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We could have universal COVID vaccines very soon — if we urgently reform the process

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  • We could have universal COVID vaccines very soon — if we urgently reform the process

    Bureaucratic and logistical roadblocks, not the science, stand in our way

    Jul 7
    Patrick Collison

    Operation Warp Speed and the broader 2020 vaccine effort was a miracle. It took less than 12 months to go from a novel pathogen to vaccine shots in arms. The response wasn’t perfect – while significantly faster than normal, the FDA was conservative – they slowed the trials and (unlike the UK) did not permit the human challenge trials that could have substantially accelerated things further. But, on the whole, the outcome was very good and one that we can all be proud of.

    Since then, our response has been far less impressive. The urgency that prevailed in 2020 has evaporated. As a result of new COVID variants, vaccines are significantly less effective, and case figures have correspondingly gone bananas. There were many more new COVID infections in the past week in the US than in the corresponding week 1 year ago and 2 years ago. So, how should we feel, and where are we going from here? ...

    What can we do about it?

    Moderna and Pfizer/BioNTech are working on “bivalent” vaccines that combine original COVID spike proteins with those from Omicron. These will help remedy the structurally silly situation that prevails today, where we’re vaccinating people with a COVID variant that was outcompeted a long time ago (early 2021). While there are nuances (Omicron appears to generate less cross-immunity than the original strain), updating the spikes as is currently proposed will almost certainly yield better immunity against current COVID variants.

    While these updated vaccines will buy us time, they’re unlikely to be a panacea. Moderna and Pfizer recently announced that their bivalent vaccine candidates have roughly 3x lower neutralizing efficacy against BA.4/5 (the current variants) than they do against BA.1 (original Omicron). These results are consistent with other data showing that BA.4/5 possess potent immune escape, even in people who were infected with the original Omicron variant. So, vaccinating people with BA.1 spikes probably won’t end this thing – nor, most likely, will any polyvalent combination of spikes from particular variants.

    ...Broadly speaking, the holdups involve some combination of logistical challenges and regulatory requirements, and the intersection between both. (You don’t in principle have to run a primate trial, but the FDA makes it harder to run a human trial if you don’t. You don’t in principle need to use “acute infection” as a trial endpoint; you could also use neutralizing antibody titers, which would be much faster and simpler.)