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?

Folks have been asking me which of the currently available UK #COVID vaccines are best, given that an older flavour, "KP2" is being given free on the NHS to the twelve or so people that remain eligible (😜🙄), whilst the newer "LP8.1" is available privately...

I'll do my best... First, the scenario remains dominated by viruses (and so vaccines) from the same branch of SARS2 that's been around for more than two years now, namely BA.2.86, and it's more infamous spawn, JN.1.

Excellent summary of this here from Marc @SolidEvidence

https://x.com/SolidEvidence/status/1957206448267833463?t=rtC-IGaXLKDycU_F0VYTag&s=19

The culling and replacement of #ACIP at RFK's behest is shocking, sure.
However, what we absolutely MUST NOT forget is that the long-term aim of this 💩 is to normalise the adoption of fringe, politically driven "scientific views" into mainstream policy, now and in the future. Now, I'm not saying that all the appointees are culpable, but I suspect you know the ones I'm talking about.
Ever since SARS2 emerged, there has been a groundswell of supposedly "legitimate" scientists given platforms to sabotage public health, vaccines, therapeutics, and policy.

@RajeevJayadevan @CoronaHeadsUp @gwladwr @red_loeb @PJeffcock Rajeev. SARS2 waves are still driven almost entirely by virus evolution with very little influence from extraneous factors. Hence, it remains unpredictable, not cyclical.
The dynamics between viral variation and immunity dictate the scale of epidemic waves as well as severity. @RajeevJayadevan @CoronaHeadsUp @gwladwr @red_loeb @PJeffcock Yes, the individual risk of severe acute COVID has been dramatically reduced by vaccines, but this scales by prevalence at population level. E.g. ~12-13K certificated deaths in the UK during 2024, ~60% as underlying.
The other issue is morbidity. #LongCovid & latent sequelae.

At the risk of sounding like a broken record...

1. Lockdown is an extreme response. There should only have been one.
2. The fact that there was >1 is due to policy failure and meddling from eejit GBD types, PRE-VACCINE🤬💔
3. Kids are NOT invulnerable.

thetimes.com/article/5a939c… 4. Failures to act quickly, unlocking too soon, and lack of mitigations set in place just continued the roller coaster ride.
5. Restrictions highlighted and exacerbated preexisting inequalities. As @covidinquiryuk shows, #Austerity, #Brexshit
6. "Key workers" faced higher risks.

OK, I have a busy day, but I've been asked about why I've criticised the GBD, antivax rhetoric etc...

First, re vaccines, see my 📌. TLDR, they're not perfect, no medicine is, but lies about modifying our DNA, mass cardiovascular problems, graphene, pharma/WEF/Gates plots are 💩 On to GBD itself...and I must be brief, you could write an essay.
Amongst its many flaws, the GBD would never work because:
1. When you segregate society, bad things happen.
2. Vulnerable people have just as much right to a life as anyone else & already put up with too much.

I'm still curious to understand what the "bespoke model" involves.

What THIS involves is an even narrower offer for free vaccines in the UK.

This is a striking difference to the US (for now 😬), which offers KP2 mRNA for all >6m.

TLDR, false economy🧵

gov.uk/government/pub… I'm not going to go into details, mainly cos it makes me so angry to sit reading it for any length of time.

Also, the bespoke model leaves me dumbfounded. What follows are generalisations, mainly because this is basically an iteration of the 23 model, where this attrition began.

We have a very safe, efficacious paediatric SARS2 mRNA vax, used 6m+.
Reduced dose and age minimises small risk of myocarditis seen in adolescents.
This sobering study by @katebrown220, @chrischirp et al shows 6m+ kids are always at risk from acute COVID.

https://x.com/chrischirp/status/1847649507321786645?t=jUmOUIwiTZ648e0n5ylVXg&s=19

Maternal antibodies should help protect newborns during the first 6m of life, but this is optimal when mums are vaxd during pregnancy. Sadly, this only happens if your term coincides with a booster campaign 🙄, which is just plain daft. Highlighted many times by @VikiLovesFACS

Sorry, looooong thread, but hopefully done soon!
Where was I?
So, let's say the small elite team of virus particles has survived the journey and landed where they want to be...
First, they will encounter innate barriers, eg mucus, which they must cross to physically reach a cell. There will also be complement, mucosal antibodies (if host is immune), and these can both inactivate and clump viruses together such that phagocytic cells literally eat them up!
So, many of the hurdles from the way out also hit on the way in, and this time, numbers are limiting.

Lots of good debate about virus transmission, yet it's dwarfed by mis/disinformation and lack of nuance, allowing eejits to dismiss the precautionary principle, or, worse, re-run 1980s bigotted attitudes🤬
Viruses don't fit easily into boxes. So, nuances of transmission, a 🧵 I will focus on the example of airborne transmission, but the underlying principles apply to all modes of infection.

Caveat: I research the start/end of the transmission process, but the middle bit is not my forte, so forgive omissions/errors!🙏
See @ukhadds for added nuance!

🚨Anti-vaxxers are twisting a study into mRNA armageddon.

TLDR, all this study says is IF certain groups experienced an adverse event COINCIDENT with vax, then it was more likely to be myocarditis than if taking a different drug🤦‍♂️

We already know this🙄

pubmed.ncbi.nlm.nih.gov/39103148/ It's behind a pay wall, so will keep brief to save anyone having to read it to stave off the various nutters quoting bizarrely inflated risks of death etc...#LiedSuddenly

Expect it may feature in certain press and on a "patriotic" news channel before long 😉

Some issues here...putting it mildly.
1. These are NOT the only high-risk groups. @CDCgov recommend >50s and children as a minimum.
2. This is an influenza strategy, we are NOT in the same place with SARS2 by a country mile.
3. Vax status by age is worrying, 1/3 u40s no vax 😬

https://twitter.com/UKHSA/status/1819304906236293350

4. % of kids u12 vaxd was only ~10% in 22/23 b4 offer was stopped...
5. We age, folks die, and are born. The % population covered by the emergency programme is therefore dwindling across all ages.
6. Yes, our protection vs severe COVID lasts way longer than vs infection, but...

So, the bugs that put me in hospital recently were multi-resistant E. coli. No oral antibiotics would work, so I was on IV for 8 days; 2nd line was looking challenging had the infection not responded.

#AMR isn't a new problem, but the can is continuously kicked down the road...

https://twitter.com/UKHSA/status/1789951634354667865

It's not the same as a pandemic, so I'm not sure about that comparison.
BUT folks need to be reminded that, pre-penicillin and other abx, any wound or infection could be life threatening.
#AMR is via part over-use, part misuse, part inadequate investment into R&D.

Elsewhere in the multiverse there's a reality where the next pandemic threat is under control.
Here, governments recognised that it was their moral duty to ensure that the suffering and pain of those affected, both directly and indirectly, mattered more than the prior status quo. They rectified #NHS disinvestment and "built back better" to ensure healthcare remained free at the point of care.

They genuinely addressed socio-economic inequality & inequity, channelling sufficient investment to actually "level up" deprived areas, independent of train tracks.

I'm experiencing an acute reminder of pretty much THE major principle of infectious disease pathology...

Namely: disease results from an imbalance between pathogen, host response (immunity and repair), and environment/niche.

Any skewed aspect of this triangle causes pathology. For most instances, the balance is quickly restored; we don't suffer severe disease, even upon 1st exposure to a pathogen, because our immunity is so proficient.

But, otherwise "mild" pathogens can become pretty fearsome, for example, when immunity or underlying health is low...

Spoke to someone from @moderna_tx this week at a conference.
Weirdly, SARS2 vaccines came up!

I was told that 3 separate new large-scale syntheses were prepped last Yr, with only one (XBB) eventually used. These are $bn processes.
Hence, vax sales need to recoup this outlay... This isn't anything sinister on the company's part, far from it - it's an entirely sensible & precautionary approach given the current situation.
As I've mentioned once or twice b4😉, we are still playing catch up when it comes to SARS2 evolution, both the skips and the Jumps!

SARS2 - HG2 or 3?
Some definitions...
ACDP HG2: "can cause disease and may be a hazard to employees. In normal usage they are unlikely to spread to the community and there is usually an effective prophylaxis or treatment available"
e.g. seasonal influenza, measles, herpesviruses ACDP HG3: "can cause severe human disease and may be a hazard to employees. The organism may spread to the community but there is usually an effective prophylaxis or treatment available"
e.g. HCV*, HIV, SARS-CoV1/2, MERS-CoV.
Local BSL3 SOP governs containment & waste disposal.

It's important to remember what's needed as a long-term solution to #COVID and future pandemics.
#VaccinesPlus requires population-scale mitigations, built around a core of broad vax coverage.
Suppression of prevalence is key to reduce exposure, risk to #CEV, and SARS2 evolution. Continued development and access to antivirals, ideally as drug combinations, will blunt the impact whilst we strive for this, increasing pandemic preparedness.
However, prevention always beats cure.
There MUST be Govt recognition and appropriate measures vs aerosol transmission.

OK, joking aside, what does this 💩 mean?
This has vast implications for health, wealth, and wellbeing, IMHO.
Money first, with my vast economic expertise...🤪
So, from a brief web search, there's just shy of 6M people in the UK over 75.
~3.5M CV/CEV, plus others ≈ 10M eligible?

https://twitter.com/SGriffin_Lab/status/1755339391851983063

I'm sure @jneill @chrischirp @Kit_Yates_Maths @Dr_D_Robertson @_CatintheHat etc will correct my numbers!
So, old vax price of ~£10, new price £25 😕...so either £100M or £250M...NOT cheap, plus need to buy/maintain stocks, including mRNA cold chains etc, and task NHS onto it...

...oops, I seem to have hit 25 tweets already! I will get to the point...
1. Well, initially, the paucity of antivirals means combinations aren't possible, fair enough.
2. When a drug 1st gets approved, of course it will be expensive, pharma Co's are BUSINESSES, this is catch 22 3. "We", as in most western govts, rely upon pharma to develop and trial drugs b4. This takes £bns, so don't be surprised that companies want to recoup their investment and then make a profit. Without getting political, welcome to capitalism!
Hence, must stop #NHSprivatisation

It was presumed in 2020 that we'd only be able to repurpose therapeutics.
Great 4 immunomodulators, but mispurposing of HCQ, IVM cost lives, still does.
Now, with 3 protease, two polymerase, M'abs (more needed), ACE blockers...

WHERE R THE COMBO TRIALS?!

nature.com/articles/d4158… Several drugs may yet have their NICE recommendations withdrawn, appeals in progress, but this is based upon MONOTHERAPIES🤦‍♂️
You can only get away with this for so long, esp if you dramatically expand single drug treatments 4 a ridiculously variable virus...as in some countries.