COVID Designer viruses as vaccines: yea or nay?

[hutchphd]

To me it seems that the response to COVID19 was limited more by social reluctance to vaccinate (and foot the bill for said pan-vaccination) than the medical prowess necessary for the developmaent of safe and effective vaccines. For a hypothetical more deadly virus this could have catastrophic ramifications. The appearance of the OMICRON variant appears to be more effective at (finally?) limiting the pandemic than the previous vaccinations.
This immediately suggests using a designer virus in lieu of a vaccine. Is this just a foolishly risky idea? How close are we to being scientifically able to do it? Of course there are a host of issues.

 

[TeethWhitener]

What’s the difference between your idea and the adenoviral vector used in (e.g.,) the J&J COVID vax?

 

[TeethWhitener]

Wait a sec, do you mean releasing a replication-competent weakened virus onto an unsuspecting population? I hope everyone sees the ethical issues with this.

 

[hutchphd]

Yes that is what I wanted to discuss. If the alternative is billions of dead people, what should the ethics look like? I truly don't know.

 

[TeethWhitener]

1. Dosing people with experimental medication without their knowledge or consent is unethical (for many many reasons).
2. Especially in this case, if a virus can replicate, it can evolve…in an uncontrolled manner…into something really really bad.

This is less of a biology question and more of an ethics question. Maybe it belongs in general discussion instead of in the biology forum.

 

[hutchphd]

Yes that is what I wanted to discuss. If the alternative is billions of dead people, what should the ethics look like? I truly don't know.

This is less of a biology question and more of an ethics question. Maybe it belongs in general discussion instead of in the biology forum.

I am fine with either, but I also hoped to provoke some technical discussion as to the level of control we have with the technology. Can we produce designer viruses? How direct is the result?

 

[TeethWhitener]

If the alternative is billions of dead people, what should the ethics look like? I truly don't know.

Is the alternative billions of dead people? If COVID had a 20% fatality rate instead of a 2% fatality rate, I have to imagine that would impact vaccine hesitancy. Add to that the fact that right now, the main reason billions of people haven't been vaccinated is because they haven't been given the opportunity.

Can we produce designer viruses? How direct is the result?

This is essentially what the J&J vaccine is, except it is purposefully made replication-incompetent. It's an adenovirus whose genome has been modified to 1) express the SARS-CoV-2 spike protein Edit: in its genome on its surface, and 2) not replicate in its human hosts.

Edit: I messed this up the first time around, so this is a clarification: the J&J vaccine is basically a delivery vehicle for the genetic information for the host cell to build the spike protein. The viral vector itself does not express the spike protein.

 

[BillTre]

The issue of releasing viable viruses into the nature to infect some particular animal (like mosquitoes) has come up before.

Here are a couple of posts:
Engineering to push the spread of modified viruses population in a virus population.
Having an election of Florida about whether to release engineered mosquito viruses.

 

[DaveE]

releasing viable viruses into the nature to infect some particular animal (like mosquitoes) has come up before.

Are you sure about this? I thought the mosquito stuff was gene drive (modification of the germ cells and transmitted via normal reproduction), not viruses. The only case that comes to my mind is Myxoma virus introduced in the Australian rabbit population, which wasn't an "engineered" virus, and didn't turn out well.

Anyway, I very curious about this and would appreciate any links to pursue.

 

[BillTre]

Are you sure about this? I thought the mosquito stuff was gene drive (modification of the germ cells and transmitted via normal reproduction), not viruses. The only case that comes to my mind is Myxoma virus introduced in the Australian rabbit population, which wasn't an "engineered" virus, and didn't turn out well.

Anyway, I very curious about this and would appreciate any links to pursue.

Opps. Yes your are right.

 

[DaveE]

I think the oral polio virus is an instructive example here. It is a weakened live virus vaccine which has been widely used. While not transmissible enough to exist without vaccination, it can be transmitted to others. There are also many cases where the transmission was detected because the virus reverted to some level of increased virulence and cause AFM in rare circumstances. For that reason it is no longer licensed in the US, where IPV is the vaccine of choice. However, IPV is harder to store and administer, so OPV is the vaccine of choice in 3rd world countries. It is believed that ultimate polio eradication isn't possible with OPV.

But this highlights two huge problems:
1) We don't know enough about transmission of viruses (immune system interactions), and the epidemiology of epidemics, to design a viruses that is reliably transmitted without vaccination. This is especially true if you desire any control over where or how much. This is why we use pre existing viruses as viral vectors (like the J&J adenovirus based COVID vaccine). I don't believe anyone has made a virus, we only know how to modify existing viruses.
2) Evolution. Specifically immune system evasion. If you succeed in launching this virus into the general population, you will have essentially no control over if or how it changes.

Finally, there is a huge political/PR problem. People don't even like GMO corn. There is already great concern for "gain of function" research as it is. A "lab generated" infectious virus would bring out every pitch fork owning protester in the suburbs. And without the regulatory apparatus to ensure adequate safety testing, I might be one of them.

The history of other biological controls and invasive species mishaps isn't promising.

 

[artis]

The appearance of the OMICRON variant appears to be more effective at (finally?) limiting the pandemic than the previous vaccinations.

Yes true, but I would like to point out that it is also partly because the naturally induced immunity has proved to be broader and longer lasting on average than vaccine induced one. So logically the latest and also more moderate Omicron given it's lower risk factor and much higher transmissibility is doing us a natural immunity boost whether we like it or not.
Just a study and a news article to base my claims , although hopefully they shouldn't be doubted given this is now public knowledge.
https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1.full.pdf

https://www.reuters.com/business/he...vaccination-during-delta-surge-us-2022-01-19/

I would tend to agree with @DaveE and others here that introducing a virus that is live and able to replicate into a population for the sake of immunity is essentially gambling.
I mean we are at the point where we can simulate certain proteins and parts of a virus on a computer but then imagine just the mammal population alone in the world and the biological "Petri dish" that it gives to a virus for both mutating and spreading, do we posses the tools to reliably predict the outcome of it? I don't think so.

What we could do and seem to be doing and I think it's the right direction is to make vaccines less vaccine like aka to have nasal sprays as vaccines etc , in forms that are more accessible and less "needle fear" inducing.
Minimize adverse/side effects, maximize production/availability and offer multiple "delivery" methods , preferably ones that can be done anywhere and safely. This alone I think would decrease vaccine hesitancy.

On a more PR/social psychology side I think the very short time scales at which everything happened was also a great contributor to hesitancy. People in general take time to get comfortable with certain new ideas/laws/rules etc.
I can say from the folks I know that those who protested the Covid vaccine and especially the mandate were absolutely fine with and all have had the "classical" vaccines like polio etc, their kids have been vaccinated and so on and so forth. So I think the fast pace of everything combined with political pressure worked against instead of in favor of vaccination. Just how society works from what I can see.

 

[Ygggdrasil]

Yes true, but I would like to point out that it is also partly because the naturally induced immunity has proved to be broader and longer lasting on average than vaccine induced one. So logically the latest and also more moderate Omicron given it's lower risk factor and much higher transmissibility is doing us a natural immunity boost whether we like it or not.
Just a study and a news article to base my claims , although hopefully they shouldn't be doubted given this is now public knowledge.
https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1.full.pdf

https://www.reuters.com/business/he...vaccination-during-delta-surge-us-2022-01-19/

Though the information you cite does seem reliable, I'm not sure there is absolutely no doubt about this issue. For example, here is what the CDC has to say on the issue, which suggests that vaccine-induced immunity provides more consistent protection than infection-induced immunity:

Key findings and considerations for this brief are as follows:

• Available evidence shows that fully vaccinated individuals and those previously infected with SARS-CoV-2 each have a low risk of subsequent infection for at least 6 months. Data are presently insufficient to determine an antibody titer threshold that indicates when an individual is protected from infection. At this time, there is no FDA-authorized or approved test that providers or the public can use to reliably determine whether a person is protected from infection.
  • The immunity provided by vaccine and prior infection are both high but not complete (i.e., not 100%).
  • Multiple studies have shown that antibody titers correlate with protection at a population level, but protective titers at the individual level remain unknown.
  • Whereas there is a wide range in antibody titers in response to infection with SARS-CoV-2, completion of a primary vaccine series, especially with mRNA vaccines, typically leads to a more consistent and higher-titer initial antibody response.
  • For certain populations, such as the elderly and immunocompromised, the levels of protection may be decreased following both vaccination and infection.
  • Current evidence indicates that the level of protection may not be the same for all viral variants.
  • The body of evidence for infection-induced immunity is more limited than that for vaccine-induced immunity in terms of the quality of evidence (e.g., probable bias towards symptomatic or medically-attended infections) and types of studies (e.g., observational cohort studies, mostly retrospective versus a mix of randomized controlled trials, case-control studies, and cohort studies for vaccine-induced immunity). There are insufficient data to extend the findings related to infection-induced immunity at this time to persons with very mild or asymptomatic infection or children.
• Substantial immunologic evidence and a growing body of epidemiologic evidence indicate that vaccination after infection significantly enhances protection and further reduces risk of reinfection, which lays the foundation for CDC recommendations.

https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/vaccine-induced-immunity.html

Of course, the guidance is older than the newer data you cite, so the CDC may revise this information in the future.

 

[hutchphd]

Has this been referenced here ?It is pretty new.
https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm#contribAff

My takeaway (graph at the end) is that infection and vaccination are both very good at prevention of severe disease, with infection being slightly better. Also infection+vaccination is no better than infection alone.

 

[artis]

Has this been referenced here ?It is pretty new.
https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e1.htm#contribAff

My takeaway (graph at the end) is that infection and vaccination are both very good at prevention of severe disease, with infection being slightly better. Also infection+vaccination is no better than infection alone.

@Ygggdrasil @hutchphd beat me to it but I wanted to cite the same study which was also one of the studies I based my claims upon although I did not cite it at my post.

The only question remains about length/duration of immunity from natural infection vs vaccination.

 

[Mike S.]

"Designer viruses" is perhaps a poor way to phrase it for PR reasons. Let's say "live attenuated vaccine". Note that the better you hobble the virus not to be dangerous, the more likely that every kid is going to need his own little sugar cube. Which is perhaps just as well in many countries where vaccine development is left to private companies that have zero interest in a product that gives itself away. There are quite a few papers that discuss live attenuated vaccines, for example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354792/ .

Nonetheless, the experience from polio is that a "live vaccine" can become a dangerous outbreak. That shouldn't happen in a country with good vaccine coverage, but it can happen where there are many susceptible people. ( https://www.cdc.gov/vaccines/vpd/polio/hcp/vaccine-derived-poliovirus-faq.html , https://abcnews.go.com/Health/wireStory/polio-cases-now-caused-vaccine-wild-virus-67287290 ). Playing with viruses is much like playing with fire, for the same reasons; still, civilization wouldn't be what it is without fire.

There is much I haven't seen about SARS-NCoV-2 that I would like to. What happens if, say, the small E protein is completely excised from its genome? Can it recover (revert) from that effect? Even an ongoing pandemic that has wracked the world has not inspired countries to fund the level of research we should be doing routinely on any pathogen that threatens the world.

 

[BillTre]

Even an ongoing pandemic that has wracked the world has not inspired countries to fund the level of research we should be doing routinely on any pathogen that threatens the world.

How do you know this?

 

[hutchphd]

This admittedly was an ill-formed question (my apologies) , but I know precious little about this technology.
I was interested in a truly dire situation: like perhaps a new virus that produces 50% mortality and has an R₀ of 10 and a 1 week incubation. It would seem to me that any conventional vaccination regime would be ~useless in this circumstance. Is it desirable to try to develop (or further develop?) the capability to produce a much less lethal but very transmissable immune dopplegangar virus at our command? Do we know how to do this (or where to start)? The obvious example here is the COVID 19 Omicron variant or perhaps (for Edward Jenner) a much more transmissable Cowpox. I am assuming this conversation is not novel, but I find myself surprisingly ambivalent.and ill-informed. Make the virus and spray it at the airport and the subway?

 

[TeethWhitener]

To the best of my knowledge, it is not currently possible to determine a priori a virus’s transmissibility or virulence. As I mentioned earlier, any virus that can replicate can mutate, potentially to a more virulent form. Also, even if I could get beyond the ethical issues of releasing an experimental virus on an unsuspecting public, I’m not sure what it gains you. Presumably it would have to go through the same testing and approval that a standard vaccine would.

I suppose you’re trying to overcome vaccine hesitancy, but as I mentioned, if the virus had a very high mortality rate, I suspect that vaccine hesitancy would magically evaporate. I have no proof, but I imagine that people who know folks that have died of COVID are probably more likely to get vaccinated and take other precautions (what little info I found on google claims that roughly 1 in 3 people know someone who has died of COVID: Link). In the case where a pathogen had a very high infectivity and mortality rate, a lot more people would know someone who had died, and a lot of people would know a lot of people who had died.

 

[hutchphd]

I was thinking of a a more dire circumstance where dissemination of a live aggressive but far less lethal virus might be the only course of action (Less lead time, very little infrastructure to disseminate, very cheap and egalitarian once released, and high coverage). Could such a thing be possible in a forseeable near futue? Can a moral case be constructed to start down that road ? This to forestall a truly cataclysmic pandemic...

 

[DaveE]

How would you do clinical trials with a highly transmissible virus? If you skip them, how would you know if it's safe and effective?

 

[TeethWhitener]

I was thinking of a a more dire circumstance where dissemination of a live aggressive but far less lethal virus might be the only course of action (Less lead time, very little infrastructure to disseminate, very cheap and egalitarian once released, and high coverage). Could such a thing be possible in a forseeable near futue? Can a moral case be constructed to start down that road ? This to forestall a truly cataclysmic pandemic...

Again, currently the only way to know how transmissible and virulent a pathogen is is to let it infect a bunch of people and record the results. Unless you already know at the onset of an epidemic 1) that pathogen A offers cross-protection against pathogen B, and 2) that pathogen A is less virulent than pathogen B, you’re flying blind.

 

[hutchphd]

The technology would need to be robust and the trials "quick and dirty" I think. Some deserted location. The alternative is truly dire in my hypothetical...Billions of people in months. How clever can we get at this technology?

 

[Drakkith]

This admittedly was an ill-formed question (my apologies) , but I know precious little about this technology.
I was interested in a truly dire situation: like perhaps a new virus that produces 50% mortality and has an R₀ of 10 and a 1 week incubation. It would seem to me that any conventional vaccination regime would be ~useless in this circumstance. Is it desirable to try to develop (or further develop?) the capability to produce a much less lethal but very transmissable immune dopplegangar virus at our command? Do we know how to do this (or where to start)? The obvious example here is the COVID 19 Omicron variant or perhaps (for Edward Jenner) a much more transmissable Cowpox. I am assuming this conversation is not novel, but I find myself surprisingly ambivalent.and ill-informed. Make the virus and spray it at the airport and the subway?

Assuming you could develop such a virus faster than you could develop a vaccine, then such an idea is certainly plausible. But probably not possible in the near future given our current knowledge and technology.

 

[Drakkith]

The technology would need to be robust and the trials "quick and dirty" I think. Some deserted location. The alternative is truly dire in my hypothetical...Billions of people in months.

I'm a bit more optimistic. The Covid-19 pandemic shows that when people actually follow proper social distancing, lockdown, and other safety measures the rate of infection is dramatically reduced. If there's a pandemic that's so deadly that people are essentially dying in the streets then I'm confident that people would take these safety precautions MUCH more seriously than the did during covid-19.

 

[TeethWhitener]

The technology would need to be robust and the trials "quick and dirty" I think. Some deserted location. The alternative is truly dire in my hypothetical...Billions of people in months. How clever can we get at this technology?

How about this? It’s a heck of a lot easier to roll out tests than vaccines or therapies. Roll out massive testing, test everyone at gunpoint, and if they have the disease, kill them. It would probably ultimately save more lives than your method. It uses existing technology. It’s quick.

It’s also morally abhorrent. Can a moral case be constructed to start down that road? What if we only load 10% of the guns? What if instead of using guns we engineer a pathogen about which we know nothing and spray it unwillingly on people?

 

[hutchphd]

But probably not possible in the near future given our current knowledge and technology.

How soon if we pushed it? Do we know enough to hazard a guess? Decades? Centuries? My guess is 3 decades. Part of me thinks our response to a truly dire pandemic would be far less accommodating to science than the present one. Unfortunately we are in this together. So it will be availible for my centenary birthday...

How about this? It’s a heck of a lot easier to roll out tests than vaccines or therapies. Roll out massive testing, test everyone at gunpoint, and if they have the disease, kill them. It would probably ultimately save more lives than your method. It uses existing technology. It’s quick.

It’s also morally abhorrent. Can a moral case be constructed to start down that road? What if we only load 10% of the guns? What if instead of using guns we engineer a pathogen about which we know nothing and spray it unwillingly on people?

I can think of many immoral alternatives but that says nothing at all (yours is actually an ad hominem argument). Please don't mischaracterize what I said. This is a real issue perhaps subject to rational discourse.

 

[TeethWhitener]

I can think of many immoral alternatives but that says nothing at all (yours is actually an ad hominem argument). Please don't mischaracterize what I said. This is a real issue perhaps subject to rational discourse.

No, it’s an argument by analogy. Please attempt to engage in rational discourse. The only difference between my scenario and yours is that at least the guns are tested. With a pathogen, you have no idea how many people you’re going to have to kill before you hit upon a variant that is less virulent and more transmissible. I have already said at least twice that there is no way to determine a pathogen’s virulence and transmissibility without infecting a lot of people with it. I’m not sure how much clearer I can be.

 

[artis]

Alot of questions arise here,

For one I agree with the opinion expressed that for a more deadly virus people would actually seek out ways to protect themselves more, with Covid many got away with few days of sweat and watching movies while out of work, sure enough such folks might be less interested in vaccination or other medical interventions.
If economics is any measure then the law holds, the more something is needed the more it is sought after.

Now as for the OP scenario , first of all is there even a virus alive today or known to us that could (given our modern medicine and ways of protection) be so lethal as to kill billions in a matter of weeks? I think natural virus, not a biological weapon designed to destroySecond of all this vaccine spraying I can already see so much wrong with it apart from the horrible ethics and bad PR, first of all how do you control for dose? How ca you even attempt to control for dose for something that gets sprayed into a public space?
Then for example how do you not give the vaccine to someone who is already infected therefore causing a double burden on ones immunity?

Anyway if you cannot control the dose you either risk having no effect at all or overboosting someone to the point where they might develop serious side effects or die.

 

[hutchphd]

I have already said at least twice that there is no way to determine a pathogen’s virulence and transmissibility without infecting a lot of people with it. I’m not sure how much clearer I can be.

Obviously I am not advocating randomly generating pathogens and spraying them willy-nilly. The question is whether we can obtain the ability to control those aspects of viruses: hence the term "designer viruses" and not "madman mutated viruses". I am fully aware that this is (yet another) terribly slippery slope.

Now as for the OP scenario , first of all is there even a virus alive today or known to us that could (given our modern medicine and ways of protection) be so lethal as to kill billions in a matter of weeks? I think natural virus, not a biological weapon designed to destroy

I have no idea, but certainly our everincreasing proximity and connectedness makes the effects of pathogens more potentially lethal. Also there may be new avenues for intermixing of viral DNA (I'm way out of my depth here) which are thereby afforded. These Corona viruses (MERS SARS COVID (different flavors) and HIV seem to have suddenly "appeared"

Second of all this vaccine spraying I can already see so much wrong with it apart from the horrible ethics and bad PR, first of all how do you control for dose? How ca you even attempt to control for dose for something that gets sprayed into a public space?
Then for example how do you not give the vaccine to someone who is already infected therefore causing a double burden on ones immunity?

Presumably the "dose" would be simply a sufficiency to produce (mild and therapeutic ) disease. The idea is that this would then be communicable. The severity of most disease is only very loosely correlated to initial viral load past threshold I believe. The increasing of immune response might be a clinical issue but it could be beneficial.
As to the ethics: that is the crux of this discussion. Given the (IMHO possible) scenario do we demand societal ethics that preclude this form of intervention. Is it "horrible" to try to salvage civilization from a new dark age? How far do you go down this road ? These are discussions we should have before it is too late to decide.

 

[TeethWhitener]

Alright I’ve calmed down a bit. Apologies to @hutchphd for getting heated.

One approach that is related but which I find significantly more ethically palatable is based on the fact that it’s really quite a fast process (or at least it can be) to prototype RNA vaccines. Once the genome of a pathogen is known and understood, modified RNA sequences corresponding to promising immunological targets can be synthesized and rolled out in a matter of days to weeks. (If I recall correctly, Pfizer had a prototype vax within 2-3 days of the publication of the SARS-CoV-2 genome sequence.) If a situation arose which were as dire as you lay out, I could condone a scenario where an RNA vax were rolled out untested to the (willing) general public, with the caveat that it is untested and the requirement to be monitored for possible exposure/vaccine efficacy. Basically, the entire vaccine rollout would be one big clinical trial.

One bottleneck would be synthesis of vaccine material, but oligonucleotide synthesis is largely automated now, so one could dream up mass manufactured black boxes to synthesize the requisite RNA in a distributed fashion at scale.

All of this technology is either already available or very near-term and already in exploratory phases for a number of applications. In the long run, a priori prediction of virulence and transmissibility is a worthy goal, but my gut feeling is that it’s either 1) 50 years away, or 2) pending some machine learning breakthrough (so much closer than we anticipate).

 

[hutchphd]

I agree that the bioethics questions are extraordinarilly difficult. Hopefully airing them in a proactive manner will produce more "light" and less "heat' (@TeethWhitener I don't mind a spirited discussion so no apology necessary.)

 

[Mike S.]

For purposes of discussion, let's direct this question to a more tangible and immediately doable case.

I just ran into someone who had been working hard to go into nursing, who changed major because the program had ... surprised her with a vaccination requirement. I was rather flabbergasted ... she said something about religion, but citing other religions, not saying it was her religion, and about concern about the vaccine.

I didn't think that was the right call on her part -- NONETHELESS, her call it is.

Now I understand you can't risk people spreading COVID to cancer and transplant patients and the old and HIV-positive or someone about to go into surgery ... I mean, I understand that you'd have to test an unvaccinated nurse almost every day and it's not practical or necessarily reliable anyway. I understand why they can't let her in. But ... there is still a way, for the person with a determined religious objection.

We could get the last few omicron patients in the county to submit samples, which we dilute out to what we think is a least infectious dose, and we could offer the refuseniks the option to infect themselves with a "mild" strain of COVID, like an inoculation you could say. Do that N times until they stop getting sick, and if they are still able to stay on their feet all day without chronic fatigue, we can let them do nursing.

Now, it seems like we should do this, I think, whenever they are willing to participate, because we can infect them and isolate them and then let them live their lives, rather than leaving them to run around the countryside like unexploded ordinance, never knowing when they're going to "go off" with an unexpected infection. At least in this scenario we don't have to consider the effects of indirectly infecting anyone but the people we are thinking of.

Yea or nay?

 

[Drakkith]

Yea or nay?

Nay. Nay. Nay. There is no reason to jump through hoops to let people get around a vaccine requirement for a nursing job when a new infection could crop up at anytime that would require new vaccines that they also wouldn't accept. So you'd just lose staff as soon as a new outbreak happens or constantly have them putting people at risk because they refuse to get vaccinated.

Many jobs have health or safety requirements. If you don't want to follow those requirements, you can choose to work somewhere else or in another career that doesn't have them. If you don't want to wash your hands, don't work in a kitchen. If you don't want to wear a hard hat and PPE (and people complain about mask requirements in jobs... psh...) then don't work in construction or in an industry that requires those things. If you don't want to follow rules on how to safely operate heavy machinery, don't work somewhere that requires you to operate a forklift, crane, or other heavy equipment.

 

[hutchphd]

I didn't think that was the right call on her part -- NONETHELESS, her call it is.

By what notion (legal or moral) do you make this EMPHATIC statement ?
It is truly absurd.

 

[Mike S.]

By what notion (legal or moral) do you make this EMPHATIC statement ?
It is truly absurd.

Erm, because she DID make that call? She isn't doing nursing now, but the Vaccine Police have not taken her away. And the rest of us are free to think about whether there is a way to negotiate.

 

[hutchphd]

Erm, because she DID make that call?

I owe you an apology I think. I read your comment to mean it was her call whether she, as a nurse, needed to be vaccinated. This is prevailing antivax idiocy.
I also am amazed that she would suddenly realize that as a nurse, certain public health requirements would be obtain. Also I do think your assessment that it is incumbent upon us to go to the societal expense of developing an FDA proven innoculation sceme so that she can be a nurse is more than a little silly. Maybe we could do homeopathy...

 

[Mike S.]

"A little silly" describes most things religious; yet the failure to take them into account has the gravest consequences. Russia failed to protect a right to be Catholic in 2002 and look where we are now. Think of religion as a Frank Herbert style "Bureau of Sabotage", that throws monkey wrenches into the plans of all those too eager to scan every face and dictate every diet. If someone, for any reason (even if we think they made it up) declares a deep-seated religious objection to a vaccine, and proves it by substantial career sacrifice, we have to look for every viable alternative. (I understand getting heart patients and 90-year-olds sick is not "viable") So I think we should be looking into methods of serological certification of COVID exposure, and even controlled circumstances for doing that exposure deliberately. That differs from the original headlined "designer virus as vaccine" only in degree: how much risk of transmission are we willing to put up with from these intentional exposures, and do we try to select, culture, or modify the Omicron virus to make it less dangerous before carrying them out?

 

[BillTre]

To me, these ideas seem way too intrusive to happen. Serological certification would require getting blood from everyone involved, which many would object to. It would also be expensive in labor and money.
Tracking of who is certified and/or exposed would be a big bureaucratic mess.
What about those were already exposed but not in a well tracked manner?

 

[hutchphd]

If someone, for any reason (even if we think they made it up) declares a deep-seated religious objection to a vaccine, and proves it by substantial career sacrifice, we have to look for every viable alternative.

1st amendment to the US constitution
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

If this person wishes to avoid vaccination, she should not become a nurse. If she doesn't like high places, she should not become a window washer. We are under no obligation, as a government, to provide special redress to ameliorate religious inconvenience for particular devotees. In fact that would be unconstitutional

 

[Drakkith]

If someone, for any reason (even if we think they made it up) declares a deep-seated religious objection to a vaccine, and proves it by substantial career sacrifice, we have to look for every viable alternative.

That's fine if the alternatives aren't vastly more expensive or complicated to implement. I don't think most here would disagree with someone taking an alternative route to the same goal if implementing that alternative route is relatively easy and doesn't put others at undo risk. But when it costs more money and generates a big headache to implement then we run into the issue of deciding where to draw the line. Why waste time, resources, and money that doesn't need to be wasted?

The real issue here doesn't even have anything to do with religion. The overwhelming, vast majority of those who object to vaccines are not doing so because of religion, despite what they may claim. They are doing so because they have a skewed understanding of medicine and the government and are often parroting things they've heard in 'echo chambers' online or through their preferred news media. They are claiming religious exemptions simply because it's an easy-to-use reason to not get vaccinated, either through legal means, as in how many states have religious exemptions, or social means, as in it's hard to tell someone their religion doesn't say anything about vaccines without many people seeing you as violating their religious freedoms.

An actual example of accommodating religion would be the inclusion of Kosher/Halal MRE's and fresh meals in the military (source and source). I expect these to be roughly the same cost as other meals and MRE's and to provide similar nutrition, but alas I can't guarantee it without what would probably be an exhaustive search effort on my part.

Dietary restrictions are a long standing tradition in certain religions, vaccine and other medical restrictions are, to my knowledge, not. At least in most western religions. I certainly never heard my grandad preach against anything having to do with modern medicine during my younger years of going to his Church of Christ, nor did I hear it at my childhood Baptist church, or in the protestant church I briefly attended in the military.

With respect, you're suggestion doesn't even accommodate religion. It accommodates misinformation, fear, and arrogance.

 

[Mike S.]

It accommodates misinformation, fear, and arrogance.

Is that a bad thing? You don't make peace with your friends, and you don't guarantee rights to people who do what you want them to. Universities, rehab clinics, public housing ... most of the infrastructure that makes a society work is meant to provide for those who don't know what they should or aren't able to act on it.

Checking titers hardly seems like a fringe idea. Sometime between alpha and delta I asked the doctor about a shingles shot and she had me get a vial of blood taken instead. She said since the titer was high I could put it off a while and perhaps have better immunity later on. So I'm not thinking of the titer checking as some kind of fringe science! If we can ask refuseniks why Covid is different than polio, they can surely ask us why Covid is different from chicken pox!

 

[DaveE]

Checking titers hardly seems like a fringe idea.

The problem with this is that no one knows what the correlates of protection actually are. That is difficult research that will take a long time to do, if it's really possible to know. Also, some "titers", like T-cells, for example, are difficult (expensive) to do. However, this is important research to do as it is how better alternate vaccines must be tested once you have an effective vaccine deployed; it is unethical to give a potentially inferior version and allow severe disease to be your effectivity metric in clinical trials.

Yes, a simple test to see if someone has effective immunity would be great. But it's science fiction at this point and will remain so for a long time.

Finally, I suspect that many who are vaccine resistant wouldn't want to be tested anyway. I don't think that would really address the compliance problem.

BTW, most of what you read in the popular press about measuring antibodies (B-cells, really) to judge vaccine effectiveness or duration is so simplified as to be meaningless crap. Your B-cell response is supposed to wane over time, with other parts of your immune system also providing durable immunity from severe disease.

 

[hutchphd]

If we can ask refuseniks why Covid is different than polio, they can surely ask us why Covid is different from chicken pox!

Yes they can. But that does not mean, for instance, that practitioners of homeopathic medicine should be funded by Medicare. Even if the individual involved really really really believes it works.
As a society, according to our founding documents, we should make decisions to "promote the general welfare" and do so according to legal process. This does not mean that all requests have equal merit. They are due equal consideration on the merit, and an adjudication is made. That is how government works best for the most people most of the time. It is a practical issue, not intrinsically a moral one..

 

[Mike S.]

Yes, a simple test to see if someone has effective immunity would be great. But it's science fiction at this point

I feel as if you're almost making an anti-vaxxer argument here. I mean not really, but close. But neutralizing antibodies do correlate strongly with COVID severity. While T cells are important, they tell a bit of an odd story, with at least this report that the cytotoxic T cells are targeting a nucleoprotein that isn't part of the vaccine.

To be sure, the vaccine isn't perfect and that's one reason why I acknowledge this woman. The stats I've seen lately seem to be trending around 50% protection from Omicron infection. (Protection from severe disease may be better, but that doesn't defend innocent bystanders) So a titer doesn't have to be a Delphic oracle to offer bystanders as much protection as a vaccine card, and it does have real meaning. Moreover, well ... we don't have to offer people an absolute guarantee against Covid exposure, because we done gone fouled that up already. If an approach like titers is reasonably likely to be reasonably effective, then instead of going to painful extremes trying to break the anti-vaxxers' spirit, we should tolerate the risk unless and until we see a disaster unfold, and in the meanwhile be doing something a little more productive like trying to spot the strain that comes out of white-tailed deer before it kills us all all over again. Which we're NOT going to do - we've laid off the contact tracers, ended the mask requirements, tied the governors' hands, and boldly whistled our way into the Exclusion Zone pretending nothing bad is ever going to happen with this disease again, knowing full well that isn't true. Is it really such a virtue also to lord it over this lady, while we do all that also, just in order to ensure that our public health people will be hated even more the next time they have to tell us things have hit the fan?

 

[DaveE]

I feel as if you're almost making an anti-vaxxer argument here. I mean not really, but close. But neutralizing antibodies do correlate strongly with COVID severity. While T cells are important, they tell a bit of an odd story, with at least this report that the cytotoxic T cells are targeting a nucleoprotein that isn't part of the vaccine.

To be sure, the vaccine isn't perfect and that's one reason why I acknowledge this woman. The stats I've seen lately seem to be trending around 50% protection from Omicron infection. (Protection from severe disease may be better, but that doesn't defend innocent bystanders) So a titer doesn't have to be a Delphic oracle to offer bystanders as much protection as a vaccine card, and it does have real meaning. Moreover, well ... we don't have to offer people an absolute guarantee against Covid exposure, because we done gone fouled that up already. If an approach like titers is reasonably likely to be reasonably effective, then instead of going to painful extremes trying to break the anti-vaxxers' spirit, we should tolerate the risk unless and until we see a disaster unfold, and in the meanwhile be doing something a little more productive like trying to spot the strain that comes out of white-tailed deer before it kills us all all over again. Which we're NOT going to do - we've laid off the contact tracers, ended the mask requirements, tied the governors' hands, and boldly whistled our way into the Exclusion Zone pretending nothing bad is ever going to happen with this disease again, knowing full well that isn't true. Is it really such a virtue also to lord it over this lady, while we do all that also, just in order to ensure that our public health people will be hated even more the next time they have to tell us things have hit the fan?

Wow, you read a lot into my reply that I don't think I said.

The general point of my comment was that we don't know how to do what you want yet. That is all.
Perhaps we should just agree to disagree on that point. Virology is a rather complex subject with many disagreements, which is a good thing, I think (as long as we aren't getting our information from Nurses and Cardiologists on YouTube or prime time news broadcasts ).

I feel as if you're almost making an anti-vaxxer argument here. I mean not really, but close.

I feel as if you're almost insulting my intelligence. I mean not really, but close.

 

[Drakkith]

Is that a bad thing? You don't make peace with your friends, and you don't guarantee rights to people who do what you want them to.

And you don't build a second bridge to an island just because some people mistakenly believe they are going to fall off the existing bridge.

To be sure, the vaccine isn't perfect and that's one reason why I acknowledge this woman.

No vaccine is ever perfect. And if the efficacy of the vaccine was something like 5% then this woman might have a reasonable leg to stand on. But the whole point of the vaccine is to prevent someone from contracting the disease and to reduce the severity and risk of transmission if they still happen to contract it. So a 50% efficacy is still REALLY good compared to just contracting the disease itself.

(Protection from severe disease may be better, but that doesn't defend innocent bystanders)

It does if the reduced severity comes from a reduced viral load, which suggests reduced viral shedding and thus reduced risk of transmission.

If an approach like titers is reasonably likely to be reasonably effective,

But we don't know if it's reasonably likely. That's one of the main issues here. If we don't know how long natural Covid-19 immunity lasts, and the only known reliable way to keep up an immunity is through vaccinations, then having mandatory vaccination requirements for doctors and nurses is reasonable in my opinion.

then instead of going to painful extremes trying to break the anti-vaxxers' spirit, we should tolerate the risk unless and until we see a disaster unfold

This has nothing to do with breaking anyone's spirit.

Is it really such a virtue also to lord it over this lady, while we do all that also, just in order to ensure that our public health people will be hated even more the next time they have to tell us things have hit the fan?

Stop exaggerating. No one's lording anything over this lady. I doubt anyone is toilet papering her house or spamming posts on her social media because she chose not to pursue a career that required a vaccine. Children aren't throwing rotten eggs down from their windows at her while holding their vaccination cards out. She doesn't have a big red AV sewn into her clothing for all to see.

 

[hutchphd]

Is it really such a virtue also to lord it over this lady, while we do all that also, just in order to ensure that our public health people will be hated even more the next time they have to tell us things have hit the fan?

I have to ask: what in heck you are talking about ?
The fact that our public health people are hated by some speaks to the rationality of the haters who wish to shoot the messenger. You can't fix stupid.

 

[Mike S.]

No one's lording anything over this lady. I doubt anyone is toilet papering her house or spamming posts on her social media because she chose not to pursue a career that required a vaccine. Children aren't throwing rotten eggs down from their windows at her while holding their vaccination cards out. She doesn't have a big red AV sewn into her clothing for all to see.

This quote seems absurd to me. She put in a lot of work learning material useful in nursing, at a time when vaccines weren't required. Then she's told it's their way or the highway - for a vaccine that offers no great assurance you won't be infected and spread the virus anyway. Now you don't have to argue with me that her reasons for rejecting the vaccine are wrong. But if you want to try to convince me that getting a house toilet papered or some nasty Twitter posts is worse than having to take another year of school for something else, well, you guys can ride *that* bandwagon without my help.

Let's put it this way: if our efforts are toward *stopping Covid transmission*, and they should be, then we should not interpose any false intermediates between our actions and that goal. It is like idolatry for epidemiologists! If we can make a reasonable assurance that someone is not infectious to the vulnerable people they tend to at the hospital, *by any means* -- preferably by reasonable inferences involving serum titers, or otherwise up to and including them exposing themselves to live Omicron virus under isolation if that's what it genuinely takes to prove they aren't more likely to pass it on to patients later -- then that is good enough. When we fail to see that as a society, it suggests that the agenda of stopping Covid has been replaced -- as it *usually* is -- by an agenda of mindless bureaucratic conformity.

 

[BillTre]

She put in a lot of work learning material useful in nursing, at a time when vaccines weren't required.

This seems disingenuous to me.
I would be surprised if there were not some vaccines that were already required before covid.
If not required they would be highly recommended.
The obvious reason would be to prevent disease spread to and from the patient population.
These could easily include (especially where working with newborns or compromised patients):

• Tetanus
• Diphtheria
• Pertussis (Tdap)
• Measles
• Mumps
• Rubella
• Hepatitis B

Anyone entering such a scientifically based field without knowing this is on a fool's errand.

Vaccination is not a

false intermediates between our actions and that goal.

in the control of most contagious diseases.
This is just wrong overstatement in the attempt to make your point.

You have a major unproven assumption, that testing can catch outbreaks before it can spread.
How's that worked out?

Your proposal amounts to: making more work for others, to enable a poorly informed few, to potentially endanger many.