Lecture date: 10 June 2021
“We are now in a desperate, but unseen and barely noticed race of variant versus vaccine; of ignorance versus knowledge; of disease versus health..to know is science, to believe one knows absent data is ignorance…”
-Gregory Poland MD
Last week was an outstanding grand rounds lecture by Mayo Clinic researcher, physician and one of the world's foremost authorities on vaccines and infectious disease, Gregory Poland MD. He is the Director of the Mayo Clinic's Vaccine Research Group and one of the most respected scientists in his field during this pandemic.
I have a 28 page PDF of my own transcribed notes that I encourage everyone to download and share with medical and scientific colleagues and those who are deeply interested in the science of the vaccines and the variants as we move into a very deadly phase of the pandemic where the unvaccinated, either by choice or by age are too young for vaccination, are at increased risk for infection by the variants, particularly B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), and B.1.617.2 (Delta).
Link to my transcribed notes: https://drive.google.com/file/d/1bF1y8-OtZfKA4KtE5Ss6Qq_SVXKoSVWN/view?usp=sharing
(In my notes I have select screenshots from Dr. Poland's lecture and additional commentary from me is in blue type.)
Link to Dr. Poland's lecture on YouTube:
Rather than repeat what can be found my notes, here is a list of take home messages from his talk worth sharing:
1/ Mutations are accumulating in the viral spike as a real time example of evolution as the virus is evolving to try to not only infect us more efficiently, but also to evade our immune response. This is the hallmark of the variants that make the pandemic in 2021 a different and more dangerous ballgame for the unvaccinated in many ways than what we dealt with in 2020 before the rise of these variants.
2/ The three main vaccine platforms to combat this pandemic are protein-based recombinant vaccines (Novavax that has been in the news today is the prime example), adenovirus vector vaccines (Johnson & Johnson as well as AstraZeneca) and messenger RNA vaccines (Pfizer and Moderna).
3/ Regardless of the vaccine platform being used, the immune system is being trained and primed by vaccination the same way. Antibodies are not the only part of this immune response we are creating. There are different arms to the immune system that have their part to play, antibodies are a convenient biomarker to assess the response of the immune system. Waning or decreasing antibody levels DO NOT equal waning protection because our immune system has multiple types of "weapons" in its arsenal and the long term immunity the domain of the memory B and memory T cells can restimulate a full immune response in the absence of detectable antibodies.
4/ mRNA as a vaccine platform was first conceived in 1960 and significant research effort and investment in the mRNA vaccine platform has been going on since 1990.
"People who call mRNA vaccines experimental and untested technology are wearing a sign on their forehead that says I’m uninformed and ignorant.” (yes, Dr. Poland actually said that. Awesome.)
5/ Vaccine breakthroughs are to be expected as we get data from the real world versus selected volunteers in the trials. That means it is absolutely expected that efficacy in a trial will be higher than efficacy in the real world use of these vaccines.
6/ When looking at potential adverse events from vaccines, it is important to look at the background rate of that event before the vaccines came along. Many issues that the uninformed blame on vaccines are actually no different than what would be going on in an unvaccinated, pre-pandemic population.
7/ Adenovirus vector vaccines were first conceptualized in the 1970s and have been the subject of significant research and investment since the 1980s.
8/ What we know about COVID from the past year will not always apply to the present or the future due to the rise of the variants.
9/ When looking at vaccine efficacy, it’s important to know WHEN and WHERE that data was collected and what variants were present and how dominant they were during the clinical trials.
10/ The vaccine, just like the other vaccine platforms, were not designed to prevent infection but to prevent significant disease. Disease = symptomatic COVID that is severe and/or requiring hospitalization. Infection = all infections, including asymptomatic and mild symptoms. THIS IS A VERY IMPORTANT DISTINCTION TO MAKE.
11/ Protein based recombinant vaccines are familiar technology in the world of vaccines having been in use since 1986 when the first protein-based recombinant vaccines was approved, the Hepatitis B vaccine.
12/ Most vaccine research and clinical trials took place BEFORE the rise of the variants in the last quarter of 2020.
13/ A more contagious virus leads to more deaths than a more lethal virus simply because a more contagious virus infects more people. B.1.1.7 (Alpha) was 50% more contagious than what we dealt with through most of 2020. B.1.617.2 (Delta) is 50% more contagious than B.1.1.7 (Alpha). That means the Delta variant is twice as contagious than what we dealt with last year and this is a very significant danger to the unvaccinated.
14/ Due to variants, about 25% of COVID hospitalizations now are in patients 18 and younger. The variants have mutations that make them more efficient at infecting children and allowing children to pass them on to others. The data coming out Europe where B.1.617.2 (Delta) is surging show this to be the case. Our assumptions about children and COVID from last year are going to be challenged and likely overturned by the danger presented by the Delta variant.
15/ B.1.617.2 (the Delta variant) is now acquiring the L452R mutation from B.1.427/B.1.429 (the Epsilon variant) that first arose in California. L452R results in a 20% increase in transmissibility (contagiousness) and that is making an already highly contagious variant, the Delta variant, even more contagious.
16/ More infections mean more chances for new variants to emerge. Dr. Poland is worried about what he calls "Variant X" that one that might set us back significantly. The often quoted number to stop the pandemic is 70% vaccinated. He feels that with the variants, it may be higher, more 80-85% need to be vaccinated to prevent the emergence of "Variant X".
17/ The variants affect the ability of the vaccines to block infection, but the vaccines are still good at blocking disease when it comes to the variants. Remember when we say “Disease blocking” we are talking about prevention of serious illness, hospitalization and death. Even with the variants, the vaccines do this very well. The vaccines were not designed to be infection blocking but by virtue of how our immune system works, some infection blocking capability is present. With the variants, the ability to block infection is reduced further. Dr. Poland is very keen on the distinction between blocking disease and blocking infection when it comes to the vaccines.
18/ “We are entering the most dangerous period of the pandemic for persons who are not vaccinated.”
19/ “Younger people are now bearing the brunt of infection and complications.”
20/ The heart of vaccine hesitancy is that people form their beliefs first, then explanations for beliefs follow.
21/ Vaccination provides a more durable, focused immune response compared to the immune response that follows COVID infection. When you are infected with COVID, your immune system has a broad range of targets on the COVID spike to go after and the response is “spread out”. Vaccination provides a specific target for the immune system to aim for rather than multiple targets following COVID infection. COVID infection gives your immune system a broad range of targets on the spike, but not all of those targets if targeted by your antibodies will neutralize the virus. Vaccination gives your immune system the BEST target to focus on.
22/ Dr Poland stated that if you got an mRNA vaccine, if your immune system is healthy, you may not need a booster for 2 years. If you got an adenovirus vector vaccine, you may not need a booster until a year. Research is ongoing to determine the proper interval for booster shots.
23/ The variants will impact how long protective immunity lasts. In general, variants reduce the time that you are protected by vaccination. That in turn means the need for booster shots is sooner rather than later.
PARTING THOUGHTS
The B.1.617.2 (Delta) variant is particularly dangerous to the unvaccinated. If you are vaccinated, you won’t have much to worry about with this variant. Data coming out of Europe where this variant is surging is that those infected with the Delta variant are twice as likely to need hospitalization, a strong indicator that this variant makes you considerably sicker.
Prior COVID infection will not protect you against these variants. You still need to get vaccinated.
The next 8-10 weeks will be critical from a vaccination standpoint if we are to prevent a late summer surge in cases and hospitalizations driven by B.1.617.2 (Delta). Vaccination is not about you, it’s about protecting everyone around you. The truest measure of character is what you do not just for those who have nothing to offer you but for those whose names you will never know. We have a moral obligation for each of us to do our part by getting vaccinated to protect the vulnerable in our society, particularly the children who are too young to get vaccinated.
RELEVANT PAST POSTS (FACEBOOK LINKS)
THE MOLECULAR BIOLOGY OF THE E484K MUTATION (10 May 2021): https://www.facebook.com/jp.j.santiago/posts/10218832046529173
IMMUNOLOGY 101: THE IMMUNE SYSTEM- REPOST/UPDATE (05 May 2021): https://www.facebook.com/jp.j.santiago/posts/10218801066954703
QUICK UPDATE: BY THE NUMBERS (27 April 2021):
https://www.facebook.com/jp.j.santiago/posts/10218750780817581
COVID VARIANTS OVERVIEW AND UPDATE (22 April 2021): https://www.facebook.com/jp.j.santiago/posts/10218722676514991
NEW COVID VARIANT OF INTEREST: B.1.617 (18 April 2021): https://www.facebook.com/jp.j.santiago/posts/10218699298170547
CASE SURGES CAN RESULT IN COVID VARIANTS (12 April 2021): https://www.facebook.com/jp.j.santiago/posts/10218657527966318
THE OVERVIEW & STATUS OF COVID VARIANTS (9 April 2021): https://www.facebook.com/jp.j.santiago/posts/10218637120816152
QUICK UPDATE: THE COVID FAMILY TREE (01 February 2021): https://www.facebook.com/jp.j.santiago/posts/10218211054244754
COVID MUTANTS: VARIANTS OF CONCERN (31 January 2021): https://www.facebook.com/jp.j.santiago/posts/10218204381877949
COVID MOLECULAR BIOLOGY: THE SPIKE (6 January 2021): https://www.facebook.com/jp.j.santiago/posts/10218019683340601