Leonard Zwelling

In this very important article buried on page A18 of The New York Times on August 30, David Leonhardt gives a brief overview of our current status with regard to the advisability of booster shots against the covid-19 viral disease. It was surprising.

The real push to get booster shots comes from data emerging from Israel that suggest that early recipients of the two dose mRNA vaccine are beginning to contract covid at an accelerated rate. But the real story is as Leonhardt notes, “more complex.”

First, remember that the initial vaccinations were done about 6 to 8 months ago in response to the initial covid-19 variants. This predates the discovery of the more contagious delta variant. In other words, the virus against which we were initially immunized has changed. What we risk contracting now might not be the same as what we might have contracted six months ago.

The Israeli data suggest an increase in breakthrough infections in the sufficiently vaccinated (two doses) who were among the first to get the vaccine. But that group is not the same as the group receiving later vaccination as the early recipients tended to be more affluent, more traveled and among the first to be exposed to the delta variant. In other words, they may have been more susceptible because they took greater risk in their travels. It’s hard to know. Leonhardt points out that this is the Simpson Paradox where a global conclusion is not supported by analysis of subgroups. He notes the same may be true in the United States if early recipients are now taking greater risks (more indoor gatherings, more travel) and exposing themselves to the delta variant.

However, covid-19 positive testing is not on the increase in the elderly or children according to Leonhardt suggesting that more infections may not be occurring. There may not be any real data to support the concept of waning immunity for those adequately vaccinated.

Let’s face it. The need for boosters does play into the hands of Pfizer and Moderna and we have not really heard from the FDA or CDC on this yet.

Leonhardt’s conclusions are:

The data for boosters are good for those who are immunosuppressed. Immunity may wane in the rest of us, but it is too soon to know for sure.

New boosters may or may not do any good for those with normal immune systems who have received two doses of the mRNA vaccines. Testing positive for covid-19 is not the same as a vaccine failure especially if the positively tested are not ill. This may be particularly germane with the delta variant which is far more contagious, but against which the vaccines may still provide protection from illness, hospitalization and death.

Boosters for all will be costly and my third shot would be less beneficial than someone else’s first to society as a whole. Mask mandates and requirements for two shots to allow most activities would be a better strategy than boosters given our current knowledge to date. This could change on a daily basis.

The bottom line is that it is not unreasonable to think that a booster shot may be needed by those with well-functioning immune systems who have received two doses of the mRNA vaccines. It is, however, too soon to know for sure and certainly true that getting everyone the two shots ought to be the priority.

A reasonable guess at this time is that boosters will be needed. When, is not clear. And that they ought to be engineered to fight the latest variant is undoubtedly preferable.

There is still a great deal that we do not know about this virus. While SARS and MERS might have been practice for covid-19, this new virus is clearly a different animal. Why is also unclear since the origins of covid-19 are still unknown.

A reasonable posture with regard to the virus now is:

Get your initial vaccines.

Wear a mask in public places.

Abide by mask mandates elsewhere.

Stay tuned in to figure out next steps.

My guess is that the FDA, CDC and NIH will be informing the public about the science. That scientific data may not yet be sufficiently mature to draw conclusions about the advisability of boosters for those with normal immune systems. We will probably know soon.

2 thoughts on “Boosters”

  1. Thanks for this excellent update!
    The failure still of many to deny vaccination and other CDC guidelines prolongs a Pandemic that is hammering healthcare workers and hospital systems. To manage other serious medical problems, e.g. cardiac, vascular, oncologic, orthopedic is already requiring triage of resources to those COVID patients most likely to recover. Otherwise, other seriously ill, responsibly vaccinated patients may be denied urgent care.
    The nonvaccinated, noncompliers to CDC guidelines need to accept that all that they may receive at stressed hospitals will be compassion and comfort measures. There may not be intensive care because none may be available. That is the tough love of their decisions.

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