Has the NIH been communicating good science?

Am I the only one out there who has observed many from the NIH seemingly communicating the party-line rather than sticking to what the science is saying?
Example from www.protectpublicstrust .org:

Bret Baier: “Can you definitively say to somebody that the vaccine provides
better protection than the antibodies that you get from actually having had
Covid-19?”

Francis Collins: “Yes, Bret, I can say that. There was a study published by CDC
just ten days ago in Kentucky. And they looked specifically at people who had
had natural infection and people who’d been vaccinated and then ended up getting
infected again. So what was the protection level? It was more than two-fold better
from the people who had the vaccine in terms of protection than people who’d
had the natural infection. That’s very clear in that Kentucky study.”

Collins’s reply evoked strong responses from the scientific community for misstating the study’s conclusion. Dr. Martin Kuldorff, another highly respected epidemiologist at Harvard Medical School, critiqued Dr. Collins on this point.
On natural immunity, NIHDirector Francis Collins is misleading the public.
Kentucky study shows less reinfections after COVID disease plus vaccine than
COVID only (both very low). He falsely claims less reinfections after vaccine
than after COVID disease.

Furthermore, CDC’s highlighting the results of a carefully selected two-month period from a single state (out of a 50 State study) led Dr. Marty Makary, a Johns Hopkins University Surgical Professor, to claim the CDC was “fishing” in order to find support for a policy position promoted by political leadership at the agency and at the White House. While policy positions are wholly within the discretion granted to political leadership, they must not conflict with the applicable
scientific integrity policies. It is not clear they cleared this bar. Dr. Makary also noted the exceedingly low infection rate of the subjects, among both vaccinated and unvaccinated, in the Kentucky study.

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He’s the author of the Great Barrington Declaration and that was super controversial and not exactly something “highly-respected.” He’s a known alt-right partisan. Shocker, they don’t agree with scientists.

Experts do not agree with Dr. Marty Makary:

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We do have to be careful and not simply attack the messenger. The statement was regarding the natural immunity obtained with recovery. I understand it is almost universally known now that natural immunity is better than the vaccine immunity. Studies in Israel and Briton do show that. Strangely, the NIH here again avoids serious study on that subject. Where is their science?

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I’ll have to look at it closer, but it is the nature of science to change, and statements are often made based on the best evidence or studies at the time, that may be superseded by further studies that further our knowledge.
I have heard that natural immunity is to die for.

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I’m not sure what you’re trying to get at here @21century . What is your main point? You apparently think that the NIH just is toting a “party-line.” That particular argument sounds a bit like the strategy of anti-science groups where if you can convince your followers that “oh our opponents only think that because of their party idealogies”… thus allowing for the widescale dismissal of science that one doesn’t like.

But yes, in this case, you are correct that Francis Collins seems to have not properly read this particular study:

I think the clearest summary from the paper is:

This study found that among Kentucky residents who were previously infected with SARS-CoV-2 in 2020, those who were unvaccinated against COVID-19 had significantly higher likelihood of reinfection during May and June 2021. This finding supports the CDC recommendation that all eligible persons be offered COVID-19 vaccination, regardless of previous SARS-CoV-2 infection status.

Kuldorff is at least correct in that the KY study shows that for those previously infected, getting vaccinated on top of that reduces the risk of reinfection by half. However, I don’t think it is warranted to say that Collins is misleading the public rather than he made a mistake.

Did he just make this up with no evidence? It seems like it. So I’ll go ahead and dismiss this without evidence unless he has some evidence to back up his claim. It’s also misleading for Makary and Kuldorff to dismiss the results of the KY study because “not a ton of people were infected.” The results are a nice demonstration that previously infected people can benefit from getting at least one vaccination.

Here was Francis Collins discussing this on February 21 of this year:

Or a bit later, discussing how vaccine acquired vs. infection acquired immunity are likely to fare should a future variant become dominant after Delta:

These sorts of issues are complicated and are being studied by NIH and other organizations.

Sigh. I need to go to bed, but this will have to be a much longer discussion it looks like because this would not be an accurate statement.

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Before you have natural immunity, you have no immunity. If you become sick with Covid-19 you could become seriously ill, beset with ongoing chronic conditions, and possibly die. So que sera sera is not a rational strategy. But if you are fortunate enough to make it through an infection intact, your immune system has been exposed to all the antigenic sites the virus presents. None of the applicable vaccines has ever been able to claim this, and is an expected outcome which has been evident from the onset.

BMJ article on natural immunity

Responses to BMJ article

Israel study

Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections

The advantageous protection afforded by natural immunity that this analysis demonstrates could be explained by the more extensive immune response to the SARS-CoV-2 proteins than that generated by the anti-spike protein immune activation conferred by the vaccine.

General article on above paper
Having SARS-CoV-2 once confers much greater immunity than a vaccine—but vaccination remains vital

The newly released data show people who once had a SARS-CoV-2 infection were much less likely than never-infected, vaccinated people to get Delta, develop symptoms from it, or become hospitalized with serious COVID-19.

Natural infection versus vaccination: Differences in COVID antibody responses emerge

Vaccination produces greater amounts of circulating antibodies than natural infection. But a new study suggests that not all memory B cells are created equal. While vaccination gives rise to memory B cells that evolve over a few weeks, natural infection births memory B cells that continue to evolve over several months, producing highly potent antibodies adept at eliminating even viral variants.

The findings highlight an advantage bestowed by natural infection rather than vaccination, but the authors caution that the benefits of stronger memory B cells do not outweigh the risk of disability and death from COVID-19.

What are the roles of antibodies versus a durable, high quality T-cell response in protective immunity against SARS-CoV-2?

Although most vaccine candidates are focusing on spike protein as antigen, natural infection by SARS-CoV-2 induces broad epitope coverage, cross-reactive with other betacoronviruses.

and there is the Cleveland study from back when vaccination was being triaged…

Necessity of COVID-19 vaccination in previously infected individuals

Individuals who have had SARS-CoV-2 infection are unlikely to benefit from COVID-19 vaccination, and vaccines can be safely prioritized to those who have not been infected before.

Longitudinal analysis shows durable and broad immune memory after SARS-CoV-2 infection with persisting antibody responses and memory B and T cells

these results suggest that broad and effective immunity may persist longterm in recovered COVID-19 patients.

When public health authorities misrepresent the state of knowledge to elicit compliance, project their preferences into voids of understanding, and leave out nuance so as not to confuse the laity, that only offers support to the paranoid and conspiracy fixated crazies. We now have policy demanding that people who can certify prior infection still be fired from their livelihood. I am not at ease with that kind of coercive and sweeping mandate, presented as based on science, when not justified by the actual data.

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No doubt survivors of Covid infection have immunity, and likely better than a vaccine. No doubt it also wanes with time and reinfection is not uncommon. That may lead to further spread of the virus from both vaccinated and post-infection groups. If someone has proof of infection, it should be roughly equivilent to proof of vaccine. Both may still benefit, and society may still benefit, from both getting a booster, so as to avoid spread. Now, it is a good question if ethically we should not get boosters until the rest of the world has an opportunity to get vaccinated, though practically it is sort of like your mom telling you to clean your plate because there are starving children in China. That is, it doesn’t get the vaccine there despite the need.

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Practically and logistically, that’s the way to get it done, though. (Speed limits, reckless driving laws and patrol cars are a good thing, in the big picture. :slightly_smiling_face: So is coercively mandating which side of the road to drive on.)

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Yes, that is problematic.

I do not dispute there is always a tension between individual freedom and the collective interest of society. In the case of rules of the road, the freedom most people are interested in is the freedom to drive from point A to B. A demonstrative case can be established from observation than driving head on into traffic is positively and causatively associated with trauma. In this case there is no real serious and organized opposition to constraining driver freedom.

It is legitimate to curtail freedom in the face of common interest and existential threats; the tricky part is in calibrating the response to the threat. Excessive public policy which may be temptingly expedient may have the unintended but foreseeable outcome of fermenting resistance and hostility. Unfortunately, in the present polarization, that calculus has become politicized to a degree that I cannot have imagined a generation ago. I’m not suggesting both sides are morally equivalent here, only to suggest that the status of health professionals would be best served by endeavoring to stay above the fray by being faithful to best understanding.

I’m not interested in others’ freedom to infect my grandchildren. We are coerced to put children in protective carseats, right?

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This makes it sound like one is in competition with the other. I want both: whatever natural immunities I may already have to all sorts of stuff (which obviously has kept me alive this far), along with the expanded arsenal my natural immunities now have from my vaccine exposure. Vaccines are enhancing your natural immunities; not competing with them.

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While I do have a lot more to add, especially with regard to @rsewell talking about and @21century subtley mentioning the one Israel preprint, CDC did drop this particular MMWR earlier today:

image

This is definitely an interesting result and will take some time to be sorted out in the literature, but they do cite seven potential limitations at the end:

  • First, although this analysis was designed to compare two groups with different sources of immunity, patients might have been misclassified. If SARS-CoV-2 testing occurred outside of network partners’ medical facilities or if vaccinated persons are less likely to seek testing, some positive SARS-CoV-2 test results might have been missed and thus some patients classified as vaccinated and previously uninfected might also have been infected. In addition, despite the high specificity of COVID-19 vaccination status from these data sources, misclassification is possible.
  • Second, the aOR could not be further stratified by time since infection or vaccination because of sparse data and limited ability to control for residual confounding that could be magnified within shorter intervals. The aOR that did not adjust for time might also be subject to residual confounding, particularly related to waning of both types of immunity.
  • Third, selection bias might be possible if vaccination status influences likelihood of testing and if previous infection influences the likelihood of vaccination. Previous work from the VISION network did not identify systematic bias in testing by vaccination status, based on data through May 2021 ( 1 ).
  • Fourth, residual confounding might exist because the study did not measure or adjust for behavioral differences between the comparison groups that could modify the risk of the outcome.
  • Fifth, these results might not be generalizable to nonhospitalized patients who have different access to medical care or different health care–seeking behaviors, particularly outside of the nine states covered.
  • Sixth, the statistical model incorporated the use of a weighted propensity score method which is subject to biases in estimates or standard errors if the propensity score model is misspecified. Numerous techniques were used to reduce potential suboptimal specification of the model, including but not limited to including a large set of covariates for machine learning estimation of propensity scores, including covariates in both regression and propensity models, ensuring large sample sizes and checking stability of weights, and conducting secondary analyses to assess robustness of results.
  • Finally, the study assessed COVID-19 mRNA vaccines only; findings should not be generalized to the Janssen vaccine.
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And we have this study just out:
Published: October 29, 2021

WASHINGTON — A newly-published study shows that while vaccines are still effective in reducing hospitalization or death from the delta variant of COVID-19, the vaccine offers little protection against spreading the variant within a person’s own household.

The article, published Friday in the peer-reviewed journal Lancet Infectious Diseases, looked at more than 600 people in the United Kingdom over the course of a year and analyzed the viral load, or the amount of the virus in the body, of vaccinated and unvaccinated individuals.

Researchers found that 25% of vaccinated household members exposed to the delta variant contracted COVID-19 compared to 38% of unvaccinated household members. But in terms of the source of the infection, infections from those exposed to fully vaccinated people was similar to infections from those exposed to unvaccinated people.

The study also found that vaccinated individuals with the delta variant saw their viral load decline faster than unvaccinated people whether those people had the original strain of COVID-19, the alpha variant or the delta variant.

And the takeaway is… getting a vaccine is still a good thing even if you’re cooped up with infected folks regardless of their vaccination status. What a difference in recommendations that is going to make! :slightly_smiling_face:

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The takeaway is: In the U.S. we have “The National Institutes of Health”, but yet we have to go to Kentucky state research or a European study to find serious information on anything but “how effective the vaccines are”. I go back to the topic heading “Has the NIH been communicating good science”. Who has/is running that agency?

Docs @Randy, @jpm, @glipsnort, want to weigh in?

This thread is really not a good way of evaluating the success or failure of the NIH. The personal comments of Francis Collins on one topic don’t reflect the productivity or lack thereof of a large government agency. And in response to the thread title, the NIH is a research organization; for communication of good science about the pandemic, look to public health authorities, especially the CDC, not the NIH.

That being said… I can’t say the US in general or the NIH in particular have done a particularly good job in advancing our understanding of SARS-CoV-2, which is certainly within their mission. The UK (among other countries) has been far more effective when it comes to studies of viral variants, of proposed therapies, and of vaccines than the US. Partly this is because both health care and public health are highly fragmented in the US, with the latter being handled by a slew of local and state health departments. That makes assembling large studies logistically very difficult. Partly (it seems to me, from my rather low perch) it’s because the NIH has been sluggish in responding – most of the work I know of has been sponsored or coordinated by the CDC, not the NIH, and while the NIH has promised rapid funding for covid-related research, in practice the process of getting funding has been achingly slow compared to the CDC.

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Thank you. :+1:  

Interesting article and discussion about study showing the superiority of vaccination:

Evidently, many people with low grade infection may not develop much in the way of an immune response either. In any case, it appears to bolster the argument for vaccination, whether previously infected or not.

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