1/ This @WSJ column implying vaccines fuel bad new variants such as #XBB.1.5 cries out for a re-analysis. I'm not talking about my own competing view but one informed by conversations with the A-team on evolution: @roby_bhatt @LubanLab and @jbloom_lab wsj.com/articles/are-v…
2/ It's correct that the main selective pressure driving evolution of the virus is our immunity, and the only variants to spread now will be ones that can get past it.....
3/ But if not for vaccines the virus would evolve to evade infection-induced immunity. Worldwide, infection-induced immunity is probably a bigger driver than vaccine-induced immunity
4/ The fact that XBB.1.5 was first detected in one of the most vaccinated parts of the world(northeastern US) isn't an indictment of vaccines because the immune evasion started with the ancestor, XBB, which emerged outside the US.
5/ The edge that's helping XBB.1.5 to spread is increased transmissibility. The @WSJ also cites a Cleveland Clinic preprint showing that the rate of + tests among healthcare workers increased with number of boosters...medrxiv.org/content/10.110…
6/That's worth a closer look, but it might be that those who got more boosters were also more conscientious and likely to test more often. Tests and boosters were both optional.
7/ The studies presented in the piece are worth considering, but they don't support a conclusion that vaccines are fueling new variants. They do pose serious questions about whether/how much boosters prevent infection and whether booster mandates make sense in the XBB.1.5 era..
8/ I'll explain this in more detail in my XBB.1.5 update tomorrow in @opinion.
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