The Booster Question
Many people have asked me about whether to get a booster shot. They have gotten the series of two mRNA vaccines six (or more) months ago, and now wonder if they should get a third shot to boost their antibody levels.
Notice I didn’t say that people who got the Janssen (Johnson & Johnson) single-shot vaccine are asking me about the booster shot. That is because the people I know who got it seem to be folks who said, firmly: “I hate needles and am willing to get vaccinated but only if it means a single shot.” Their protection from getting Covid is (and always was) less than those who got the mRNA vaccines, but they have some protection. I applaud them for getting vaccinated.
One more word about people who got the Janssen (J&J) vaccine: If they have a change of heart and want better protection, getting a mRNA vaccine (Pfizer or Moderna) after the J&J vaccine gives a big jump in antibodies. More antibodies, actually, than what two mRNA vaccines gives you. It does, alas, mean another shot, so there’s that.
The day the White House came out with a recommendation for everyone to get a booster dose, I remember thinking, “Why is the executive branch of the government pushing something immunologists don’t yet recommend?” So I’ve waited to hear from immunologists, and now “they” have spoken.
The FDA committee concerned with vaccines met yesterday and voted to recommend a booster shot for people over 65 years old, as long as it has been six months since the second shot. They also recommend that people who are at high risk of serious disease get a booster. The FDA is likely to agree with their recommendation. Probably people with “occupational exposures”, meaning medical workers, will also be included by the FDA when they consider whether to adopt this recommendation.
I think this makes a lot of sense. If people are at high risk for serious disease, and that includes people over 65, then you don’t want them even to get a little bit sick. Currently, being fully vaccinated protects people from getting seriously ill (which means being hospitalized, being intubated, and dying). But many vaccinated people have become mildly ill. The reason for this is that the level of antibodies drops with time after vaccination. This is true for all vaccinations, and is completely expected, and does NOT mean the vaccines are not doing their job. The two mRNA vaccines are extraordinarily effective and extremely safe. I have written about this previously, so check out my August 20 post on my Facebook page for the details. Or on Medium at https://amygivler.medium.com/why-vaccinated-people-get-covid-fa9bec9b53e6
Being fully vaccinated is protecting many people against even mild illness. My husband and I are both family physicians and have been exposed to many, many people with symptomatic Covid, yet have not become ill. Vaccines work. (Masks also work — we wear masks!) And though I am talking casually about “mild disease”, I know that mild disease may not feel very mild while you are experiencing it. True, you’re not hospitalized, but you could be achey, fatigued, feverish, short of breath, and generally miserable for a week or so. Not fun.
Antibodies are the way our bodies keep any virus from even gaining a toehold. They kill the virus right from the first moment it enters the body. We may get “infected” but we don’t get “sick”. But antibodies aren’t our only protection. With vaccination, we also make B and T memory cells which are waiting in the wings, ready to spring into action and fight the virus as soon as it is detected. But that “spring into action” takes a few days as antibodies are made and killer cells multiply. Those few days are when people are getting mildly ill, even though they were vaccinated.
I was lukewarm about the thought of everyone getting a booster. It would mean hundreds of millions of additional doses, while at the same time low-income countries are not able to give most of their citizens even the first dose. The U.S. buying vaccines for low-income countries is not a totally selfless action. If the virus is allowed to multiply unchecked in a population, then new variants will emerge. That is just what viruses do. They make variants. The way to prevent future variants is to vaccinate the world.
Two more thoughts: One, a booster is different from the “third shot” recommended for immunocompromised people. Those folks, which includes people taking immune-suppressing medication such as prednisone, may not have produced a vigorous immune response to the first two vaccine doses. They need a third shot to complete the vaccine series in order to become protected.
Two, people who test positive for the SARS-CoV-2 virus and are at risk of serious disease, EVEN IF THEY ARE VACCINATED, should immediately try to get the monoclonal antibody infusion (called “Regeneron”). It is pretty easy to get around here in northern Louisiana, but I know that in some places it is hard to find an infusion site with available time slots. The earlier this infusion is given, the better.
It seems crazy to me this far into the pandemic, but many doctors don’t know about this infusion, even now. So, if you test positive, or you know someone who tests positive, you may have to investigate on your own where and how to get the infusion. The criteria for getting Regeneron includes people with hypertension, diabetes, renal disease, etc., in addition to overweight or obese people (BMI over 25) and anyone over 65. Please don’t wait until symptoms get “bad”. Get it early on, when you are still feeling pretty good. This infusion has saved many lives, and I hope it saves yours.
