Should the definition of “complete vaccination” include booster shots?

For many Americans who scrambled to be vaccinated with COVID-19 as soon as their turn came, the remedy for gaining immunity was the only reward. Achieving a “fully vaccinated” condition has also given a faint halo of virtues.

Currently, both the biological protection of the shot and the satisfaction that contributes to the immunity of the herd have proven to be short-lived. And because of concerns about new coronavirus variants that could further erode vaccine-induced immunity, health officials are discussing whether the definition of “complete vaccination” should be modified to include booster shots. increase.

Scientists are highly supportive, and public health leaders are not far behind.

So far, the Centers for Disease Control and Prevention has not officially changed the goal post. Americans who are subject to work-related vaccination obligations or who need to present proof of “complete vaccination” to attend a gym, restaurant, or public event may meet the requirements without a booster. I can do it.

However, the CDC has achieved these goals and has told everyone except the youngest Americans who have been vaccinated that additional doses are needed for durable immunity. Encourage everyone over 16 years old You can get it immediately if you qualify.

Dr. Anthony Fauci, senior adviser to President Biden’s pandemic, also crossed the line, but not.

“The best protection is done on the third shot.” This week’s CNN. He did not see the official definition of “fully vaccinated” change this week or next week, but added that it would certainly happen at some point.

By the current definition, the number of fully vaccinated Americans is Over 200 million marks This week, and a quarter of them got boosters. It leaves millions of Americans on their list to do another thing, asks if they get better if they get it, and wonders if it’s the last ..

I can understand their confusion.Early promises of vaccine efficacy have given way to some Pessimistic headlines about weakened immunity.. However, the CDC, for most healthy Americans, “complete vaccination” (Pfizer’s two jabs-BioNTech or Moderna vaccine or one Johnson & Johnson shot) is hospitalization or death for patients with breakthrough infections. Continues to claim to provide strong protection against.

Until recently, independent vaccine experts also seemed to conflict. In September and October, CDC and Food and Drug Administration advisors who reviewed the latest evidence were clearly overwhelmed by the proceedings to recommend boosters to healthy adults under the age of 65.

They sincerely endorsed the additional shots for older Americans and those with weakened immunity. However, many want to conclude that young adults will benefit from boosters, especially given the risk of heart-related side effects that primarily affect young men and the risk of blood clotting in women under the age of 50. I wasn’t there.

Their vote to limit access Immediately rejected by the CDCRecommended booster immunization for almost all adults 6 months after two doses of one of the two mRNA vaccines, or two months after the J & J shot.

Just said Dr. William SchaffnerA suspicious expert, an infectious disease specialist at Vanderbilt University School of Medicine, has abandoned their worries.

For starters, he said, Send various messages For different ages and occupational groups Turned out to be too confusing.. In addition, new studies show that the first two doses of the mRNA vaccine and the single dose of the J & J vaccine are like a single “prime” dose that requires a follow-up “boost” to be fully effective. The behavior is becoming more and more apparent. “

Like most vaccines, a COVID-19 booster is needed to boost and sustain immunity. And he said there was precedent for a three-dose series. Vaccines widely used for hepatitis B and polio And other illnesses You need at least 3 shots.

Dr. Peter Hotez“From the beginning, I’ve said this is a three-dose vaccine,” said the Dean of the National School of Tropical Medicine at Baylor University.

Given the urgency that was prevalent when the vaccine was first available, it makes sense to bring the first and second doses of the mRNA vaccine closer to each other, Hotez said. “But based on our experience with vaccines, we know that it leads to weakened immunity, and after a while, a third dose is needed.”

By the summer, rising rates of “breakthrough infections” have increased support for the speculation. Most of the early cases were elderly, immunocompromised people who often did not show a strong immune response to the vaccine. Many experts wanted the need for boosters to end there.

But evidence of weakened immunity From all vaccines,and Age spectrum, teeth Growing.. Even fully vaccinated young adults Breakthrough infections can lead to serious illness and death.

This week First real-world evidence Of the benefits of boosters in young and healthy people. Israeli researchers have found that a third dose of the Pfizer vaccine prevented infection more dramatically at ages 16-29 than at any other age group measured. Given the important role of young adults in maintaining a pandemic epidemic, some scientists have suggested that universal booster policies can do more than reduce hospitalization and mortality. It also has the potential to curb new waves of infection.

And another new study from Israel also supports evidence of the strong benefits of boosters to middle-aged adults. Israelis over the age of 50 who received the third vaccination were one-tenth more likely to die of COVID-19 than their vaccinated but unboosted companions. Israelis over the age of 60 have a one-twelfth reduction in the risk of serious illness and an almost 15-minute chance of dying from COVID-19 compared to Israelis who did not have a third infection. It was 1.

Los Angeles County provides further evidence of the impact of boosters. In the seven days to 29 November, there were 43 new infections per 100,000 fully vaccinated but non-immunized residents. However, among those who acquired boosters, the rate of new infections was only 7 per 100,000.

For now, Hotez needs to get booster shots for their protection, rather than changing the definition of “complete vaccination” that affects everyday life in cities like Los Angeles and San Francisco. He said it was important to clearly communicate to people over the age of 16.That Vaccination proof required Enter indoor businesses such as restaurants and gyms.

He said health officials are working on the next pandemic move and may decide that reducing COVID-19 deaths and keeping people away from the hospital is the most urgent priority. It will direct more focus on increasing the rate of initial vaccination than booster immunization.

However, if the case rate begins to decline, emphasizing boosters may be a way to delay infection and end the pandemic sooner — and changing the definition of complete vaccination is sufficient to meet such goals. May support, Hotez said.

Some experts remain skeptical that it makes sense to take that step. They are ethical and productive in providing additional doses to those who are most unlikely to get sick when many of the world’s poorest countries have barely started vaccination of the population. Ask if there is one.

New findings from Israel clearly show that booster shots are valuable to people over the age of 50. Dr. Emily P. Heil, Infectious disease specialist at Massachusetts General Hospital. But it’s “a little difficult” to conclude that they help young people, she added.

“I’m looking for more detailed data on the types of symptoms they’re preventing. Is it Snuff Day or a week or two of serious illness?” Heil said. “It’s really useful to know that.”

The answer informs a more complete debate about whether acquiring more Americans, or other countries in the world, is a more effective use of scarce resources for the initial administration of their vaccine. She said she might give. It should also trigger “some tough conversations” about the goals that US health authorities should aim for. That is, eliminating infections altogether, minimizing serious illness and death, or returning to pre-pandemic life without public health restrictions.

Hotez said a fourth shot (or more) may be needed. It depends on many unknowns beyond the response of the human immune system to boosters, such as the emergence of mutants that erode vaccine protection and the priorities of health leaders.

“We don’t know until we know,” he said.