Weaker variants and better treatments

I am not surprised.  From The most vaccine-hesitant group of all? PhDs by Ray Hall.

But according to a new paper by researchers from Carnegie Mellon University and the University of Pittsburgh, this does not paint the full picture. The researchers analysed more than 5 million survey responses by a range of different demographic details, and classed those people who would “probably” or “definitely” not choose to get vaccinated as “vaccine hesitant.”

In some respects the findings are as predicted — for example the paper finds that there is a strong correlation between counties with higher Trump support in the 2020 presidential election and higher hesitancy in the period January 2021 — May 2021. 

But more surprising is the breakdown in vaccine hesitancy by level of education. It finds that the association between hesitancy and education level follows a U-shaped curve with the highest hesitancy among those least and most educated. People with a master’s degree had the least hesitancy, and the highest hesitancy was among those holding a Ph.D. 

What’s more, the paper found that in the first five months of 2021, the largest decrease in hesitancy was among the least educated — those with a high school education or less. Meanwhile, hesitancy held constant in the most educated group; by May, those with Ph.Ds were the most hesitant group. 

So not only are the most educated people most sceptical of taking the Covid vaccine, they are also the least likely the change their minds about it… 

Click through for the links.  The original paper is here, Time trends and factors related to COVID-19 vaccine hesitancy from January-May 2021 among US adults: Findings from a large-scale national survey by Wendy C King, et al.  

Which raises a separate issue I have not seen much discussed. Vaccines are well and good but natural immunization through infection is almost always better.  One characteristic of viruses is that they tend to start out selective and lethal, i.e. hard to spread and generally deadly.  From an evolutionary perspective this is generally a losing strategy.  It is why Ebola outbreaks tend to be limited.  It kills faster than it spreads.

What often happens, though, is that the virus will evolve, becoming both more infectious and also milder in symptoms.  The longer you wait, the more likely you are to be dealing with a milder variant.  That appears to be what we are seeing with the Delta variant.  More cases but a lower percentage of deaths.

Simultaneously, from a public health perspective, there are three human responses to a new virus.  First is the instinct to limit exposure by masking, social distancing and lock downs.  Prior to Covid-19 most national and UN protocols acknowledged the limited effectiveness of these approaches.  They work for some conditions under particular circumstances for a constrained number of people but they are ineffective at a societal level.

For a variety of reasons, many national health authorities chose to discard these protocol, perhaps simply to be seen to be doing something about a minor but novel and ineluctable perceived threat.  

The second approach in addressing novel viruses is to research and develop effective treatments to the new virus.  That has been a surprisingly overlooked and under-addressed strategy in this pandemic.  For especially lethal viruses, such as Ebola, the very nature of the virus makes it hard to develop treatments.  For Covid-19 though, that has not been the case.  Individual teams around the world have been working away on coming up with an array of treatment protocols.  They have been the red-headed step children though from the perspective of national health authorities and there has been little national attention paid to sorting the wheat from the chaff and summarizing and distributing treatment protocols.  In addition, in some countries, the treatment has become politicized to ell effect for everyone.

Finally, the third response is to develop vaccines.  It is a chancy business with low success rates and frequently many questions about long term effectiveness and possible associated risks.  Operation Warp Speed was an exception, developing at least four vaccines with two different technologies within the space of a year.  Questions remain about long term efficacy and possible future risks, especially regarding the mRNA versions, but there is no doubt that it has been, in the near term a surprising success.

Nations are rolling out the vaccines and while a few, usually smaller countries, are getting to very high of vaccination rates, many are stalling out after some early successes based on pent up demand.  The US is at about 60% vaccination with possibly another 10% having had the natural infection and therefore immune.

So why would smart people with PhDs be more vaccine hesitant?  A Just-So story could legitimately be told about concerns about the rapidity with which vaccines were deployed without full vetting.  That is merely a difference in calculation about the risk consequences of the chance of infection from a novel virus and the chance of lethal outcome versus the chance of negative outcomes from new vaccines from novel technologies with limited trials.  

But there is a further consideration and this is the one I have not seen being discussed at all.  The longer someone waits and successfully remains uninfected, the better their chances or acquiring natural immunity through infection.  This is because the virus is likely to be a weaker variant (like Delta) and the medical treatment options are likely to be better.  

This potentially significantly changes the risk calculation.

If I am a healthy 35 year-old facing the choice between the possible negative consequences of novel and under-tested vaccines versus the possible consequences from a weaker virus variant and better treatment protocols, the more the risk slider will edge towards waiting for a natural infection.

I am not claiming this is the calculus of any PhD.  Merely that it is a real and valid calculus which national health authorities are overlooking to their own detriment in terms of both national health and in terms of trust in national health authorities.