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Why aren’t kids getting vaccinated?

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While much of the world is engaged in a frantic scramble to get vaccinated against covid-19, there’s one group noticeably absent from the queues of people at vaccine clinics: children.

The Pfizer-BioNTech vaccine is still approved for use only in those aged 16 years or older, and the Moderna vaccine is only for adults. Both are now in trials for younger age groups, and results are expected by the summer. The Oxford/AstraZeneca and Johnson & Johnson vaccines are also due to start trials in children soon. But in a world where most vaccines are given to children under two, why is it that during a global pandemic, children are being left behind? And what does it mean for how the pandemic will unfold in adults? 

One reason children are not yet priorities for vaccination is that they are much less affected by SARS-CoV-2 infection than adults. Children make up nearly 13% of all cases reported in the United States so far, but less than 3% of all reported hospitalizations and less than 0.21% of all covid-19 deaths. When they have symptoms, they are similar to adults’—cough, fever, sore throat, and runny nose—but less severe.

Even a year into the pandemic, it’s not yet entirely clear why this is the case. Research points to a different immune response to viral exposure in children, which may signify that their immune systems are able to neutralize the virus much faster and therefore stop it from replicating. Children may also benefit from cross-protection by antibodies to other circulating coronaviruses that they are more regularly exposed to.

And there’s also the possibility that children have fewer ACE2 receptors in the cells that line nasal passages, which are the doorways the SARS-CoV-2 viruses uses to gain entry to host cells and infect them. That would make it less likely for the virus to get a foot in the door. There is a more serious complication of SARS-CoV-2 exposure that can occur in children, called multisystem inflammatory syndrome in children, or MIS-C. However it is rare, with fewer than 1,700 cases and just 26 deaths reported across the US.

Children’s apparent resilience to covid-19 makes them a lower priority for vaccination, especially when demand for vaccines far outstrips supply. 

Children also are a challenge in vaccine development—and in any kind of drug development—because they are considered a vulnerable population, says Beth Thielen, a pediatric infectious disease specialist at the University of Minnesota. “We want to take extra safeguards to protect them from injury,” she says. “We tend to just be a lot more cautious about enrolling children in studies and not exposing them to undue risk.”

The prospect of the potential harm from trialing a new vaccine or drug in children outweighing the benefits is of particular concern when it comes to MIS-C, says Anna Sick-Samuels, a pediatrician in the Division of Infectious Diseases at the Johns Hopkins School of Medicine. MIS-C is thought to result from a massive inflammatory response to the SARS-CoV-2 virus. “It will be important to assess whether the current MRNA vaccines can lead to an antibody response that also triggers MIS-C or if this is only a complication of the viral infection,” she says.

It therefore seems likely that there will be a delay before children start getting vaccinated in large numbers. This means there may be a demographic shift in covid-19 infections as older sections of the population acquire immunity and the burden of infection shifts to the unvaccinated younger groups. It doesn’t mean more children will get the virus, but if fewer adults are at risk, children will be overrepresented in infection numbers relative to adults—the opposite of what is seen currently around the world.

It raises the possibility that delaying the immunization of children could make them a reservoir of the virus in the population, which could continue to seed further outbreaks. That could pose a problem even for vaccinated adults, says Mobeen Rathore, an infectious disease specialist and epidemiologist at the University of Florida College of Medicine.

The current approved vaccines offer a high level of protection against infection, but it’s not total protection. In the clinical trials, a small number of adults who were vaccinated still got infected, though they were far less likely to get seriously ill. There’s also no data yet on whether the vaccines prevent transmission from a vaccinated but infected person to another person—although research is now under way to find out if they do, and the early signs are promising.

“So the question really is: those people who are immunized, they get the infection—they’re not going to get sick, but you will not be able to stop the infection cycle,” Rathore says. And as long as the virus is circulating in the population, there’s the risk of disease, deaths, and mutations.

Transmission questions

Earlier in the pandemic, it was thought that children were less likely to transmit SARS-CoV-2 to other children or to adults. A study of schools in England in June and July 2020, after they reopened following the first major lockdown, found relatively few infections or outbreaks. But further research, especially after the reopening of schools, universities, and colleges, suggests that infection rates are particularly high in young adults. 

The evidence on transmission within and from younger age groups is conflicting, says Stefan Flasche, a vaccine epidemiologist at the London School of Hygiene and Tropical Medicine. It’s complicated by the fact that infected children are also less likely to show symptoms than infected adults, which makes them less likely to get tested for infection in the first place. “It seems like we’re in a situation where children can transmit, but they’re not sticking out as the key transmitter,” he says.

That could change once more adults are vaccinated and therefore less likely to get the disease. A similar development has already been seen in the UK, not as a result of vaccination but of more recent lockdown measures that restricted the movement of adults while schools stayed open. “In that setting, it looks like children were actually the residual source of transmission or a substantial contributor to the residual transmission,” Flasche says.

There are also concerns that the new variants may pose a greater threat to children: early evidence suggests they may be more susceptible to the UK variant, although it’s not yet clear whether the higher prevalence of B.1.1.7 in children—compared with the original SARS-CoV-2 strain—is actually the result of lockdowns that reduced adult exposure to SARS-CoV-2 overall.

There’s no doubt that children should—and likely will—be vaccinated against covid-19. They are still at risk of getting sick, and in very rare cases dying, from the disease. For a virus that is transmitted by all age groups, a large unvaccinated section of the population will always undermine efforts to achieve herd immunity through vaccination; assuming, that is, that vaccines can even achieve herd immunity against covid-19. 

Flasche believes it’s a long shot. “We have a highly transmissible pathogen where basically everyone in the population is contributing their bit to transmission,” he says. “Even with the best of vaccines, that means that it’s going to be very, very challenging at best to reduce transmission.”

Rathore would love to have a COVID-19 vaccine for children immediately, but says high-risk groups are a greater priority. 

“I’m an advocate for children and I want them to be as safe, and vaccines are the best thing we have to keep everybody and children safe,” he says. “But let’s make the best of what we have. We have not done that yet, so that’s where our focus needs to be at the current time.”

Lyron Foster is a Hawaii based African American Musician, Author, Actor, Blogger, Filmmaker, Philanthropist and Multinational Serial Tech Entrepreneur.

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Investors still love software more than life

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Welcome back to The TechCrunch Exchange, a weekly startups-and-markets newsletter. It’s broadly based on the daily column that appears on Extra Crunch, but free, and made for your weekend reading. Want it in your inbox every Saturday morning? Sign up here.

Ready? Let’s talk money, startups and spicy IPO rumors.

Despite some recent market volatility, the valuations that software companies have generally been able to command in recent quarters have been impressive. On Friday, we took a look into why that was the case, and where the valuations could be a bit more bubbly than others. Per a report written by few Battery Ventures investors, it stands to reason that the middle of the SaaS market could be where valuation inflation is at its peak.

Something to keep in mind if your startup’s growth rate is ticking lower. But today, instead of being an enormous bummer and making you worry, I have come with some historically notable data to show you how good modern software startups and their larger brethren have it today.

In case you are not 100% infatuated with tables, let me save you some time. In the upper right we can see that SaaS companies today that are growing at less than 10% yearly are trading for an average of 6.9x their next 12 months’ revenue.

Back in 2011, SaaS companies that were growing at 40% or more were trading at 6.0x their next 12 month’s revenue. Climate change, but for software valuations.

One more note from my chat with Battery. Its investor Brandon Gleklen riffed with The Exchange on the definition of ARR and its nuances in the modern market. As more SaaS companies swap traditional software-as-a-service pricing for its consumption-based equivalent, he declined to quibble on definitions of ARR, instead arguing that all that matters in software revenues is whether they are being retained and growing over the long term. This brings us to our next topic.

Consumption v. SaaS pricing

I’ve taken a number of earnings calls in the last few weeks with public software companies. One theme that’s come up time and again has been consumption pricing versus more traditional SaaS pricing. There is some data showing that consumption-priced software companies are trading at higher multiples than traditionally priced software companies, thanks to better-than-average retention numbers.

But there is more to the story than just that. Chatting with Fastly CEO Joshua Bixby after his company’s earnings report, we picked up an interesting and important market distinction between where consumption may be more attractive and where it may not be. Per Bixby, Fastly is seeing larger customers prefer consumption-based pricing because they can afford variability and prefer to have their bills tied more closely to revenue. Smaller customers, however, Bixby said, prefer SaaS billing because it has rock-solid predictability.

I brought the argument to Open View Partners Kyle Poyar, a venture denizen who has been writing on this topic for TechCrunch in recent weeks. He noted that in some cases the opposite can be true, that variably priced offerings can appeal to smaller companies because their developers can often test the product without making a large commitment.

So, perhaps we’re seeing the software market favoring SaaS pricing among smaller customers when they are certain of their need, and choosing consumption pricing when they want to experiment first. And larger companies, when their spend is tied to equivalent revenue changes, bias toward consumption pricing as well.

Evolution in SaaS pricing will be slow, and never complete. But folks really are thinking about it. Appian CEO Matt Calkins has a general pricing thesis that price should “hover” under value delivered. Asked about the consumption-versus-SaaS topic, he was a bit coy, but did note that he was not “entirely happy” with how pricing is executed today. He wants pricing that is a “better proxy for customer value,” though he declined to share much more.

If you aren’t thinking about this conversation and you run a startup, what’s up with that? More to come on this topic, including notes from an interview with the CEO of BigCommerce, who is betting on SaaS over the more consumption-driven Shopify.

Next Insurance, and its changing market

Next Insurance bought another company this week. This time it was AP Intego, which will bring integration into various payroll providers for the digital-first SMB insurance provider. Next Insurance should be familiar because TechCrunch has written about its growth a few times. The company doubled its premium run rate to $200 million in 2020, for example.

The AP Intego deal brings $185.1 million of active premium to Next Insurance, which means that the neo-insurance provider has grown sharply thus far in 2021, even without counting its organic expansion. But while the Next Insurance deal and the impending Hippo SPAC are neat notes from a hot private sector, insurtech has shed some of its public-market heat.

Stocks of public neo-insurance companies like Root, Lemonade and MetroMile have lost quite a lot of value in recent weeks. So, the exit landscape for companies like Next and Hippo — yet-private insurtech startups with lots of capital backing their rapid premium growth — is changing for the worse.

Hippo decided it will debut via a SPAC. But I doubt that Next Insurance will pursue a rapid ramp to the public markets until things smooth out. Not that it needs to go public quickly; it raised a quarter billion back in September of last year.

Various and Sundry

What else? Sisense, a $100 million ARR club member, hired a new CFO. So we expect them to go public inside the next four or five quarters.

And the following chart, which is via Deena Shakir of Lux Capital, via Nasdaq, via SPAC Alpha:

Alex

 

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The Product Manager asterisk

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Product manager might be one of the most grey roles within a startup. However, as a company progresses and the team grows, there comes a time when a founder needs to carve out dedicated roles. Of these positions, product management might be one of the most elusive — and key — roles to fill.

Ken Norton, who recently left his job as director of product at Figma to consult rising PMs, thinks it’s easier to start with defining what they aren’t: the CEO of the product.

“Product managers need to realize that there is a lot of janitorial work that gets done in product management,” he said. “It’s not fun or glamorous, and it’s certainly not being the CEO of the product. It’s just stuff that needs to get done.” I wrote up a guide on how and when to hire your first product manager that expands on some of these insights, including how focus might be the biggest trait to interview for:

Hiring continues to be one of the hardest parts of building a startup, and those early employees can define the trajectory, culture and eventual success of it. Even during TC Sessions: Justice this past week, Precursor’s Sydney Thomas explained how startups need to make “pretty final decisions, pretty early on in what type of company you want to build.”

It’s a slight asterisk to the common narrative of how startups pivot every other day. It’s not that simple, and I’ll probably remind you of that every other week, dear Startups Weekly readers.

The rest of today’s newsletter will include notes on a hot up-and-coming edtech IPO, an exit that includes Jay-Z, and the latest in agricultural tech robots. Also, remember you can always find me on Twitter @nmasc_ or e-mail me at natasha.m@techcrunch.com.

The public markets get educated

It’s been yet another busy week for the public markets. I published a scoop earlier this week that Coursera is filing to go public soon, which would be one of the first debuts that will let us see how an education company’s finances changed, and accelerated, amid the pandemic’s impact on remote learning.

Here’s what to know: Like clockwork, Coursera’s S-1 dropped late Friday, giving us the first glance of the numbers behind the business. The startup tried to pain a picture of a path of profitability, with rising revenues as well as rising net losses. We get into the meat of it here. 

Image Credits: Fotograzia / Getty Images

What’s better than one billionaire? Two 

One of the biggest headlines of this past week was Square buying a majority stake of Tidal. A fintech and music collaboration might not seem that obvious, but the music economy remains one of the most under-tapped (and under-innovated) opportunities that remains out there.

Here’s what to know: Square CEO Jack Dorsey used his other company, Twitter, to share more information about the $297 million deal. As part of this transaction, Tidal owner Jay-Z got a board seat with Square, triggering conversations about the future of musical NFTs. The deal also officially confirmed that Jay-Z isn’t just a businessman, he’s a business, man.

Singer Jay-Z performs before US President Barack Obama speaks at a campaign rally in Columbus, Ohio, on November 5, 2012. After a grueling 18-month battle, the final US campaign day arrived Monday for Obama and Republican rival Mitt Romney, two men on a collision course for the world’s top job. The candidates have attended hundreds of rallies, fundraisers and town halls, spent literally billions on attack ads, ground games, and get out the vote efforts, and squared off in three intense debates. AFP PHOTO/Jewel Samad (Photo credit should read JEWEL SAMAD/AFP/Getty Images)

Decentralized insect farming, anyone?

In this week’s Equity Wednesday episode, we brought on TC’s climate tech editor, Jonathan Shieber, to talk about the opportunities within agtech right now. We covered a lot within the 20-minute episode: from $100 million for mealworms, farm-to-grill robots and decentralized insect farming.

Here’s what to know: Farms have always had a compelling reason to turn to robotics to make tedious work much, much easier. We got into two different businesses and their approaches on how to serve farm robots, from SaaS leases to selling the robots one by one.

Image Credits: Fernando Trabanco Fotografía / Getty Images

Around TechCrunch

Thanks to all of you who tuned into TC Sessions: Justice this past week, it was so fun to hang — and make sure to give virtual kudos to my colleague, and showrunner, Megan Rose Dickey.

Next up is TechCrunch Early Stage, our yearly event that is all about tactical advice to help new and first-time founders navigate the Wild West world that is venture capital and startups. We just announced the judges of the pitch-off competition, and have already landed top-tier venture capitalists to share what you won’t find on Twitter: behind the scenes startup advice that is beyond 180 characters.

It’s the bootcamp you always wished you could attend, so get your tickets here.

Across the week

Seen on Extra Crunch

Understanding how investors value growth in 2021

Dear Sophie: Can you demystify the H-1B process and E-3 premium processing

11 words and phrases to cut from your VC pitch deck

Making sense of the $6.5B Okta-Auth0 deal

Seen on TechCrunch

SoftBank makes mountains of cash off of human laziness

Mary Meeker’s Bond has closed its second fund with $2 billion

The technology selloff is getting to be somewhat material

What China’s Big Tech CEOs propose at the annual parliament meeting

And finally…

I wanted to end by using this platform to address the rise of anti-Asian violence across our country. Conversations around how to be a more inclusive and anti-racist society need to be more loud, and more collaborative in order for change to actually happen. Intention around inclusion will impact the world we live in, the startups we create and the success of our collective. Here are some resources to donate, petition and learn.

Thanks,

N

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Tens of thousands of US organizations hit in ongoing Microsoft Exchange hack

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A stylized skull and crossbones made out of ones and zeroes.

Enlarge (credit: Getty Images)

Tens of thousands of US-based organizations are running Microsoft Exchange servers that have been backdoored by threat actors who are stealing administrator passwords and exploiting critical vulnerabilities in the email and calendaring application, it was widely reported. Microsoft issued emergency patches on Tuesday, but they do nothing to disinfect systems that are already compromised.

KrebsOnSecurity was the first to report the mass hack. Citing multiple unnamed people, reporter Brian Krebs put the number of compromised US organizations at at least 30,000. Worldwide, Krebs said there were at least 100,000 hacked organizations. Other news outlets, also citing unnamed sources, quickly followed with posts reporting the hack had hit tens of thousands of organizations in the US.

Assume compromise

“This is the real deal,” Chris Krebs, the former head of the Cybersecurity and Infrastructure Security Agency, said on Twitter, referring to the attacks on on-premisis Exchange, which is also known as Outlook Web Access. “If your organization runs an OWA server exposed to the internet, assume compromise between 02/26-03/03.” His comments accompanied a Tweet on Thursday from Jake Sullivan, the White House national security advisor to President Biden.

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