Are the COVID Vaccines Unusually Ineffective?

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russ_watters
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Summary:
Are the COVID vaccines substantially different from/inferior to other vaccines in terms of their effectiveness?
Background:
While discussing a moderator action in the private forum a statement was made that points to a potentially fundamental misunderstanding of how vaccines/vaccinations work that may be pervasive regardless of which side is correct. I'm spinning that discussion off and re-starting it here. I'll paraphrase the positions so that the people originally involved can join or decline to participate as they wish. My main objective is to clarify a correct understanding, and in particular have some of our resident subject matter experts confirm what is correct.

Groundrules:
  • The issue has clear political implications (that's why it was brought up), but we will not be discussing the political implications, only the factual epidemiological aspect.
  • Anti-vax misinformation will not be tolerated. To be sure, when discussing what at the start may be a wrong claim there is a risk of "misinformation", but what separates just being wrong from infractionable "misinformation" is the quality of the argument and willingness to accept quality contradicting information. In other words, cite quality sources and interpret them faithfully and you'll be fine. But we'll have a tight leash here.
The Issue/Claim:
The issue raised, and I'm mostly paraphrasing here, is this:
Most vaccines (e.g. measles, smallpox) have efficacy defined such that (for example) a 95% effective vaccine means that for a group of thoroulghly exposed people, 95% of the vaccinated are "immune" and will not get infected or pass the disease along and 5% might. The protection from infection is all or nothing and whether one can transmit the disease is also all or nothing (the "infected" can, the "not infected" cannot). That's why they don't have resurgences and "breakthrough infections" for most vaccines.

The COVID vaccine is fundamentally qualitatively different from other vaccines in that neither the "immune" nor "unprotected" states of the vaccinated are absolute; the vaccines will not prevent people from getting infected or spreading the disease. And that's why there are breakthrough infections and resurgences of the disease even in heavily vaccinated populations. The example of a similar "different" type of vaccine that isn't "effective" and doesn't provide "immunity" is the flu vaccine. The measles and smallpox vaccines are of the "normal"/effective type.


The CDC was provided as a source for the claim/definitions:
"Historically, the vaccine has been effective in preventing smallpox infection in 95% of those vaccinated"
https://www.cdc.gov/smallpox/vaccine-basics/index.html

My Understanding:
Here's a few sources:
https://en.wikipedia.org/wiki/Vaccine
https://www.health.ny.gov/publications/7022/
https://www.cdc.gov/vaccines/vpd/measles/index.html
https://en.wikipedia.org/wiki/MMR_vaccine#MR_vaccine
https://pubmed.ncbi.nlm.nih.gov/31039835/

The wikipedia describes the purpose of a vaccine to be creating antibodies for the purpose of protecting against disease. While it's tempting to read that or the CDC quote above as binary, my second source provides the same quote with an important qualification:
Smallpox vaccination provides full immunity for 3 to 5 years and decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts even longer. Historically, the vaccine has been effective in preventing smallpox infection in 95% of those vaccinated... It is important to note, however, that at the time when the smallpox vaccine was used to eradicate the disease, testing was not as advanced or precise as it is today, so there may still be things to learn about the vaccine and its effectiveness and length of protection. [emphasis added]
It is my contention/claim that the CDC quote is over-simplified due in part to limited testing/tracking. There's some logic that I think should be obvious:
  • When a virus is introduced/attacks, it's a numbers game. The number of virus particles vs the number and strength of antibodies determine how many cells are infected and how fast (or if) the body fights off the attack. There must be an infinitely granular spectrum of potential results. "Infected" and therefore "immune" are not clear-cut/binary states. With better testing and data analysis we can detect the virus in smaller and smaller quanties in people, even if the viral load is so low that they are asymptomatic. 50 years ago these people would have been labeled "not infected", and if vaccinated, counted as "immune". Today, they are asymptomatic infections.
  • Vaccine efficacy wanes over time. This is another indication of a spectrum of protection.
The MMR vaccine source discusses how measles had a large resurgence in the late 1980s after-which it was changed from a one dose to a two dose regimen to boost the effectiveness. But as I'm sure everyone knows, measles is not extinct and resurgences happen (though it was claimed they don't....perhaps a threshold issue?). Perhaps not as well known is that breakthrough cases happen even amongst the vaccinated. The last source may be the most compelling on this:
In an outbreak of measles in Gothenburg, Sweden, breakthrough infections (i.e. infections in individuals with a history of vaccination) were common... Sixteen of 28 confirmed cases of measles in this outbreak were breakthrough infections... Measles viral load was significantly lower in nasopharyngeal samples from individuals with breakthrough compared with naïve infections.... No onward transmission from breakthrough infections was identified. Our results indicate that a high risk of onward transmission is limited to naïve infections.
This should make clear:
The measles vaccine program has several of the claimed negative characteristics of the COVID vaccine program; breakthrough cases, variable immunity, inability to prevent the disease in the vaccinated.

What you see with this example is that: high vaccination rate * high vaccine effectiveness * high transmissibility = high potential for resurgence and high fraction of cases amongst the vaccinated. That's what we're seeing with COVID.

A few other thoughts:
  • The Delta variant adds another monkey wrench to this. In some ways, it is a separate or secondary pandemic.
  • All this is happening *fast* and with extreme data granularity.
Editorial:
The claimant on to say (actually opened with):
When I was a kid, everyone knew this is how vaccines work...

I believe the issue here is two-fold:
  • Clipped/concise communication, while efficient, leads people to fill in the gaps or add caveats as needed, leading to an understanding that is overly simplistic or aligned with biases.
  • Improved testing and tracking has provided an ability to split the "effectiveness" hair, when it wasn't possible to split it before. In the past, "immune" was considered binary because the data was incapable of showing that it wasn't.
I'll put the key output I'm looking for simply:
  1. Is my understanding of how vaccines work correct? or:
  2. Is there a fundamental qualitative difference between different types of vaccines based on which the COVID vaccines fall into a "substantially not as good" category? Even if it's something I missed/didn't describe properly in the premise?
Anticipated complication: "sterilizing immunity".
 
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Answers and Replies

  • #2
Astronuc
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Summary:: Are the COVID vaccines substantially different from/inferior to other vaccines in terms of their effectiveness?

The COVID vaccine is fundamentally qualitatively different from other vaccines in that neither the "immune" nor "unprotected" states of the vaccinated are absolute; the vaccines will not prevent people from getting infected or spreading the disease. And that's why there are breakthrough infections and resurgences of the disease even in heavily vaccinated populations. The example of a similar "different" type of vaccine that isn't "effective" and doesn't provide "immunity" is the flu vaccine. The measles and smallpox vaccines are of the "normal"/effective type.

The CDC was provided as a source for the claim/definitions:
"Historically, the vaccine has been effective in preventing smallpox infection in 95% of those vaccinated"
https://www.cdc.gov/smallpox/vaccine-basics/index.html

I had a case of influenza the one year out of the last 7 that I didn't get the vaccine, so it's effectiveness may be like the COVID-vaccine, i.e., it doesn't last more than a year and declines. Now, along with my wife, I (we) get a boosted influenza vaccine (I believe is double the dose). I could have contracted one of the strains (variants?) of influenza that was not covered by the vaccine (the doctor didn't bother to do a sample to type it), as a colleague has experience. We both got the standard vaccine last year, but he came down with the flu (probably a Type B, or a Type A not covered in the vaccine). Fortunately, in my case and his, we were treated with Tamiflu, an effective treatment. I now make sure to get an annual influenza vaccine.

I don't know that we know how effective the small pox vaccine is. The CDC indicates its effectiveness diminishes, "Smallpox vaccination can protect you from smallpox for about 3 to 5 years. After that time, its ability to protect you decreases." Then on a separate page, "If you need long-term protection, you may need to get booster vaccinations regularly. To stay protected from smallpox, you should get booster vaccinations every 3 years."
https://www.cdc.gov/smallpox/vaccine-basics/who-gets-vaccination.html

Back when a received the small pox vaccine, I received it at school. Every student received the vaccination. So may be the eradication of small pox was in part because 'every' (99 - 99.99%?) of the population was vaccinated. If I was traveling to certain parts of the world, I'd be required to have updated vaccinations.

Interestingly, the page on small pox vaccination states, "If the vaccination is successful, a red and itchy lesion develops at the vaccine site in 3 to 4 days. In the first week, the lesion becomes a large blister, fills with pus, and begins to drain. During the second week, the lesion begins to dry and a scab forms. The scab falls off in the third week, leaving a small scar." I never had such a reaction, although I did have a scar, and I don't anyone at the time who did. As I recall, and it's more than 50 years ago, after we got the shot, we didn't cover the site. We just went back to class.

Are breakthrough cases of measles or rubella tracked in the US. I know of several outbreaks of measles in the US, which apparently were attributed to unvaccinated children.
One such outbreak - https://clark.wa.gov/public-health/measles-investigation
details of the 71 confirmed cases:
  • Age
    • 1 to 10 years: 52 cases
    • 11 to 18 years: 14 cases
    • 19 to 29 years: one case
    • 30 to 39 years: four cases
  • Immunization status
    • Unimmunized: 61 cases
    • Unverified: seven cases
    • 1 MMR vaccine: three cases
So at least, one apparent breakthrough case, and potentially others.

There were other outbreaks in Washington State in 2019
https://ehs.washington.edu/about/latest-news/wa-state-measles-outbreak-got-mmr

https://www.npr.org/sections/health...les-cases-mount-in-pacific-northwest-outbreak
cases have popped up in 11 states so far this winter, and the Centers for Disease Control and Prevention is tracking three outbreaks (defined as three or more confirmed cases) in New York City, New York state and Washington state.
Vaccination rates in the Pacific Northwest are among the lowest in the nation. While all school-age children are required to receive the MMR vaccine, which protects against measles, mumps and rubella, Washington is among the 17 states that allow "philosophical exemptions," meaning a parent can excuse a child from being vaccinated for virtually any reason.

Currently the vaccination rate across Clark County is 78 percent, but some schools in the area have rates under 40 percent, according to the Clark County Public Health website. Such low rates have public health officials working around the clock to contain the outbreak.

Cases in NY State - https://en.wikipedia.org/wiki/2019_New_York_measles_outbreak
Outbreaks in US during 2019 - https://firstwatch.net/u-s-measles-cases-number-over-1000-in-2019/
Other years - https://www.cdc.gov/measles/cases-outbreaks.html

According to my mother, I had measles as a child, ran a pretty high fever and was very ill. I don't remember. I eventually got the MMR and other required vaccines. I do remember having a case of Rubella, probably during middle school. More recently (during the last two decades when my kids were in school), I developed a mild case of whooping cough (even though I had the vaccine, but long ago), which was going around the unvaccinated student population in the district.

I think it will take time to collect the data to determine the effectiveness the different COVID vaccines. Aren't the claims for Pfizer and Moderna on the order of 94-95% initially (after two weeks) and then effectiveness may wane in 6 months or so, hence the discussion of booster vaccinations? Another consideration is the rapid development of the vaccine, which happened within one year, as opposed to years. Meanwhile, the virus is mutating.

Putting some context into the magnitude of the current SARS-Cov-2 pandemic, the US reports over 650,000 fatalities (approaching and expected to pass the number fatalities attributed to the 1918-1919 influenza outbreak in the US) with over 41 million confirmed cases. Compare that with,
By the epidemiological studies conducted between 1910 and 1912 during epidemics in the United States, Frost found a widespread exposure to poliomyelitis but a low incidence of clinical disease to those susceptible to infection. During the epidemic in the north eastern United States in 1916, the role of asymptomatic persons in the spreading of infection was recorded by the Public Health Service. This epidemic caused widespread panic; over 27 000 persons were reported to have been paralyzed, with 6000 deaths.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782271/
https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html
 
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  • #3
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(approaching and expected to pass the number fatalities attributed to the 1918-1919 influenza outbreak in the US) with over 41 million confirmed cases. Compare that with,
Are you certain? Fifty to one hundred million fatalities globally is the figure is the figure I've seen cited.
 
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...e.g. measles, smallpox...
It may be useful to add that the mentioned diseases has sufficient length of incubation period (between onset to first symptoms) for the immune memory to kick in and start to produce antibodies.
In case of covid, the incubation period is usually rather short.
 
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It is also a matter of defining what it means to "work" as a vaccine. I.e. The difference between being so sick you need to be hospitalized, and may wind up dead, vs suffering flu-like symptoms, and being irritable for a few days...
 
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jack action
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It is my contention/claim that the CDC quote is over-simplified due in part to limited testing/tracking. There's some logic that I think should be obvious:
  • When a virus is introduced/attacks, it's a numbers game. The number of virus particles vs the number and strength of antibodies determine how many cells are infected and how fast (or if) the body fights off the attack. There must be an infinitely granular spectrum of potential results. "Infected" and therefore "immune" are not clear-cut/binary states. With better testing and data analysis we can detect the virus in smaller and smaller quanties in people, even if the viral load is so low that they are asymptomatic. 50 years ago these people would have been labeled "not infected", and if vaccinated, counted as "immune". Today, they are asymptomatic infections.
  • Vaccine efficacy wanes over time. This is another indication of a spectrum of protection.

I believe the issue here is two-fold:
  • Clipped/concise communication, while efficient, leads people to fill in the gaps or add caveats as needed, leading to an understanding that is overly simplistic or aligned with biases.
  • Improved testing and tracking has provided an ability to split the "effectiveness" hair, when it wasn't possible to split it before. In the past, "immune" was considered binary because the data was incapable of showing that it wasn't.
All of this reminds me of my thread What is the cause of death? Nothing is binary when it comes to life, yet we are still presented with binary data instead of probabilities. And now it's getting to you as well. Welcome to the dark side.
 
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Astronuc
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Are you certain? Fifty to one hundred million fatalities globally is the figure is the figure I've seen cited.
I was referring to fatalities in the US. I heard an epidemiologist estimate 800 K fatalities by the end of 2021 in the US. Only time will tell. Maybe the number will be more like 750 K, which is a lot of people from a single primary and mostly preventable cause.

Worldwide, it is estimated about 4.55 million fatalities due to COVID-19, and the pandemic is still ongoing.

The earliest documented case was March 1918 in Kansas, United States, with further cases recorded in France, Germany and the United Kingdom in April. Two years later, nearly a third of the global population, or an estimated 500 million people, had been infected in four successive waves. Estimates of deaths range from 17.4 million to 100 million, with an accepted general range of 25–50 million, making it one of the deadliest pandemics in human history.
https://en.wikipedia.org/wiki/Spanish_flu
The name "Spanish flu" is a misnomer, rooted in historical othering of infectious disease origin, which is now avoided. The pandemic broke out near the end of World War I, when wartime censors suppressed bad news in the belligerent countries to maintain morale, but newspapers freely reported the outbreak in neutral Spain. These stories created a false impression of Spain as the epicenter, so press outside Spain adopted the name "Spanish" flu.
 
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FWIW, most of the deaths from the Spanish Flu were from secondary bacterial pneumonia infections (there were no antibiotics at the time):

https://www.nih.gov/news-events/new...ia-caused-most-deaths-1918-influenza-pandemic



I think measles is a good comparison, given the similar virulence to COVID - however when measles vaccines were introduced, the disease had been endemic for a long time, so there was plenty of the supposedly superior 'natural immunity'. As SARS-CoV-2 is a novel virus, should it be compared to the impact of a disease like measles on isolated populations? I do not know if there was a situation where, say, an indigenous population was vaccinated against a disease like measles simultaneous to that population's first exposure to the virus

Also - are all virus types equal? This is the first coronavirus vaccine - so how much depends on virus family / subfamily?
 
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  • #9
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All of this reminds me of my thread What is the cause of death? Nothing is binary when it comes to life, yet we are still presented with binary data instead of probabilities. And now it's getting to you as well. Welcome to the dark side.
As far as I can tell, nobody made such a claim in that thread (though you seemed to be incorrectly claiming that was the claim). I haven't switched sides here and it's a different issue anyway.
 
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Astronuc
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FWIW, most of the deaths from the Spanish Flu were from secondary bacterial pneumonia infections (there were no antibiotics at the time):

https://www.nih.gov/news-events/new...ia-caused-most-deaths-1918-influenza-pandemic
One potential comorbidity with the H1N1 pandemic (1918-1919) is tuberculosis.
https://www.physicsforums.com/threads/covid-19-fatal-effects.986633/post-6334986

In addition, "Malnourishment, overcrowded medical camps and hospitals, and poor hygiene, exacerbated by the war, promoted bacterial superinfection, killing most of the victims after a typically prolonged death bed."
Ref: https://en.wikipedia.org/wiki/Spanish_flu
 
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In case of covid, the incubation period is usually rather short.
Ten days to two weeks? Compared to hours for "Spanish Flu?" America's Hidden Stories, Season 1, Episode 3.
 
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Ten days to two weeks?
As far as I know the original (covid) had three to seven days of incubation period: delta has two on the lower end.

Compared to hours for "Spanish Flu?"
Sorry, but could you please get a source for that? A real one.
Flu - as far as I know - usually goes with one to four days. One day is already extreme. Hours?
 
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  • #13
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I think that a big part of this is public perception of science vs actual science. The public tends to take scientific claims as very black and white. E.g. GR proved that Newtonian gravity is wrong. When in actuality science is almost always understood by scientists in much more nuanced terms. E.g. Newtonian gravity correctly predicts orbits of most planets to an accuracy sufficient to do astronomy and rocketry and GR does that too and also correctly predicts the reading on clocks.

"Immunity" is a loaded word. It makes people think of legal immunity where a witness absolutely cannot be prosecuted for their own crimes because of a deal they made to help prosecute someone else. Biological immunity is much more subtle and is neither complete nor static. This is true of all vaccines. All vaccines have breakthrough infections and can then spread from the breakthrough infections to others. There is no biological equivalent of legal immunity.

What makes COVID vaccines different from the smallpox vaccine is not the fact that immunity is not complete. Rather the difference is that the prevalence of COVID is far higher than the prevalence of smallpox ever was, and the transmissibility of COVID is also higher than smallpox. Also, during the last outbreaks of smallpox there was no 24 hour news cycle.

My personal opinion is that even 100% vaccination will not eradicate COVID like smallpox was eradicated. I believe that the animal reservoirs are too large for that to ever happen. Again, however, that is a difference in the pathogen rather than a functional difference in the vaccines. If COVID had the epidemiological characteristics of smallpox then the existing COVID vaccines would be effective enough to eradicate it.
 
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jack action
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As far as I can tell, nobody made such a claim in that thread (though you seemed to be incorrectly claiming that was the claim).
I must have misunderstood then. The claim seems to be:
The protection from infection is all or nothing and whether one can transmit the disease is also all or nothing (the "infected" can, the "not infected" cannot).
The issue seems to be:
It is my contention/claim that the CDC quote is over-simplified due in part to limited testing/tracking.

I believe the issue here is two-fold:
  • Clipped/concise communication, while efficient, leads people to fill in the gaps or add caveats as needed, leading to an understanding that is overly simplistic or aligned with biases.
  • Improved testing and tracking has provided an ability to split the "effectiveness" hair, when it wasn't possible to split it before. In the past, "immune" was considered binary because the data was incapable of showing that it wasn't.
What I understand from that is that you say some people think past vaccines appears to be more efficient than the Covid vaccines, but you think that it is not the case; it is just because they didn't see the whole picture back then, and they "fill in the gaps", and you even added "aligned with biases".

When you are talking about "numbers game" and "binary", aren't you talking about "shades of grey" vs "black & white"?

I'm not aware of the discussion you are referring to in the OP, so it is not that clear to me, but it seems your objective is to find arguments against people who claim that Covid vaccines are not as efficient as past vaccines. And you want to play the "statistics & probabilities" card to explain the "effectiveness and length of protection" differences. Am I understanding you correctly?

That being said, and to partly answer your question, your "understanding of how vaccines work" seems interesting and logical to me but, like you, I would be glad to hear an expert opinion about that.
 
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The wikipedia describes the purpose of a vaccine to be creating antibodies for the purpose of protecting against disease.
I found this painful to read. The purpose of a vaccine in the very short term (months) is related to anti-bodies. If you are expecting to have benefits longer than a year, antibodies can't be the driver; vaccines need to induce T and B cell immunity as well. Focusing only on antibodies is a horribly inaccurate model.

Adding T and B cells to the mental model is not that hard. I can't understand why people constantly miss this on a science site.

It may be useful to add that the mentioned diseases has sufficient length of incubation period (between onset to first symptoms) for the immune memory to kick in and start to produce antibodies.
In case of covid, the incubation period is usually rather short.
Thank you for this. And the underlying gap that you're hinting at here is that new anti-bodies can be 'manufactured' during incubation period when one has robust T and B cell immunity.

The discussion of smallpox and its vaccine is somewhat interesting. It may also be worthwhile for people to think about the chickenpox vaccine.
 
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If you are expecting to have benefits longer than a year, antibodies can't be the driver; vaccines need to induce T and B cell immunity as well.
Yes, and that is one reason why a mere decline in antibody levels is not the same as a decline in immunity. This is relevant in the booster discussion. The boosters produce a definite physiological effect, but the clinical benefit is not as clear. That is why there is disagreement even among experts like the FDA vs the CDC.
 
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For what it's worth (I will self-declare that it isn't much), my understanding is similar to yours: The COVID vaccines aren't fundamentally different from other vaccines. The general public doesn't have the patience or (terrifyingly) any interest in getting informed enough to understand the subtleties of the language required to accurately describe the situation. The mixture of theoretical, empirical, and preliminary information only adds to the confusion.

As I understand it (please correct me if I'm confused):

The '95%' of people who can't get measles in your 'Issue' paragraph don't really) exist - it's a statistical 95%. People want to believe that 95% of those individuals have 'perfect' immunity - that probably isn't the case.

Even the term 'infected' is misunderstood/misapplied. Anyone who inhales (or otherwise ingests) live virus is 'infected.' At that point, it's a race between your immune system and the reproductive rate of the virus. Depending on the size of the initial exposure, the reproductive rate of the specific virus/variant and the quality of the immune response, a range of outcomes is possible. The quality of the available immune response is variable, but (in the case of COVID) vastly improved by a vaccination. The level of virus required to declare an 'asymptomatic infection' is somewhat arbitrarily just the result of what can be detected. A vaccine cannot prevent infection - the goal is to prevent significant infection, where 'significant' means enough to produce symptoms or shed enough virus to transmit to others - not absolutes.
 
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Saw a guy the other day (he was in Australia, so good to know we dont have a monopoly on dumbasses) acknowledging the higher COVID survival rate for vaccinated people, but claiming it was due to hospitals secretly giving them Irvemectin, which they withheld from the unvaxxed
 
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The CDC was provided as a source for the claim/definitions:
"Historically, the vaccine has been effective in preventing smallpox infection in 95% of those vaccinated"
https://www.cdc.gov/smallpox/vaccine-basics/index.html
The next sentence is “In addition, the vaccine was proven to prevent or substantially lessen infection when given within a few days after a person was exposed to the variola virus” which does vaguely hint that there might be a bit more nuance to the immune response…. But it’s not enough to avoid the oversimplification trap.

Snopes has some contemporary photos comparing mild smallpox in the vaccinated with severe infections in the unvaccinated. If the commentary is accurate the inoculations were not post-exposure prophylaxis but given years ago, more evidence that vaccination is not a simple ”95% not to get it”.
 
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I think that a big part of this is public perception of science vs actual science. The public tends to take scientific claims as very black and white. E.g. GR proved that Newtonian gravity is wrong. When in actuality science is almost always understood by scientists in much more nuanced terms. E.g. Newtonian gravity correctly predicts orbits of most planets to an accuracy sufficient to do astronomy and rocketry and GR does that too and also correctly predicts the reading on clocks.

"Immunity" is a loaded word. It makes people think of legal immunity where a witness absolutely cannot be prosecuted for their own crimes because of a deal they made to help prosecute someone else. Biological immunity is much more subtle and is neither complete nor static. This is true of all vaccines. All vaccines have breakthrough infections and can then spread from the breakthrough infections to others. There is no biological equivalent of legal immunity.

What makes COVID vaccines different from the smallpox vaccine is not the fact that immunity is not complete. Rather the difference is that the prevalence of COVID is far higher than the prevalence of smallpox ever was, and the transmissibility of COVID is also higher than smallpox. Also, during the last outbreaks of smallpox there was no 24 hour news cycle.

My personal opinion is that even 100% vaccination will not eradicate COVID like smallpox was eradicated. I believe that the animal reservoirs are too large for that to ever happen. Again, however, that is a difference in the pathogen rather than a functional difference in the vaccines. If COVID had the epidemiological characteristics of smallpox then the existing COVID vaccines would be effective enough to eradicate it.
Dr. Amesh Adalja who is a contributor for THEHILL.COM spoke this morning on our local radio station KDKA and essentially supported your opinion that "even 100% vaccination will not eradicate COVID like smallpox was eradicated."
 
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I think some of the discussion here centers on a statement I read some time ago on the internet that the mRNA vaccines were not legally considered vaccinations because they do not necessarily prevent getting the disease. I apologize that I don't remember where I saw that. Regardless, the J&J vaccine was created using the "usual" method of creating vaccines. I know this first hand because my sister worked for Merck prior to retirement and so she opted for that vaccine since she was familiar with how it was made. She actually is still taking part in the trials and she did get the actual vaccine. I and most in my area however took the Pfizer vaccine which was for some time the only available one anyway. My J&J sister just got over a bout of COVID only a few days ago (she passed with two negative tests) which she likened to a bad flu - although she is still quite tired. Our next door neighbors had the Pfizer and they had COVID as well which they also likened to a bad flu - how bad depended on the person. So this real life situation seems to suggest although both vaccines here were constructed differently, the outcome is about the same. Neither prevented the disease forever, and both seemed to protect the recipient from a worse outcome.
 
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Dr. Amesh Adalja who is a contributor for THEHILL.COM spoke this morning on our local radio station KDKA and essentially supported your opinion that "even 100% vaccination will not eradicate COVID like smallpox was eradicated."
On the program did he explain his reasoning why he thought that?
 
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"COVID-19 is an endemic respiratory virus, it cannot be eliminated or eradicated."
Coronaviruses and others have been notoriously challenging with respect to developing vaccines.

Vaccines are an important public health strategy to better protect people from viruses like measles and influenza. Despite efforts to produce a vaccine for the common cold, no such product has yet been developed.

Scientists have been trying to develop a cold vaccine without success since the 1950s. This is due in part to the fact that colds aren't caused by a single virus. However, new technologies may soon overcome this challenge and bring the promise of a cold vaccine closer to reality.
https://www.verywellhealth.com/why-there-will-never-be-a-vaccine-for-the-common-cold-770451

Vaccines target a specific disease-causing pathogen, such as a virus. One of the difficulties in developing a vaccine for the common cold is there are at least 200 different viruses that can cause cold symptoms, including adenoviruses, coronaviruses, parainfluenza, and rhinoviruses.

Rhinoviruses are to blame for up to 50% of all common colds. That seems like a big enough target to focus on. But of these rhinoviruses, there are more than 150 strains circulating at any one time.

https://pharmaceutical-journal.com/...development-is-about-more-than-fighting-colds
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291752/

Respiratory syncytial virus is another challenge.
 
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Ygggdrasil
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On the program did he explain his reasoning why he thought that?
Here's a nice article published in Nature that considers the future of COVID-19 as an endemic virus by considering the history of other similar viruses.

After the pandemic: perspectives on the future trajectory of COVID-19
https://www.nature.com/articles/s41586-021-03792-w

In particular, here are the three scenarios they suggest for the COVID-19 pandemic:
The first—and most worrisome—scenario is that we will not gain rapid control of this pandemic and thus will face a future with ongoing manifestations of severe disease combined with high levels of infection that, in turn, could foster further evolution of the virus. Vaccinations and previous infection could achieve long-term herd immunity, but we will need a very broad application of vaccines worldwide combined with comprehensive disease surveillance by accurate and readily available diagnostic assays or devices76.

A second and more likely scenario is the transition to an epidemic seasonal disease such as influenza. Effective therapies that prevent progression of COVID-19 disease (for example, monoclonal antibodies that reduce hospitalization and death by 70–85%) may bring the burden of SARS-CoV-2 infection to levels that are equivalent or even lower than influenza. However, we should remember that the annual mortality burden of influenza, in non-pandemic years, is estimated to be between 250,000 and 500,000 deaths, with up to 650,000 all-cause deaths globally, comprising around 2% of all annual respiratory deaths (two thirds among people who are 65 years and older)77. This is an extremely important health burden and equates to a relatively ‘optimistic’ view of the future of the COVID-19 pandemic.

A third scenario is the transition to an endemic disease similar to other human coronavirus infections that have a much lower disease impact than influenza or SARS-CoV-2. There is, however, limited data on the global burden of disease by common human coronaviruses78 and as noted in above, it is not possible to predict with confidence whether further adaptations of SARS-CoV-2 to humans will increase or decrease its intrinsic virulence.

One reason why most do not see eradication of SARS-CoV-2 or other similar coronaviral diseases as likely is that (like with influenza), humans are not the only reservoir of the virus. Viruses like smallpox were able to be eradicated because they infect only humans. SARS-CoV-2 has shown the ability to infect a number of different wild and domesticated animals, meaning that even if vaccination could eliminate the virus from all human populations, the virus would still persist in the wild ready to re-enter populations once immunity has waned or vaccination becomes less common.
 
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