Thank you. This is an example of an excellent post. It combines a discussion of how policy is made, epidemiologic data, and clear, practical recommendations about how an individual should make a decision regarding their health. It is timely, since my 6 month reminder arrived yesterday.
Thanks so much for this comment. These are the type of posts that I enjoy writing the most, but actually get the least engagement. Unfortunately, I think it shows me there's a reason mass media approaches headlines and articles in an alarmist way, which are unhelpful and exhausting.
Thank you! I wanted to hear that this committee was not RFK appointed. I’m honestly very surprised at these potential Covid vaccine changes. And potentially doing it for flu!? Absolutely not! Almost every child we hospitalize (and most children who die of flu) are unvaccinated. I do not see how they can responsibly not recommend it for all.
At a time when formerly reputable agencies are being staffed by questionable people, I appreciate your newsletter more than ever. As a mental health provider, I am perplexed about “vaccine fatigue,” wondering if it’s a reflection of fragility and the inability of many people to manage their own lives. It takes all of 15 minutes to schedule a vaccine appointment, drive to Walgreens and get a vaccine. I get COVID vaccines every 6 months, but all others either once a year or less. I marvel at the inability of many to put this into perspective. It is an incredibly small price to pay for sustained good health.
Great comment. What I hear from others is that it's two fold. 1. Tired about the topic. 2. Tired about Covid in particular (which I get after going through hell for years.) 3. There is a genuine fear from some people that they are getting too many vaccines. One great example is pregnant women. We know they are willing to get 3 vaccines, but 4 is too much in their mind.
There are those who don't have access to transportation or health insurance. For some finding the time or being able to pay gets lost in simply surviving day to day.
Also, health care access in the US, even with great insurance, can be challenging for many.
You noted that Long Covid cases are dropping. I have not seen that data but my info might be outdated. The last I saw was that the risk rate per infection was steady at 5-7% (so every infection was like a D20 dice roll) but they were starting to be able to identify other factors. Is the dropping the fact that some (but not all) cases are resolving so the cumulative number is shrinking? Or is it that actual annual rates of new LC cases per infection are dropping? Thanks!
This was presented during the ACIP meeting. It sounds like there's interest in a deep dive of long covid, so we are going to put that together and talk a little more in detail about it! Stay tuned.
That would be great. I think for a lot of people who still pay attention, LC is one of the biggest drivers. If there's more specific knowledge now on how or why it's decreasing, that can inform decisions.
Our household definitely has a lot of interest in a long covid deep dive.
The household's income is from two knowledge workers. The financial (and personal) consequences of brain fog or other cognitive effects (even if they eventually resolve) would be absolutely ruinous. Like, lose-the-house ruinous.
We know multiple families still dealing with deficits from infections early in the pandemic, and their situation is very bad. We haven't been able to ascertain if such extreme repercussions are still possible from new infections.
Therefore, the whole house has been hedging on the side of masks and caution -- but the collective mental health and social costs of *five years* of that are becoming totally untenable. At least 15 other families we know (mostly overseas), are in the same boat (without long covid, but very cautious due to lack of good information). All of us are desperate to resume even a few aspects of a more normal life.
Having better information about actual risk would really, really help. (So would information about treatment -- if long covid is now a low-probability/high-cost event, the availability of effective treatments would influence our decisions.)
I recently got a Pfizer Covid shot, but would have preferred Novavax, which is no longer available in my vicinity. Did it run into a problem with its FDA approval? Your newsletter is a lifeline! Thank you. It has become increasingly difficult to find out what is happening with these diseases and government policy.
I saw somewhere but didn’t verify that the 2024/2025 Novavax vaccine was expiring (shelf-life) in April. If this is true, then perhaps they ran out and couldn’t restock?
Separately there was some chatter about the possibility of Novavax not being approved for 2025/2026. (I hope it was due to no clear new, dominant, immune-escaping strain at this time, and not politics. Novavax takes much longer to produce than mRNA, so they have to start planning sooner.) Comments about it were being accepted up until a week or so ago. So we shall see.
Thank you for this cogent and timely information. One thing I didn't see mentioned about the difference between the US and European model: the size of the populations. The US population is significantly larger, as well as being spread over a much larger area, which - in addition to all of the access issues discussed - makes a risk-based model more problematic.
The degree to which vaccine policy takes into account only hospitalization and death rates, ignoring all of the research that has been done regarding the longer term negative impacts of repeated viral infections and viral persistence and further regarding the life-changing impacts of long COVID, is seriously discouraging - but unfortunately completely unsurprising given our experiences with the US medical system as consumers and with our observations of how physicians are educated and trained in our country. Per infection odds of LC may be declining, but with the demonstrated reluctance of many MDs to listen to and acknowledge the lived realities of patients with symptoms that often don't present neatly and uniformly, has the overall LC prevalence declined? Seems doubtful.
This is happening in so many aspects of life, not just health care - poor or nonexistent cost-benefit ratio analysis. I think many insurance companies hope we die before they have to pay out for care. It's a reason our emergency rooms are overcrowded with advanced preventable illnesses or, on the other hand, relatively minor issues which urgent care could have handled.
When we've reverted to the Middle Ages and a feudal system with a king, a few lords and dukes wholly subservient to the king and everybody else is considered of less worth than the dirt they're standing on, what need is there of cost-benefit ratio analysis really? So wrong, and so terribly discouraging!
If the US follows the European model for Covid/flu, and we don’t fall into any recommended categories, can we still get the vaccines? Can we pay for them if necessary? I can’t imagine not being able to get a flu shot for me and my family.
Thank you for a great post, as always. I find it really scary that we'd move to an "at risk" model for Covid. Even if you're not immunocompromised or over 65, what about co-morbidities and Long Covid? If vaccines can protect me then I want them! I wonder how the infection numbers look in these countries that use the at-risk models
We know a lot of people living in risk-based vaccination countries. Anecdotally, covid circulates as freely as you'd expect.
I don't know if anyone is tracking long covid symptoms in those countries. However, I am familiar with one symptom that is now quite common (and elicits shoulder-shrugs) over there: post-covid hair shedding. For some reason, there are a lot of people wandering around with wispy hair and clogged shower drains overseas.
Thanks for the Cliff Notes. Any update on the Novavax covid vaccine?
Europeans are healthier than Americans, so I welcome changes to unnecessary food additives (dyes,etc) and risk-based vaccine recommendations, and probably eliminating/reducing added fluorine to drinking water.
Pre-pandemic, we spent about 25% of the year in the UK and EU (for business and family reasons). We lost significant weight every time we were there. At first we thought it was simply due to being in more walkable environments, but several incidents of being injured in ways that prevented much walking/exercise still resulted in significant weight loss. We have no explanation for why that might be, but intuitively it seems to justify a look at the food/water there vs here.
Thank you for an excellent summation of the ACIP meeting, which I followed live online as it was happening.
It seems those backing a risk-based approach to COVID vaccine recommendations are missing the point that everyone could benefit from the protection they offer, not just those deemed “high risk.”
Why would scientists capitulate to “vaccine fatigue,” “hesitancy,” politics, or “fear” (aka mis/disinformation) when the vaccine works - not perfectly, sure, but pretty well?
If good scientists let those factors sway their recommendations, they make it easy for the MAHA and Barrington Declaration crowd to gain the upper hand in public messaging. Shouldn’t the public be able to count on scientists to take a stand for science and public health?
We had many weeks last year when more than 2,000 people a week were dying of COVID in this country. But most people are blissfully unaware of that sad fact.
And it’s not just the risk of death that is a concern. A recent article in the NY Times (A Clearer Picture of COVID’s Lasting Effects on the Body) discussed in detail what COVID does to all body systems - even in people with mild cases. Why not give people that information - and recommend universal COVID vaccines to mitigate?
Thank you for raising these important points. I agree: teach the public about long covid and recommend universal vaccines. If an individual has access to the full story and access to immunization, but experiences "fatigue," that's their choice. I shouldn't have my choice taken away.
I’m living with the damage caused from a moderate case of Covid (long Covid). As someone with a weakened immune system and under 65, I find these new recommendations frightening.
Kennedy has already interfered, first in having the February meeting postponed, then recently forcing FDA's Peter Marks to resign (aka fired), and having a political appointee oversee this week's meeting.
https://covidandvaccineupdate.substack.com/ has been covering the ACIP meetings on vaccines for the past 5 years. Thankfully, for the most part, this week's meeting proceeded normally, sticking to the science. However, the departure was the active role that the political appointee took in raising vaccine doubt as reported by YLE and elsewhere. In a bygone era, Marks only interjected when asked by committee members to provide guidance on FDA's intentions.
In addition, the political appointee would not divulge the status of the Novavax vaccine when asked by a committee member. This was not a minor matter. Kennedy has claimed that single-antigen vaccines don't work for respiratory diseases. Either he is unaware that the recombinant flu vaccine is single-antigen (HA protein) as are the mRNA COVID vaccines (encoding the S protein), or more ominously, all these vaccines are in peril.
In addition to other vaccines, the two-day meeting included evaluating the data for a new Moderna COVID vaccine, which will be covered in https://covidandvaccineupdate.substack.com/'s scheduled Monday posting.
Minor quibble - ACIP doesn't generally recommend specific brands and doesn't have any authority over approval. There's a good reason for this - a lot of the companies are publicly traded and if there was even a whiff of any info about specific vaccines, that would be material, and all of a sudden there's concern about possible insider trading. I don't know about you, but I don't want the SEC involved in public health.
It's true ACIP doesn't do approvals. The discussion about Moderna's jab on Tuesday was just an update on COVID vaccines. However, ACIP does recommend to CDC how to implement use of the brands authorized or approved (licensed) by FDA with the advice of its VRBPAC.
Thank you. This is an example of an excellent post. It combines a discussion of how policy is made, epidemiologic data, and clear, practical recommendations about how an individual should make a decision regarding their health. It is timely, since my 6 month reminder arrived yesterday.
Thanks so much for this comment. These are the type of posts that I enjoy writing the most, but actually get the least engagement. Unfortunately, I think it shows me there's a reason mass media approaches headlines and articles in an alarmist way, which are unhelpful and exhausting.
Thank you! I wanted to hear that this committee was not RFK appointed. I’m honestly very surprised at these potential Covid vaccine changes. And potentially doing it for flu!? Absolutely not! Almost every child we hospitalize (and most children who die of flu) are unvaccinated. I do not see how they can responsibly not recommend it for all.
I was very surprised too!
At a time when formerly reputable agencies are being staffed by questionable people, I appreciate your newsletter more than ever. As a mental health provider, I am perplexed about “vaccine fatigue,” wondering if it’s a reflection of fragility and the inability of many people to manage their own lives. It takes all of 15 minutes to schedule a vaccine appointment, drive to Walgreens and get a vaccine. I get COVID vaccines every 6 months, but all others either once a year or less. I marvel at the inability of many to put this into perspective. It is an incredibly small price to pay for sustained good health.
Great comment. What I hear from others is that it's two fold. 1. Tired about the topic. 2. Tired about Covid in particular (which I get after going through hell for years.) 3. There is a genuine fear from some people that they are getting too many vaccines. One great example is pregnant women. We know they are willing to get 3 vaccines, but 4 is too much in their mind.
There are those who don't have access to transportation or health insurance. For some finding the time or being able to pay gets lost in simply surviving day to day.
Also, health care access in the US, even with great insurance, can be challenging for many.
You noted that Long Covid cases are dropping. I have not seen that data but my info might be outdated. The last I saw was that the risk rate per infection was steady at 5-7% (so every infection was like a D20 dice roll) but they were starting to be able to identify other factors. Is the dropping the fact that some (but not all) cases are resolving so the cumulative number is shrinking? Or is it that actual annual rates of new LC cases per infection are dropping? Thanks!
This was presented during the ACIP meeting. It sounds like there's interest in a deep dive of long covid, so we are going to put that together and talk a little more in detail about it! Stay tuned.
That would be great. I think for a lot of people who still pay attention, LC is one of the biggest drivers. If there's more specific knowledge now on how or why it's decreasing, that can inform decisions.
Our household definitely has a lot of interest in a long covid deep dive.
The household's income is from two knowledge workers. The financial (and personal) consequences of brain fog or other cognitive effects (even if they eventually resolve) would be absolutely ruinous. Like, lose-the-house ruinous.
We know multiple families still dealing with deficits from infections early in the pandemic, and their situation is very bad. We haven't been able to ascertain if such extreme repercussions are still possible from new infections.
Therefore, the whole house has been hedging on the side of masks and caution -- but the collective mental health and social costs of *five years* of that are becoming totally untenable. At least 15 other families we know (mostly overseas), are in the same boat (without long covid, but very cautious due to lack of good information). All of us are desperate to resume even a few aspects of a more normal life.
Having better information about actual risk would really, really help. (So would information about treatment -- if long covid is now a low-probability/high-cost event, the availability of effective treatments would influence our decisions.)
Yeah, what information indicates that Long Covid rates have gone down?
In mentioning long COVID, do you have plans for an another comprehensive update on prevalence and new research findings?
We can definitely do that if it's of interest!
Thank you for considering it
Super interested.
Agreed. Can we please get a comprehensive update on prevalence and new research findings about Long COVID?
I recently got a Pfizer Covid shot, but would have preferred Novavax, which is no longer available in my vicinity. Did it run into a problem with its FDA approval? Your newsletter is a lifeline! Thank you. It has become increasingly difficult to find out what is happening with these diseases and government policy.
I saw somewhere but didn’t verify that the 2024/2025 Novavax vaccine was expiring (shelf-life) in April. If this is true, then perhaps they ran out and couldn’t restock?
Separately there was some chatter about the possibility of Novavax not being approved for 2025/2026. (I hope it was due to no clear new, dominant, immune-escaping strain at this time, and not politics. Novavax takes much longer to produce than mRNA, so they have to start planning sooner.) Comments about it were being accepted up until a week or so ago. So we shall see.
We prefer Novavax, too. Would love more information about what's up with that.
Also, a few years ago there was some hubbub around a pan-coronavirus vaccine that the Army was working on. Any updates there?
Thank you for this cogent and timely information. One thing I didn't see mentioned about the difference between the US and European model: the size of the populations. The US population is significantly larger, as well as being spread over a much larger area, which - in addition to all of the access issues discussed - makes a risk-based model more problematic.
Great question. I would also appreciate learning more about the pros and cons of the two approaches as we go forward.
Just: thank you so much for this important work.
The degree to which vaccine policy takes into account only hospitalization and death rates, ignoring all of the research that has been done regarding the longer term negative impacts of repeated viral infections and viral persistence and further regarding the life-changing impacts of long COVID, is seriously discouraging - but unfortunately completely unsurprising given our experiences with the US medical system as consumers and with our observations of how physicians are educated and trained in our country. Per infection odds of LC may be declining, but with the demonstrated reluctance of many MDs to listen to and acknowledge the lived realities of patients with symptoms that often don't present neatly and uniformly, has the overall LC prevalence declined? Seems doubtful.
This is happening in so many aspects of life, not just health care - poor or nonexistent cost-benefit ratio analysis. I think many insurance companies hope we die before they have to pay out for care. It's a reason our emergency rooms are overcrowded with advanced preventable illnesses or, on the other hand, relatively minor issues which urgent care could have handled.
When we've reverted to the Middle Ages and a feudal system with a king, a few lords and dukes wholly subservient to the king and everybody else is considered of less worth than the dirt they're standing on, what need is there of cost-benefit ratio analysis really? So wrong, and so terribly discouraging!
If the US follows the European model for Covid/flu, and we don’t fall into any recommended categories, can we still get the vaccines? Can we pay for them if necessary? I can’t imagine not being able to get a flu shot for me and my family.
Yeah, these are good questions. I'm interested in hearing the answers too.
Thank you for a great post, as always. I find it really scary that we'd move to an "at risk" model for Covid. Even if you're not immunocompromised or over 65, what about co-morbidities and Long Covid? If vaccines can protect me then I want them! I wonder how the infection numbers look in these countries that use the at-risk models
We know a lot of people living in risk-based vaccination countries. Anecdotally, covid circulates as freely as you'd expect.
I don't know if anyone is tracking long covid symptoms in those countries. However, I am familiar with one symptom that is now quite common (and elicits shoulder-shrugs) over there: post-covid hair shedding. For some reason, there are a lot of people wandering around with wispy hair and clogged shower drains overseas.
Thanks for keeping us updated with clear, thoughtful facts!
Thanks for the Cliff Notes. Any update on the Novavax covid vaccine?
Europeans are healthier than Americans, so I welcome changes to unnecessary food additives (dyes,etc) and risk-based vaccine recommendations, and probably eliminating/reducing added fluorine to drinking water.
Pre-pandemic, we spent about 25% of the year in the UK and EU (for business and family reasons). We lost significant weight every time we were there. At first we thought it was simply due to being in more walkable environments, but several incidents of being injured in ways that prevented much walking/exercise still resulted in significant weight loss. We have no explanation for why that might be, but intuitively it seems to justify a look at the food/water there vs here.
Thank you for an excellent summation of the ACIP meeting, which I followed live online as it was happening.
It seems those backing a risk-based approach to COVID vaccine recommendations are missing the point that everyone could benefit from the protection they offer, not just those deemed “high risk.”
Why would scientists capitulate to “vaccine fatigue,” “hesitancy,” politics, or “fear” (aka mis/disinformation) when the vaccine works - not perfectly, sure, but pretty well?
If good scientists let those factors sway their recommendations, they make it easy for the MAHA and Barrington Declaration crowd to gain the upper hand in public messaging. Shouldn’t the public be able to count on scientists to take a stand for science and public health?
We had many weeks last year when more than 2,000 people a week were dying of COVID in this country. But most people are blissfully unaware of that sad fact.
And it’s not just the risk of death that is a concern. A recent article in the NY Times (A Clearer Picture of COVID’s Lasting Effects on the Body) discussed in detail what COVID does to all body systems - even in people with mild cases. Why not give people that information - and recommend universal COVID vaccines to mitigate?
https://www.nytimes.com/2025/03/10/well/covid-long-term-health-damage.html?unlocked_article_code=1.B08.TlQn.iX_2m23bsONx&smid=nytcore-ios-share&referringSource=articleShare
Thank you for raising these important points. I agree: teach the public about long covid and recommend universal vaccines. If an individual has access to the full story and access to immunization, but experiences "fatigue," that's their choice. I shouldn't have my choice taken away.
I’m living with the damage caused from a moderate case of Covid (long Covid). As someone with a weakened immune system and under 65, I find these new recommendations frightening.
Agreed. And I’m so sorry that you’re living with Long Covid.
Kennedy has already interfered, first in having the February meeting postponed, then recently forcing FDA's Peter Marks to resign (aka fired), and having a political appointee oversee this week's meeting.
https://covidandvaccineupdate.substack.com/ has been covering the ACIP meetings on vaccines for the past 5 years. Thankfully, for the most part, this week's meeting proceeded normally, sticking to the science. However, the departure was the active role that the political appointee took in raising vaccine doubt as reported by YLE and elsewhere. In a bygone era, Marks only interjected when asked by committee members to provide guidance on FDA's intentions.
In addition, the political appointee would not divulge the status of the Novavax vaccine when asked by a committee member. This was not a minor matter. Kennedy has claimed that single-antigen vaccines don't work for respiratory diseases. Either he is unaware that the recombinant flu vaccine is single-antigen (HA protein) as are the mRNA COVID vaccines (encoding the S protein), or more ominously, all these vaccines are in peril.
In addition to other vaccines, the two-day meeting included evaluating the data for a new Moderna COVID vaccine, which will be covered in https://covidandvaccineupdate.substack.com/'s scheduled Monday posting.
Minor quibble - ACIP doesn't generally recommend specific brands and doesn't have any authority over approval. There's a good reason for this - a lot of the companies are publicly traded and if there was even a whiff of any info about specific vaccines, that would be material, and all of a sudden there's concern about possible insider trading. I don't know about you, but I don't want the SEC involved in public health.
It's true ACIP doesn't do approvals. The discussion about Moderna's jab on Tuesday was just an update on COVID vaccines. However, ACIP does recommend to CDC how to implement use of the brands authorized or approved (licensed) by FDA with the advice of its VRBPAC.
Last year ACIP's rec was "Get whatever you can get in the fall"
Thank you for your up to date, comprehensive vaccine overview.
As always, clear, concise, well written.
Please continue!
Steve Smith