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WPCNR YOUR LOCAL EPIDEMIOLOGIST By Dr. Katelyn Jetelina. Reprinted with permission. July 21, 2022:

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, biostatistician, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank, and at night she writes this newsletter.

Yesterday, ACIP—CDC’s external scientific advisory board—unanimously voted to authorize the Novavax vaccine (called NVX-CoV2373) in the U.S. This was big news for the small, underdog Maryland company who had a long road to authorization.

After rigorous clinical trials, FDA and CDC scientific meetings, and more than 1 million vaccines already rolled out across the globe, it’s clear this vaccine is safe and effective. There are two ways this vaccine could potentially help us in the U.S.:

1. Vaccinating the unvaccinated
2. Broadening protection through multiple vaccine platforms (e.g., mRNA primary series + Novavax booster)

Unfortunately, I’m not optimistic for either. I don’t think Novavax is the silver bullet we need in the U.S. to close out our fight against SARS-CoV-2.

Vaccine for the unvaccinated

Novavax was authorized as a primary series. In other words, this is intended for those who are still unvaccinated. There is still a significant need and opportunity to improve COVID-19 vaccination rates in the U.S. Around 26-37 million (10-14%) of adults have not received a COVID-19 vaccine. The majority of these folks are multiple races (30%) or non-Hispanic White (22%), living in rural areas (22%), below poverty (19%), and/or uninsured (31%).

Novavax uses a different vaccine platform than current COVID-19 vaccines do. A diverse portfolio is important for many reasons, like freeing up supply bottlenecks and providing options for those allergic to vaccines ingredients. The Novavax vaccine also may reduce vaccine hesitancy because it uses a more traditional biotechnology. Its method has a much longer track record than the newer approaches, as it’s used for some flu and HPV vaccines.

The CDC conducted a poll with unvaccinated people in the beginning of the year and found 16% of the unvaccinated would “probably” or “definitely” get the Novavax vaccine. Given pandemic fatigue and lots of infections since, it’s not surprising that this number is lower now: a more recent poll (June 2022) found only about 10% of unvaccinated people will line up for this vaccine.

Among unvaccinated people who do not want Novavax, top concerns include “concern about side effects,” “worried the vaccine moved through clinical trials too fast,” “don’t think the vaccine will be effective,” and “don’t trust the company making the vaccine.” Moving the dial is going to be difficult because it requires building trust. This isn’t done overnight with a new vaccine release.

Boosting with Novavax

The other potential is for the larger population vaccinated with mRNA vaccines to use Novavax as a booster. I was most excited about this. Originally, we hypothesized combining vaccines from different platforms would broaden protection, as the body was exposed to the virus in different ways, potentially giving it more tools. While boosting with Novavax has been shown to be safe, preliminary effectiveness of this approach is underwhelming. (To be clear, the current authorization does not “allow” Novavax boosting yet.)

One study published in Lancet assessed the effectiveness of vaccinating with one dose of mRNA with a second dose of Novavax. The figure below (left panel) shows antibodies after Pfizer+Novavax (purple) wasn’t as high as the two mRNA vaccines (orange and yellow). The same pattern was found for T-cell protection (right panel below).

Another study in Science compared three mRNA doses with two Novavax plus one mRNA dose. The antibody response was about the same, even against some of the newer Omicron subvariants, like BA.4/5.

If we switch the series order (2 mRNA+1 Novavax), the story doesn’t change. A randomized control trial published in Lancet found Novavax did boost immunity, but not significantly more than other combinations. Interestingly, T-cell-boosting effects of Novavax were lower in people who had received two mRNA vaccines compared to those who received two doses of the Oxford’s Adnovirus vaccine. This study shows that combining can be advantageous for certain vaccines, but that doesn’t seem to be the case for mRNA and Novavax.

One thing we don’t know is the durability of combining mRNA with Novavax. Although antibodies may be the same, the combination could theoretically slow the rapid waning we see with the mRNA series. I’ll be anxiously awaiting the data.

Bottom line

Novavax is a great vaccine for the unvaccinated, and it will save millions of lives. It can eventually be used as a booster, but the effect will not be as impactful as I would have hoped. For now, I don’t recommend using Novavax off-label as a booster or, worse, waiting for a booster because Novavax is coming.

It’s abundantly clear that first generation vaccines, like Novavax, are not the silver bullet we need to close out this pandemic. We desperately need the funding and the drive for second generation vaccines, like pan-coronavirus vaccines (variant proof) or nasal vaccines (future post to come), to finally get ahead of this virus.

This column originally appeared on WPCNR on February 1, 2003, and celebrates the Dreamers, the Achievers, the High and the Mighty:

 The Apollo 11 Crew: Neil Armstrong, Michael Collins,  Buzz Aldrin, Jr. Mr. Armstrong set foot on the moon 53 years ago on July 20, 1969 (NASA Photo)

One of the papers I receive at WPCNR White Plains News Headquarters, White Plains, New York, USA did not tell me ALL week this week was the 53rd anniversary of the week when Neil Armstrong walked on the moon.

The exact hour  was  20:11 GMT (Greenwich Mean Time). That was the culmination of the last great American achievement  – the personal computer, the cellphone and the internet, social media were to come — after the amazing American achievement conquering space in 9 years — when Apollo 11 with Armstrong in command, with astronauts Michael Collins and Edwin E. Aldrin, Jr. blasted off to the stars  for real.

They became the real Flash Gordons, Buck Rogerses, Tom Corbetts and Captain Videos for all-time.

The Apollo 11 mission was a success.

There have been the tragedies associated with striving for the stars and being the best, achieving the best, working for the good. Those are the persons who keep dreams alive by their deaths and personal sacrifice. I wrote the following after the explosion of the Columbia Space Shuttle upon reentry into the Earth’s atmosphere after 19 days in space in January 2003.

Saturday’s fatal Columbia Space Shuttle accident killing all 7 astronauts aboard when the historic spacecraft broke up over East Texas at daybreak Saturday morning begins a period of national mourning. 

The expected media speculations have started, guessing at the cause of the reentry that went bizarrely, awfully wrong.
The truth is the civilized world takes absolute scientific miracles for granted. We do not appreciate the courage and skills of the men and women creating the future.

Those of us with cell phones, internet connections, high-speed trains, satellite communications and entertainment (all products made possible by the space program), do not realize the magnitude of daring achievements that you and I have come to accept to be executed like clockwork.

I first learned of Columbia’s fate late Saturday afternoon when my wife mentioned that instead of sports programming being videotaped on our television, there was coverage of a live NASA event on ABC.

(Incredibly, the radio station I had been listening to on the way from a sports clinic had not reported any hint of the accident. That station was Z-100, the most listened-to station in the New York metropolitan area. America Online also on their first up page did not mention the missing craft as of midday. That kind of communications misjudgment is sad.)

As I watched the close of Peter Jennings’ coverage at about 3 PM, he signed off with no recap, no names of astronauts, and some parting words about what he thought was the cause of the disaster.

I’ll write what he should have said.

Columbia’s seven astronauts who died — we know their names: they were

Columbus, Magellan, Cook, Lewis, Clark, the Wrights, Lindbergh, De Laroche, Earhart, Markham, Gruber, Chaffee, Grissom, White, Gargarin, Komarov, the Challenger Crew, the crew of Soyuz 11. They are a handful of the hundreds of brave men and women who went into the unknown. Some did not come back.

Apollo 11′s Crew which landed and walked on the moon turned the dreams of the 1950s visualized in television shows like Tom Corbett, Space Cadet (above, Astro, Roger and Tom) and Captain Video, “The Master of Science” below  into reality.

America’s Spacemen and Spacewomen and the explorers before them are the people who trust in their ability and their vessel to expand the world’s horizons, to know the unknown, whose legacies build a better world. Whose deeds inspire and achievements are the catalysts for achievement to come. Their failures ever reminders of the uniqueness of their courage and resolve.

From Captain Cook’s fragile vessel which sailed the Pacific, to the marvel that was the Columbia, the captains courageous who sailed the Roaring 40s, blazed the Oregon Trail, discovered how to fly, flew the oceans without radar, journeyed to the stars, knew the risks they were taking. They loved the concept of being ever onward.

The media  trivializes their courage, their skills, and the difficulty of what they did and wanted to do, to concentrate on the causes of their failure, as if knowing the cause will make their loss acceptable.

The Magnificent Seven

I do not know Columbia’s Magnificent Seven. I just see their smiling faces in their photograph, and I regret the loss of every one. They had achievement on their faces, pride in their demeanor. Their eyes shown with the glow of being alive and striving to do the great things they set out to do.

Civilization has been created because of people like the crew of the Columbia’s Magnificent Seven, not the incompetence we see demonstrated daily today where technology is concerned.

The Columbia itself had flown 26 missions since launching in 1981. It was guided and outfitted with the best 2003 communications and equipment had to offer.

Not like Captain James Cook’s bark, Endeavour, a 100-foot ship powered by sail that conquered the “space” of his time, the Pacific Ocean. It was the Columbia’s Magnificent Seven’s “Endeavour.” They were tracked, they were backed up, but they perhaps more than anyone here on the ground knew the high dangers of the shuttle mission.

Liftoff, as their predecessors, The Challenger crew fell victim to, is fraught with risk.

Reentry, which needs to be negotiated at precisely the right angle of attack, is equally risky.

Soyuz 11’s spacecrew of Dobrovolskiy, Volkov, and Patsayev died in 1971 on reentry, when the Russian cosmonauts took too long to descend.

No guarantees in real life. Machines sometimes run out of miracles.

The magnificence of the explorers’ sacrifice and dedication, is that they accept the risk of “the Endeavor.”

They accept the challenge, bear it alone, seizing challenge with an indomitable spirit and confidence, facing death when it comes with the satisfaction that they made the effort, and I suspect analyzing, coping, trying to fix it until the end, the very end.

They never give up.

Columbia’s Magnificent Seven, after 16 days in space, are gone now.

My sorrow is with their families who will miss these Magnificent Seven, and who know in their hearts that they died trying to reach the pinnacle of their aspirations.

They are only human.

They tried their best, achieved their best, and experienced what they longed to experience. They dared to live the great adventure.

Not all of us have the courage to follow our longed-for adventures and make them real. You can watch movies that attempt to give that experience by transference. That’s why, I believe, you and I take it so personally when we lose heroic personalities of our time. We wonder what they are like. We glorify them, rightly so.

Follow Me! They Say.

I wonder how those Magnificent Seven felt, how satisfying it must have been, to be at your best, doing what you love, coping with the risks.I envy them that.

The Columbia Crew is the Miracle.

In reality it is not machines that conquer, it is the intrepid personalities, each unique, each contributing, who perform the miracles with God’s help. That they fall short is an example to us, not to take ourselves, our fates, or our existences for granted.

This is true of the everyday people we take for granted: the firefighter, the policeman, the train engineer, the airline pilot, the construction worker, the doctor fighting COVID, the nurse, the leader trying to do what must be done despite opposition. All are highly trained disciplined workers, executing precise tasks for which the non-expert has no feel or understanding . When one of them gives up it is rare. And when they do, they leave the task to us.

What makes for the desire to achieve? What is out there or up there that leads them on?

The Feel of the Unknown

I took Anne Morrow Lindbergh’s biographical adventure diary, Listen! The Wind down from the aviation bookshelf.

She was the young bride of the aviator-pioneer, Charles Lindbergh. She navigated for him in his aircraft, and ran his radio communications on his many exploratory flights around the world.

In a passage she describes a night flight over the ocean, in which she was operating the radio for her husband Charles, who was at the controls. Mrs. Lindbergh is describing the feelings she has as she tries to tune in the South American coast at sea in the dark of night in 1933, 89 years ago.

The feeling, the courage of the adventurer, the explorer has not changed. This is great:

“Night was the hardest. It would be all right once it was day. I kept saying…We began to hit clouds. I could tell without looking up, for the plane bumped slightly from time to time, first one wing down and then the other. And the moon blackened out for short periods.

Then for longer periods. I could not see to write my messages. I stiffened, dimly sensing fear – the old fear of bad weather – and looked out. We were flying under clouds. I could still find a kind of horizon, a difference in shading where the water met the clouds. That was all. But it seemed to be getting darker.

Storms? Were those clouds or was it the sky? We had lost the water. We were flying blind. I turned off the light quickly (to give my husband a little more vision), and sat waiting, tense, peering through the night. Now we were out again. There were holes through which one could see the dark sky. It was all right, I felt, as long as there were holes.

More blind flying. This is it, I thought is what people forget. This is what it means to fly across the ocean, blind and at night. But day is coming. It ought to be day before long… Daybreak! What a miracle. I didn’t see any sign of day and yet it must be lighter. The clouds were distinguishing themselves more and more from water and sea.
Daybreak—thank God—as if we had been living in eternal night—as if this were the first sun that ever rose out of the sea.