COVID Transmissions for 10-9-2020

Bad science badly reported

Oct 09, 2020

Good morning! It has been 327 days since the first documented human case of COVID-19. Another week is over—have a great weekend.

Today I want to focus on a particular problematic headline. There has been so much misinformation during the pandemic and I want to call out a little more how you can know when a scientific story is not being covered properly.

I also wanted to provide a great reader question, found in the Talk Back section, as well as my response. The gist of this question is whether getting a less-effective first-generation COVID-19 vaccine will limit the benefit that a person could get from a more-effective second-generation vaccine. Really good question—I hope I’ve provided a good answer, which you can read later on.

As usual, bolded terms are linked to the running newsletter glossary.

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Now, let’s talk COVID.

Moderna will not enforce intellectual property rights to its vaccine patents

As reported in STAT News, Moderna has announced that they will not be enforcing their IP rights with respect to their vaccine: https://www.statnews.com/pharmalot/2020/10/08/moderna-covid19-coronavirus-pandemic-vaccine-who-patents/

I recognize that article is under a pay wall, apologies for that.

This is a goodwill move that will allow companies to develop and manufacture vaccines based on Moderna’s technology and increase vaccine access. I think that’s great, but I also want to point out what it’s really about: ensuring that companies in developing countries can create vaccine doses, particularly where doing so might not be profitable at all for Moderna.

Moderna will still be years ahead of the competition in key markets like the US, where the regulatory process is often a bigger hurdle for a biologic product like a vaccine than patent exclusivity may be. Vaccines are held to very high manufacturing standards, and it is not easy to convince regulatory agencies that a new product is equivalent to something else that has already been marketed. Presuming that long-term immunity is possible to COVID-19, Moderna won’t have to worry about competition in key markets from this decision.

Instead, they are improving access in markets that they might not be able to enter at all. Moderna is a small company. I don’t expect that they have significant operations in China or India, or that such operations would be worth the cost for them to establish. The same is probably true of many other, smaller markets.

Instead of allowing their IP rights to be a barrier to those markets getting the vaccine, they have decided they will not stand in the way.

This is a far cry from Jonas Salk, who refused to even patent the polio vaccine he invented. “Could you patent the sun?” Dr. Salk famously asked, portraying his vaccine as something naturally occurring and not the product of difficult work and research.

Moderna hasn’t gone this far, but it’s nice to see they went somewhere. Now, let’s hope their vaccine gets the job done and is actually safe and effective.

Male infertility in COVID-19: reporting a story that shouldn’t be reported

Today, I saw a couple of Israeli news venues covering a story about a study suggesting that COVID-19 could lead to male infertility. I do not believe that this story should ever have been reported and I want to walk through why.

However, let’s start with this note: it’s possible that COVID-19 affects organ systems related to male fertility. Several viruses are documented as being able to do this, though it’s more likely with viruses that circulate in the blood, something that SARS-CoV-2 has not been demonstrated to do. Regardless, I wouldn’t rule out male genotoxicity (aka, harm to the gonads) as a possibility. The thing about possibilities is that they require the support of evidence.

The article in the Jerusalem Post suggests that Israeli doctors have established such evidence: https://www.jpost.com/health-science/covid-19-could-cause-infertility-new-israeli-study-644767

It focuses on an unpublished study led by a researcher named Dan Aderka. This work has not been peer reviewed, and even though I could perform my own personal peer review for you, I can’t find it online anywhere even in preprint form. All that I have to go on about it is the word of Dr. Aderka as reported in JPost.

The reporting there suggests that “virus” was found in the sperm of some patients Dr. Aderka studied. Immediately this triggers alarm bells for me, and here’s why:

Was it virus, or was it virus RNA? Virus cannot be found in all the fluids where virus RNA can be found, but the presence of virus RNA does not imply a pathology
Patient numbers for these data are not given; the only patient numbers that are given are for the postmortem studies that were conducted on a total of 12 patients

This is clearly not a large study if those numbers carry through to others and the methodology is, unsurprisingly, not provided in a satisfactory way in this popular newspaper that is not a scientific journal.

I’d like to go a step further, though, and be clear that I do not think appropriate science journalism took place here. One standard of science journalism is that you really should only report on peer-reviewed studies. In the breathless need to report on COVID-19, this rule has often been ignored. However, there is another standard practice in science journalism that has not been universally ignored: the need for an unbiased evaluator as a source within the story.

When you report on even peer-reviewed science, you cannot be sure that the paper is actually as good as the authors say it is. Plenty of bad science has passed peer review. At the same time, the journalist is not the appropriate person—even when qualified—to make this evaluation. For this reason, science journalists usually question a third-party source not affiliated with the work in order to provide an outside view of the study quality.

As you can see in this JPost article, there is no such outside source questioned. This is true in every article that I have read about Dr. Aderka’s work in other sources as well; there are only quotes from Dr. Aderka, providing information about his study without any balance.

This is a serious problem. Here we have an unpublished study with no data available anywhere that could allow its claims to be given an unbiased review. It is being reported by a paper of record as though it is scientific fact, when there has been no appropriate evaluation of its status.

It reads like a press release—and I partly believe that must be what it is based on. Science by press release is not appropriate. Press releases are issued by institutions to talk up the work their researchers are doing. They are not balanced and they are not meant to be; journalists are expected to do their jobs and find the other side of the story.

In this case, they did not, and I find it unacceptable because it will mislead people. Even if Dr. Aderka’s claims ultimately turn out to be true, the handling of this is completely inappropriate.

What am I doing to cope with the pandemic? This:

Trying to sleep

Is anyone else having trouble sleeping during these trying times? I know I am.

Do you have any ideas about good ways to preserve your sleep schedule and quality when the days blur together and the world feels full of crisis? I’d love to hear them, and feature them here. Please, speak up in the comments.

Yesterday, I got some very kind words as well as an excellent question from reader “archivistellie”:

Question: what is the likelihood that taking an early, less-effective vaccine prevents a future, more-effective vaccine from working correctly? Or, to phrase is more positively: do you expect that different COVID-19 vaccines will work independently and provide stacking protection? (I find myself having unusually vaccine-hesitant thoughts about the in-progress COVID-19 vaccines, and I finally figured out that this is the question that's bothering me.) Thank you for writing this newsletter, reading it has become a welcome part of my morning routine!

This is SUCH a great question. I tried my hand at an answer that I’d like to share with all of you:

This is a fantastic question. In the past, I've discussed the possibility that a bad vaccine could cause problems for the immunogenicity of a future, better vaccine. This kind of thing happens sometimes with influenza virus exposure; the first immune response in a person's lifetime to an influenza virus can be the strongest, and this strong immune response can actually get in the way of responses to later viruses--or vaccines. This concept is called "original antigenic sin," because virologists like to think we've very clever.
However, this doesn't apply to all viruses.
There is also the possibility that a bad vaccine could produce an "inappropriate" immune response that interferes with future immune responses. That's a little more complicated, but to give it in a nutshell, it's possible for a pathogen to induce an immune response that is not appropriate to that type of pathogen. For example, a bacterium might activate immune responses that are for larger parasites. When pathogens do this, it's often a response that evolves because it distracts the immune system from mounting a proper fight. Theoretically, a bad vaccine could also induce such an inappropriate response, and not be very effective. Later attempts to boost that response might still be blocked by this earlier inappropriate response.
I've not seen much evidence that COVID-19 has this kind of inappropriate immune response, though.
What I have seen so far is reasonable evidence that the vaccines being developed produce effective antibodies as well as T-cells. I've also seen reasonable evidence that antibodies have some kind of effect against SARS-CoV-2. Finally, and most importantly, I've seen clear evidence that a vaccine schedule involving a second "booster" dose improves the quality of antibody and T-cell response for the leading vaccines with available data.
This leaves me hopeful; if boosting helps these vaccines, then it's also possible that a mixed schedule of different vaccine types will boost the response. Our second-generation technologies for COVID-19 vaccination may simply work well as effective boosters for those of us who receive the first-generation option. This is a very optimistic view, and there is still much we don't know, but I do think that this is the direction that things may go.
A former colleague of mine, Dr. Florian Krammer, is an expert on vaccines and antibodies who has spoken on this topic in the past. He's very active on Twitter, and if you're on there, I'd recommend following him for potential future statements on this topic.

Something I think I should have noted in this comment is that my view on this is going to totally change (even if the ultimate conclusion remains the same) when we have available Phase 3 data for any of the vaccine candidates. Those data are going to change everything, and I expect to be writing at length about them in this newsletter!

I try my best to feature excellent comments and questions in this space when they come in—if you have a burning question or comment, I’d love to feature it here.

Join the conversation, and what you say will impact what I talk about in the next issue.

Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.

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