Looking forward to your recommendations about how long to wait post infection. Entire family just finished m recovering from an infection last week, and would like to optimize my protection for the holiday season
What about immunocompromised though? I’m assuming we shouldn’t wait but would love to hear your thoughts. Also, I’m seeing some suggestions to space out various vaccines (for immunocompromised) since the small loss of efficacy of coadmin could actually make a difference to us (even though it’s thought to be nonconsequential for immunocompetent.)
Lukewarm take: one of the best things immunocompromised people (like my mom who has CLL or pretty soon like me if I start taking an injectable steroid for my excruciating neck pain) can do is avoid *one another*, the same way people with cystic fibrosis do. There's SO MUCH we could learn from that community.
Yeah, and we are essentially variant factories. That’s why I was so careful to end my COVID infection with me and was lucky enough to be able to stay out of work long enough after my rebound that I was no longer infectious (several weeks). I know not everyone can though.
I do recall that RSV should not be coadministered due to lower of efficacy but unable to retrieve the data. However, out of caution, it is suggested two weeks on either side of the flu/covid vaccine. It has suggested that at risk groups like immunocompromised should be targeted by the CDC.
I’m still not even clear if immuno under age 60 Can get the RSV vaccine. All the guidance seems to say over 60 *and* with x conditions (including immuno) should get it.
Share your concern with the muddled message. CDC website says, "RSV can cause illness in people of all ages but may be especially serious for infants and older adults. Infants and older adults with chronic medical conditions like heart or lung disease, weakened immune systems, or who live in nursing homes or long-term care facilities, are at highest risk of serious illness and complications from RSV." but no mention of vaccine other than 60+. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rsv.html
I just tried an experiment. I need a shingles (typically 50+, I’m 46) vaccine anyway so I tried to book an RSV and it won’t even show up with my date of birth, even when I put that I’m moderately to severely immunocompromised. The Shingrix I was able to book without issues. My dr says I should be eligible for RSV but I doubt I’ll be able to get it unless they clarify.
I'll be looking forward to it! My 9-year old son was verified positive for the first time Sunday, catching it during his first week back to public school. Thanks for everything you do!
Looking forward to that! I am over 65 and have gotten every other COVID vaccine the moment it was available. But I had COVID in May. At that time, the XBB variant (which is what the shot targets) was the predominant one. So the question is whether I get the shot now or wait to get it until say November in order to have maximum protection if a surge comes in January. And that may depend on the extent to which that May infection still provides some protection.
I'm also wondering whether the results of an antibody test would be useful in making a decision.
Last year it was 4 months, I believe. No reason that should change. That's what I'm planning, and I caught Covid 4 weeks ago. First time I let my guard down in 3.5 years and it got me... Even after Covid don't let your guard down. 2nd infections can happen as soon as 4 weeks after symptoms. Less likely, no doubt, but possible.
(I'm 72 and have had six shots, all Pfizer, incl two bivalents, in october and April. My Covid was the mildest 'cold' I've ever had, fwiw. Glad I got that 2nd bivalent!)
Thank you so much for this information. I'm so impressed with how quickly you put this together! I've noticed that Covid is definitely on the rise where I live and work, so I plan to get the vax this fall. I'm hoping that you will cover information about mixing vaccines...the pros and the cons. All of my vaccines have been Pfizer so far, but I'm considering Novavax this time to switch it up. Not sure if that is a wise decision or not.
I appreciate your writing and this summary greatly. I think it's a bit dangerous to say that "Severe disease is similar to flu for the kiddos" with the threat of long covid in childhood and adolescence. If it weren't for long covid, even the increased risk of heading to the ICU still makes that statement untrue. If you were just skimming this you might walk away thinking "no big deal" for getting COVID in childhood. But we know that every infection reduces T-Cell count and increases risk for long covid. We don't get the flu multiple times in the same year - we don't increase our risk for chronic disease by getting the flu. Met a 17 year old who had a stroke post omicron - no co-morbidity. That's not like the flu at all. Please stop comparing COVID to the flu, it's inaccurate. Other than that, appreciate your work.
We've already seen issues with people discounting COVID infections in kids, mistakenly claiming they couldn't get it. (That's just poor infectious disease thinking. Period.) This little bit of misinformation was driven by misunderstanding the disease process. I've some ideas as to why it represented a lower apparent infection rate, including lower virus loads making detection by both rapid-antigen and PCR tests early on more difficult. We now know infection in kids is real, even if severe disease in the 5-17 year age group is less prominent.
T-cell exhaustion is something others will have to evaluate as it's not in my area of expertise, but I suspect that over time, we'll see T-cell recovery if we can reduce/eradicate SARS-CoV-2 (repeat) infections.
MIS-C appears to follow a different course in kids than Long-COVID in adults, but it's going to take time (longitudinal studies; years) to determine just how true this is. Processes and overall effect appear different.
As for your anecdote of the stroke, I've long considered SARS-CoV-2 a virus with a predisposition toward vascular effect rather than a respiratory virus. It's spread by aerosol in most cases, but it enters cells via an ACE-II receptor pathway and can then be transported elsewhere depending on where the cells infected reside. microclots have been reported, one of the first clues the virus affected the vascular system. Thus, strokes are something we need to consider.
We compare COVID to the flu because the lay public already does that. We have to demonstrate, with more evidence than we should, that the evidence-free groups claiming they're similar are simply wrong. Katelyn's comparisons are not in error. They give a frame of reference to those who claim the two diseases are similar.
I think we should be breaking that framework comparison for "lay people" because people feel comfortable with the flu and I propose we should not feel comfortable with COVID. We can disagree.
Part of the issue is people should NOT feel comfortable with influenza. Although some seasons are worse than others, it's still responsible for a significant number of hospitalizations and deaths each year (with the exceptions of 2020/2021). Overall, the COVID death rate is worse, but complacency in either case is bad.
Society has always treated respiratory diseases as part of "normal" life. Whooping cough (pertussin) and consumption (TB) were a part of life or death. I posted a Note in my Substack about the new "normal" by Branswell. Good read.
"Conclusions and Relevance This study provides valuable insights into the impact of SARS-CoV-2 VOCs on the severity of COVID-19 in hospitalized children across different age groups and countries, suggesting that while ICU admissions decreased across the pandemic in all age groups, ventilatory and oxygen support generally did not decrease over time in children aged younger than 5 years. These findings highlight the importance of considering different pediatric age groups when assessing disease severity in COVID-19."
$120 per shot is going to deter even people who can afford it and be prohibitive for millions more. We are so broken. Glad to hear that the numbers of long COVID cases are declining somewhat, though.
I listened to part of the meeting and was very pleased that the new CDC Director Mandy Cohen emphasized the importance of public trust and clear communication. Within the first few minutes, the CDC acknowledged Novavax and said there’s an “urgent need” for a non-mRNA vaccine choice. Hip hip hooray!
The doctor from Novavax said their vaccine is manufactured and is ready to be distributed - unclear whether they’ve been able to manufacture enough to meet demand.
Novavax gave two prices: $130 for fully insured and $75 ish for CDC. I’m assuming the lower price is what the Bridge program would pay - their goal is vaccine equity for under- and un-insured. Bridge sites (4,000?) will reach 85% of this population which in the past has had lower uptake and (probably) higher complications with Covid. A non-mRNA vaccine might appeal to this group given their past skepticism, plus Novavax has fewer distribution and storage challenges as compared to mRNA. Novavax could be a perfect vaccine for Bridge!
If Novavax is offered at Bridge sites, FDA will want to double and triple check safety data along demographic lines consistent with target population.
As someone over 70 years old, do I wait for the Novavax, or do I jump on Moderna/Pfizer as soon as available? I'm fully vaccinated and had boosters previously, and also had COVID once before vaccines and once after
"Additionally, clinical trial data presented Tuesday on the effectiveness of the updated vaccines didn’t include children under 12, which left ACIP member Dr. Pablo Sanchez, a pediatrician at Nationwide Children’s Hospital in Ohio, feeling uncomfortable about making a blanket recommendation for everyone 6 months and older. He was the committee’s only no vote.
“I just want to be clear that I am not against this vaccine,” Sanchez said. “The limited data that are available does look great.
In the meanwhile, the CDC does need to message target the 65+, immunocompromised and at risk. These are making up a great majority of hospitalization and death so far.
Though 65+, I am planning to wait for Novavax. It is non inferior to mRNA vaccines and have fewer side effects. Besides, mixing seems to be better in long run. Having primary and boosters, my humoral immunity is matured. Besides, Thymus gland may not be what they used to be but still somewhat functional. Also have a plan for the possibility that SARS.CoV-2 infection turns into COVID-19. Most of us has been infected but our mucosal and humoral has done a great job since introduction of the vaccines.
I am 71 and very anxious to get this updated vaccine because I'll be getting a hip replacement in 2 1/2 weeks. C-19 in wastewater in my area has risen steeply in past two weeks. I got my RSV vaccine last week, will get my flu shot tomorrow, and hope I can get the updated C-19 shot no later than this coming Monday, the last day my surgeon says I can get it before surgery. Fingers crossed!
Very important: “Remember, effectiveness is “relative” to some combination of prior vaccination, prior infection, or both. This means the 65% benefit is above and beyond an individual's underlying immunity.” I forget this myself; thanks for the reminder.
“This is the first time the government is not paying for Covid-19 vaccines. Pfzier/Moderna is charging ~$120-129 per dose and Novavax is ~$130. (I think the cost of these vaccines is absurd given taxpayers funded Operation Warp Speed.)”
I think it’s worse. 1. Much (all?) of the mRNA tech development long before Covid was, I am guessing, taxpayer-funded via NIH or NSF grants. 2. Taxpayer-funded Warp Speed. 3. Taxpayer-funded, massive purchases of the winners of Warp Speed. 4. And now, privatized profit (at outrageous prices) in perpetuity.
We will have paid pharma four separate times, it seems to me. That’s appalling—but business as usual in really-existing capitalism.
The Bayh-Dole Act in the late 70s precludes the government from benefiting financially from government-funded research. For this to change, new legislation is required. Write your Congressional Representatives and Senators.
Recall that both companies had to build new facilities to produce the vaccines for wide-spread delivery, and that the ultra-low temperatures required were also expensive to facilitate. Moderna benefitted from NIH collaboration while Pfizer did not. BOTH benefitted from large purchases by the Federal government of their vaccines. NIH grants do not give the government ownership of intellectual property brought to fruition in the research process.
I'm not an expert on the economics of the production and distribution of these vaccines; I'm a mere scientist who's benefitted from Federal research funding in the past. As such, I know a little about how the arcane rules work in research funding.
Clarification: NIH grants to Moderna aren't at issue, I agree. It's the NIH's own research by NIH scientists that might justifiably be considered to be of value. What the legal agreements between NIH and Moderna were and who should be named inventors on relevant patents I don't know. NIH lawyers might have given everything away (for all I know).
Sounds like a lot of questions on Novavax! The major ones being 1) should one wait for the Novavax booster or 2) get the mRNA booster and wait awhile then get the Novavax booster? This twitter thread just yesterday notified me of the possible benefits of the Novavax!
How can you be so positive that myocarditis is not a risk with repeated boosters for young males when most college aged males did NOT opt for the bivalent? I just don’t see how there is enough data for that age group/bivalent.
She didn't say anything about being "so positive", only that the available evidence doesn't indicate that this is an issue, especially when weighed against the risks of not being vaccinated.
No, she actually said that the benefits outweighs the risks for adolescents, without any qualification for the scant evidence and without any nuance as to whether she was comparing that to unvaccinated adolescents or to adolescents who were already vaccinated, boosted and likely infected.
Research has shown that people who are vaccinated are roughly 40 to 60 percent less likely to have a heart attack or stroke following a Covid infection than those who are unvaccinated. This may be because vaccinated people are less likely to develop severe Covid, which in turn lowers the risk of many of these heart-related issues. Or the vaccine may help protect the cardiovascular system itself — by reducing the inflammatory effects of Covid, for example.
There is a small risk of developing myocarditis (inflammation of the heart muscle) in the weeks after getting an mRNA Covid vaccine made by Pfizer-BioNTech or Moderna. However, the risk of myocarditis after having Covid is much higher. A study by the Centers for Disease Control and Prevention reported that males ages 12 to 29 — who have the greatest risk of vaccine complications — were four to eight times more likely to develop myocarditis following a Covid infection than in the three weeks after receiving a dose of vaccine. For males 30 and older, the risk of myocarditis was 28 times higher from Covid than from the vaccine.
“While it’s important to understand that this vaccine-related event is real,” Dr. Glassberg said, “the risk to your heart is much greater from Covid than from vaccine.”
This is versus unvaccinated. The question is about whether adolescents, particularly young males, who are already vaccinated, boosted and have had infections should continue to get repeated boosters. Again, nuance.
Thanks as always. I managed to listen to about an hour, when the companies presented their data (great timing) and was really excited about the expected efficacy for emerging variants!
I also very much appreciated the person who raised the lack of data for those who are immunocompromised, 3% of the US population. This is still sorely lacking especially as this group represents a high risk population!
FINALLY they did not exclude children! Someone did request that data too, but given the vigorous historical data for prior vaccination, I am feeling comfortable in the meantime.
I cannot agree enough about spacing from prior vaccination as well as recent infection. A range would be more appropriate IMO, such as anywhere from 3-6 months, indicating earliest but then optimal timing.
Thank you, looking forward to Thursday.
FWIW I did listen to the Ezra Klein podcast and you were great. Thank you for all of this communication- it has been invaluable!
I took part in a booster study for immunocompromised in April. Then a rebound study recently. It isn’t hard to include us in studies. I was supposed to be in a monoclonal study this fall but got my first covid infection, and that’s an exclusion if it was in the past 120 days. I listened to that part with great interest as well. We are a growing group, especially due to the use of biologics.
That evidence is probably pretty solid. I'll likely wait on flu, however, as it's not started increasing in my community just yet. I'll get RSV and COVID when COVID is available. Interestingly, I'm TDY in another city, and if it comes available here, I'll go get it ASAP, first one I can get. For flu, I'm waiting 'til the first week in October, as I want it effective prior to European travel but not so early that I might miss a late peak in the spring.
But if you had Covid in June would you wait for the covid booster? YLE I think had one time suggested 6 months? I know she’s going to dive deeper into it.
I think 4-6 months is probably reasonable. I would certainly wait 90 days, especially if you've been vaccinated and fully boosted ("Up To Date") and subsequently had been infected. After 90 days? I'd be considering it.
Re Op Warp Speed, Pfizer didn't take the money, but Moderna did. Also, NIH designed the critical mRNA sequence changes for Moderna. Moderna got a freebie. We the people should own the vaccine. Whereas Pfizer paid for their vaccine development without any help from OWS.
Moderna had a long history of working with NIH. Pfizer had been working on mRNA for other purposes and was well-along in their development. Neither company needed a lot of help taking the sequence and deriving elements of the S1 spike to use for a vaccine. Pfizer did partner to get their lipid nanoparticle encapsulation with BioNTech; Moderna did their own encapsulation in-house.
NIH collaboration and funding certainly helped Moderna, but there's a lot of their own intellectual property involved. Research grants and collaboration didn't necessarily create a scenario where the US Government "owned" the Moderna technology. I've been involved in government grants for research. It's only recently that the code and data associated with certain research programs have been required to be shared. And grants where significant intellectual property is involved, there are safeguards to protect the future of the companies involved.
The big difference is simply that Moderna took OSA money and Pfizer didn't.
At one point NIH was disputing Moderna's patent because it excluded NIH researchers. I don't know where that stands now, but it had seemed that a decent case could be made that NIH scientists should have been named inventors, along with the Moderna people. But there's a strict legal definition of inventorship, as I'm sure you know, and it's all in the hands of lawyers. Working on a project that results in an invention is not sufficient for inventorship legally. Very different than standards for authorship. When I was in industry, I was an inventor, while my academic collaborators weren't, even though we published together. It was the lawyer's decision...
I've had a few academic research grants too (about $75M). The ancillary expectations have indeed crept steadily up and up. Glad I'm retired now... But I do support access to data, especially in genomics. When I was an Editor in Chief, we developed new policies requiring that and specifying formats, nearly 20 years ago. Software code too eventually.
In fact, when I was a NASA contractor, I came up with a design that solved a problem one of my subcontractors had identified for a Spacelab flight experiment (and subsequent Station deployment) that they took and made into a working system. I was named as a participant in the patent but not as an inventor. I just have a few article citations and a warm glow about that and other work. And we could talk about authorship too. I left a position (actually to go to NASA) with a number of articles out for review and my name was scrubbed from all of them. In several cases, lead author became the department chair. But that’s another story.
Looking forward to your recommendations about how long to wait post infection. Entire family just finished m recovering from an infection last week, and would like to optimize my protection for the holiday season
Expect on YLE Thursday!
What about immunocompromised though? I’m assuming we shouldn’t wait but would love to hear your thoughts. Also, I’m seeing some suggestions to space out various vaccines (for immunocompromised) since the small loss of efficacy of coadmin could actually make a difference to us (even though it’s thought to be nonconsequential for immunocompetent.)
Yes, guidelines for the immunocompromised are of interest here too!
Here too
Lukewarm take: one of the best things immunocompromised people (like my mom who has CLL or pretty soon like me if I start taking an injectable steroid for my excruciating neck pain) can do is avoid *one another*, the same way people with cystic fibrosis do. There's SO MUCH we could learn from that community.
https://www.cff.org/get-involved/five-feet-apart
Yeah, and we are essentially variant factories. That’s why I was so careful to end my COVID infection with me and was lucky enough to be able to stay out of work long enough after my rebound that I was no longer infectious (several weeks). I know not everyone can though.
I do recall that RSV should not be coadministered due to lower of efficacy but unable to retrieve the data. However, out of caution, it is suggested two weeks on either side of the flu/covid vaccine. It has suggested that at risk groups like immunocompromised should be targeted by the CDC.
https://www.medpagetoday.com/special-reports/exclusives/106112
and this showed up today.
https://www.medpagetoday.com/opinion/faustfiles/106292?xid=nl_mpt_DHE_2023-09-12&eun=g2007433d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%202023-09-12&utm_term=NL_Daily_DHE_dual-gmail-definition
I’m still not even clear if immuno under age 60 Can get the RSV vaccine. All the guidance seems to say over 60 *and* with x conditions (including immuno) should get it.
Share your concern with the muddled message. CDC website says, "RSV can cause illness in people of all ages but may be especially serious for infants and older adults. Infants and older adults with chronic medical conditions like heart or lung disease, weakened immune systems, or who live in nursing homes or long-term care facilities, are at highest risk of serious illness and complications from RSV." but no mention of vaccine other than 60+. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rsv.html
I just tried an experiment. I need a shingles (typically 50+, I’m 46) vaccine anyway so I tried to book an RSV and it won’t even show up with my date of birth, even when I put that I’m moderately to severely immunocompromised. The Shingrix I was able to book without issues. My dr says I should be eligible for RSV but I doubt I’ll be able to get it unless they clarify.
I'll be looking forward to it! My 9-year old son was verified positive for the first time Sunday, catching it during his first week back to public school. Thanks for everything you do!
Looking forward to that! I am over 65 and have gotten every other COVID vaccine the moment it was available. But I had COVID in May. At that time, the XBB variant (which is what the shot targets) was the predominant one. So the question is whether I get the shot now or wait to get it until say November in order to have maximum protection if a surge comes in January. And that may depend on the extent to which that May infection still provides some protection.
I'm also wondering whether the results of an antibody test would be useful in making a decision.
This was covered at today’s meeting
Worth noting it was second infection for the two adults and the 13yo, first for the 16yo and all up to date on boosters.
Last year it was 4 months, I believe. No reason that should change. That's what I'm planning, and I caught Covid 4 weeks ago. First time I let my guard down in 3.5 years and it got me... Even after Covid don't let your guard down. 2nd infections can happen as soon as 4 weeks after symptoms. Less likely, no doubt, but possible.
(I'm 72 and have had six shots, all Pfizer, incl two bivalents, in october and April. My Covid was the mildest 'cold' I've ever had, fwiw. Glad I got that 2nd bivalent!)
I'll get the new one in the winter. 🤞🏻
My goal is not to get covid until I'm in my 70's - like you! I'm 48 now.
Thank you so much for this information. I'm so impressed with how quickly you put this together! I've noticed that Covid is definitely on the rise where I live and work, so I plan to get the vax this fall. I'm hoping that you will cover information about mixing vaccines...the pros and the cons. All of my vaccines have been Pfizer so far, but I'm considering Novavax this time to switch it up. Not sure if that is a wise decision or not.
I appreciate your writing and this summary greatly. I think it's a bit dangerous to say that "Severe disease is similar to flu for the kiddos" with the threat of long covid in childhood and adolescence. If it weren't for long covid, even the increased risk of heading to the ICU still makes that statement untrue. If you were just skimming this you might walk away thinking "no big deal" for getting COVID in childhood. But we know that every infection reduces T-Cell count and increases risk for long covid. We don't get the flu multiple times in the same year - we don't increase our risk for chronic disease by getting the flu. Met a 17 year old who had a stroke post omicron - no co-morbidity. That's not like the flu at all. Please stop comparing COVID to the flu, it's inaccurate. Other than that, appreciate your work.
We've already seen issues with people discounting COVID infections in kids, mistakenly claiming they couldn't get it. (That's just poor infectious disease thinking. Period.) This little bit of misinformation was driven by misunderstanding the disease process. I've some ideas as to why it represented a lower apparent infection rate, including lower virus loads making detection by both rapid-antigen and PCR tests early on more difficult. We now know infection in kids is real, even if severe disease in the 5-17 year age group is less prominent.
T-cell exhaustion is something others will have to evaluate as it's not in my area of expertise, but I suspect that over time, we'll see T-cell recovery if we can reduce/eradicate SARS-CoV-2 (repeat) infections.
MIS-C appears to follow a different course in kids than Long-COVID in adults, but it's going to take time (longitudinal studies; years) to determine just how true this is. Processes and overall effect appear different.
As for your anecdote of the stroke, I've long considered SARS-CoV-2 a virus with a predisposition toward vascular effect rather than a respiratory virus. It's spread by aerosol in most cases, but it enters cells via an ACE-II receptor pathway and can then be transported elsewhere depending on where the cells infected reside. microclots have been reported, one of the first clues the virus affected the vascular system. Thus, strokes are something we need to consider.
We compare COVID to the flu because the lay public already does that. We have to demonstrate, with more evidence than we should, that the evidence-free groups claiming they're similar are simply wrong. Katelyn's comparisons are not in error. They give a frame of reference to those who claim the two diseases are similar.
I think we should be breaking that framework comparison for "lay people" because people feel comfortable with the flu and I propose we should not feel comfortable with COVID. We can disagree.
Part of the issue is people should NOT feel comfortable with influenza. Although some seasons are worse than others, it's still responsible for a significant number of hospitalizations and deaths each year (with the exceptions of 2020/2021). Overall, the COVID death rate is worse, but complacency in either case is bad.
Society has always treated respiratory diseases as part of "normal" life. Whooping cough (pertussin) and consumption (TB) were a part of life or death. I posted a Note in my Substack about the new "normal" by Branswell. Good read.
Yes, discounting COVID-19 disease in children is discounting over 1,000 pediatric death from SARS-CoV-2.
https://www.cnn.com/2023/01/30/health/covid-deaths-children/index.html
I am going to refer you to this paper in JAMA.
"Conclusions and Relevance This study provides valuable insights into the impact of SARS-CoV-2 VOCs on the severity of COVID-19 in hospitalized children across different age groups and countries, suggesting that while ICU admissions decreased across the pandemic in all age groups, ventilatory and oxygen support generally did not decrease over time in children aged younger than 5 years. These findings highlight the importance of considering different pediatric age groups when assessing disease severity in COVID-19."
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2808592?guestAccessKey=a424ddcd-7d2f-416b-8e4a-349646811094
$120 per shot is going to deter even people who can afford it and be prohibitive for millions more. We are so broken. Glad to hear that the numbers of long COVID cases are declining somewhat, though.
Insurance will cover most. Medicare definitely will. But the uninsured are being left out, sadly.
The bridge program for the uninsured is in place until December 2024
Excellent!
As they are with everything else. Because freedumb. Or something.
Fabulous summary, thanks!
I listened to part of the meeting and was very pleased that the new CDC Director Mandy Cohen emphasized the importance of public trust and clear communication. Within the first few minutes, the CDC acknowledged Novavax and said there’s an “urgent need” for a non-mRNA vaccine choice. Hip hip hooray!
The doctor from Novavax said their vaccine is manufactured and is ready to be distributed - unclear whether they’ve been able to manufacture enough to meet demand.
Novavax gave two prices: $130 for fully insured and $75 ish for CDC. I’m assuming the lower price is what the Bridge program would pay - their goal is vaccine equity for under- and un-insured. Bridge sites (4,000?) will reach 85% of this population which in the past has had lower uptake and (probably) higher complications with Covid. A non-mRNA vaccine might appeal to this group given their past skepticism, plus Novavax has fewer distribution and storage challenges as compared to mRNA. Novavax could be a perfect vaccine for Bridge!
If Novavax is offered at Bridge sites, FDA will want to double and triple check safety data along demographic lines consistent with target population.
Ah thanks for catching that price difference for Novavax. I corrected my original post.
I’m encouraged by the Bridge program. I’m not sure if it’s new or if it’s been around a few years but it sounds promising
yes it’s new! but i’m not convinced it’s sustainable. we’ll see
Everything is sustainable if we prioritized it
I presume it will be as sustainable as halving child poverty, and for the same reasons.
It’s new actually!
74M here. Would like specific recommendations on Moderna vs Pfizer or wait for Novavax? Thanks a bunch!
Simple: No preference. Get a vaccine, preferably the first you can get. I see no reason to claim one is better than another.
As someone over 70 years old, do I wait for the Novavax, or do I jump on Moderna/Pfizer as soon as available? I'm fully vaccinated and had boosters previously, and also had COVID once before vaccines and once after
Is a bigger benefit to get Noavax if you’ve had mRNA vaccines and covid?
Very little evidence to support this that I've seen... on the order of none.
Just a note about the one nay vote.
"Additionally, clinical trial data presented Tuesday on the effectiveness of the updated vaccines didn’t include children under 12, which left ACIP member Dr. Pablo Sanchez, a pediatrician at Nationwide Children’s Hospital in Ohio, feeling uncomfortable about making a blanket recommendation for everyone 6 months and older. He was the committee’s only no vote.
“I just want to be clear that I am not against this vaccine,” Sanchez said. “The limited data that are available does look great.
“We have extremely limited data on children … and I think that needs to be made available … to the parents,” he said in explaining his discomfort." https://www.cnn.com/2023/09/12/health/cdc-covid-19-vaccines/index.html
In the meanwhile, the CDC does need to message target the 65+, immunocompromised and at risk. These are making up a great majority of hospitalization and death so far.
Though 65+, I am planning to wait for Novavax. It is non inferior to mRNA vaccines and have fewer side effects. Besides, mixing seems to be better in long run. Having primary and boosters, my humoral immunity is matured. Besides, Thymus gland may not be what they used to be but still somewhat functional. Also have a plan for the possibility that SARS.CoV-2 infection turns into COVID-19. Most of us has been infected but our mucosal and humoral has done a great job since introduction of the vaccines.
Thank you. I was looking for the reasoning behind the No vote
I am 71 and very anxious to get this updated vaccine because I'll be getting a hip replacement in 2 1/2 weeks. C-19 in wastewater in my area has risen steeply in past two weeks. I got my RSV vaccine last week, will get my flu shot tomorrow, and hope I can get the updated C-19 shot no later than this coming Monday, the last day my surgeon says I can get it before surgery. Fingers crossed!
Well wishes for your surgery, Martha. And for that which precedes it and follows it. 🌸
Hi Martha, wondering how you're coming along these days as your surgery date draws near. 🌸
Good luck with your surgery but have a back up plan with paxlovid, Redesivir or (least effective) Molnupiravir.
Very important: “Remember, effectiveness is “relative” to some combination of prior vaccination, prior infection, or both. This means the 65% benefit is above and beyond an individual's underlying immunity.” I forget this myself; thanks for the reminder.
“This is the first time the government is not paying for Covid-19 vaccines. Pfzier/Moderna is charging ~$120-129 per dose and Novavax is ~$130. (I think the cost of these vaccines is absurd given taxpayers funded Operation Warp Speed.)”
I think it’s worse. 1. Much (all?) of the mRNA tech development long before Covid was, I am guessing, taxpayer-funded via NIH or NSF grants. 2. Taxpayer-funded Warp Speed. 3. Taxpayer-funded, massive purchases of the winners of Warp Speed. 4. And now, privatized profit (at outrageous prices) in perpetuity.
We will have paid pharma four separate times, it seems to me. That’s appalling—but business as usual in really-existing capitalism.
The Bayh-Dole Act in the late 70s precludes the government from benefiting financially from government-funded research. For this to change, new legislation is required. Write your Congressional Representatives and Senators.
Recall that both companies had to build new facilities to produce the vaccines for wide-spread delivery, and that the ultra-low temperatures required were also expensive to facilitate. Moderna benefitted from NIH collaboration while Pfizer did not. BOTH benefitted from large purchases by the Federal government of their vaccines. NIH grants do not give the government ownership of intellectual property brought to fruition in the research process.
I'm not an expert on the economics of the production and distribution of these vaccines; I'm a mere scientist who's benefitted from Federal research funding in the past. As such, I know a little about how the arcane rules work in research funding.
Clarification: NIH grants to Moderna aren't at issue, I agree. It's the NIH's own research by NIH scientists that might justifiably be considered to be of value. What the legal agreements between NIH and Moderna were and who should be named inventors on relevant patents I don't know. NIH lawyers might have given everything away (for all I know).
Fully concur.
Technically it's still a tax expenditure, since the vaccines are paid for by pre-tax financial instruments (like health insurance or FSA's)
Sounds like a lot of questions on Novavax! The major ones being 1) should one wait for the Novavax booster or 2) get the mRNA booster and wait awhile then get the Novavax booster? This twitter thread just yesterday notified me of the possible benefits of the Novavax!
https://x.com/jeffgilchrist/status/1700854098755563660?s=20
How can you be so positive that myocarditis is not a risk with repeated boosters for young males when most college aged males did NOT opt for the bivalent? I just don’t see how there is enough data for that age group/bivalent.
She didn't say anything about being "so positive", only that the available evidence doesn't indicate that this is an issue, especially when weighed against the risks of not being vaccinated.
No, she actually said that the benefits outweighs the risks for adolescents, without any qualification for the scant evidence and without any nuance as to whether she was comparing that to unvaccinated adolescents or to adolescents who were already vaccinated, boosted and likely infected.
"How vaccines reduce the risk
Research has shown that people who are vaccinated are roughly 40 to 60 percent less likely to have a heart attack or stroke following a Covid infection than those who are unvaccinated. This may be because vaccinated people are less likely to develop severe Covid, which in turn lowers the risk of many of these heart-related issues. Or the vaccine may help protect the cardiovascular system itself — by reducing the inflammatory effects of Covid, for example.
There is a small risk of developing myocarditis (inflammation of the heart muscle) in the weeks after getting an mRNA Covid vaccine made by Pfizer-BioNTech or Moderna. However, the risk of myocarditis after having Covid is much higher. A study by the Centers for Disease Control and Prevention reported that males ages 12 to 29 — who have the greatest risk of vaccine complications — were four to eight times more likely to develop myocarditis following a Covid infection than in the three weeks after receiving a dose of vaccine. For males 30 and older, the risk of myocarditis was 28 times higher from Covid than from the vaccine.
“While it’s important to understand that this vaccine-related event is real,” Dr. Glassberg said, “the risk to your heart is much greater from Covid than from vaccine.”
https://www.nytimes.com/2023/09/07/well/live/covids-heart-health.html
I should also point out that extended time between doses reduced the risk considerably.
This is versus unvaccinated. The question is about whether adolescents, particularly young males, who are already vaccinated, boosted and have had infections should continue to get repeated boosters. Again, nuance.
Thanks as always. I managed to listen to about an hour, when the companies presented their data (great timing) and was really excited about the expected efficacy for emerging variants!
I also very much appreciated the person who raised the lack of data for those who are immunocompromised, 3% of the US population. This is still sorely lacking especially as this group represents a high risk population!
FINALLY they did not exclude children! Someone did request that data too, but given the vigorous historical data for prior vaccination, I am feeling comfortable in the meantime.
I cannot agree enough about spacing from prior vaccination as well as recent infection. A range would be more appropriate IMO, such as anywhere from 3-6 months, indicating earliest but then optimal timing.
Thank you, looking forward to Thursday.
FWIW I did listen to the Ezra Klein podcast and you were great. Thank you for all of this communication- it has been invaluable!
I took part in a booster study for immunocompromised in April. Then a rebound study recently. It isn’t hard to include us in studies. I was supposed to be in a monoclonal study this fall but got my first covid infection, and that’s an exclusion if it was in the past 120 days. I listened to that part with great interest as well. We are a growing group, especially due to the use of biologics.
Does this mean once the new Novavax is out it will be available for all ages?
12+ is what Novavax said. But it sounds like it won’t be restricted like it was before, which is good.
Thanks for this excellent round up! Is there any data on how to time the flu vaccine vs the covid vaccine? Is it best to get them at different times?
It's not a problem to get both at the same time. There was a study suggesting that using different arms may give better protection. Tentatively...
And yet another study showing getting COVID shots in the same arm is better for response as well.. https://www.cidrap.umn.edu/covid-19/covid-shots-same-arm-may-elicit-better-immune-response
That evidence is probably pretty solid. I'll likely wait on flu, however, as it's not started increasing in my community just yet. I'll get RSV and COVID when COVID is available. Interestingly, I'm TDY in another city, and if it comes available here, I'll go get it ASAP, first one I can get. For flu, I'm waiting 'til the first week in October, as I want it effective prior to European travel but not so early that I might miss a late peak in the spring.
But if you had Covid in June would you wait for the covid booster? YLE I think had one time suggested 6 months? I know she’s going to dive deeper into it.
I think 4-6 months is probably reasonable. I would certainly wait 90 days, especially if you've been vaccinated and fully boosted ("Up To Date") and subsequently had been infected. After 90 days? I'd be considering it.
Our doc said COVID and flu vaccines together is fine. He did recommend that we not take them as the same time as RSV, however.
Re Op Warp Speed, Pfizer didn't take the money, but Moderna did. Also, NIH designed the critical mRNA sequence changes for Moderna. Moderna got a freebie. We the people should own the vaccine. Whereas Pfizer paid for their vaccine development without any help from OWS.
Moderna had a long history of working with NIH. Pfizer had been working on mRNA for other purposes and was well-along in their development. Neither company needed a lot of help taking the sequence and deriving elements of the S1 spike to use for a vaccine. Pfizer did partner to get their lipid nanoparticle encapsulation with BioNTech; Moderna did their own encapsulation in-house.
NIH collaboration and funding certainly helped Moderna, but there's a lot of their own intellectual property involved. Research grants and collaboration didn't necessarily create a scenario where the US Government "owned" the Moderna technology. I've been involved in government grants for research. It's only recently that the code and data associated with certain research programs have been required to be shared. And grants where significant intellectual property is involved, there are safeguards to protect the future of the companies involved.
The big difference is simply that Moderna took OSA money and Pfizer didn't.
At one point NIH was disputing Moderna's patent because it excluded NIH researchers. I don't know where that stands now, but it had seemed that a decent case could be made that NIH scientists should have been named inventors, along with the Moderna people. But there's a strict legal definition of inventorship, as I'm sure you know, and it's all in the hands of lawyers. Working on a project that results in an invention is not sufficient for inventorship legally. Very different than standards for authorship. When I was in industry, I was an inventor, while my academic collaborators weren't, even though we published together. It was the lawyer's decision...
I've had a few academic research grants too (about $75M). The ancillary expectations have indeed crept steadily up and up. Glad I'm retired now... But I do support access to data, especially in genomics. When I was an Editor in Chief, we developed new policies requiring that and specifying formats, nearly 20 years ago. Software code too eventually.
In fact, when I was a NASA contractor, I came up with a design that solved a problem one of my subcontractors had identified for a Spacelab flight experiment (and subsequent Station deployment) that they took and made into a working system. I was named as a participant in the patent but not as an inventor. I just have a few article citations and a warm glow about that and other work. And we could talk about authorship too. I left a position (actually to go to NASA) with a number of articles out for review and my name was scrubbed from all of them. In several cases, lead author became the department chair. But that’s another story.
Sounds very unfair.