The increasing evidence of the COVID vaccines’ leakiness and reduced efficacy, both in terms of waning immune efficiency and in terms of vaccine escape through variants, show the folly of vaccines being the only substantial tool being used to tackle coronavirus. The vaccines we currently have are primarily designed to prevent severe infection and fatality, with the efficacy against transmission reducing substantially with variants compared to the trial data. Against the Delta variant in particular, vaccinated populations have similar levels of viral load compared to unvaccinated as well as similar protection levels as natural infection.
A significant part of the issue is the very nature of the COVID vaccines, which don’t prevent transmission and now aren’t substantially reducing viral load. “The question now is how does host immunity (or ‘resistance’) change the optimum virulence relative to that in a completely non-immune (‘susceptible’) host population? Still assuming a homogeneous host population, we consider four different forms of immunity, with efficacies denoted r1, r2, r3 and r4, which independently affect different stages of the pathogen’s life cycle. The first is anti-infection immunity, which decreases the probability that a host becomes infected. The second is anti-growth-rate immunity, which directly reduces virulence and concomitantly affects transmission rate and host recovery. The third is transmission-blocking immunity, which only decreases parasite transmission. The fourth is anti-toxin immunity which directly reduces virulence but, contrary to anti-growth-rate immunity, does not affect parasite transmission and host recovery rates”. In the case of the r2 vaccine (anti-growth-rate), this translates to reduced efficacy combined with increasing viral prevalence.
“Anti-growth-rate vaccines, on the other hand, have hardly any effect on prevalence because of a balance between two forces that act in different directions—reduced transmission due to the direct effect of the vaccine and increased transmission through the evolution of higher virulence in vaccinated hosts”. COVID vaccines most resemble the anti-growth-rate vaccines in that it directly targets virulence (with decreasing results), thus limiting the extent of hospitalised or fatal cases. However, it also presents selection pressures through which more virulent strains can develop. UK data already presents such pressures in the spike protein targeting function of the current vaccines, with anti-S antibodies (those induced with vaccination) having substantially higher seroprevalence than anti-N antibodies (those induced by natural infection), particularly amongst older age cohorts. N proteins only receive up to approximately 30% coverage in the youngest age cohorts compared to 96-98% S protein coverage amongst all age cohorts, despite hospitalisations from or with infection concentrating amongst older age groups. As COVID evolves, targeting N protein evolution could be one of the potential antigenic escape vectors. “Mass vaccination has drastically altered the environment in which SARS-2 circulates. This was always expected to change the behaviour of the virus – just not in this precise way. In return for only limited protection against severe outcomes, the vaccines appear to encourage the spread of SARS-2, in multiple different ways”.
The same UK data from the weeks 41 and 42 reports also show waning antibody coverage from the vaccines amongst all age groups for both N-negative and N-positive samples (except for N-positive 17-29 year olds). With current vaccine efficacy rates, vaccinated 80+ year olds have similar hospitalisation and death rates as unvaccinated 60-69 and 70-79 year old cohorts respectively. From week 40 to 41, there are reductions in the rates of hospitalisation and death between vaccinated and unvaccinated populations. These processes of antigenic escape via selection pressure and decreasing efficacy follow Gandon et al.’s model.
This also raises the question regarding the necessity of mandates and passports to enforce vaccination as these are given the justification of preventing significant viral transmission and thus limiting its evolution. Israel has already shown how quickly coronavirus can spread even in vaccinated populations. As Israel had an immunologically naïve population (compared to European nations and regions), extensive vaccination has not prevented viral transmission nor substantially dented hospitalisation during the fourth wave, with Israel reintroducing substantive interventions and booster shots to reduce their rates. As the UK begins to match Israel’s wave-like case growth, relying on vaccines as the primary tool for ending pandemic conditions appears to be limited.
The policy position internationally is moving toward a vaccine black hole where everything is reliant on vaccines, with any reductions in efficacy or viral evolution blamed on the unvaccinated or those who don’t follow the rules. It will also involve changing the definition of vaccinated as booster shots become more prevalent. The drive toward vaccination as the only game in town replicates the governance failures that got nation-states into this position in the first place, from chronic malinvestment in healthcare systems to a complete lack of pandemic preparedness. It is an irreversible feedback loop of failures, with one centralised solution after another predominating in healthcare policy, with vaccines being another failure to add. As we get sucked into this black hole, we are faced with complete indeterminacy as any move away from vaccination is met with derision and denial, with no capability to change direction despite glaring gaps emerging.