward as a society to support the right policies. Equally true for Ukraine and COVID19.
Unfortunately it looks like both issues are going to be with us for a while, so I'll have to continue tweeting about COVID19. It means no disrespect to Ukraine even though Ukraine is the more immediate and tragic issue.
Read 6 tweets

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