How to convince people to get vaccinated

Now you are making good points, although I still disagree, and I'll explain why.

There's been studies showing that the natural immunity acquired from having had the full infection is inferior to the natural immunity (from having had the infection) plus at least one dose of the vaccine. Given that Delta (and also Gamma, the variant formerly know as P.1 out of Brazil) have the ability to re-infect people who had Covid-19 before, receiving the vaccine even for those people, is still advantageous. The interesting point is that the study that is going around here on PF showing that simply having had Covid-19 before is more protective against a second bout, than two doses of the vaccine are protective against a first bout, doesn't only have two arms (arms in this jargon is a group of people who are similar for a condition in a study, in this case, an arm of survivors of natural infection, and an arm of people who have not had the natural infection but have had two doses of the vaccine). That same study people are using to yell out loud that the natural immunity is better, also has a third arm: people who have had the virus AND one dose of the vaccine. That third group fared even better! That's the group that got the best protection against a second infection. And the study didn't even consider people with natural infection plus two doses of the vaccine, likely even better. They didn't look at people with 3 doses either (two doses plus a booster) while in Israel a recent study with 1.2 million people showed a 10-fold increase in antibodies after a third dose.

I respect your idea of donating vaccines to people in other countries, and I support it. I've posted about the two advantages of doing that: one, humanitarian, and the other one, decreasing infections abroad will decrease the number of nasty variants that may be generated there and may come back to bite us. Still, given the striking data on the advantages of boosters, I'd prefer to take care of our own first, completing more vaccination for hesitant Americans, then completing boosters for everybody. We could even do it simultaneously. We could calculate how many doses we'll need and if we have more than that, start donating more, simultaneously. We could also get rid of most of the waste. There's been millions of doses thrown in the garbage either because they expired (the "use by" date got reached) or because they were thawed but nobody showed up to take them all, by the end of that thawing day. The latter is hard to manage but the former could have been donated to other countries a few days before they expire, hopefully for those eager countries with huge populations that would love to have the vaccines, to rapidly administer them before they expire.

Sure, the idea of "what's really in the shot?" is making some Americans hesitant... but this is such a ridiculous idea ("microchips put there by Bill Gates to control ya") that it borders a collective psychosis... I'm not sure if people who harbor this kind of far-fetched beliefs can be convinced anyway... This kind of conspiracy theorist, typically, if you try to reassure him/her with explanations, just drifts to some other far-fetched theory. So I'm not sure that the most decisive factor to generate these conspiracy theories is the idea that it's been shown that the vaccine is still beneficial even for those who had the natural infection. If not that, these conspiracy theorists will just find some other far-fetched belief to justify their ideas...

The idea of requiring immunity rather than vaccines is interesting and has a precedent. For example, certain healthcare organizations require the Hep B shot as a condition for employment, except if the person can show a blood test showing high anti-hep B antibodies titer showing immunity. It's for those who are not immune that then the shot is required. But the problem with this approach for Covid-19 is that it's not as clear cut as it is for hep B, a condition that confers lifelong immunity that is 100% certain (that is, nobody with immunity against hep B will catch it again). We do not know for how long the immunity to the SARS-CoV-2 lasts, and unlike the Hep B virus, certain variants of the SARS-CoV-2 do have the ability to reinfect. So it hasn't been established yet, what kind of antibody titer is fully protective. Also, the Hep B panel is very simple. It's one main antibody that is looked at. The SARS-CoV-2 has 29 proteins and there's antibodies against the N, the M, the E, the S... So serology tests for diagnosis of past infection don't necessarily show full immunity because of the issue of neutralizing antibodies versus binding antibodies. We do not have enough data at this point to certify someone as immune to a second bout of Covid-19.

"They still become infected in order for the antibodies to respond" - that is true but only if you think of it in strict terms rather than in pragmatic ones. Sure, copies of the natural virus need to get in for the primed immune system to jump-start again... but again, the issue of neutralizing antibodies changes the pragmatic aspects of this, in what we call "sterilizing immunity." If a person has had his/her titer of neutralizing antibodies (the ones against the S protein) fading, yes, those will be the breakthrough infections in vaccinated people, and those will be the people who will take a couple of days for the cellular immunity to be triggered and to activate plasma cells that will launch into fresh production of neutralizing antibodies... but there is also another group of people, those for whom the neutralizing antibodies haven't faded and they have a sufficiently high titer. For these, the virus doesn't stand a change. The few copies that will get in will be immediately zapped. So technically the person still got "infected" but in such a negligible way, that you can't really talk about a clinical infection in the broad sense, and that person will NOT be infectious, not even in the very beginning because the virus is not given a chance to replicate and be shed out to get to others. Not every vaccinated person has sterilizing immunity... but many do. That's why I said that the vaccines still lower your ability to catch the illness in the first place...

"and the antibodies from the vaccine target the spike protein, that causes the damage and many of the symptoms, instead of the virus itself. They can still carry the virus."

I'm not sure about what you're getting at with the spike protein part. Yes, the vaccines target the spike protein, which is the virus' Achilles Heal so to speak. The vaccines instruct human cells to make the spike proteins so that when the host encounters the full virus, neutralizing antibodies against the spike protein will be produced. When the spike proteins of the full virus are neutralized by antibodies, the virus loses the possibility of entering human cells, because the spike proteins are what the virus uses to attach to the human cells. Without entering the human cells the virus can not replicate and dies out. But I wouldn't say that the spike proteins cause the symptoms. Most symptoms are caused by viral replication. Once a virus invades a human cell, it replicates wildly inside the cell, and then the infected cell bursts and dies. Byproducts of that cell rupture cause fever, etc. That's what causes the symptoms, such as the viral pneumonia and the damage to the lung structures, the damage to the heart fibers, the damage to the kidney cells, etc.: the virus kills human cells. But when you catch Covid-19, it's not that you have the virus on one hand, and the spike proteins on the other hand. The spike proteins are attached to the virus. They are what the corona (crown) is. They are part of the virus.

Now, yes, just the spike proteins circulating alone without the virus (the ones fostered by the vaccines) can have a bit of toxicity (that's why some people who are very healthy and have a very strong immune system therefore make a lot of spike proteins from the vaccines, can get mild and transient myocarditis from the mRNA vaccines due to a direct toxic effect for the heart of the spike proteins). But that pales in comparison to the full virus circulating, full of spike proteins on its surface. The inflammation in the heart (a.k.a. myocarditis) occurs sixteen times more from the full virus than from vaccine-generated spike proteins.

Again, yes, vaccinated people can still carry the virus... for a very short time, and not all of them do (those with high titers of neutralizing antibodies from the vaccines, don't).

Again, booster shots can dramatically increase the titer of neutralizing antibodies, effectively restoring immunity against Delta (Delta seems to require higher neutralizing antibody titers to be defeated, than previous less aggressive strains).

The bottom line is, the vaccines have benefits that far outweigh the risks, including for those who have had the natural virus before. Everybody, including those who had the virus before, benefit from the vaccines and should get them, and once we get all our people taken care of, yes, we should help others abroad (or simultaneously, if well-planned regarding the necessary number of doses to get all Americans protected - or at least, all of us who want to be protected).

 

Sure, that's the hepatization rate as a function of infections... If you reason at a fifth grade level.

Tell me, would you think 100% of covid hospitalizations have been tested for covid? Would you think 100% of infections have been tested? Just because you can (barely) do 5th grade math does not mean you are coming to correct conclusions.

 

Hard to "expand health care" when vaccine denialists are putting additional pressure on an already strained system where we have labor shortages. We can't "expand health care" when anti-vaxx loonies are packing our ERs, our ambulances, our ICUs, etc. all while also creating a situation where people are having their cancer surgeries canceled to free up more doctors to take care of the crisis caused by their willingly-ignorant tantrums.

 

Expand health care. Train and hire more nurses and doctors and create covid specific clinics. This should have happened from the beginning. It's not hard. You just do.

 

This lack of data I believe is a crucial missing setpoint for hospitals, doctors, the scientific community. Because without this data, we can theoretically inject enough shots to where it becomes a negative(ie: an overload of the proteins causing a negative reaction.) I believe that's why it's time phased to begin with right? Otherwise, we risk that overload that causes the storm that resulted in many deaths at the beginning.

 

It's so funny. These people believe government can easily solve problems, and they think putting government in charge of the country's healthcare would be a great idea. Yet apparently they can't seem to solve the problem of a few tens of thousands of people with Covid needing special care.

Just goes to show how hypocritical and two-faced they are.

Right now I hear even in Canada they're having problems. Guess that government-run system doesn't solve the problem. Or more likely, in reality, they don't really see it as much of a problem. It's mostly just talk and pretending like it's a big problem they really care about.

 

Not at all. Not sure of your point with the rest of your post. No one claims the flu vaccines are 95% effective.

 

The issue is, people like you are worsening the problems. And still, YOU call others hypocritical and two-faced. Amazing. Wow.

 

Pay Cash $ to unvaccinated
getting their shot.
Maybe $50 cash. No records besides the vaccination.


Moi

Money Talks
S**t Walks​

 

I don't think, that 'natural immunity + vaccine' is better than just natural immunity, is a good excuse to ignore natural immunity.
Natural immunity is the de facto standard, and I believe it's the states obligation to prove it is insufficient, if they are to ignore people's immunity status outside of vaccination. You cannot put that burden on random people with no means to prove it is sufficient.

 

But it's already been proven by various studies. So what exactly are you talking about? Studies showed - situation A - that having the natural infection + vaccine provides better immunity to a second bout than just - situation B - having the natural infection without the vaccine. This is shown in two ways: one, situation A fosters bigger neutralizing antibodies titers than B, and two, A gets fewer cases of a second bout of Covid than B.

So you are expressing an opinion that natural immunity is better and is the standard... when studies show that it's not the case.

Your idea seems attractive in terms of common sense... but unfortunately it just isn't true (and it's been demonstrated). Natural immunity is not complete, because this virus can re-infect.

Natural immunity in a sense distracts the immune system by fostering antibodies against several viral proteins (which are "binding antibodies" that are not very effective at avoiding infection), while the vaccines focus on the spike protein which are "neutralizing antibody" that do avoid infection.

ELISA-measured IgG antibody titers against the RBD (receptor-binding domain) of the S protein correlate best with neutralizing antibodies (nAbs). Titers range from 1/<40 to 1/161,000. Good neutralization titers have a median of about 1/3190 at about 40 days from first symptoms. They peak at 5-6 weeks. Then, they decline.

Say, you need for full protection, a titer of at least 1/3190 (that's just an example; it varies from patient to patient). But with the natural infection, they decline to a median of 1/660 after about 200 days.

What can explain it? Your natural immunity without the help of the vaccine, is split among various others viral proteins (N, E, M, etc. in addition to the RBD of the S protein) and there is smaller activity left over for the IgG against the RBD of the S protein. The immune system is making lots of antibodies to other proteins that aren't very helpful, and proportionally, a smaller number of plasma cells are making IgG against the RBD of the S protein.

When you add the vaccine to the natural infection, then those titers jump up again, to above the 1/3190 titer you had at peak from your natural infection, because the vaccines zoom in and focus on the S protein only.

That's why adding the vaccine is important.

Do you want another way to see this?

Consider the Sinovac vaccine called CoronaVac. It's approved in various countries but not in America. Unlike our mRNA vaccines that focus on the S protein, this vaccine is made of whole inactivated virus. So it mimics much more the natural immunity since it introduces the real whole virus to the immune system. Guess what? The immunogenicity of the CoronaVac is inferior to the one stimulated by the Pfizer and the Moderna mRNA vaccines.

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That proof that natural immunity is insufficient you are requesting, already exists, from the studies above, from the fact that the whole virus vaccine is less efficacious than the mRNA vaccines, and from the fact that Delta and Gamma re-infect people in real life.

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You are approaching this from a political standpoint - the responsibility of the citizen versus the government of showing sufficient or insufficient immunity. Me, I'm approaching it from a Virology/Immunology standpoint: adding an mRNA vaccine to someone who has had the natural infection confers better immunity against re-infection, than the natural infection alone.

 

Yeah... Except that's not really happening. Right?

 

Let me simplify what I am trying to say. It does not matter if something is 'better' many vaccines are better than others but they are all approved for a person to be able to reach vaccination status. You simply cannot ban all other vaccines except the best because you want to achieve the highest efficacy. https://www.raps.org/news-and-artic...ssues-covid-19-vaccine-guidance-setting-50-ef
What matters is if they reach the minimum, 50% efficacy threshold. If natural immunity reaches this threshold, the government has no reason and no grounds to discriminate against natural immunity.

You can argue that pfizer has better efficacy than natural immunity all you want. If two people have the same immunity, one from Johnson and Johnson and one from natural infection, and one is not allowed to enter the store. It is no longer about protecting the people in that store. It is about discriminating against them based on their medical choices, because you disagree with their choice, period.
If a person with the Johnson and Johnson vaccine has the same

 

No. He did mention these. The come under 'correcting the myths'

 

I understand your political take, and actually respect it. But as a medical scientist, my take is much more the Virology/Immunology one, and strictly speaking from the standpoint of these branches of science, adding the vaccine to the natural infection makes sense. It might be my cognitive bias but I just can't get over this point. As for choices of better vaccines, the FDA was restrictive enough in America that we don't have that many options. Basically we have two fairly identical vaccines (except that one is dosed higher than the other), Pfizer and Moderna, and the J&J which has been sort of disgraced, occupies a small niche, and is probably going to lose even more of the market share, going forward. So for pragmatic purposes, we have mRNA vaccines for the most part, and that's it. So the comparison between vaccines is not very relevant to America. I used the comparison with the Chinese CoronaVac just to make the point about multi-antibody natural immunity versus S-focused mRNA vaccine immunity, just to explain why we see bigger neutralizing titers with the mRNA vaccines. But the CoronaVac is not approved here. So politically speaking, people will pretty much almost always just get an mRNA vaccine, both for basic vaccination and for boosters.

Science and politics are not entirely unrelated. There's been a political choice, that of requiring the vaccine (in situations when a mandate is implemented) even of people who have had the natural infection. While you can make points about the civil liberties and burden of proof involved in this (and like I said, I respect this viewpoint), I do believe that scientifically speaking the political choice makes sense because adding the vaccine to a natural infection has been shown to improve immunity against re-infection. This virus is nasty enough in one bout; you don't want to catch it twice. And people catching it twice prolong and perpetuate the pandemic. So in this regard the political choice was correct. But from the standpoint of individual freedoms and the role of government imposing or regulating that, then you make good points.

By the way, it seems like your post was cut short. You didn't complete your last phrase.

 

The phantom virus is so nasty that it is survived by 99% of those infected.

 

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1
Conclusions This study demonstrated that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity.

So we have 80 million people left "unvaccinated"
At least half of them probably have immunity.

Supposedly we should be done with vaccination if more then 80% are protected.
Why do we need these North Korea style repressions?

 

That is B.S.
Vaccine immunity will vane in 4 - 6 months.
Yea, we need modern slavery where people put in jail for not getting boosters.

 

In support of a position I took earlier in this thread where I advocated allocating more vaccine distribution in doctor offices. I offer two links which directly parrot my reasoning. https://www.ama-assn.org/delivering...tes-get-more-covid-19-vaccine-doctors-offices
" The recently issued guidance from the Centers for Disease Control and Prevention (CDC) urges states to significantly increase the share of vaccines allocated to primary care doctors “to promote health equity and address disparities in adult COVID-19 vaccination.” The AMA has been urging the Biden administration to increase the vaccine distribution to physician offices and this is a good first step.

Read this AMA Leadership Viewpoints column by AMA President Susan R. Bailey, MD, on why it’s essential to give physician offices a greater shot at vaccine supply.

Why it’s important: Analysis has found that those counties with higher level of social vulnerability also had lower levels of vaccination. To help address that, the CDC recommends that at least 60% of doses distributed to medical offices be allocated to those located in the most socially vulnerable communities...
Studies have found that a doctor’s strong recommendation “is closely correlated with vaccination,” the CDC says. Meanwhile, 30% of adults now hesitant to get vaccinated against COVID-19 say they would be likelier to do so if the vaccine were offered to them “during a routine medical visit,” says the agency.

Doctors “working in community health centers and rural health clinics, who are often trusted community members, can play an especially powerful role in increasing vaccine confidence and access,” the agency says.

Meanwhile, the AMA is encouraging doctors to use the unique power of their voices to strongly recommend that their patients get vaccinated against COVID-19, especially now that the supply of vaccines is exceeding demand in many areas.

Bring up COVID-19 vaccination during visits with patients, of course—but don’t stop there. Whether it’s phone calls, letters, emails or social media posts, doctors should use every communications tool at their disposal to send the pro-vaccine message. The Department of Health and Human Services’ new Vaccines.gov website enables users to search for nearby vaccine appointments and also answers frequently asked questions."

From the link to the editorial above by Dr. Bailey "Another missed opportunity lies with failing to leverage existing physician-patient relationships, which allow for quick and easy identification of patients with co-morbidities that place them at higher risk of hospitalization and death from COVID-19. A physician’s office can provide vulnerable patients–even those who lack a primary-care doctor or who may not have seen a physician in many years—with a comfortable and secure environment where their concerns will be heard, their questions will be answered, and the vaccine safely administered.

Ensuring that physician offices receive vaccine allocations will also boost the rate at which traditionally underserved populations receive them. Mass vaccination sites in urban areas are not always easily reached even by those who live in the same city, while those residing in distant or rural locations are at an even greater disadvantage. Physicians working in those communities are one of the easiest and most accessible options for these patients—provided that their offices receive vaccine allocations, of course.

 

All good. I couldn't agree more.

On the other hand, you also need to understand that not all physician offices are equipped to maintain the cold chain for the mRNA vaccines, with personnel to ensure its integrity, trained on how to conserve and administer a rather fragile vaccine, and with auxiliary personnel to manage the stock and iron out all the logistics.

In my university, which is a REALLY major one, extremely prestigious, with a formidable reputation and a HUGE medical system attached to it, and one of the very top medical schools in the nation (hell, actually, in the world), guess what? Our outpatient family medicine center does not offer the Covid-19 vaccine to its patients. Not even huge guys like us could pull it off. Yes, we do have the vaccine, and yes, we can deliver it in various locations throughout our huge medical center... but not in our family medicine center, which is the closest thing we have to a regular doctor's office.

Lots of small private practice offices just don't have the resources to deal with it, or do but don't even want the added complication.

Sure, these local and rural doctors can still recommend it, and can still direct their patients to obtain appointments (or walk-ins) in local pharmacies and local health departments, but it's not always that small private offices want to directly provide the Covid-19 vaccines.

 

I'll summarize the point you made, because it really rang home: Our Natural immune system while powerful and effective at treating a variety of conditions, because it focuses on that variety it's not able to conjecture up enough to a specific threat, whereas the vaccine is able to 'prime' the immune system to focus on the specific threat when/if it occurs.

In this way, the vaccine shouldn't be seen as an alternative to the immune system, but a strengthener of the immune system.

 

I certainly get that its hard to provide anyone's favorite most temperature sensitive vaccine, but if it requires refrigeration for 30 days or less(covering two of the 3 popular vaccines), if the refrigerated temperature is between 32-45 degrees then almost any small space in the refrigerator ( devoted to medicine such as eye or ear drops, the insulin, and the Augmentin, as opposed to staff food) should do the trick. As for management and personnel time. You have to take and record that temperature of the unit and vaccine periodically, you have to take and record inventory numbers, check expiration dates and rotate the stock, and then you have to provide and document the shots given and then provide copies to the patient, his medical chart and govt authorities

From what I read, it sounds like a bit of a paperwork hassle and maybe allocate about 60-90 minutes more time per day depending on how popular you can make the shots on any given day.

Divide the workload among the staff of the office, and its not unreasonable.

Am I missing something practical here?

What am I missing

 

Absolutely.

 

It's not unreasonable; I'm just saying that many offices are not interested. Remember, these are for-profit operations and there aren't many profits in this, if you have to allocate resources to it, especially in offices that are small and already tight in terms of personnel.

I'm not making a judgment of value here. I'm just saying that many offices are not interested. They prefer not to mess with any of that and simply tell the patient to go to CVS or Walgreens or the Health Department.

Would I want them to do it? Yeah, absolutely. I'm just saying, some don't want to.

 

Well everyone is having to 'mess with this' virus. if we collectively feel free to demand barber shops, restaurants, churches, video game shops 'mess with' lock-downs for months and sports venues and theaters, and orchestra pits go bone dry for a year, I really think the damn doctor offices with staff all vaccinated, and professing to lead the charge on this virus, can 'mess with' that paperwork and that extra hour of labor per day. Color me indifferent to whining from the hypocritic oath takers who view these 'sacrifices' as concerning. when people in nursing homes, hospitals and memory care settings worked directly and intimately with active cases before there was a vaccine.

This is nothing to ask comparatively. I would require it just as we have impositions on other businesses. I would be willing as a taxpayer to reimburse for the investment in the refrigerator if the doctor's office has none, and the rest they can suck up!