Let’s not throw out the baby with the bathwater!

Today, I read A. Siri’s tweet:

Sorry, but I respectfully disagree with A. Siri.

• Regarding the COVID-19 vaccines:
  
  I believe it is regrettable that the FDA has still not implemented the long-requested and much-needed moratorium on the use of all COVID-19 vaccines across all age groups:
  https://voiceforscienceandsolidarity.substack.com/p/please-dont-call-me-a-visionary?r=y46t6

• Regarding his comments on removing vaccines that do not prevent transmission:
  
  Give me a break! I can only hope that the next ACIP will not be composed of lawyers. A. Siri has heard the clock toll but does not exactly know where the clapper hangs. Let me educate him a bit on vaccinology:
  First and foremost, I want to point out that vaccines which, independently of their mode of administration, prevent transmission and thus infection simply do not exist. Such vaccines would have to exert sterilizing immunity to completely prevent productive infection.
  Nevertheless, it is perfectly possible with some existing vaccines — even though they lack sterilizing immunity — to prevent infection and transmission; however, this is only achievable for acute, self-limiting infections where antibodies (Abs) are a correlate of protection.
  By vaccinating prophylactically, high Ab titers can be induced that neutralize viruses causing such acute, self-limiting infections. This protection, however, lasts only as long as the Ab titers in the blood remain above a neutralizing threshold (comparable to the minimum therapeutic concentration of a drug!). Once titers fall below this neutralizing concentration, vaccine-induced Abs are no longer capable of preventing infection and transmission. Does this mean that these vaccines become worthless at that point? Absolutely not! When an immunologically naïve person has been primed, high Ab titers will be rapidly recalled upon exposure, enabling disease prevention and effective containment of transmission — just as happens with reinfection following prior natural infection (and immunity).
  Thus, no ‘suboptimal’ immunity arises; the disease duration will be very short and mild, and vaccination will not lead to asymptomatically infected individuals who could ‘silently’ transmit the pathogen and serve as a reservoir for immune escape variants, thereby preventing the population from establishing protective herd immunity.
  Asymptomatic carriers and the risk of sustained transmission and immune escape are also generated when perfectly preventive vaccines are used incorrectly, for example by priming an entire immunologically naïve population already exposed to the virus (see mass COVID-19 vaccination during the pandemic!), or when vaccines are employed that—even under optimal conditions (e.g., prophylactic administration and boosting to induce high Ab titers)—cannot prevent the infectivity of the pathogen because the nature of the induced immunity can only limit infection but not prevent it entirely. This is, indeed, the case with pertussis vaccination, and here I agree with A. Siri that large-scale immunization programs against pertussis will simply make things worse in that we’ll pay the price of symptom mitigation with persistent transmission and pathogen immune escape. The same applies to streptococcal vaccination. There is, therefore, no scientific rationale to recommend these vaccines, let alone make their administration mandatory.
  However, immune escape is actually beneficial for the vaccine industry, since the emergence of new variants allows antigenic components to be swapped or newly added via simple cut-and-paste processes, facilitating rapid production of new vaccines through existing procedures. In vaccinology, there is a key principle that states, ‘the vaccine is only as good (or as bad) as the antigen.’ This principle is particularly relevant for chronic infections. If these are targeted with the current vaccine concepts and types of (foreign-centered) antigens, immune escape is inevitable. This is because vaccinology still has not overcome the MHC restriction of cytotoxic T cells, which is known to be essential for combating chronic infections. Regarding prevention, HBV (hepatitis B virus) and HPV (human papilloma virus) represent small exceptions since high Ab titers can neutralize the virus before it enters target host cells. However, in endemic situations, large-scale priming of antiviral Abs against these viruses leads to immune escape again. Due to the lack of sterilizing vaccines, we also lack curative (therapeutic) vaccines against chronic or latent infections.

  
  My argument aims to clarify that ‘prevention of transmission’ is not necessarily an intrinsic characteristic of a vaccine as A. Siri is erroneously suggesting. Hence, the decision to remove certain vaccines from the current childhood vaccination program should not be based solely on whether or not existing vaccines can prevent transmission, but also on whether such limitations are determined by administration modalities and/or the epidemiological situation.
  Although the other vaccines A. Siri mentions cannot prevent pathogen transmission, this is not, in my opinion, a valid reason, or THE valid reason, to remove them from the schedule.
  THE valid reason for urging global health authorities to stop polio vaccination with the inactivated vaccine is that it is administered in a context of circulating VDPV (vaccine-derived poliovirus), which irrevocably causes immune escape — as shown in multiple publications. The live attenuated vaccine was effective in limiting wild poliovirus transmission, but because it was administered orally, that live attenuated virus entered wastewater on a large scale. Due to its high resistance to environmental factors, wastewater served (directly or indirectly) as a reservoir for VDPV transmission, which despite attenuation was still sufficiently virulent to cause more cases of Vaccine-Associated Paralytic Polio (VAPP) than cases of paralytic polio caused by wild poliovirus (reversion to virulence being only one of the causes).
  Given that nearly one-third of the world population—especially where polio remains endemic—lacks access to clean drinking water, it is clear that the priority for global health should be providing clean water, not polio vaccination. Therefore, stopping this vaccination should be considered from a completely different perspective.
  Finally, I find A. Siri’s concerns about tetanus vaccination unfounded. The goal of such a vaccine was never to prevent bacterial transmission, but to protect against the deadly and highly resistant neurotoxins produced by the bacteria after spores from the environment insidiously enter the body, preferably through small wounds or cuts (anaerobic conditions). While one may debate the need to make this vaccine mandatory, I personally continue to recommend it. I suspect A. Siri’s concerns stem more from his aluminum phobia, which probably relates more to the autism debate.

  
  Hopefully, my reply once again illustrates the need for thorough scientific debate in which trained experts (not dilettantes) openly exchange views on this complex matters. One-liners and black-and-white statements serve no one. Dissolving the current ACIP is, in my opinion, a good step. However, it will be quite a challenge to create a new, expert ACIP from the small circle of independent scientists and vaccine specialists.