Covid Vaccines: Viral Evolution, Political Revolution

My husband and I just received updated vaccine shots against Covid at a nearby drug store. I am passing along excerpts from three columns linked to the Substack page of Eric Topol, who has been among the writers tracking the relevant science and epidemiology of the Covid pandemic. Please note the dates of the articles to follow the timeline of emerging information, most recent publication listed last.

Also note that several terms may seem opaque, but a little homework will map the terrain quite easily. For example, Topol refers to PCR, the acronym for Polymerase Chain Reaction (see PCR link below from the National Library of Medicine). Shortly after PCR was added to diagnostic and research tools in the 1980s, I was a patient at a teaching hospital in Philadelphia, and my doctor was surprised when I knew the term. There was a remarkable change in the conversations I had with doctors and researchers, literally within hours. I had to explain that my knowledge of science and medicine was barely elementary, but that many members of the AIDS activist movement had become amateur epidemiologists by necessity.

Unfortunately, the legitimate distrust of Big Pharma has become no more than a reactive habit among some people who have indeed been treated poorly by the medical establishment. (Note that Pfizer and Moderna are engaged in legal disputes which concern charges of plagiarism and medical patents. The problems in the manufacture and distribution of vaccines is an ongoing story which is, in some respects, all too familiar from earlier chapters in pandemics and medical marketing.)

I say explicitly and repeatedly: I am not a doctor, I am not a scientist. I am a member of we, the people, who is committed to health care for all. Every medical crisis reveals a new territory of problems and possibilities. At present, it is quite true that these new vaccines do not have a long-term public track record of testing and research data. Also a familiar dilemma in the history of pandemics.

These Covid vaccines are not cures and preventatives. The strongest medical argument for getting the vaccines is to reduce the worst symptoms of infection, and to reduce the number of hospitalizations and deaths. Non-symptomatic infections can vary, and occur even among people who have been vaccinated or who have received direct viral transmission. However, vaccines and boosters also limit public coughing and sneezing, which accelerate transmission.

To argue that “natural immunity” is better than vaccination only makes sense if the very young, the elderly, and people with compromised immunity are consigned to the triage wards of social Darwinism. Lean hard on that argument, and you may be a consistent “libertarian” in ideology, but you will also abandon the elementary ground of solidarity. (I will just say in passing that a few podcasters claiming to be leftists fall unwittingly into that camp.) My advice to friends and comrades is to do your own homework, and to take the calculated risk of vaccination. Follow your conscience, but also follow the evidence so far as possible.

The fight for basic health care, housing, and education will require a political revolution. No friction, no traction.

Polymerase Chain Reaction
NIH / National Library of Medicine

The BA.5 story
The takeover by this Omicron sub-variant is not pretty
Eric Topol
Jun 27
Ground Truths


The Omicron sub-variant BA.5 is the worst version of the virus that we’ve seen. It takes immune escape, already extensive, to the next level, and, as a function of that, enhanced transmissibility, well beyond Omicron (BA.1) and other Omicron family variants that we’ve seen (including BA.1.1, BA.2, BA.2.12.1, and BA.4). You could say it’s not so bad because there hasn’t been a marked rise in hospitalizations and deaths as we saw with Omicron, but that’s only because we had such a striking adverse impact from Omicron, for which there is at least some cross-immunity (BA.1 to BA.5). Here I will review (1) what we know about its biology; (2) its current status around the world; and (3) the ways we can defend against it.

BA.5, Chapter 2
Significant updates from the previous BA.5 story
Eric Topol
Jul 10
Ground Truths


There’s clearly more room for the virus to evolve, get more fit, gain advantages as an immune escape artist and more efficiently infect cells. Yet we are watching its accelerated evolution akin to the behavior of a Formula One race car lapping around the track with humans in the stands. At best, there will not be a BA-5 specific booster until November or December and that represents a failed strategy of variant-chasing, knowing full well that BA.5 will not be the dominant circulating virus in 5 to 6 months. We need to get ahead of the virus, stop acting as bystanders with “hope and prayers’ that it will not get worse than what we are dealing with now. No, BA.5 has taught us once again, the virus doesn’t just get milder and fade away. While the virus revs up its mutations under selection pressure, we’ve ironically become immutable, more resistant to taking an aggressive stance with second-generation and nasal vaccines that are clearly in our reach.

The imminent BA.5 vaccine booster
Eric Topol
Aug 24


We’ve just learned that in the next few weeks, soon after Labor Day, the first Covid updated vaccine will be available to all Americans age 12+, with over 170 million doses ordered, beginning with the bivalent vaccine (directed to both BA.5 and ancestral strains) from Pfizer/BioNTech, and later, in October, for adults, from Moderna. You’ll see it described as a BA.4/5 vaccine, but the spike protein is identical for these 2 variants and BA.5 is >90% of new cases in the US right now, so I’ve dropped BA.4 in the title of this post and subsequently. There are many considerations going into this plan that I’ve tried to briefly summarize in this Table, and will now get into the data and concerns.

Ground Truths