WHAT HAVE YOU DONE FOR ME LATELY — Entering our third pandemic summer, it's easy to get frustrated with the vaccines. They aren't as effective against variants and subvariants that keep taunting us. They aren't preventing ongoing transmission of infection — and reinfection. They didn't restore our pre-pandemic normal (partly because too many people refused a vaccine, often for ideological reasons). And we keep needing more boosters. But the vaccines are a victim of their own success. We complain about them because we have such high expectations for them — because they've worked so well. Heading into June 2022, it's easy to forget where we were in October 2020. Back then, we were hoping for a vaccine — one vaccine — that would be at least 50 percent effective. Instead the world has numerous vaccines — and more in the pipeline. The ones used here in the U.S. — Pfizer, Moderna and, to a lesser extent because of the clotting risk, Johnson & Johnson — are way more than 50 percent effective at protecting us against serious disease and death. Hundreds of people are still dying from Covid-19 every day. But not thousands. Whatever their shortcomings, the coronavirus vaccines are extraordinary. They've saved millions of lives, Harvard epidemiologist William Hanage reminded Nightly. The pandemic has put horrific pressures on health care systems and health care workers. But everything would have been even worse without the shots. "Remember back in 2020, you had only one way to get immunity — to get infected. To be sick. And that was extremely high risk, for older people in particular," Hanage said. But that was then. Our expectations — and our pandemic fatigue — are higher now. The question for vaccines now is what's next. The answer could come in one of several forms. The government is now emphasizing both vaccination and treatment. White House Coronavirus Response Coordinator Ashish Jha said the other day that public health officials are "making sure that we have a new generation of vaccines that are being worked on right now, that we have availability of treatments and testing and we have the resources." The FDA and its advisory board are considering whether and how the vaccines should be modified to better protect against variants. The shots we get now were a response to the original or "wild" or "ancestral" version of the virus that spread throughout the world in early 2020. We've been through two-thirds of the Greek alphabet since then. More data about a reformulated version should come within a few weeks, an administration official told Nightly. But even if the shots are updated to better target the virus as it exists today — or to make the protective response more enduring — it wouldn't guarantee that a newer vaccine would protect us as effectively against yet another mutation should one arise. But broader protection should help. The holy grail is a pan-coronavirus vaccine, one that would protect us against all variants and subtypes. The science is within reach — but so far, the money isn't, Eric Topol, a cardiologist, med school professor and founder of the Scripps Research Translational Institute, told Nightly. Congressional Republicans have snubbed even the scaled-down pandemic spending bill President Joe Biden has requested. Nor has any international consortium, of other nations or philanthropies, stepped up to fund what is basically an Operation Warp Speed Part 2. That lack of urgency — and financing — worries Topol. "The cracks (in protection) against serious, severe disease haven't been adequately acknowledged," Topol said. "We've got chinks in the armor." Another path is to develop a nasal (or possibly an oral) vaccine. That would give us "mucosal immunity" — meaning it would target our noses so the virus couldn't get in. We'd be less likely to get breakthrough infections and less likely to spread the coronavirus to others. A few are already in clinical trials. Emily Landon, an infectious disease specialist at the University of Chicago Medicine, said the antibodies produced by a traditional injection are like "the bouncers of the immune system," kicking viruses out of our cells before they harm us. A nasal vaccine would create "the bouncer's bouncer" — an outer perimeter of protection. Plus a nose spray would probably have fewer side effects, Topol said. And there are no needles, which is a bonus because needle phobia is one reason some people have shunned vaccination so far. "Heterologous" immunity — scientists' polysyllabic term for "mix and match" vaccines — is another potential tool. So someone who had an mRNA shot might get a booster of a more traditional kind of vaccine. It's being studied — but it's difficult, partly because there are so many possible combinations of vaccines and doses and intervals. (Plus, vaccine makers don't have an incentive to do expensive studies that hand a portion of their market to a competitor). A final pathway — and it's not the one most of us want to hear — is that we (or at least the high risk among us) may in fact need shots twice a year for some time to come, Landon said. We get flu shots (or we are advised to) every year — but the flu circulates for only a few months at a time. At the moment, Covid is a year-round phenomenon, rolling from one region or hot spot to another and back around, so a once a year shot isn't enough. Plus, she said: "Our immunity to respiratory viruses just doesn't last very long. It never has." Welcome to POLITICO Nightly. Tyler here. I'll have more to say below, but I wanted to thank all of our readers. Your time and trust in us means more than you know. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight's author on Twitter at @JoanneKenen.
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