Health
Biden’s controversial COVID-19 vaccine booster program
so plot The cumulative population-based hospitalization rates for vaccinated and non-vaccinated people from January to July show that the vaccinated line is largely undisturbed and the non-vaccinated line rises.according to Unpublished treatise Presenting that data, the cumulative hospitalization rate for unvaccinated people was 17 times higher than for vaccinated people.
“I see, at best, there is weak evidence in favor of using boosters for everyone,” Richterman said.
Observational study issues
A constant challenge for public health authorities is how to best interpret many of the observational studies that assess the efficacy of vaccines or boosters over time. time.
Even some studies that look relatively simple do not necessarily show what they claim to be.
Take new york study, This has found a decrease in the effectiveness of the vaccine against infection and is interpreted by many as evidence of a decrease in immunity. What’s interesting about this data, according to Daudi, is that while vaccine efficacy is declining in young people and across the population, it is not declining for people over the age of 65 (see Figure 1). ..
“People who get the first injection and have to have the weakest immune system — there is no reduction in the effectiveness of the vaccine over time,” he said. “At least these data suggest that immunity does not decline significantly over time.”
Instead, what may be happening is that young people changed their behavior during the summer, but older people did not. “The natural explanation for this is that over time they are exposed more often and more intensively,” he said.
According to Daudi, these additional exposures can overwhelm even good vaccines, likening an umbrella that works perfectly in a storm but is less useful in a hurricane. “It doesn’t mean that the umbrella is less effective, it means you’re getting it. [more] It was exposed, “he said.
That doesn’t mean that the immune system isn’t weakened, or that it doesn’t happen, Daudi said. But it emphasizes how difficult it is to interpret some epidemiological data.
Immunological evidence
Immunological data also support the idea that in healthy people, vaccines are stable against severe COVID-19, if not always, against infections and milder illnesses. ..
“We can see that the antibodies are reduced, but we know that these vaccines have very good T-cell and B-cell responses and are very likely to protect against serious illness.” E. John WellyHe told us that he is an immunologist at the University of Pennsylvania and is studying the immune response of vaccinated people.
High levels of so-called neutralizing antibodies are required to completely prevent infection. Sterilized immunity..But if they decline, it is normal, There are still immune cells to prevent the disease. In other words, B cells that make antibodies and T cells that support the process. kill Infected cells limit the spread of the virus in the body.
Both cell types take longer to prepare when a person is first infected or first vaccinated, but on a second exposure, the cells recombine and proliferate more than before. , The immune response can be initiated more quickly. ..
“Severe illness develops when the virus begins to replicate unchecked in the lungs and the immune system misfires to control it.” Deepta Bhattacharya, An immunologist at the University of Arizona School of Medicine told us. “Fortunately, the lungs have much easier access to antibodies than the upper respiratory tract, where the virus first enters. In addition, the virus hits the upper respiratory tract first, so before the lungs can access the virus. Therefore, for these reasons, protection against serious diseases is expected to be maintained much longer than protection against all infections. “
With Wherry’s lab others Have got It is shown These long-lived memory B and T cell responses to mRNA vaccination should be durable and persistent. at least 6 months, maybe more.
Some unpublished jobs According to a report from the Wherry Lab, a pool of memory B cells that can recognize viruses gain With the passage of time after vaccination, unlike declining antibodies.
All of this is why immunologists suspect that boosters may not be needed for some time.
“I was able to protect myself from serious illness for a year, two or three years,” said CHOP’s Ofit. “I understand.”
Ofit is also the reason for not accepting the government’s claim that the decline in vaccine immunity against infectious diseases and mild illnesses inevitably foresaw a diminished effect on severe illnesses. “I think it’s based on the wrong assumptions,” he said.
Bhattacharya also said he believes it will take “years” before booster immunization is needed to strengthen defenses against severe illness. However, if the goal is to prevent infection, boosters may be needed each year to keep antibody levels high.
What are the benefits of boosting now?
The experts we talked to said that a third dose of mRNA vaccine could now help to some extent, but only to a limited extent, which is not beneficial enough to immunize unvaccinated people. I agreed not.
“Boost will almost certainly increase antibody levels for some time. It’s much harder to predict how much clinical benefit you’ll see,” Bhattacharya told us by email. “Most estimates suggest that the current double-dose regimen is about 80% or more effective against symptomatic infections, so there is little room for improvement.”
“The real question is whether booster shots improve memory,” Daudi said. “If so, they can boost immunity for a longer period of time, but we don’t have any evidence of it, and immunity from the first vaccine series to the extent that boosters are needed. There is no compelling evidence that it has declined. “
On the surface, Israeli studies suggest that boosters can have a significant impact, but their effects have been observed only for a short period of time and it is unclear how long they will last. ..
“It would be very surprising if a third dose of a vaccine that we already knew was effective did not reduce the risk of infection to some extent in the short term,” Richterman said. .. However, he said that the additional dose was “probably as much as these observational studies from Israel suggest, as there is a significant difference in exposure risk / behavior between those who obtained the booster and those who did not. I will not reduce it. “
Richterman was particularly skeptical of booster preprints, which claimed to have reduced the risk of serious COVID-19 by a factor of 10. He said it was “essentially uninterpretable” due to a design flaw known as the Immortal Hour Bias. The boosted group’s results weren’t counted until 12 days after getting the booster, so that group may have less follow-up than the unboosted group, biasing the results in favor of the booster. He said it was expensive. “It takes an average of 5 days from diagnosis to the onset of a severe infection, often much longer, so I imagine that the boosted group probably didn’t even have the opportunity to get this result in many cases. I can do it.”
Once the Pfizer / BioNTech results are available, we need to be more clear about what the booster will do. Phase 3 randomized controlled trials, He said.
Daudi also warned against being overly dependent on Israeli experience. He pointed out that the population of the country is about the same as that of Michigan, and it is unlikely that the United States will formulate a national policy based on one state. . The size of Israel. “
Another potential benefit of boosters is their impact on reducing coronavirus infection. But many scientists are skeptical that boosters will do a lot to end the pandemic.
“I don’t think this will have a dramatic impact on the pandemic trajectory,” Bhattacharya said. “We know that breakthrough vaccinated infections can be transmitted, but the main cause of a pandemic remains the infection with unvaccinated people.”
“The problem now is not that we need to boost people who are already vaccinated. The problem is that we need to vaccinate those who have not been vaccinated,” said Ofit. I am. “The vaccine works, but it doesn’t work unless given.”
Compared to vaccination of new people, booster shots are expected to help reduce infections and alleviate pandemics little by little, according to Richterman. “Remember that 1% of the low-income world is vaccinated. If you want to end the pandemic, you have to work there,” he added.
As part of that, the Biden administration says it can “do both” — providing boosters to Americans while helping other countries get the first and second jabs. Authorities say the United States is the world leader in vaccine donations Presentation On September 2, the government announced that it would invest nearly $ 3 billion to expand domestic vaccine production.But critics say I should do more.
Beyond ethics Even from a purely self-serving point of view, Mr. Daudi said that the United States is not deploying booster shots to its own population, but the first and second doses of its commitment to vaccine fairness. He said he could argue that the focus should be on helping to manage the. It limits the circulation of the entire virus and helps prevent the emergence of more contagious or dangerous viral variants.
Boost or not boost?
Ultimately, the decision to boost is “It must be made in the face of incomplete evidence, “Daudi said. The administration is in a difficult situation trying to balance waiting for sufficient evidence against the risk of a surge in incidents.
“I feel that the current data to support every decision is pretty weak,” he said. “But that’s also the nature of it. There’s no way you can make a decision with good data without seeing a surge in cases.”
Some scientists have asked many of the best ways to do COVID-19 boosters, including number, dosing interval, whether boosting with a mutant-specific vaccine is advantageous, or combining with different vaccines. He said he had questions left.
“I think we’ll need more complex research to sort that out,” Wheel said of the possibility of changing the timing of dosing and using combined shots. “And I don’t know if we’ll reach that root in the current pandemic situation.”
We’ll learn more in the coming weeks as the FDA and CDC make recommendations and potentially publish more research on what’s next in the administration’s booster program.
Editor’s Note: SciCheck COVID-19 / Vaccination Project This is possible with a grant from the Robert Wood Johnson Foundation.Foundation has No control The editorial decisions of FactCheck.org, and the views expressed in our article, do not necessarily reflect the views of the Foundation. The goal of the project is to increase exposure to accurate information about COVID-19 and vaccines while reducing the impact of false information.
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