To Boost Or Not To Boost

Monica-Gandhi-Family

I traveled to seven countries in four months and noticed the vastly different situations around vaccines and tests outside the US.

When I left India, it was going through a shortage of tests and vaccines; then in Europe, RTPC tests that cost €150 each  were only available to  citizens of EU countries. Back in the US, tests and vaccines were free and in abundance. People are even getting paid to get vaccinated here!, said Shayamal Vallabhjee, a renowned Sports Scientist and Motivational Speaker at The Art of Work-Life Balance workshop by INK Global Foundation in Saratoga, California on October 5th.

“The rich nations have hoarded 5 doses of Covid-19 vaccine for each of their citizens,” said Dr Monika Gandhi, Professor of Medicine at UCSF/ San Francisco General Hospital at the Ethnic Media Services briefing. 

In a tweet, Dr. Gandhi said, “What is at stake is #globalvaxequity. Please consider signing our petition to get excess doses of excess mRNA vaccine (after ensuring enough for US) to India from the US given the public health emergency unfolding in India right now; vaccination rate in India must quickly increase https://change.org/USVaccinesForIndia.

                                                     Covid Shots Given Worldwide

 

Do I Need A Booster? 

The United States has made ample provision to inoculate its residents with booster shots.

Currently, only those who took the Pfizer vaccine for their first two shots are eligible for a third shot. Boosters are not yet available for people who got the two-dose Moderna vaccine or the single-shot Johnson & Johnson vaccine. Not all who took the Pfizer vaccine are eligible.

Vaccines with shorter intervals between doses (like Pfizer vaccines given 3 weeks apart) are likely to have their antibodies wane sooner than vaccines with longer intervals between doses (like Moderna), explained Gandhi.

Dr. Ben Neuman, Texas A&M

“What we have evidence of is waning immunity. As time passes after vaccination, after 5 months, the amount of protection decreases to 50 percent” said Dr. Ben Neuman, Chief Virologist at Global Health Research Complex at Texas A&M University at an Ethnic Media Services briefing.

With a booster shot, people end up with 5 times and 10 times as much antibody as they had at the peak, after the second vaccination, and as much as 50 percent antibody right before the booster, said Dr. Neuman.

 

How antibodies work

Antibodies are only one component of our immune response, said Dr. Gandhi. They can’t stay in the bloodstream for very long.

Instead, Memory B-cells (long-lived plasma cells and T-cells) — continue to offer robust protection against disease and death when antibodies diminish over time. If antibodies from all the viral infections and vaccines stayed in our bloodstream we would have very thick blood. Instead the  B-cells and T-cells produce antibodies when the body faces infection.

Studies prove really strong and enduring protection is provided by the two shots of vaccines against prevalent variants in various parts of the world, said Dr. Gandhi.

“In people whose immune systems are strong, natural immunity or vaccination generates B cells that go into memory and then they produce antibodies directed against variants they see,” she added.

“Antibodies will wane with time (including IgA) but your memory B cells and T cells will make more.” and “there is the ability of those memory B cells & triggered antibodies to respond to variants.” 

However not everyone is the same—some medical conditions reduce the body’s ability to build an immune response to vaccines. Organ transplant recipients, people with autoimmune diseases, cancer patients taking immunosuppressive drugs cannot develop a strong immune response after vaccination. Some people have genetic conditions that compromise their immune systems. Vaccines work a little less well in older than younger folks. 

Keeping this in mind, the Center for Disease Control has prioritized booster shots for immunocompromised individuals and high-risk workers. 

 

A study on by the Cold Spring Harbor Laboratory on SARS-CoV-2 mRNA vaccines in healthy and immunocompromised individuals, found cellular immunity shows a 3rd shot (“booster”) is important among those who are immunocompromised.  

The CDC recommends a booster shot of the Pfizer-BioNTech COVID-19 vaccine in certain populations and for those in high risk occupational and institutional settings. CDC recommends:

  • people 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
  • people aged 50–64 years with underlying medical conditions should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
  • people aged 18–49 years with underlying medical conditions may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks, and
  • people aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.

 

Dr. Ben Neuman noted, “We have seen the benefit of a booster is very, very large regardless of age group. I do not see why vaccines are limited on the basis of age. Universal boosters are going to be beneficial. With additional vaccine doses we move from reasonable protection to a position of certainty. That benefit is very large.”

 

A Shot Here Is A Shot Denied Somewhere Else

Only 2 percent of the vaccines have been given to the developing world. The World Health Organization questions whether rich countries should be vaccinating their people a third time when so much of the world is desperate for their first dose? 

“The government is trying to address the shortfall and the weak link in our efforts to vaccinate. If we don’t stop this everywhere it will come back in some form,” said  Dr. Ben Neuman.

Though he agrees that at the moment it is still a matter of getting a first and secondary dose in most parts of the world and Covid isn’t over until it is over everywhere, Dr Neuman prefers the approach of a firefighter. “Fight this out as you would fight a fire. Put it out completely in one place and then widen the ring of protection till it covers everyone.” 


Ritu Marwah is a 2020 California reporting and engagement fellow at USC Annenberg’s Center for Health Journalism.


 

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