No news for you: When the topic of vaccines comes up these days, everyone is at least a little confused. The current confusion has been generated by brand new guidelines, if you can call them that, from the FDA and the CDC.
They say those of us over the age of 50 are “eligible” for a second booster of the Pfizer or Moderna mRNA vaccines. Some medical authorities like the move; some think it is at least premature. Most of you probably shrugged wearily and continued. Some become angry and venomous, thinking that government officials don’t know what they are doing and should shut up. And some pay heed to it reluctantly.
For those of you in the last group, I both share your weariness as the pandemic continues unabated, and I want to help you. So I tried to make sense of the good science about vaccine boosters that we currently have in hand. Here I will provide you with the best possible advice by sketching profiles of people who might be similar to your situation and suggesting what I think are the best actions under these circumstances. I hope these help.
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Please note that the database is currently far from complete enough to provide certainty for the suggestions below. Also note that data is accumulating at a fantastic rate, so what I’m proposing may be solidified or may change in a matter of weeks or months depending on what we know soon.
Before presenting these sketches, allow me to make these reminders:
- Moderna and Pfizer vaccines are excellent. The current data shows very clearly that they remain highly effective in preventing the worst outcomes of infections, even in the face of the outrageously transmissible omicron variant, BA.2. For ballpark numbers, unvaccinated people who develop infections are about nine times more likely to die than fully vaccinated people who don’t get a booster. And unvaccinated people are about 21 times more likely to die than vaccinated and boosted people.
- A disturbing manifestation of COVID-19 infections, occurring in about 30-50% of cases, is what is known as long-haul COVID. Data is accumulating showing that the risk of developing it is greatly reduced by vaccination, perhaps by as much as 50%.
- Vaccines are not perfect, however. For example, they do not prevent mild or asymptomatic infections with the omicron, BA.1, and BA.2 variants. ; and unfortunately, these cases can still be highly contagious. In addition, they do not fully protect people with weakened immune systems, which is why some vaccinated and strengthened people still become seriously ill and die. And as with all doses, the protection offered by a second booster tends to wear off over time. Finally, vaccines sometimes have severe side effects… but these are rare and remain rare after additional injections.
- The only data we have on the protection delivered by a second booster comes from a very recent Israeli study. Although this is a preliminary study, not yet validated by peer reviews or confirmatory studies, it is interesting. It showed that adults over 60 who received a fourth dose of the mRNA vaccine, Pfizer or Moderna, were 78% less likely to die from COVID-19 than those who received only three injections. Until we have more information, we cannot say that these results are completely convincing. That’s why some experts disagree with the CDC’s opening up additional eligibility for people over 50.
- Yes, of course, we need more information about how effective vaccines are in various circumstances and how safe they have been over the years. That takes time. We must be patient.
- You should know that SARS-CoV-2 continues to cause infections around here: new cases reported to CDC from New York State, excluding New York City, number approximately 1 000 per day and about 10 deaths per day. Our cases in Warren County are increasing, 28 new cases on Thursday, one new hospitalization, but thankfully no new deaths.
- The virus is devilishly clever; he will probably continue to throw new things at us. Indeed, as I explained in a previous essay, we may be on the verge of a new wave. Ugh.
- Another thing: Pfizer and Moderna are promoting the use of these vaccines…they’re making a lot of money out of it. In their defense, they are also pushing research into new vaccines.
- The same goes for other organizations. Novovax has developed what looks like an excellent protein subunit vaccine (without mRNA). It was recently approved by the World Health Organization but is not approved in the United States. Another protein subunit vaccine called Corbevax was developed by the Texas Children’s Hospital Center for Vaccine Development. It is designed to expand access to the vaccine for people in low- and middle-income countries because it is easy to produce at low cost. Indeed its developers have made it patent-free! That’s the spirit!
- Oh, I almost forgot to mention that. I was an adult doctor. I don’t want to talk about those terrifying things called children.
OK, here are some thoughts. If any of the following situations more or less describes your case, consider the suggestions on what to do as mere suggestions and not as real advice. After all, I’ve been retired for a long time…and my creepy kids would suggest…well, never mind.
1. If you are under 50 and healthy, you don’t have to worry about a second booster. But by all means, since the data is so clear that being fully vaccinated and then boosted once makes you much better protected against the damn thing, do it!
2. Regardless of your age, if you have received the Johnson & Johnson vaccine, even with a J&J booster, make sure you have a dose of an mRNA vaccine from Pfizer or Moderna. You will then have much stronger protection against hospitalization and death.
3. What about those of you who are immunocompromised, meaning you have a disease that has impaired your immune system’s ability to defend you – cancer or disease autoimmune or something like that? These put you at high risk of serious illness and death if infected. If you’re immunocompromised—regardless of your age—and haven’t, tell your doctor right away. She will probably instantly advise an extra dose four months or more after the first booster.
4. If you’re over 50 and have a comorbidity, such as kidney or liver disease, smoking or chronic lung disease, diabetes, or even obesity (there’s a long list – you can check it out on the CDC website), yes, have a second booster. The earlier the better.
5. If you are over 60, even if you are in fairly good health, consider a second booster about four months after the first. However, you might want to wait a few weeks to see what COVID-19 is doing here. If he keeps building up against us, go for it. If he slackens, wait. Because, as after any dose of vaccine, the protection decreases over the months. You may want to schedule your second reminder when a new pandemic wave begins to surge so that you are optimally protected then.
6. The older you are, regardless of your health, the more likely you are to be subtly immunocompromised. So if you’re over 65 or 70, you might want to do the second booster now, because the virus is obviously still there.
7. Of course, if you’re as old as me… well. …
Note from all of this that in general, the less healthy you are at any age, the more likely you are to have a bad COVID-19 result, so the better off you are to have an extra injection. It is the same for the years that advance. Please take the age and comorbidity items above not as rigid categories, but as indications of what might be wisest for the range of conditions you might fall into somewhere. Use your judgment and, of course, ask your doctor all your questions.
There’s a lot more to say about vaccines, some we currently know about and a lot to learn. We all need to stay informed, for our sake and that of our loved ones, friends and neighbours. But that’s enough for now, since I have to go chop firewood, plow back 40, raise a barn or two, cook dinner, listen to the news from Ukraine…you know.
Richard Leach, MD, is a retired internist, infectious disease consultant, and travel and tropical medicine specialist. He practiced in Glens Falls for 35 years, as an infection control officer and hospital epidemiologist at Glens Falls Hospital.