More traditional technology may sway the vaccine hesitant

It is often said that we are at war with COVID-19. The universal elements are all there. International leaders like Xi Jinping, Boris Johnson, and Scott Morrison have all invoked wartime rhetoric. The U.S. mobilized a “war effort” with unprecedented industrial and human resources to combat an enemy virus. Both sides of this conflict continue to evolve and learn. One recursive of prolonged battle is that an enemy can adapt to its opponent through new behaviors or technologies. When the U.S. embarked upon WWII, we had inferior training, battleships, and aircraft. By the end, the allies dominated the seas and the skies. During the late middle ages, the French and English battled for 116 years. This tumultuous period witnessed the evolution of new tactics, the longbow, and eventually gunpowder.

Our protracted war with COVID-19 is no different. Despite early losses, both self-inflicted and from a largely indefensible enemy we have advanced on all fronts. Our generals are preparing for another push forward with armamentaria to be used alongside first-generation mRNA weaponry. The newest battlefield intervention soon to debut: the Novavax vaccine.

Our time with COVID-19 has been nothing short of a grind. It is, in fact, easier to compare our experience to pitched battle as opposed to modern, technologically driven warfare. After the initial shock of worldwide spread eased, we hunkered down in our respective cities and towns, awaiting transmission of the virion particle like barbarians at the gate. When the time came to counterattack, we did so on the back of vaccines. The vaccines were our heavy mounted cavalry providing the shock tactics necessary for victory. These relatively new constructs containing encoded information were superb, slashing through enemy hordes by gutting infection, transmission, and poor outcomes. Now, some 2 years in, the cavalry is exhausted. And the enemy evolves.

Omicron is a cunning foe whose manifest destiny has unfolded before us in the crucible of the human body. A kind of hyper-speed Darwinian evolution has rendered it supremely able to infect, though less able to kill. It has learned from us how to optimize itself for maximum fitness. It is now able to partially side-step our cavalry, but that cavalry is more important than ever.

Approximately 87% of U.S. adults have had at least one COVID-19 vaccination. When this is viewed in context with the natural immunity imparted by the rapid spread of Omicron, the totality of immunity has rarely looked more sanguine. But there still is, and may always be, an element of stochasticity with this virus. While people with significant comorbidities are at highest risk for severe outcomes, every once in a while, it comes for the healthy. And still, millions of Americans refuse to be vaccinated.

Given the historical scope of vaccine hesitancy and our natural predilection for certain freedoms, we really deserve a collective pat on the back for a job well done rather than the de rigueur self-flagellation. But this is not the time for complacency.

We have yet another opportunity to drive vaccination that should not be squandered. Novavax will be looking for their U.S. emergency use authorization in short order. With international authorizations from the World Health Organization and European Medicines Agency, key partnerships with the Coalition for Epidemic Preparedness Innovations and the Serum Institute of India, and pending applications with the remaining Anglosphere, the company is well positioned worldwide. Novavax produces a recombinant protein subunit vaccine that reconstitutes spike without the need for genetic materials. The upshot here is that this construct has a significant history of use for diseases like pertussis, hepatitis B, and pneumococcus. In trials, the vaccine showed similar protection to currently available vaccines, and none of the participants experienced severe clotting, anaphylaxis, or myocarditis.

Novavax has disappointed many with an oft-delayed regulatory path and manufacturing difficulties, but they have a following that should not be underestimated. Social media and Reddit groups maintain a cult-like fanaticism for their marketed vaccine product known as Nuvaxovid or Covovax. The stock, caught up in this fever but simultaneously throttled by a souring vaccine landscape, is as wild as a Yellowstone bucking bronco. But its real value may be in giving the un-jabbed another chance. Many unvaccinated do not see themselves as vaccine hesitant — this label merely reflects the lens through which they are viewed in this highly politicized environment. In their defense, it has been egregiously unfair to brand the millions up to date with their schedules as “anti-vax” because of a one-time offense. This is their chance to square up.

The impending release of another vaccine offers a critical opportunity for institutions like the CDC and the media to get their messaging right. In order to do so, it is useful to understand that there exists a spectrum of “vaccine hesitancy,” ranging from vaccine apathy to outright conspiracy. The extremes of the spectrum, and the shades of gray within, require precise messaging, communicated with empathy and compassion. The media, in order to avoid accusations of preference bias or worse, should deliver the same pomp and circumstance for this vaccine as it did for the likes of Pfizer and Moderna. Up to this point it has been eerily quiet.

If we are indeed still waging a pitched battle against this virus then it is time to refresh some of our chargers and give other beasts in the stable a chance. Vaccines will continue to be our best means to fight the enemy no matter how many therapeutics are advanced. Adding a protein subunit construct to the melee finally gives us the much needed, traditional option available for both the immunologically naïve and those hesitant to get boosted. It may provide a path forward for some who are pro-vaccine, but who drew the line at novel mRNA products. This is especially important given the disconnect that can exist between COVID-19 advocacy, science, and the manner in which this plays out in the realm of public policy. The Novavax option may indeed act as a compromise for some vaccine hesitant who are cornered by policies that squeeze healthcare workers, disregard naturally acquired immunity, require young and healthy adolescents to be boosted, or prevent children from leading more normal lives. Having another vaccine option just makes sense. It’s just a shame it didn’t arrive sooner.