Let’s talk about booster shots.
David Kessler, the White House chief science officer for the COVID-19 response recently raised the prospect of annual revaccinations (aka “boosters”). Then last week, the CEOs from Pfizer and Moderna both suggested that we’ll need booster shots against COVID-19 in 6 to 12 months.
This messaging has created an enormous kerfuffle — with fear and anxiety spreading faster than a middle-school rumor.
But before we freak out, let’s frame this thing.
First off, it’s terrific that the pharmaceutical industry is preparing for the potential eventuality of needing boosters. Thank you! It’s wonderful that our federal government is poised to support the effort to develop, study, approve, and deliver booster shots if needed. Great! This is all excellent news all around.
But I and anyone who understands immunology, virology, and infectious diseases highly doubt that we’ll need booster shots in 6-12 months. In fact, we probably won’t need them at all.
Our immune protection from the vaccines is more than meets the eye.
It’s not just about antibodies. The T cell response to the COVID vaccines is extraordinarily robust and durable.
Let’s briefly travel back to biology class. Our immune system has TWO MAIN ARMS: B cells and T cells.
Both cell types react to immediate threats (e.g. a virus or, in the case of the COVID vaccines, a synthetic viral protein). Both cell types also make memory cells in reaction to threats for long-lasting immune protection.
- B cells make antibodies. They hang tough for years in our bodies in order to make fresh batches of antibodies if we’re re-exposed to the same or similar threat.
- T cells directly kill cells infected by a virus and help our overall immune system react to threats. In the world of virology, T cells are QUEENS. Even more than antibodies from B cells, T cells do most of the work protecting our bodies from viral infections.
Ok, so now back to why we won’t need boosters in 6-12 months (if ever):
- Let’s recall an essential premise: We’ll only need boosters if new variants of the coronavirus emerge that are able to evade immune protection from the vaccines. This has not happened yet and may never! The T cell response to the Pfizer-BioNTech, Moderna, and J&J COVID vaccines has been shown in numerous studies to beautifully protect us against the currently circulating variants (B117, B1351, P1, etc..). In other words, currently there is no indication for booster need.
- T cells last a long time.
- Studies show us that people who’ve had a measles vaccine, for example, have durable T cell immunity 34 years later.
- Studies show that people who recovered from an infection with the other awful coronavirus called “SARS” back in 2003 still have strong T cell immunity 17 years later!
- We have memory B cells fighting for us. Studies in real time show that people vaccinated against COVID with the current vaccines develop lasting (aka “memory”) B cells in our lymph nodes — hence the “swollen glands” in our neck, armpits, and groin after vaccination! And they hang out for YEARS waiting for a similar threat. People who’ve recovered from the 1918 flu, for example, have memory B cells that can readily make a fresh batch of antibodies when faced with a new or different flu virus — even 97 years later.
Our bodies are cool like that. We need to trust them.
Alrighty. If your confidence in your own immune system still needs a boost, I’ll anticipate some of your questions here:
Q: As the coronavirus continues to mutate, is it possible that a variant might emerge such that the vaccines wouldn’t protect us?
A: Absolutely! The more people that coronavirus is able to infect, the more opportunity we give it to mutate in a way that outsmarts our immune system. It just hasn’t yet — and is unlikely to do so for the above reasons. Here are three MORE ways to combat anxiety about this possible scenario:
- Every day that we vaccinate approximately 3.5+ million more Americans, we give coronavirus fewer opportunities to infect, spread, and mutate. Recall the extraordinary efficacy of the vaccines: just last week the CDC reported that the breakthrough rate of COVID-19 is 0.005% (yes, two zeros and then a five after the two zeros). Whaaaat, you say? If we take out the 29% of the 5814 people who were infected without symptoms, the risk of actually getting COVID (by definition, COVID is an infection with symptoms) is 0.005%. Also recall that if you were in that wee percentage that did get COVID after vaccination, you’d have a cold or mild flu. The vaccines also dramatically reduce the risk of transmission.
- Even if a down-the-road variant does render our immune system less effective at fighting it, our body has so many tricks up its sleeve that you wouldn’t be completely unprotected. For example, you might get a mild flu as opposed to getting a sniffle with the original coronavirus. In other words, viruses aren’t nearly as smart as our own bodies — especially when they’ve been vaccinated.
- Even in the off chance that a variant renders your immune system COMPLETELY USELESS against it, booster shots are already being made. Hence the news from last week. In the event we need boosters, they are chilling on ice like the wine in my fridge right now. Bonus: now that we have the technology down pat, we’d be able to crank out boosters with relative ease.
Q: What if I’m immunosuppressed such that my immune system can’t mount a robust B cell and/or T cell response to the current vaccines, not to mention a response to any new variants that come along?
A: Excellent question! My patients who take Enbrel for rheumatoid arthritis or other immunosuppressive medicine after organ transplantation or for cancer treatments, for example, generally won’t generate the same quantity of antibodies or have the same quality of T cell responses to the vaccine. So what should you do if you are one of these people? Talk to your doctor. We can measure your antibody levels with a blood test. We sometimes can also measure T cell responses. However, there are many components of the immune system that we cannot measure, so even if you have a less-than-ideal antibody response, for example, your immune system is still better off having been vaccinated than not. Should you get your blood checked for antibodies and T cells if you have a normal immune system like the vast majority of people? There’s no real need to except for reassurance.
In sum, our immune system is nuanced and sophisticated (thus making the reporting on it difficult and often panic-inducing).
Why are many of us feeling edgy about boosters and variants and breakthrough infections (oh my!) when abundant real-world data should serve as a balm for anxiety? Because after the year we’ve been through, the last thing anyone wants right now is more uncertainty and unpredictability.