It is now roughly 6 months since the start of mass vaccination in the United States .  I think that we can definitively say that the vaccination campaign saved the national economy and society as a whole.  Thinking back to the first wave of COVID-19 in March and April 2020, the second wave in June-August 2020, and the 3rd in November 2020 through February 2021 one has to recognize how certain weaknesses and inequities in our society were so starkly revealed.  Israel and the United Kingdom were the first countries to roll out a significantly large vaccination campaign, and they were successful in reducing case counts, serious disease, hospitalization and deaths.  The same was true in the United States despite that even now only slightly more than 50% of eligible persons have been fully vaccinated.

These successes, however, were short lived as we are now in a 4th wave, which so far is much less significant (in numbers) than the prior waves, except in those areas of the country which have low vaccination rates.

The Delta variant is the current dominant strain.  It is more contagious than the original strain, and the vaccines are somewhat less effective against becoming infected, although they are still very good against severe infection, hospitalization, and death.

The term “vaccine” has traditionally meant that infection is prevented (“immunity”), but  the current  “vaccines” were not designed for that, and since we aren’t aggressively testing the population for asymptomatic cases, we don’t really know the true incidence of Delta infections in the vaccinated population.   The CDC has stopped using the word “immunity” in favor of the term “protection”.

But it is clear that “breakthrough cases” (infections in vaccinated people) are not rare.  In terms of the numbers of people hospitalized and dying with COVID, such breakthrough cases are a small minority.

“Booster” shots may provide additional protection (Yalemedicine.org on September 24th).  The word “may” means that we don’t really know yet to the usually accepted degree dictated by science.   The booster has been approved for those over 65 years of age, and for those younger persons who are  severely immunocompromised  (solid organ transplant patients taking immunosuppressive drugs, people under treatment for solid tumor and blood malignancies, advanced or untreated HIV infections,  active treatment with high dose steroids and other strongly immunosuppressive medications, as well as a few other rare immunodeficiency syndromes).  Booster shots are now recommended for those eligible persons who have received the Pfizer “vaccine” but not yet for the Moderna or Johnson and Johnson products.

On another side of the debate about the response to the pandemic, there are prominent scientists, including a Nobel Prize winner (Luc Montaigner) and others, some of whom were instrumental in the development of mRNA vaccines, who since the beginning of the pandemic have raised concerns about the current strategy.  Among the issues that are raised is that using a “vaccine” that does not prevent infection but does promote an immune response (which we know now works very well to prevent severe infection, hospitalization, and death, even in the case of the Delta variant) will increase the “evolutionary pressure” on the virus to mutate (which happens normally in any case).    With regard to this point, the Delta variant mutation is thought to have originated in India, which at that time had an extremely low vaccination rate.  But the example of India does not invalidate the concern.

Another question has been raised about the mRNA vaccinations creating what is known as “antibody dependent enhancement”.  This has been demonstrated in other Coronavirus diseases.   In brief, the “vaccines” place a short piece of genetic code into your body which instructs your cells to create a part of the viral “spike protein”.  That spike protein subunit (S1) has the job of attaching itself to the cells.  These proteins are recognized as foreign and provoke the immune system to create an antibody to them.  The antibody combines with the spike protein subunit, changing its shape so that it is much less likely to do its job of attaching to the host’s cells.  But it is possible for the differently shaped molecule to bind to other receptors on the cell surface, and “attachment” is then accomplished anyway.  The spike protein of the coronavirus has a 2nd subunit (S2) which has the job of then fusing the outer membrane of the virus with the outer membrane of your cell, at which point the entire genetic code of the virus enters your cells and then your cells start to make more complete virus particles.  At that point, you may or may not be sick, but you can transmit the virus to others.

I lack the expertise to definitively evaluate these claims.  There are other concerns that have been raised.  But what is most disturbing is that when these dissenting voices are raised, they are either ignored or are silenced (even censored), or labeled as “anti-vaxxers”, even though some of them have worked in the field of vaccine development for decades.  The rapidity and virulence of their silencing and marginalization is not in the tradition of true science.   The silencing of debate also creates suspicion.

So what are we to do?  Ironically, I wind up in the same place as when I first started posting about the vaccines.  In the short run they are relatively safe and reduce the likelihood of severe disease, hospitalization and death.  By so doing they relieve the intolerable strain upon the health care system, and serve to protect the many among us who provide needed services to infected people (health care workers, first responders, and the many other “essential workers.”)  Social isolation and its attendant risks (domestic abuse, opioid dependence and overdoses, the lost opportunities for learning for many millions of children, etc.) are reduced.  Society almost “opened up” in the late spring but the Delta variant arose to blunt the then prevailing optimism.

As a society, we could aim for a “zero tolerance” policy which necessitates mass vaccination, severe and protracted lockdowns, strict masking and distancing, long-distance learning and working.  Or we could aim to tolerate the disease, practice masking and social distancing, targeted lockdowns, vaccinate those at the highest risk (although we can’t identify all of those individuals at this time) and eventually natural immunity would develop in sufficiently large numbers of the population that the disease would become much milder and would be considered to be “endemic” (present in the population but not out of control, and usually much milder).  Natural immunity is superior to vaccine-induced immunity.

Countries that took the zero-tolerance option (China and New Zealand, for example) were initially very successful but were still eventually vulnerable to the Delta variant.  The response in China depended on an authoritarian top-down control structure that is antithetical to democracy.  I imagine that New Zealand was able to do zero-tolerance owing to clear messaging from politicians and scientists and a more internally cohesive society that accepted the policy.

In the reality that faced us at the beginning of 2020, with the severity of the rapidly growing epidemic in Wuhan, China, the United States was not prepared.   In the last few years of the Obama administration with congressionally mandated budget cuts, and continuing straight through the Trump years our “pandemic preparedness” was not properly maintained.  Stockpiles of personal protective gear, including masks became depleted owing to expiration dates and lack of maintenance for other equipment, including ventilators.  Income inequality has been increasing for the past 40 years and has reached levels last seen before the economic collapse of 1929-30.  There is a widespread lack of trust in our institutions and rather severe polarizations in our society along class, racial, and political lines.

Another aspect of “booster shots” is the fact that while the rich, developed countries of the world are able to provide “vaccine” protection to their populations, a very large percentage of the world’s population cannot afford to do so.  Although the developed world has promised to donate vaccine to the poorer countries, the effort is so far inadequate.  In the meantime, more people can get sick and potentially recreate the chaos that other parts of the world have already experienced, as well as providing the virus with more opportunities to mutate, as has already happened with the delta variant.  The morality of booster shots in the developed world while the rest of the world does not have access to any protection has emerged as a major issue.

At least we can presently say that most of these issues are now being discussed.  Whether there is sufficient political will to address them is uncertain at this moment.  Perhaps we will be better prepared in the future.