Follow-up of our call

In context

A single line often inverts meaning once you see what it answers, so neighbouring messages are always shown.

1. 2022-08-01 18:53 Anthony S. Fauci
   Rob: The point that I was making during the zoom call was that we should get the data which I believe is available that looks specifically at the titer of neutralizing antibody against BA.5 induced by the bivalent BA.5 boost versus the title of the neutralizing antibody against BA.5 induced by the monovalent ancestral boost. The reason I say we need that data at hand is because if we are going to say that the BA.5 bivalent boost is far superior to the ancestral boost and that is the reason should wait for it until the Fall, we better make sure that we have data that substantiates that. This is important, since there are people out there saying that the BA.5 variant boost is really not that much different from the monovalent ancestral boost when you compare neutralizing antibody titers against BA.5. If the data show that the BA.5 bivalent boost is only marginally better than the ancestral monovalent boost, we should say that the bivalent is "somewhat" better and not make it look like the bivalent is a major advance. Having said all of that, I still believe that the scenario that we agreed upon as delineated in your not to me is sound. I just do not want us to oversell how good and different the bivalent boost will be because this will trigger pushback from the immunology community. Best regards, Tony ------
2. 2022-08-02 09:08 Richard Koup open
   Hi Tony, Sorry about not getting back to you earlier. I don't know why I didn't see this on my cell phone this morning. There is no question that the bivalent BA4/5 will probably do better against BA4/5 than the current ancestral boost. This is based upon circumstantial evidence, some of which is presented below. (Mouse immunogenicity, infection with omicron). The actual human data do not exist yet. The best we have is from John Beigel in the mix and match study, which shows only a marginal increase in BA4/5 neut titers, and which Peter Marks decided not to present at the VRBPAC, probably because the data did not support his desired outcome. I think the problem is that the FDA wants to say that they have a better vaccine coming. Instead, they should be saying that if people need vaccination now they should get the vaccine now. As with all vaccines, they will be rolling out updated vaccines as they become available and when there are data to support the change. People in need of vaccines now should not delay in hopes of getting a "better" vaccine. John Beigel can share his data with you. Best, Rick Richard A. Koup, MD Acting Director Chief, Immunology Laboratory Vaccine Research Center, NIAID, NIH Tel: 301-594-8585 Fax: 301-480-2779 rkoup@mail.nih.gov Had my twice daily follow up conversation with Kevin O'Connor regarding the condition of the president. The POTUS continues to remain with minimal an unchanged symptomatology characterized by fatigue and his usual post nasal drip related cough. It is still rather concerning that his CT levels are still very low and have not come back reflecting a very high viral load. We maintain the decision discussed above about not treating a lab test and only reinstituting therapy if he has an exacerbation of symptoms. I emphasized that he must be followed closely for return of significant sxs, which might trigger retreatment. PHYSICIAN TO THE PRESIDENT THE WHITE HOUSE 2 August 2022 MEMORANDUM FOR: KARINE JEAN-PIERRE ASSISTANT TO THE PRESIDENT AND WHITE HOUSE PRESS SECRETARY

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