[conspire] 2 Virology professors explain why bivalent vaccine won't stop transmission

[Rick Moen]

Quoting Les Faby (lfaby2018 at gmail.com):

> Rick asked for evidence to help him decide if he should just require
> boosters or additionally require the bivalent booster.
>  I asked Prof Vincent Racaniello, who Dierdra knows. His colleague, who has
> her lab at the FDA, agrees with him.
> They are COVID vaccine proponents for getting the 2 shots plus one booster.
> They are pro-vaccine but have seen no evidence that the current shot makes
> you safer for others.

OK, I'll add that to my pondering, and thank you for taking the trouble.
I'll get back to that "safer for others" bit below.

> Dr. Paul Offit, who has developed a vaccine and is on the CDC(?) vaccine
> committee, also concurs.
> Them answering the question:
> (30-60 seconds)
> https://youtu.be/sc5XeZuoUCc?t=1847

> Dr. Paul Offit, who has developed a vaccine and is on the CDC(?)
> vaccine committee, also concurs.

He's a member of CDC's Advisory Committee on Immunization Practices.

Citing Dr. Offit is _slightly_ tendentious.  (Not a complaint.)  Dr.
Offit is a real, respectable figure in this field, but he's been very
much a maverick outlier with just about everyone else about the rollout
policy re: the earlier boosters and about the desirability of the
covalent booster at the time of approval, relative to the data that were
then available.  

I respect his reasons for being a maverick, and his views are entirely
within the bounds of science.  They are, however, distinctly a minority
among informed parties.  Here's NY Magazine's "Intelligencer" feature
discussing his Dec. 2021 view that boosters for _everyone_ was in his
view not justified at that time.
https://nymag.com/intelligencer/2021/12/omicron-dr-paul-offit-is-skeptical-of-boosters-for-all.html

And one of my favourite site covering fringe-science giving reasons
why Dr. Offit is _not_ a crank even though he's a contrarian:
https://sciencebasedmedicine.org/i-wont-call-dr-offit-an-anti-vaxxer/

Here is Dr. Offit, two days ago, stating a carefully qualified bit of
doubt about an aspect of present evidence for the bivalent booster(s):
https://www.nytimes.com/2022/11/14/us/politics/moderna-booster.html

  "We still do not have a single shred of evidence that the bivalent
  vaccine works better than the monovalent vaccine," said Dr. Paul A.
  Offit, the director of the Vaccine Education Center at Children’s
  Hospital of Philadelphia and a member of the Food and Drug
  Administration’s panel of outside vaccine experts.

  "The only evidence we have today has been neutralizing antibodies, and
  that hasn’t been particularly supportive," Dr. Offit said. "You could
  argue we never needed to include these circulating strains, until a
  circulating strain arises that is resistant to protection against severe
  disease."
  [...]

  Neither company "controlled for length of time after the last dose,"
  Dr. Offit said, adding, "There are a lot of problems with that." He
  said the longer interval after the third dose could have strengthened
  the immune system of participants who received the updated booster,
  leading to higher antibody levels.

Each of Dr. Offit's contrarian opinions has been scientifically
defensible, e.g., when he opined that the evidence on hand at the time
of this-or-that FDA decision was too weak and that the decision was
hasty.  However, in each case, a decisively strong majority of 
qualified experts has respectfully disagreed.	


You said Dr. Racaniello and Dr. Rosenfeld's answer concerned
whether boosters beyond the first makes anyone safer for others.
As always in science, it's vital to make sure one is investigating
the correct question.  Individuals seeking information about infectious
diseases might ask "Will X make it less likely to become infected if
exposed?"  "Will X affect my likelihood of symptomatic disease?"  "Will
X affect my period of infectiousness to others?"  "Will X affect my
probable time to recovery?"

The question you asked Racaniello and Rosenfeld was "I have a friend
hosting a dinner party.  Do you think it is necessary to have the
bivalent [booster...]?  How will [the bivalent booster] affect 
transmission beyond a couple of months?"  But the answer was a little
squirrely.  Racaniello said "Dixon had a bivalent and it didn't prevent
him from getting reasonably symptomatic COVID, which was treated with
Palovid.  So, Les, my feeling is three shots, that's what I had, that's
what Amy has, that's enough.  I got infected, I had symptoms, I took
Paxlovid, beautiful.  Life is good.  That's the way I think you should
do it.  I don't think it's going to impact transmission, very much at
all.  It seems to me that the bivalent is not really doing much for
preventing infection, even two weeks after you get it.  Two weeks!  When
antibody levels should be high."  Rosenfeld: "Well, at first it's not
going to affect infection."  Racianiello: "That's correct.  Not after a
few months.  But even two weeks after, it _should_ affect infection, but
it's not going to...."  Rosenfeld:  "Well, you would tell me that Dixon
is old and he doesn't make any memory B cells, so you have to...."
Racianello:  "Yeah, but, Amy, after two weeks, you're not depending on
memory B cells.  You're depending on effector B cells, that are going to
be around for maybe a few months, and then go away.  Then, you depend on
memory cells, and Dixon is screwed, right.  He can't make memory cells,
right."

Neither of the good doctors is consistent on what question he or she is
addressing.  This is troubling.  

And if the question was supposed to be "Does the bivalent booster make a
CABAL attendee safer for others?", then neither of them seem to have 
properly addressed that question at all.  (What you said, specifically,
was "transmission beyond two months".  I'm unclear on why the scope 
of your question was limited to 2+ months after a bivalent booster, but
I note that's what you asked.)

Now, a side-light about who these two good people are.  Vincent R.
Racaniello, Ph.D. is a Columbia professor of Microbiology & Immunology, 
whose expertise is virology (including but not limited to poliovirus).

Amy B. Rosenfeld, Ph.D. is also a virologist, with most of her work
having been on enteroviruses in Dr. Racaniello's lab.  

If I had a question about viruses, I would be ecstatic about ability to
consult these two doctors.  If my question were about vaccines and 
epidemiology, though, it's not entirely clear their expertise is 
in quite the right area.  

Ideally, one would want to consult experts on _vaccines_, specifically
these ones, and what evidence there is for the bivalent booster reducing
infection and/or retransmission of current strains, relative to having
had no other COVID booster or vaccine for many-months-to-a-year.  And
then one would want to ask them the right question.  A "safer for
others" framing _does_ seem the most relevant questing to CABAL
attendance, which I guess equates to asking about the bivalent booster
reducing infection and/or retransmission of current strains.

On the evidence, I'm not sure Drs. Racaniello and Rosenfeld understood
you to be asking about that, given their answers, and given your wording 
"How will [the bivalent booster] affect transmission beyond a couple of
months?"  I'm not sure you asked the right question, and I'm pretty 
certain the doctors were unclear on what question they were choosing to
answer.

Anyway, thank you for asking, and pointing to their answer.  That gives
me more to ponder.

I'll admit, I've been lately paying attention mostly to the best
reporters' assessment of experts on my behalf, reporters like _The
Atlantic_'s Katherine J. Wu.
https://www.theatlantic.com/health/archive/2022/11/annual-covid-vaccine-booster-shots/672037/
But this is, obviously, a complex topic, and I'll need to stop for the
time being.