[smt88]

Five years from now, we'll be taking a Covid vaccine for whatever the prevalent variant is (exactly like we already do for the flu).

The only difference is that, if you don't take your flu vaccine every year, you're much less likely to be hospitalized or die.

[LurkingPenguin]

The flu is a completely different virus. In fact, what we call "the flu" is actually several different influenza viruses, so your flu shot isn't targeting just one virus, it's targeting multiple influenza viruses. The rate of mutation of these viruses is very different than that of SARS-CoV-2.

The reason there's a different flu shot every year is that the efficacy of last year's vaccine against the current influenza viruses will likely be too low to provide adequate protection, not just against infection but against serious illness. This again is because of how much the influenza viruses mutate in a short period of time.

Currently, the data indicates that the SARS-CoV-2 vaccines are holding up very well in preventing severe illness, hospitalization and death for all SARS-CoV-2 variants. This is the reason why the boosters that were approved are the same vaccine, not a new variant-specific one.

SARS-CoV-2 vaccines do not provide sterilizing immunity, and it is clear that the neutralizing antibodies produced immediately after vaccination wane quickly, which allows vaccinated individuals to still become infected.

Unless and until you see a drop in the efficacy against severe illness, hospitalization and death, this idea that we will or should be taking COVID vaccines indefinitely every year is hard to justify with science.

[smt88]

I understand the differences betwen flu and Covid. My analogy was limited to the (widely accepted) routine of vaccination.

We don't yet know whether protection from hospitalization will wane, but waning protection from infection[1] is still a problem.

An infection can take time away from work or family, spread to others, and have long-term effects that we can't yet understand. Again, not unlike flu: we try to prevent infections with vaccines, not just hospitalizations.

Public health orgs have to weigh the benefit of boosters over the risk of lower supply where it's needed, but given unlimited vaccine supply, I would be surprised if we don't get a new Covid vaccine every year.

1. https://www.cidrap.umn.edu/news-perspective/2021/08/studies-...

[LurkingPenguin]

Vaccinating large numbers of people every 6-12 months with a non-sterilizing vaccine when the initial vaccination series is said to remain highly effective at preventing serious illness against all major variants that are currently in wide circulation is not at all routine or "widely accepted".

Again, the flu vaccine is different each year because the influenza viruses it aims to protect against are different. You are getting a different vaccine, not a "booster".

The flu vaccine is not a sterilizing vaccine and neither are any of the COVID vaccines. It is widely accepted that the flu vaccine is usually 40-60% effective at preventing illness in years where we target the right influenza viruses, and that many vaccinated individuals will get (mostly) mild infections.

From the CDC:

> A 2021 study showed that among adults, flu vaccination was associated with a 26% lower risk of ICU admission and a 31% lower risk of death from flu compared to those who were unvaccinated.

> A 2018 study showed that among adults hospitalized with flu, vaccinated patients were 59 percent less likely to be admitted to the ICU than those who had not been vaccinated. Among adults in the ICU with flu, vaccinated patients on average spent 4 fewer days in the hospital than those who were not vaccinated.

By these metrics, against the endpoints of severe outcomes, the COVID vaccines currently look much more efficacious than the flu vaccine after the initial series, even without boosting.

While "long COVID" is of concern, many of the post-infection sequelae of COVID appear similar to known post-viral sequelae. Furthermore, the initial data suggests that the initial series of vaccination reduces the risk of long COVID sequelae in breakthrough infections. To my knowledge, there is not yet any data on long COVID and boosters, so it is highly premature to hint that repeated boosters are required to maintain protection against "long COVID".

Shutting down the world indefinitely because of COVID "infections" when the vast majority of people will have mild courses of illness makes no sense. We don't do this for the flu even though in bad flu seasons, people lose work and school days and the ERs and ICUs fill up. Furthermore, as time goes on, fewer and fewer people will be SARS-CoV-2 naive. They will either have some level of protection from exposure to the initial vaccine series or prior infection. The immune system is miraculous and there is a reason it doesn't indefinitely keep high levels of neutralizing antibodies in circulation for every pathogen (or vaccine) you're exposed to.

Finally, you should consider including repeated frequent booster vaccination in your "long-term effects that we can't yet understand" thinking. While I am not suggesting that the mRNA are "unsafe" or responsible for die-offs of baby dolphins, the reality is that we have no long-term data around giving people these jabs on a regular basis. The issue with myocarditis in some populations, questions about whether the vaccines affect the menstrual cycle[1], etc. are a reminder that there is still a lot we don't know and it is contrary to the principle of "first, do no harm" to strongly recommend (or try to force) people to receive regular pre-exposure prophylaxis when there is strong evidence that they already have substantial protection against serious outcomes from an initial vaccination series.

[1] https://covid19.nih.gov/news-and-stories/covid-19-vaccines-a...

[pbak]

As somebody who has spent a fair amount of time in elder care facilities around these times of the year (mandatory Civilian service in my country), boy do I have some depressive anecdotes for you.

Flu shots can be just this side of too strong for some frail and fragile elders, and cause nearly as many victims as the flu a month later, when the vaccine turn's out to be not good enough.