Thread by @SGriffin_Lab

I've never really understood the logic of "targeted vaccination".

Of course, money is a huge issue and we seek to get the most out of every £ spent.

Of course COVID and flu waves would be far worse without it.

But, what doesn't sit well for me is the following...

1. Clearly, we don't cover enough of the susceptible population to prevent peaks of hospitalisation, serious illness, and death. Annually for flu, and until 2025, multiple times a year for SARS2. This doesn't mean stop, it means, logically, we must vaccinate MUCH MORE, surely?

2. Uptake in older groups is usually much better than in younger, "vulnerable" populations or frontline staff, but all are declining.

Messaging is a HUGE factor.

Weirdly, if you spend all year minimising SARS2, and use flu to do so, your "seasonal" vax campaigns struggle 🙄

3. Vax 4 vulnerable groups is vital, but they're also the folks that are least likely to make an ideal response.
This means that the lesser aspects of vax efficacy, e.g. reduced transmission, are going to struggle to make an impact.
We then measure VE, and find it to be poor...🤦‍♂️

4. Following on, without vaccinating more widely, we further erode the vaccine responses in the protected groups because of a key, oft overlooked, factor.

EXPOSURE TO INFECTION.

Immunity is not absolute, a nice metaphor is wet weather gear in a storm.
But, in a hurricane...

5. It's always struck me that those who favour allowing infection-induced immunity to predominate in a quest for "herd immunity", tend to overlook that an HI threshold has NEVER been achieved without a vaccine.
It's also at best temporary vs variable viruses, hence boosters.

N.B. HI is defined as the threshold of immune individuals in a population above which introduction of an infection de novo results in R<1, i.e. self limiting outbreak.
Population immunity is a better term to describe the complex mix of protection we all develop, ideally via vax.

6. There's also the myth that "only the vulnerable/elderly" succumb to serious disease courses following infection.
Multiple genetic factors and underlying conditions dictate the course of COVID and flu. Yes, a good memory response can compensate for much of this, but not all...

7. Children encapsulate many of the myths around vax for flu and SARS2.
Common perception, propagated I must say by some who should know better, includes their apparent invulnerability, only vaxing to reduce transmission, etc.
However, flu, SARS2, RSV, & many of our "seasonal"...

viruses pose unacceptable risks for kids. The issue is that a) we compare to adults, and b) we don't have vax for most of them! However, we do for the big 3, and we should use these excellent tools. Why?
First, there's a U/V-shaped age vs risk. 6m - 5yr are high-risk, simple.

Young babies are protected by maternal antibodies, hence PREGNANT WOMEN SHOULD BE ELIGIBLE DUE TO THIS, IN ADDITION TO DIRECT RISKS TO BOTH MOTHER AND CHILD DURING PREGNANCY.

Did I make that clear enough?

The high risk group involve serious hospitalisations, continuously.

Yes, vaxing kids reduces transmission in the community, IN ADDITION to protecting the kids themselves.
This is a good thing, see "exposure" above.
Some say that vax is higher risk than these viruses...this is just abject bollox.
They NEVER compare vax vs disease for one...

They also use unconfirmed data like yellow cards/VAERS...which explicitly state they aren't usable in this way...
The nasal flu vax has an excellent safety record, as does the juvenile mRNA vax vs SARS2 - the reduced paediatric dose has essentially 0 signal for myocarditis.

If you haven't already seen it, check out this excellent @TheLancet paper on this subject...
thelancet.com/journals/lanch…

N.B. when we discuss vax safety, we are of course discussing population effects. This should not discount those individuals that make severe adverse reactions to vaccines, and much more clinical AND societal support is needed, the latter to stop antivaxers preying upon them...

8. Many take a fatalistic view that more simply cannot be done, and that vax en masse isn't cost effective.
My response here is, yes, it can, especially when combined with infection-resilient environments #VaccinesPlus
"Normal" just isn't good enough...

independentsage.substack.com/p/just-the-flu…

In terms of cost vs benefit, well, I think there needs to be a serious rethink in this regard to incorporate societal, clinical, financial impacts in the short AND long term.
Current models focus on preventing acute hospitalisation, which is vital...
But what about other stuff?

It struck me that the most welcome rollout of the chicken pox vaccine for kids was partly justified by parent/carer leave when kids got sick...
Is this applied to other vax? No.
As above, we don't stop these waves. NHS "pressures" have HUGE direct & indirect costs/consequences.

Sick people need care. Whether transient or permanent, it is a huge challenge to regular work.
How many times do hear how many working age folks aren't engaged with/seeking work since 2020?
Perhaps carers? Or, to my next point, do they have preventable long term illness?

9. Long term illness is squarely ignored, to my knowledge, certainly for COVID vax evaluation, and probably for other vaxable viruses that can trigger similar issues.
We don't have the greatest track record re chronic/invisible illness. The Tory conference was a case in point...

Of course #LongCovid isn't the only game in town, but in terms of prevalence, it's a MASSIVE ADDITIONAL HEALTH BURDEN that is MITIGATED BY VACCINES.
"Long flu", one imagines, will be similar...
Millions affected in the UK alone, including 10s of 1000s of kids.
Heartbreaking 💔

How do we rescue the economy from Brexit with this increased health burden? Yes, break down barriers to working, but also perhaps PREVENT ILLNESS IN THE FIRST PLACE?!
How many people and/or families/carers are affected by this? What are the costs to the NHS, society, the economy?

10. In addition to LC, we know that other, latent, sequelae have increased dramatically and continue to do so.
What's the cost for a child needing insulin for life after developing T1D?
Cardiovascular, neurological, metabolic, autoimflammatory problems, all taking their toll...

11. Finally, I'd like to come back to those very vulnerable folks that we seek to protect...the ones who have a vaccine, nothing else, to protect them from disease, and to which they don't respond well and yet face constant exposure to infection...
This is GBD-lite by vaccine.

The rest of society moves on, gathering population immunity by infection, with those awkward costs that no-one ever discusses, yet those #ForgottenLives and @cv_cev don't get anything like "reasonable adjustments" in society, despite all our knowledge.
Shocking, no?
#VaccinesPlus