Follow the Science?

The command to follow the Science has been heard repeatedly over the last three years. Seemingly sound advice, in an era of unbridled extremist views which seem to cloud rational thought; but a look under the hood of this simple statement leads to the acknowledgement of all sorts of questions. Who’s Science, is first on the list. Being a scientist and submitting articles for publication is no guarantee that the author is free from bias dictating what data they report and which they suppress. Nor are some scientists above spinning the presentation of data in creative ways to confuse the reader (particularly the lay public), and obfuscate results which are damaging to their cherished program, or future grant prospects. The number of scientific, peer reviewed, COVID related articles published and subsequently retracted over the last two years is unprecedented. I was going to take a break from contributing to the information stream this Thanksgiving, but the spectacle of the CDC continuing to circle the drain demands some comment. Full disclosure, this will be short, lacking in humor and full of editorialization. Watching an institution which I have admired throughout my career continue to loose credibility and prestige has been extremely disappointing.

This week the CDC published a study in MMWR, which was seized upon by the White House at their press conference as evidence that the new bivalent boosters work better than the previous monovalent vaccine. Some members of the press immediately took the bait and published headlines proclaiming this, other more insightful science journalists delved deeper, and realized that the study, in no way, showed the new vaccine to be superior. This study in immune-competent people, which is referenced below, did not compare the two vaccines, it simply showed what we already know—that giving another shot of mRNA vaccine to a person previously vaccinated with a primary series will lead to a short term measurable increase in protection from symptomatic disease. Unfortunately for many of us, the degree of protection, particularly in the over 65 yo group was very disappointing. Please read the paper for yourself if so inclined, or trust my overview. The study did confirm what has been argued (myself included), that a 2 month interval between doses, as recommended initially by the CDC, is much too short. Over the study’s very limited mean follow up of 2 months, the 65 yo group given a booster 2 months after their last dose of monovalent vaccine had a 24% increase in protection, while older folks boosted 8 months after their last dose reached a 43% level. When we consider the rapidity with which we know protection from boosters fades, and the fact that BA.5 is currently less than 23% of the circulating virus, and soon to be history—this is hardly a celebration.

Effectiveness of Bivalent mRNA Vaccines in Preventing Symptomatic SARS-CoV-2 Infection — Increasing Community Access to Testing Program, United States, September–November 2022

Ruth Link-Gelles, PhD1; Allison Avrich Ciesla, PhD1,2; Katherine E. Fleming-Dutra, MD1; Zachary R. Smith3; Amadea Britton, MD1; Ryan E. Wiegand, PhD1; Joseph Miller3; Emma K. Accorsi, PhD1,4; Stephanie J. Schrag, DPhil1; Jennifer R. Verani, MD1; Nong Shang, PhD1; Gordana Derado, PhD1; Tamara Pilishvili, PhD1

The real confusion arises, I think, because of the authors choosing to calculate a “Relative Vaccine Efficacy”, which is actually comparing the occurrence of symptomatic disease between the recipients of the new booster compared to a group that has previously received either 2, 3 or 4 doses of original vaccine at some point in the past. They also calculate an “Absolute Vaccine Efficacy” comparing the incidence of disease in Unvaccinated people to the new Booster group (who of course are all fully vaccinated with the original vaccine). The results there are pretty dreadful (with thousands in each comparator group); the vaccinated and newly boosted 65 yo group showing only a 22% increased protection over the 2 months of follow up. Even more surprising is that vaccinated people with 3 or 4 original shots, had lower protection after boosting than a group with only 2 initial vaccine doses. (Is this a result of Immune Fixation or immunologic fatigue from repeated exposure?). The authors as expected throw out all sorts of guesses and suppositions about why the results are so underwhelming. Of course the most likely explanation is the Unvaccinated have basically all been infected by now, and their natural immunity is providing only marginally less protection than the fully vaccinated and recently boosted.

This is a poorly written publication, which I can only view as pushing an agenda that I have called the Hard Sell. Why would the CDC choose to present their data in what I deem a slanted perspective? Well, I suppose having made the call to spend billions of dollars on a revamped vaccine, when plenty of the original sits around unused, there is an institutional need to justify that decision—otherwise people might eventually start asking questions. As for the President continuing to repeat, “If everybody would just take the new booster shots, virtually EVERY COVID death could be avoided.”—that nonsense should stop. If scientists and Public Health officials expect the public to trust them, and accord them some special standing in the world, then they need to police their own ranks. They need to stop publishing second rate journal articles manufactured to push a thinly disguised political agenda. Journal editors and peer reviewers needed to interdict the endless stream of observational reports telling us that ivermectin, hydroxychloroquin and other repurposed drugs were useful in the treatment of COVID. They need to stop pretending that EVERYONE needs just one more new and improved booster dose—one size does not fit all, as is frequently the case in biologic systems and medicine. And they need to VERY PUBLICLY admit that natural immunity has played a tremendous role in building up the defensive wall of both vaccinated and unvaccinated people. Above all, the Public Health Authorities and governmental agencies need to be honest in their messaging to the public about the very limited extent and duration of increased protection offered by the new boosters, and remind people that the other non-pharmacological means of transmission mitigation, as unpopular as they have become, are still effective in the era of the new variants. It may be unpopular politically to stress this, but it is negligent to avoid continuing to message these facts to the vulnerable. The argument that, “People are tired and don’t want to hear this”, holds no water for me. People are likely sick and tired of being told not to drink and drive, to avoid junk foods and to not smoke. Some people will scoff at the advice and some will listen; but we don’t allow the awareness that many in the population will ignore the warning to prevent us from telling the truth.

I hope you are enjoying the Thanksgiving holiday weekend with friends and family. Despite the terrible trials of the past three years we have much to be thankful for. First among them perhaps was the incredible effectiveness of the mRNA vaccines during their early debut against the original virus. Thanks for reading these pages, please continue to share with your circle.