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On November 19, the head of the Centers for Disease Control and Prevention (CDC) approved the Food and Drug Administration’s (FDA) recommendation to make COVID-19 booster shots available to all American adults who received their Pfizer/BioNTech or Moderna vaccines at least six months prior. Those vaccinated with the Johnson & Johnson vaccine, which has always been the outlier, had already been cleared for a booster two months after their initial dose. This move comes amid growing evidence of diminishing vaccine immunity, highlighted by recent studies and increasing infection rates.
“Booster shots have shown the ability to safely enhance individuals’ protection against infection and serious outcomes, serving as a vital public health measure to bolster our defenses against the virus as we approach the winter holidays,” stated CDC director Rochelle Walensky.
So what’s the catch? While the CDC hasn’t mandated that everyone aged 18-49 receive a booster, they have stated that individuals in this age group may opt for one if they wish. Meanwhile, those aged 50-64 are encouraged to get a booster, a shift from earlier guidelines that only recommended boosters for those in that age bracket with pre-existing health conditions. The CDC has already advised that anyone over 64 should obtain a COVID-19 booster, irrespective of their health status.
But why the sudden push for boosters? The answer lies in declining vaccine immunity.
Understanding Waning Vaccine Immunity
“Waning vaccine immunity” describes the gradual decrease in a vaccine’s effectiveness over time. For example, the Pfizer vaccine is about 90% effective against symptomatic infection shortly after the second dose. However, a study from England shows that efficacy drops to around 70% twenty weeks later. Similarly, the effectiveness of Moderna also diminishes over time. U.S. and Canadian studies differ on the specifics of how much the efficacy of Pfizer and Moderna declines against the Delta variant, but the consensus is clear: it does decline. One U.S. study indicated that Pfizer’s protection plummeted to just over 50% after less than 20 weeks.
That’s a bit concerning, Pfizer. I got the Moderna and a booster, but that data might have me avoiding the mailman!
On a brighter note, both Canadian and English studies indicate that Pfizer and Moderna vaccines still maintain a decent level of efficacy in preventing severe illness and hospitalization due to COVID-19. While we are witnessing waning immunity, the situation isn’t as bleak as it may seem. Yes, there are more cases of COVID, and yes, some of those cases are severe. However, even without a booster, your vaccine is still providing a measure of protection.
It’s crucial to remember that the primary aim of a COVID vaccine has never been to prevent the virus entirely. Instead, these vaccines are designed to reduce the risk of severe illness and death. “The main goal of the COVID vaccine is to avert severe disease and mortality, and they continue to perform well in that regard,” noted Dr. Sarah Collins, an expert in public health.
What This Means for the Winter Season
Waning vaccine immunity poses challenges. We face not only the unvaccinated population but also those who believe they don’t need a booster, potentially spreading the virus further among the unvaccinated. Dr. Andrew Smith warns that the combination of declining immunity and the aggressive Delta variant could lead to an uptick in “breakthrough” infections among vaccinated individuals.
Fantastic.
As we enter what could be a perfect storm of a holiday season, individuals with waning vaccine immunity may gather with staunch anti-vaxxers, all while sitting down to a turkey feast without masks. Currently, COVID cases have surged to 80,000 per day, the highest in a month. Hospitalizations have also risen for the first time in ten weeks, with 40 states reporting high transmission rates.
We need to keep advocating for vaccinations—convincing those who remain unconvinced that they require a COVID shot, and then persuading those who have already received their vaccine to get a booster. According to Dr. Smith, the effectiveness of our winter COVID strategies will largely rely on how well we roll out a booster campaign.
Three Shots May Become the New Standard
Dr. Smith believes that in the future, we may not view booster shots as optional but rather as an integral part of our vaccination regimen. “As an immunologist, I foresee that a third shot with mRNA vaccines should become a standard part of the original vaccination schedule, making boosters essential for optimal protection,” he asserted.
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Summary
The approval of COVID-19 booster shots for all adults highlights the growing concerns surrounding waning vaccine immunity. While studies show that overall effectiveness against severe illness remains high, the risk of breakthrough infections is increasing, particularly as we approach the winter months. Public health officials stress the importance of booster shots in strengthening immunity and preventing severe outcomes during the holiday season.