How to End Booster Vaccine Confusion

By Faye Flam

The message about booster shots is cumbersome and confusing, but the science is pretty straightforward and reassuring. Your vaccine still reduces your risk of getting a severe case or dying from COVID-19, even if it has been several months since you received it.

Regardless of when they first received vaccinations, an additional dose is recommended for people 65 years of age and older and for those with any health conditions that compromise immunity, or with conditions that greatly increase the risk of contracting COVID-19, which are listed by the Centers for Disease Control and Prevention (CDC, for its acronym in English). But what if you are young and healthy and vaccinated?

“The three vaccines currently used in the United States will continue to protect against serious diseases at a high level and there is no evidence of erosion.“, he told me Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia.

Eric Toner, a senior scholar at the Johns Hopkins School of Public Health, widely agrees. One of the reasons this has been debated, he said, is that the Pfizer and Moderna vaccines already offer pretty good protection, even after seven to nine months.

The biggest change is the recommendation made by the CDC last week that everyone who received the single dose of Johnson & Johnson vaccine received a second dose, not because the single dose does not work, but because some measurements suggest that it is not as protective as the other vaccines available in the United States .

Recently, the efficacy of the J&J vaccine against severe disease was determined to be 74%, a figure that increases to 94% with a booster, based on clinical trials. The second dose aligns her with Pfizer and Modern, which still show more than 90% protection against serious illness, even as protection against milder illness now appears lower than last spring.

The other big change, which should be reassuring, is that you can get your second or third dose of any of the three vaccines offered in this country. There doesn’t seem to be any risk in mixing and matching them.

Toner stressed that since there is now consensus on who should get a booster shot, there is little need for an antibody test to try to determine if their protection is wearing off.

For one thing, the correlation between antibody tests and an individual’s protection is unclear, he said. And immunity is complicated: there are also cells that fight for a long time against viruses, those B and T cells, that hide in the bone marrow and lymph nodes.

Risk is more important than antibody levels, and scientists have been consistent in acknowledging that it is much higher for older people. And they have always said that infections in vaccinated people are usually mild, or at least not life-threatening enough to require hospitalization, but they can be fatal in people with certain conditions that damage the immune system: people like Colin Powell, who died at 84 years of COVID-19 after a long battle with cancer.

Scientists have also been consistent in the message that the risks posed by vaccines and boosters are low. So for people who are more likely to get the disease, the benefits of an additional vaccine clearly outweigh the risks.

Still, people are confused by the mixed messages they are getting about whether the vaccines are wearing off or not working as well as we were told. When I researched this to write a column last summer, Eric Topol of the Scripps Research Translational Institute in La Jolla, California, he lamented that while the news was full of alarming reports about the increase in hospitalizations, no one could find basic and crucial information about people hospitalized: their age, health status, if they were vaccinated, what vaccines received and when they were administered.

It was also a mistake that some doctors tried to spread the message that vaccines did not prevent people from transmitting the virus, he said Monica Gandhi, Ph.D. in infectious diseases from the University of California, San Francisco.

That message is puzzling or false when people are urged to get vaccinated to protect others. The bottom line, he said, is that vaccines greatly reduce one’s chances of infecting other people.

Vaccines not only make you much less likely to have a severe case. They also reduce the number of mild or asymptomatic cases and, if infected, vaccinated people shed the virus faster, so vaccines reduce the chances of passing the disease to another person.

They are not perfect. That’s why experts agreed that a booster is also a good idea for healthcare and nursing home workers or others whose work puts them at risk or in contact with vulnerable people.

Don’t blame the experts for the confusion. Many have gone to great lengths to help people understand what is happening, including the three interviewees for this column. But they don’t always have access to the information they would like.

A recent press release from Pfizer, for example, touted a study that followed 10,000 people after receiving two or three doses of the vaccine. The results sounded impressive: 109 were infected in the two-dose group and only 5 were infected in the three-dose group. But the press release did not mention the level of infection they recorded – was it severe, mild, or just a positive test? The ages were not specified either.

As I wrote last summer, part of the problem is that the numbers can be read in different ways, depending on whether the goal is to persuade people to get vaccinated or to persuade the vaccinated to wear a mask in public.

The messages that have been true and have been maintained over time are those that aim not to scare people or change their behavior, but to inform us so that we can understand and mitigate our own risks and recognize our responsibilities towards others .