The Morning Dispatch: What’s Next for COVID-19 Vaccines

Happy Thursday! The last surviving World War II Medal of Honor recipient died yesterday, at the age of 98. Woody Williams received the medal for his fighting in the Battle of Iwo Jima, where an officer asked him to break through a line of pillboxes. “I’ll try,” Williams responded. And over the next four hours, he destroyed seven pillboxes with six different flamethrowers.

“It was just another day of battle, as far as I was concerned,” he later remembered. “I was just the guy who was trained to do the flamethrower.”

Quick Hits: Today’s Top Stories

• NATO formally invited Sweden and Finland to join the security alliance Wednesday at its Spain summit, the culmination of a swift change of heart for the two countries, which were content to remain outside the alliance until Russia invaded Ukraine. The move still needs final ratification from all 30 member countries, but Turkish president Recep Tayyip Erdogan has withdrawn his opposition. President Joe Biden also announced Wednesday that the U.S. will further boost its military presence in NATO allies, including sending two more destroyers to Spain and two more F-35 squadrons to the United Kingdom. 

• Ukrainian intelligence officials said Wednesday 144 Ukrainian soldiers captured by Russians have been released in a prisoner exchange—including 95 who defended Mariupol during Russia’s months-long siege of the city. This is the largest of more than a dozen prisoner swaps since the war began.

• The Supreme Court ruled 5-4 in Oklahoma v. Castro-Huerta Wednesday that the states can prosecute non-Native Americans who commit crimes against Native Americans on reservations, narrowing a 2019 decision that had held only federal or tribal courts could prosecute crimes committed on Indian territory. “As a matter of sovereignty, a State has jurisdiction over all of its territory, including Indian country,” Justice Brett Kavanaugh wrote for the majority.

• Supreme Court Justice Stephen Breyer will formally step down shortly after the Court releases its remaining opinions today, making room for Judge Ketanji Brown Jackson to be sworn in as the Court’s first black female justice at noon. “It has been my great honor to participate as a judge in the effort to maintain our Constitution and the Rule of Law,” Breyer wrote to Biden.

• Revised Commerce Department numbers released Wednesday show that consumer spending rose 1.8 percent year-over-year in the first quarter, not 3.1 percent as previously estimated. The contraction suggests Americans were more pinched by inflation than previously estimated.

• The latest round of negotiations to restore the 2015 Iran nuclear deal ended Wednesday without progress. “Two intense days of proximity talks in Doha,” European Union mediator Enrique Mora wrote. “Unfortunately, not yet the progress the EU team as coordinator had hoped-for.” Iran has rapidly advanced its nuclear program since the U.S. left the deal and talks previously stalled over its insistence that the U.S. remove the Islamic Revolutionary Guard Corps from its terror blacklist.

• Texas police have arrested four men in connection with the deaths of 53 migrants found in a tractor-trailer in San Antonio. The Department of Justice said one has been charged with conspiracy to transport illegal aliens resulting in death. Texas Gov. Greg Abbott said state police will resume inspecting vehicles crossing the border, targeting similar tractor-trailers to prevent similar deaths.

• The House committee investigating the Jan. 6 Capitol riot subpoenaed former White House lawyer Pat Cipollone Wednesday. Cipollone has been mentioned repeatedly at previous committee hearings, witnesses testifying he warned about potential legal liability from former President Donald Trump’s efforts to overturn the 2020 presidential election results. Cipollone gave an “informal interview” to the committee April 13 but has declined to cooperate further, the subpoena says.

• Former R&B star R. Kelly was sentenced to 30 years in prison and a $100,000 fine Wednesday for racketeering and sex trafficking after he systematically sexually abused underage fans for decades. He will stand trial for child pornography and obstruction-of-justice charges in August.

Are Our COVID-19 Vaccines Still Up to the Task?

All things considered, you could credibly argue the United States’ pandemic situation is better today than it’s been at pretty much any point over the past two-plus years. About 80 percent of the country has received at least one COVID-19 vaccine dose, and nearly 25 million children between six months and five years of age are now eligible for the shots if their parents so choose. The national average number of daily confirmed cases may not be at its all-time low, but the virus is no longer wreaking the havoc it once was: Admissions to intensive-care units (ICUs) have plummeted and stayed low for months, and the average number of daily deaths attributed to the virus has stayed below 400 since mid-April after peaking at nearly 4,000 this past winter.

But we’ve been here before—almost exactly one year ago. On June 23, 2021, the seven-day rolling average for new COVID-19 cases in the United States fell, by one count, to just 11,284, a 22-fold decrease from the national peak up to that point. We all know what happened next: The country was hit, back to back, by two of the deadliest waves of the entire pandemic. The Delta and Omicron variants have claimed more than 420,000 American lives since that late-June low.

It was with this context in mind that the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) met earlier this week to discuss the state of COVID-19 vaccines ahead of another likely surge later this year. The biggest question before the committee: Given how much the virus has mutated over the years, are our current vaccines—which were designed off of the original strain—still up to the task?

After nearly nine hours of virtual deliberation on Tuesday, the infectious disease specialists on the VRBPAC voted 19-2 that they were not, recommending the FDA spearhead a booster campaign this fall that more directly targets the Omicron variant. But that overwhelming 19-2 vote papered over a significant amount of disagreement and uncertainty. 

“Looking in the past doesn’t help us a great deal to look in the future for this virus, which has baffled a lot of us and made predictions almost irrelevant,” said University of Michigan epidemiologist Dr. Arnold Monto, the acting chair of the VRBPAC. “I think we have done the best we can in a difficult situation with imperfect data and inability to say what is going to follow what looks like Omicron 4 or 5 wave.”

The panel of outside advisers was only tasked with voting on one question—“is a change to the current COVID-19 vaccine strain composition necessary at this time?”—but the FDA urged the experts to debate a handful of other ones. If an update is determined to be necessary, should a vaccine targeting Omicron be based on the original Omicron variant that was discovered in November (BA.1), or the newest Omicron subvariants (BA.4 and BA.5) that combined have become the dominant strain in the country in recent weeks? Should the agency pursue a monovalent vaccine that elicits an immune response to one antigen (the Omicron variant), or a bivalent vaccine that provides protection against two (the Omicron variant and the original strain)?

The specialists were not nearly as united on the latter two questions as they were on the first, but a tentative consensus appeared to emerge over the course of the day as various data were presented: A bivalent vaccine targeting both the original SARS-CoV-2 virus and the newest Omicron subvariant is the best path forward.

“I’m in the bivalent camp, with an emphasis that we need to be paying attention to safety,” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation. “I also want—in the spirit of the Stanley Cup—[to skate to] where the puck is going, rather than where it’s been, so I lean to the BA.4/BA.5 variant.”

But even the more “forward-looking” option of the two could prove outdated by the time updated shots are actually going into arms this fall. Were this exercise conducted in early April rather than late June, for example, BA.2.12.1 would have been seen as the up-and-comer worth targeting. Now it’s being surpassed by BA.4 and BA.5. “We’re going to be playing whack-a-mole as this virus evolves, because it’s going to continue to evolve,” Gellin conceded. “We’ll get better at this, but we still need to get ahead of it.”

According to representatives from Moderna and Pfizer present on Tuesday, it may already be too late to “get ahead” of a potential fall wave. Both companies have been working on Omicron-specific vaccine candidates for months, but not necessarily in line with the latest VRBPAC specifications. Moderna, for example, recently publicized a bivalent booster candidate, but it was tailored toward the original SARS-CoV-2 strain and the original BA.1 Omicron strain—and the immune response against BA.4/BA.5 in small clinical trials was “approximately 3-fold lower” than the one against BA.1. That vaccine would reportedly be ready by this summer, but updating it to target the latest subvariants would push the delivery date to late October or early November.

Pfizer, meanwhile, has been testing both a monovalent and bivalent booster, and found the former candidate to produce significantly more neutralizing antibody titers against Omicron than the latter one. But it, too, was designed off the BA.1 strain, and appears to be less effective when up against BA.4 and BA.5. An executive said the company could have an unspecified quantity of BA.4/BA.5 boosters ready by the first week of October, if the FDA agreed to streamline certain parts of the regulatory process.

The presentations were clearly enough to impress a majority of the VRBPAC, but not Dr. Paul Offit, who was one of the two panelists to vote against recommending Omicron-specific boosters. “[Our current] vaccines still protect you against severe disease. BA.4 and BA.5 are now half the circulating experience, but we don’t have an increase in deaths, we have a minimal increase in hospitalization,” Offit—an infectious disease specialist at the Children’s Hospital of Philadelphia and vaccinology professor at University of Pennsylvania Medical School—told The Dispatch, noting it’s unclear the minimal increase in neutralizing antibody titers from an Omicron-specific vaccine would even provide any clinical benefit. “There may come a time when this virus evolves to the point that it is completely resistant to protection against severe illness, in which case then we need a variant-specific vaccine, and probably a standalone variant-specific vaccine. That hasn’t happened yet, and it may never happen.”

But other public health officials see COVID-19 vaccination evolving to eventually resemble something like an annual flu shot—and in the future, the two may even be combined. “As with flu, the virus changes. And as with flu, our immunity is not durable enough to go year after year after year, as it is with other vaccines,” said Dr. William Schaffner, a vaccine expert at Vanderbilt University School of Medicine. “We’re going to have to remind our immune system to stand up and get strong again.”

And in a dramatic shift from how the COVID-19 vaccines were first marketed, the goal of the shots—even the potential variant-specific ones—is, like the annual flu shot, no longer to prevent infection, but to make your symptoms milder when you inevitably contract the virus. “COVID has taught us these respiratory viruses that have a very short incubation period are really tough to prevent the milder infection,” Schaffner told The Dispatch. “What you can prevent is the dissemination throughout the body, and the causation of serious infection. And if there is a bonus in partially reducing mild infections and partially reducing transmission, I take that as icing on the cake.”

For that to happen, however, Americans will need to actually go get the shot when it’s authorized—and it’s pretty clear large swaths of the country have lost interest in doing so. Although nearly 80 percent of the country has received at least one COVID-19 vaccine dose, that number falls to 67 percent for two doses, 32 percent for three, and 5 percent for four. Another dose this fall may be a tough sell, especially if it’s not seen as particularly effective.

“The parallel track of influenza strains selection, which works very well, was a process that was honed over many, many years. And so we probably have quite a bit of work,” said Dr. Jerry Weir, a vaccine researcher at the FDA’s Center for Biologics Evaluation and Research. “This is a different virus. We have a lot of work to do on the strain selection process for COVID vaccines.”

“None of us has a crystal ball,” Dr. Peter Marks—director of the FDA’s Center for Biologics Evaluation and Research—said on Tuesday’s call. “If you do, come over to my house right now. I really would like it.”

Worth Your Time

• We’ve generally been pretty skeptical that the January 6 Committee hearings would, at this point, change anyone’s mind about what happened that day—but now we have evidence that we were wrong in at least one (1) instance. “I still believe that the Democrats are hoping these proceedings save them from having to compete with Trump on the campaign trail,” Newsweek deputy opinion editor Batya Ungar-Sargon writes for Common Sense. “And yet, I’ve come to believe that the question of what exactly happened on January 6 matters. It matters because there is a lot of talk flying around about the weakness of our democracy. Most people making that argument point to the violence of January 6 as Exhibit A. But the picture that’s emerging from these hearings is quite the opposite: Institutions, staffed by patriotic Americans, held against a massive onslaught from without and perhaps a greater one from within.”

• With all the talk of the world going in the toilet, take a moment to consider that, in many ways, we’re better off than previous generations. Cars are safer, homeownership has actually gotten more affordable, and we eat way more blueberries than our forebears. Don’t take our word for it—Timothy Lee unpacks the data in 24 charts at Full Stack Economics. That’s enough charts to rival an edition of Capitolism. 

• Don’t call it karma: The cryptocurrency crash has likely depleted North Korean coffers full of stolen cryptocurrency. To raise revenue while skirting sanctions, the country has invested in bands of hackers to steal hundreds of millions in crypto heists in recent years, Josh Smith reports for Reuters. The U.S. Treasury put the value of one theft at nearly $615 million pre-crash. It’s hard to estimate how much of that haul the crash has wiped out. “If the same attack happened today, the Ether currency stolen would be worth a bit more than $230 million, but North Korea swapped nearly all of that for Bitcoin, which has had separate price movements,” Smith writes. $230 million is still nothing to sneeze at, but North Korea has some major expenses to cover. “One estimate from the Geneva-based International Campaign to Abolish Nuclear Weapons says North Korea spends about $640 million per year on its nuclear arsenal. The country’s gross domestic product was estimated in 2020 to be around $27.4 billion, according to South Korea’s central bank.”

Presented Without Comment

Also Presented Without Comment

 Toeing the Company Line

• It’s a dog eat dogma world out there, Jay Nordlinger and Jonah conclude on Wednesday’s episode of The Remnant. With the requisite rank punditry and Nordlinger’s linguistic acumen, they blaze through the Dobbs decision, what it means to be a conservative, and a bit of etymology. And on today’s Remnant, fan-favorite Megan McArdle returns to talk abortion, crime, and gender.

• We reported a few weeks ago that it’s miserable to fly in the U.S. right now—but Scott actually has some ideas about the root causes and implied solutions. He explores them in Wednesday’s Capitolism (🔒), starting with the success of airline deregulation efforts and then explaining the “cabotage” restrictions bringing us all down.

• Is Dobbs a blow to our democracy? Let’s consider what that “our democracy” line means, Jonah suggests in Wednesday’s G-File (🔒), and what actually threatens our system of government. “The dysfunction of our entire political system stems from the fact that too many people make the wrong decision for the long run because they think they can maximize the benefits for themselves in the short run,” Jonah writes. “The only way ‘our democracy’ can die is when we reach a critical mass of leaders who think that way.”

• On the site today, Brent Orell takes a look at why 47 million members of the workforce quit their jobs in 2021, and what employers can do to retain their employees and attract people back to work.

• The Texas GOP added some interesting planks to its platform this year—among them, a resolution declaring the 2020 presidential election fraudulent. Augustus Bayard breaks down what else you need to know about what Republican delegates got up to in Texas.

• Russia has had control of Ukraine’s Zaporizhzhia nuclear power plant since March, and the International Atomic Energy Agency says the situation is dire. Every day the “risk of an accident or a security breach increases.” Anthony Ruggiero and Andrea Stricker explain the situation, plus what President Biden can do to help.

Let Us Know

Will your decision making on future COVID vaccinations be influenced by FDA recommendations? Or anything the U.S. government says? Why or why not?