> If that's not enough, change the definition of "vaccines"
If “vaccine” meant “thing that 100% stops you from ever even getting infected”, most vaccines throughout the history of vaccination wouldn’t meet that definition.
But that’s not, and has never been, the definition – so nothing needs to be changed.
>> Vaccine: A product that stimulates a person’s immune system to produce immunity to a specific disease, protecting the person from that disease.
That doesn’t mean what you seem to think it means (so-called “sterilizing immunity”). A 20-fold reduction in hospitalization is by any read protecting you from a disease.
An unsourced “I claim most people have this misunderstanding, therefore the claim that vaccines work must be responsive to this incorrect understanding (plus some vague mishmash of implications about conspiracies to change the definition of vaccination, or something)” doesn’t strike me as a terribly productive line of argument to be honest.
Most people have a yearly interaction with the flu vaccine, where it's made perfectly clear that you can still get the flu, but it will be mild and the efficacy is something like 60-80%. (At least this is what my pharmacist has told me every time I get the flu shot)
Yet it's still fairly popular, even with that mentioned popular opinion. According to CDC, 63.8% of under 17yo got it, and 48.4% over 18yo (season 2019-2020). These are numbers with little pressure.
That is popular in isolation (when was the last time 64% of Americans agreed on anything??), but not for something that some feel should have a universal mandate.
For something that doesn't really hospitalize most people and the vaccine isn't 95%+ effective? I'd say it's a great success given how popular it actually is
Oh yes. This is a good lesson in complexity for the whole society. Instead of a binary works/doesn't work people have learned that there are different kinds of vaccines, that not all vaccines prevent the spread of a disease, that some vaccines need more than one shot to increase efficiency, that vaccinated people can still die from the disease they were vaccinated against, that some vaccines need to be taken seasonally to be effective and so on.
(This is from someone who is taking a vaccine orally everyday (that doesn't "block transmission and infection" as it is allergy-related.)
A vaccine taken daily is so far from the typical associations that it is similar to the insistence by biologists to call a tomato a fruit. How something functions for the practicing human is different from how something functions in that human, the person is more likely to associate how it functions "for" them.
The Salk polio vaccine was about 60-70% effective and is certainly a vaccine. Please don’t confuse your misunderstanding of what a vaccine is with an attempt to change the definition.
We're down to 30-40% protection against infection for two dose Pfizer-BioNTech. Is it a vaccine if you need a booster every 6 months the vaccine only protects against severe infection?
More important than petty arguments is how this virus was sold to the public. Pfizer-BioNTech suggested 95-100% efficacy after 30 days. Now we're gaslighting people into saying protecting against severe infection was always the goal.
Nope. You’re mixing numbers. Both the trials and independent national studies found vaccines like the Pfizer-BioNTech one to be about 95% effectiveness against severe disease and hospitalisation, not infection.
It was never claimed that they’d completely prevent infection.
New variants like Beta, Delta, and Omicron have varying levels of escape from both vaccination and prior infection, which means effectiveness at preventing severe disease or hospitalisation against those variants has decreased, requiring a booster.
Nor is this unusual, as the flu vaccine also needs to be constantly adjusted to take new variants into account.
No, the data from the first clinical trials for the Pfizer and Moderna vaccines showed 95% efficacy against symptomatic infection. You had Fauci, Birx and countless other talking heads in the media implying or stating outright that the vaccines conferred sterilizing immunity.
Of course, we know now that the variants have evolved some degree of immune escape, that the vaccines no longer prevent infection while still being effective against severe disease, but that's not what the "experts" originally claimed. It's disappointing to see the Hacker News crowd buying into the gaslighting that vaccines are only ever meant to prevent hospitalization. That was not the scientific consensus 2 years ago, and still isn't.
The scientific consensus, as summarised in this Nature article announcing the news, seems pretty clear on what was being looked at and that the trials focused on severe disease outcomes.
Nope. The Nature article was written well before the actual results and studies were released. The studies are unequivocally clear that the primary goal of the studies (at that time) were to measure prevention against symptomatic infection.
I don't understand what you're trying to claim, are you trying to say that the trial results were falsified? Because there's no other way your insistence on this makes sense. That journal article accurately reports on the findings of the Phase III trial, which did show spectacular success against the wild type.
In simple terms, had SARS-CoV-2 not mutated, and we were still dealing with the original wild type, then this pandemic would have been over months ago. They were that all-round effective.
The emergence of variants is what has caused the pandemic to continue, as many scientists warned. As I showed with the Nature article, general scientific consensus was optimistic but cautious and warned about waning immunity and variants.
You seem to think this is all some kind of gotcha, when it's really about adapting to a changing situation and an evasive virus.
>Nope. You’re mixing numbers. Both the trials and independent national studies found vaccines like the Pfizer-BioNTech one to be about 95% effectiveness against severe disease and hospitalisation, not infection.
Nope. Please click and read either of the links I sent.
Here, I'll quote them for you.
>The trial enrolled 2,260 adolescents 12 to 15 years of age in the United States. In the trial, 18 cases of COVID-19 were observed in the placebo group (n=1,129) versus none in the vaccinated group (n=1,131).
>A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions.
>The first primary end point was the efficacy of BNT162b2 against confirmed Covid-19 with onset at least 7 days after the second dose in participants who had been without serologic or virologic evidence of SARS-CoV-2 infection up to 7 days after the second dose; the second primary end point was efficacy in participants with and participants without evidence of prior infection. Confirmed Covid-19 was defined according to the Food and Drug Administration (FDA) criteria as the presence of at least one of the following symptoms: fever, new or increased cough, new or increased shortness of breath, chills, new or increased muscle pain, new loss of taste or smell, sore throat, diarrhea, or vomiting, combined with a respiratory specimen obtained during the symptomatic period or within 4 days before or after it that was positive for SARS-CoV-2 by nucleic acid amplification–based testing, either at the central laboratory or at a local testing facility (using a protocol-defined acceptable test).
>Major secondary end points included the efficacy of BNT162b2 against severe Covid-19. Severe Covid-19 is defined by the FDA as confirmed Covid-19 with one of the following additional features: clinical signs at rest that are indicative of severe systemic illness; respiratory failure; evidence of shock; significant acute renal, hepatic, or neurologic dysfunction; admission to an intensive care unit; or death. Details are provided in the protocol.
Primary goal, symptomatic infection. Secondary goal, severe infection.
That accurately reflected the results of the trial, which reflected performance against the original wild type. Do you dispute them?
However, scientific consensus was that we may not see such great results in the real world, especially if variants emerged. That was all highlighted in the Nature article I posted, which came out at the same time.
I don't understand why this is so difficult for people to understand. Mutations always change the game, but the commentary (and hope) was that the vaccines would continue protecting against severe disease, hospitalisation and death even with new mutations. That has broadly been the case.
>However, scientific consensus was that we may not see such great results in the real world, especially if variants emerged. That was all highlighted in the Nature article I posted, which came out at the same time.
They were not released at the same time. Check the dates. Your Nature article was written almost two months before the actual studies were released. It was based on preliminary evidence. It's not a rebuttal to the actual studies. The actual studies are a rebuttal to the Nature article.
>I don't understand why this is so difficult for people to understand
Likewise. Why do you insist on lying and perpetuating lies?
I could bring up dozens of other examples of prominent scientists and public health professionals saying the same thing after the final Phase III results were published, but frankly I have to wonder if you’re worth the time it would take to collate them given the way you keep using pejorative terms like ‘gaslight’ and ‘lie’ in this discussion.
You’re starting from a predefined agenda and seeking evidence to fit, which is no way to go about things.
“Protecting from disease” was always recognised in the medical community as meaning you’d not get the severe symptoms of the disease, not that you could not get infected at all and not pass it onto others.
Few, if any, vaccines have blocked infection. They work by preventing the onset of severe disease and usually by severely blunting infectiousness.
Neither vaccine was fully sterilising. In fact current US CDC advice if going to a country with a polio outbreak is to get a booster.
In both those cases the vaccines just blunted the transmission rate enough for r0 to drop below 1. We were also lucky that the responsible viruses had very stable mutation rates & no animal reservoirs unlike SARS-CoV-2. That meant they mostly died out over time once the transmission rate was reduced.
Even if the polio vaccine isn't fully sterilizing, would you put our current COVID vaccines in the same league? Imagine we're living in the 60s right now, and we have a polio or smallpox vaccine with 70%+ uptake in the adult population, but the infection rate remains virtually unchanged. Would you consider this good enough?
I mean, take this quote from Dr. Fauci himself:
> As a physician and as a scientist and a public-health person, I think it is not entirely correct to make this very strong dichotomy between waning protection against hospitalization and death and waning immunity against infection and mild-to-moderate disease. It is an assumption that it’s okay to get infected and to get mild-to-moderate disease as long as you don’t wind up in the hospital and die. And I have to be open and honest: I reject that. I think we should be preventing people from getting sick from COVID even if they don’t wind up in the hospital.
It's a different type of virus. We have never, ever, successfully achieved the level of immunity against a rapidly mutating airborne virus as we have with SARS-CoV-2. Our greatest successes, Polio and Smallpox, were both extremely stable and without animal reservoirs, making vaccination much more straightforward.
You're demanding perfection and insisting that anything that falls short is worthless. That makes no sense.
I'm not saying the vaccines are worthless, I'm saying there is a trend of public figures gaslighting and making excuses for their ineffectiveness against Omicron, by redefining commonly accepted notions of what a vaccine is intended to do and pretending our goal all along was to merely prevent severe disease. The goal, as we've seen with past mass vaccination campaigns that worked, should be to stop the spread. Period. We need new vaccines, not fourth or fifth shots of the same thing.
The first and primary public focus was always to prevent severe illness and death and alleviate the load on hospitals. Messaging on that has been fairly consistent.
Some countries pursued an eradication goal early on and some public health officials publicly spoke about their hope to achieve that, but while that was possible with the wild type it no longer is with the variants and animal reservoirs. It was a reasonable, rational strategy at the time, later undermined by the nature of new mutations.
You’re attempting to redefine the baseline of what’s considered acceptable for a vaccine, beyond what has ever been the case. In fact the vaccine most people would be aware of and have come into contact with, the flu vaccine, only partially protects against severe illness.
We have only been able to eradicate two viruses in human history through vaccination. In all other cases it’s a tool used to prevent worse outcomes and control the disease’s severity and spread.
Nonetheless, new vaccines that better target variants like Delta and Omicron, and hopefully any new ones that may emerge, are already in active development and trials. So we will see improvements in our ability to protect people against COVID-19.
By lowering its R0 below 1. Which doesn't not require "sterilizing" vaccines (which is good, since neither the smallpox nor polio vaccine eliminated infection or transmission with anything close to 100% effectiveness).
The only people moving the goal post are the anti-vaxers. Ok, they reduce the severity of the disease...but..but..but COVID is still spreading so I will write off vaccines entirely.
