I will not mince words here - Omicron has been a major setback for vaccines and the whole pro-vaccine movement because of the sheer number of breakthrough cases that have occurred. Hospitalizations and deaths have still been largely reduced thanks to vaccines but I’ve become disillusioned seeing just how many people, including several people on this very site, can’t seem to appreciate that because they still got sick. I wonder if the enthusiasm for vaccination has been considerably dampened thanks to Omicron, a variant nobody could have seen coming and nobody could have prepared for. Omicron is still the same virus, but its biology seems to be the most dramatic departure compared to the original Wuhan strain that we have seen yet, and the scientific community is still trying to come up with the best ways to analyze the thing.
I do want to clear up some misconceptions, without getting into the specific science of things. First of all, last November both mRNA vaccine companies applied for booster authorization from the FDA and they requested the use of the original 2019 Spike protein. This was not done out of laziness. There were mountains and mountains of data, generated by myself and many others, indicating that variant-specific boosters only had a marginal effect on antibody titers and efficacy. The rationale to change the formula simply wasn’t there. The layman probably assumes that if you match the vaccine to whatever is the most prevalent variant then it should work better, but it’s not that simple.
Second, the booster EUA request and approval happened BEFORE Omicron. There was literally no way to get an Omicron booster out the door in time. But let’s say, for the sake of imagination, that Omicron had been detected and announced before those EUAs were filed. Yes, these vaccines can be designed quickly but they still need to be manufactured and (most importantly) tested in human populations. You can’t just go to the FDA and say you *think* this new booster should do better than the original vaccine. You need to fucking demonstrate that there is added value to what you’re doing. If this were the flu or another well-known and studied virus then sure, you might be able to get away with that, but not with a novel virus in the context of a global pandemic.
Third, it is insanely difficult to hit a moving target, especially when we don’t know what will be needed in a few month’s time. Say we magically had the BA2 vaccine ready to go 2-3 months from now. Say it worked against BA2 better than the other variant-specific boosters did (something that we still can’t say for sure). Who is to say that it will still matter in 2-3 months? Maybe cases drop to nothing, meaning that you’d just be contributing to general vaccine fatigue. Or maybe some other variant has supplanted it, one where the BA2 variant does not fare any better than any other variant booster. Coming up with ways to future-proof this stuff is a daunting task because it’s not just a moving target but a target that is moving in multiple directions at once. This virus does not evolve in a linear fashion; if it did then this pandemic would have been over for awhile now.
I am not telling you guys this because I want praise and adulation for the work that my colleagues and I are doing. I don’t give a fuck about that. What I care about is you all knowing and understanding that each decision in this process is not made lightly. We might get it right or we might get it wrong, but I promise you that it’s never as simple as you think it is.