(iv) Durability of immunological protection against COVID-19 is still unknown for each of these vaccines.
(v) The J&J 1-dose does quite well against the SA variant. That's a big deal! In contrast, the AstraZeneca vaccine appears to have almost no efficacy against that variant (~10% efficacy in confirmed cases).
(vi) Lastly, the J&J vaccine had substantial increases in neutralizing antibodies after two doses (T cells were not reported post-boost). nejm.org/doi/full/10.10…
The J&J COVID-19 1-dose vaccine data have been filed with the FDA and are under review there (probably final decision tomorrow).
Here are my thoughts on the J&J 1-dose COVID-19 vaccine, now that the data are public.🧵
(Janssen=J&J = Johnson & Johnson) Vaccine name: Ad26.COV2.S
Executive summary:
🔵 1-dose. Very convenient! And easy to store.
🔵 Essentially 100% protective against death or hospitalization. Very good!
🔵 69% protection against symptomatic COVID-19. Just ok.
🔵 Similar protection against the South Africa variant (72%-->64%). Very good!
The FDA EUA package data are consistent with the statements in the J&J vaccine press release several weeks ago.
Obviously I can only speculate for now. Actually, let's be really clear:
SPECULATION
IF there is an effect of COVID vaccines on long COVID (I don't want anyone to have unrealistic hopes without there being data from a well-designed clinical study!), the simplest options are:
1. The strength of the vaccine immunization serves to reset a homeostatic baseline to the immune system.
Not only was a positive signal seen in 97% of vaccinated people, the signal was fantastically strong!
As noted by Bill Schief in his talk, this is probably the first vaccine trial to succeed in confirming its intended mechanistic hypothesis. A big moment for germline targeting vaccine design strategies!
In a new pre-print by the excellent @McGuire_Lab , they report a big jump in neutralizing antibodies after a single COVID RNA vaccine immunization (Pfizer or Moderna).
Penny Moore and Alex Sigal and colleagues now report on antibodies from AZ ChAdOx vaccinated people, and there was a dramatic loss of function against the B1351 variant. It appears to be more than a 20x reduction. A complete loss of neutralization in most individuals (~80%).
First, what to think of the antibody neutralization loss?
It is much steeper than reported by multiple groups elsewhere for COVID19 cases or other COVID vaccines. Multiple labs reported ~2x drop in neutralization of B1351 or related virus, with antibodies from vaccinated people
I am a big fan of this COVID immunity paper from @Anto_Berto . This was the first paper to longitudinally track viral loads AND virus-specific T cells in COVID patients quantitatively in the same study, from early time points. 🧵
SIX successful COVID-19 vaccines! SIX! Three just in the past week! Extraordinary. The newest one is the Russian (Rus) adenoviral (Ad) vector COVID vaccine. The clinical trial data look really good at face value. 🧵
What about vaccinating people who have already had COVID? I get this question a lot. New answers now! 🧵 nytimes.com/2021/02/01/hea…
Excellent and rapid work to find that, for people who have previously had COVID, one COVID vaccine dose gives a bigger antibody response than seen in COVID-negative people receiving a normal two dose COVID vaccine regimen.
One study by Viviana Simon & @florian_krammer and colleagues. And an independent stduy by Sajadi and colleagues in Maryland.
2/ That includes USA, Latin Amer, and South Africa study sites. It will be important to see more data, because the initial press release was definitely thin on data. But, initial report 72% efficacy against "moderate to severe" disease. That is good for a single dose immunization
3/ The J&J COVID-19 vaccine generated good immune responses in people after one immunization, but there was a substantial boost to the antibody response after a 2nd immunization. A 4x gain. (T cell responses after the 2nd dose were not reported) nejm.org/doi/10.1056/NE…
1/ Novavax UK first:
~90% protection again any symptomatic COVID-19. And that high level of protection was accomplished under conditions of very intense community transmission in the UK, which is a high bar. 1/n bit.ly/3oEpann
2/ (i.e., most likely a higher bar for protection than USA summer transmission, or anywhere with low level SARS2 transmission). And that was under conditions of high prevalence of the "UK variant" (B117), which is significantly more transmissible than the parental SARS2 strain.
3/ The Novavax vaccine was quite protective against both the parental strain and the UK variant, which is welcome news.
1/ Here's my review on adaptive immunity to COVID-19 and SARS-CoV-2. I hope you find it useful. It was a lot of work. Thanks to Prof Alex Sette @SetteLab and others for direct contributions and broader input over the year! cell.com/cell/fulltext/…@CellCellPress
2/ And thanks to all of the amazing scientists and labs around the world that have done so much work making incredible progress on these challenging COVID-19 immunology topics in the past year!
3/ FYI, here's the right version of Figure 1. It should be updated in the next version posted online.
2/ Definitely good news to see these data on the Pfizer vaccine working against the 501 variant. If anything, the vaccine works better against this variant. biorxiv.org/content/10.110…
3/ It isn't the end of the story, because the UK / SA variants have mutations in addition to 501, but these vaccine data are an important piece of the puzzle. As noted in the article, more is expected from labs in the coming weeks, but these results are expected & encouraging.
1/ One pre-print on B117 viral loads (i.e., B.1.1.7 SARS-CoV-2 ) found substantially higher viral loads (median 10-100 times). Another UK study found 3 times higher viral loads in people with B117 (Bonsall/Golubchik study). medrxiv.org/content/10.110…
2. The immune system can remember viruses. And there are multiple different parts of the immune system that can remember a virus in different ways, so the immune system can fight the virus in multiple ways.
3. Our data shows that the body’s immune system remembers novel coronavirus for at least 8 months after COVID-19, and multiple different branches of the immune system remember the virus.
1. I am convinced that the new "UK variant" of SARS-CoV-2 (B.1.1.7) is a big problem. I look forward to seeing more epidemiology by more labs (not my area), but the overall picture plus these new viral load data now have me convinced. (my PhD was RNA virology)
Thread
2. An analysis of 641 COVID-19 cases found "S-negative" (B.1.1.7 inferred) cases had 10 to 100-times higher nasal viral loads than 'regular' COVID-19. Virologically, that is a massive difference. It could easily explain higher transmissibility. doi.org/10.1101/2020.1…
3. The authors of that work are appropriately cautious in their interpretations (e.g. they didn't directly sequence confirm B.1.1.7 cases), and it will be very valuable to see similar studies from other sites. But, I find the data compelling.
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