October 2, 2023
Noble Nobel
The Nobel Prize in Medicine was announced today. Given to the two people, Katalin Karikó and Drew Weissman, who did the research for developing mRNA vaccines. They richly deserve it. Without their research, the vaccines for COVID-19 would not have been developed as quickly as they were. Many more would have died or been seriously ill from COVID-19. We may still be suffering worldwide deaths. The vaccines saved millions. We all benefited from their work. Even if you decided against vaccination, they helped slow down the spread.
The mRNA technology makes designing a vaccine simpler than other types of vaccines that use other methodologies. mRNA vaccines were being tested for other disease like Zika and Rabies before COVID. Since those diseases are rare, getting the data to prove their safety and usefulness was taking time. Generally it takes years to get enough. Because of the immenseness of the pandemic, the testing of vaccines targeting SARS-CoV-2, the virus that causes COVID-19, was easy to achieve when millions are infected and millions are dying. The data proving its effectiveness and safety came quickly.
That was one reason some people questioned the vaccine. They were worried corners were cut and they weren’t tested enough. I get that. Now we have lots more data showing its effectiveness at reducing serious illness and deaths. I am grateful for that and hope people are more open now. The vaccines are now fully approved by the FDA.
Yes, the vaccines don’t prevent infections, but they do prevent many of the risks. The main reason they don’t prevent infections is that the virus is continuously mutating to try to get around our immunity. Common in viruses. That’s what happens with all the variants, like Delta and Omicron. The vaccine needs to be updated as variants arise and escape our immunity. The cool part of the mRNA design is that tweaks can be made easily as the virus mutates to target the new changes.
In fact, the original mRNA vaccines are no longer given since they are ineffective against the variants. The J&J/Janssen vaccine approval has expired in the US and is no longer available. You can only get the updated boosters now from Pfizer and Moderna. Or the Novavax which is approved for people over 12 and uses protein subunits of the virus, the spike protein specifically, with an adjuvant that stimulates your immune system to react to that protein. For most of us the mRNA updated vaccines are the best options. The CDC continues close monitoring for effectiveness and adverse events of all the vaccines.
Check out https://www.vaccines.gov to find where to get yours.
I’ve talked with several people who wonder if meds like Paxlovid or Lagrevio are still working because of all the variants. Be reassured that at this time, they are still working, molnupiravir (or Lagevrio) is 77% effective at reducing mortality and nirmatrelvir-ritonavir (or Paxlovid) is 84%. Pretty reassuring. They target a different part of the virus than the immune system (immunization) does. They inhibit viral replication, stopping the infection.
There is some concern that molnupiravir may cause more viral mutations in the way it works since it induces mutations in the replication of RNA, which keep the virus from functioning. In locations where it used more often, mutations are being found, so far none of concern. We don’t know what that means but scientist say they are not surprised and are watching closely to see what happens. It is similar to Tamiflu used to fight influenza.
Paxlovid is a mixture of two protease inhibitors. Protease inhibitors cleave proteins that are the building blocks of newly formed viruses. Without functioning proteases, no new viruses can be formed. Nirmatrelvir inhibits the SARS-CoV-2 protease, ritonavir targets HIV protease. Why use ritonavir when this is not HIV? It is used as a boosting agent to raise levels of nirmatrelvir. This makes it more effective and spreads out the timing of the doses. We’ve used ritonavir since the late 90’s to raise the levels of meds in HIV patients. It is probably what causes most of the side effects of Paxlovid. The reason why people on certain drugs can’t take it- because it blocks metabolism of certain meds, possibly raising meds to dangerous levels.
That is your science lesson for the week. The bottom line is that when viruses reproduce, they make millions of copies at once, generally with lots of mutations due to the speed. That can be used against them, like molnupiravir, making unusable virus building blocks due to even more mutations. Or using protease inhibitors to block the cutting of proteins needed to make new viruses.
The meds we have available are not affected by the variants we have now. But may be in the future as more mutations happen. Stay tuned.
And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available. Thanks for reading.
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https://www.axios.com/2023/10/02/nobel-prize-medicine-covid-mrna-vaccine
https://www.seattletimes.com/seattle-news/health/nobel-prize-announcements-are-getting-underway-with-the-unveiling-of-the-medicine-prize/
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/overview-COVID-19-vaccines.html
https://www.fda.gov/media/159898/download
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety.html
https://www.vaccines.gov
https://www.theguardian.com/world/2023/sep/25/use-of-antiviral-molnupiravir-evolution-covid-virus-mutations
https://www.seattletimes.com/nation-world/what-to-know-about-paxlovid-rebound-after-covid/
https://www.nytimes.com/2023/09/26/well/live/covid-paxlovid-rebound.html
https://www.medpagetoday.com/special-reports/exclusives/106438
https://www.msn.com/en-us/health/medical/covid-drug-molnupiravir-may-be-driving-the-virus-to-mutate-should-we-worry/ar-AA1hePVk
https://www.yalemedicine.org/news/9-things-to-know-about-covid-pill