Tony's Diary Package — page 1006

% Viral Lineages Among Infections 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% v 5/7/22 5/14/22 §/21/22 5/28/22 6/4/22 6/18/22 6/25/22 7/2/22 7/9/22 7/16/22 7/23/22 7/30/22 USA WHO label Lineage # USClass %Total 95%PI Omicron BAS VOC 85.5% 83.8-87.0% BA.4 VOC 7.7% 7.0-8.5% BA4.6 VOC 41% 3.2-5.4% BA.2.12.1 VOC 26% 2.4-2.8% BA.2 voc 0.1% 0.1-0.1% B.1.1.529 voc 0.0% 0.0-0.0% BA.1.1 voc 0.0% 0.0-0.0% Delta B.1.617.2 VBM 0.0% 0.0-0.0% Other Other* 0.0% 0.0-0.0% * Enumerated lineages are US VOC and lineages circulating above 1% nationally in at least one week period. "Other" rep ts the aggregati lineages which are circulating <1% nationally during all weeks di ** These data include Nowcast estimates, which are modeled projections that may differ from weighted estimates generated at later dates # AY.1-AY.133 and their sublineages are aggregated with B.1.617.2. BA.1, BA.3 and their sublineages (except BA.1.1 and its sublineages) are aggregated with B.1.1.529. For regional data, BA.1.1 and its sublineages are also aggregated with B.1.1.529, as they currently cannot be reliably called in each region. Except BA.2.12.1, BA.2 sublineages are aggregated with BA.2. Except BA.4.6, af DA £ arn annranantiad eublinananase Af DA A aca Dawn.Oconnell@hhs.gov>; alcido, Dori A. EOP/WHO sa.L.Barclay@who.eop.gov A lot of activity working with Rob at the FDA and Ashish and CDC to get the right messaging about recommendations for the booster in the fall. The FDA would like to say that the bivalent BA.5 boost is significantly better then the mono valent ancestral strain boost. There is a lot of pushback from the immunology community led by John Moore saying that the bivalent BA.5 boost is only marginally better then the monovalent ancestral strain. The data is somewhat confusing as explained below in an e-mail from Rick Koup to me. The debate is whether to ask people who are otherwise that low to moderate risk to get vaccinated now with the ancestral strain will wait until September when a supposedly much better boost is available. Most of us have no problem with low risk people waiting, however, I and others are concerned about overselling that the bivalent boost is much better then the ancestral boost, which is not the case I will list a couple of emails below that outline the dilemma: From: Fauci, Anthony (NIH/NIAID) [E] <afauci@niaid.nih.gov> Sent: Monday, August 1, 2022 6:53 PM To: Califf, Robert <RMC001@fda.hhs.gov> Cc: Murthy, Vivek (HHS/OASH) <Vivek.Murthy@hhs.gov>; Kessler, David (HHS/IOS) <David.Kessler@hhs.gov>; O'Connell, Dawn (OS/ASPR/IO) <Dawn.Oconnell@hhs.gov>; Ashish.K.Jha@who.eop.gov <ashish.k.jha@who.eop.gov>; Salcido, Dori A. EOP/WHO <Dori.Salcido@who.eop.gov>; Barclay, Lisa L. EOP/WHO <Lisa.L.Barclay@who.eop.gov> Subject: Follow-up of our call