Avoiding the hospital is not the only reason to get a Covid booster

First, I really loved this Q&A by and with some of NCSU’s finest on the ethics of vaccine boosters:

The Abstract: The Biden administration has said that people in the U.S. who received mRNA vaccines (Pfizer and Moderna) may want to consider vaccine boosters eight months after their second shot. Does that raise ethical concerns related to global vaccine access, since many people in other nations haven’t been able to get their first dose of vaccine?

Julie Swann: We need to continue to help get people vaccinated globally. A virus doesn’t know borders, the society we live in is very connected globally, and there are too many people dying. As of Aug. 28, vaccine trackers show that the vast majority of doses (over 80%) worldwide have been administered in countries that have high or upper-middle income. The U.S. has committed to providing initial doses but can do more to make sure that people worldwide have access to vaccine.

The doses in U.S. pharmacies, hospitals, clinics and doctor’s offices cannot be given directly to other countries. The expiration date would be too soon and the logistics too complicated. So we have doses that can be used for boosters, and also for children younger than 12 when they become eligible. We can vaccinate the American public while also helping others worldwide, especially given that vaccine manufacturing has now scaled up.

Matt Koci: Yes, we should be able to do both. The goal of the vaccines, beyond saving lives, is to help stop the virus from replicating uncontrollably around the world. Unfortunately, over the past 28 days the U.S. has accounted for around 27% of all the confirmed cases in the world. We need to help vaccinate the rest of the world, but we also owe it to the rest of the world to get our cases under control, so we don’t become the source of a new variant. Ideally that would be through getting nearly everyone vaccinated who is eligible. But if we can’t do that, and boosters can help tamp down breakthrough infections and limit case numbers, we should do that too.

TA: I’ve heard several risk reduction and ethical arguments that Pfizer and Moderna should lift intellectual property protections to permit broader production and distribution of their vaccines. Could that make a significant difference for public health in the United States?

Koci: Other countries being able to make their own vaccine would help make sure they aren’t dependent on the U.S. In the long run, that helps us here, as that would mean the case numbers would start to go down everywhere faster, which means fewer chances of new variants, which means the whole thing will be over sooner.

But IP rights aren’t the thing holding these countries back from being able to make their own vaccine. They have to have the infrastructure. They have to have the expertise. If I gave you the blueprints for how to build a rocket ship, it would still take you years to build it.

If the goal is to help these other countries produce their own vaccine, we need to do it based on what works for them and their infrastructure.

Back when we were focused on influenza as the next pandemic (1997-Feb 2020), the Biomedical Advanced Research and Development Authority (BARDA) developed a program to train scientists around the world on how to make influenza vaccine to increase total global capacity. In fact, NC State’s BTEC was one of the places these scientists came to train. This program greatly expanded the expertise and capacity around the world, but that took years. And making flu vaccine is not the same process as mRNA COVID vaccine.

If the goal is to help these other countries produce their own vaccine, we need to do it based on what works for them and their infrastructure – not what works best in the U.S. Before December 2020, no human vaccine had to be kept at -80 Celsius. We didn’t even have the infrastructure. There are other COVID vaccines out there that seem to work as well as the mRNA vaccines, that are based on technologies that would be easier for other countries to start to produce. We need to work on getting them making those vaccines. We can work on helping develop their capacity to make and distribute mRNA vaccines once we have COVID behind us.

And, meanwhile, what initially got me going on this post was an interview with a Duke MD that just annoyed me:

There’s growing consensus among scientists that people who received two shots of COVID-19 vaccine will eventually need a third, but the timing and urgency of those booster shots remains unclear, according to an infectious disease expert at Duke University.

Dr. Cameron Wolfe said Wednesday that more data is needed to determine when people who are not at high risk of getting sick or dying of COVID-19 should get a booster shot. So far, very few vaccinated people with healthy immune systems and no underlying health risks are getting sick enough from COVID-19 to end up in the hospital.

“So when we talk about boosting for individuals in the general community, I want to be very clear that that is far less important than still reaching those individuals who are not yet vaccinated at all,” Wolfe said. “We need to continue to talk to those individuals about safety data and how robust it is and about the profound difference in their risk of hospitalization and death by the single act of getting vaccinated.”…

Wolfe said studies in Israel and the United Kingdom suggest that the protection provided by the Pfizer and Moderna vaccines begins to wane six to eight months after the second dose. But, he said, that has not yet resulted in a substantial increase in the number of vaccinated people who get sick enough from the coronavirus to end up in the hospital.

That raises questions about if and when healthy people who don’t face unusual risks of contracting the virus should get a third shot of vaccine, Wolfe said. He said if the FDA approves, he would support boosters for health care workers and nursing home residents, the first two groups that qualified for vaccination when it became available last December.

“If there’s going to be a larger load to bear for people getting infected and having breakthroughs, it’s going to be front and center with health care workers and older adults first,” he said.

The Sound of Judgment

A battle for racial justice in NC confronts bloody past, uncertain future

But Wolfe said he’d like to see more data that would show whether providing booster shots to the wider population would provide any benefit. He gave an example of a 35-year-old healthy person who doesn’t work in health care or other risky situation.

“I think we need to still see a little more data to fully understand why that person would need to be boosted and if that’s absolutely crucial,” he said.

OMG I’m tired of this framing.  Everybody knows the most important thing is to get those first two doses in new people.  Everybody.  Stop pretending that those of us boosting boosters are somehow unaware of this.  But, realistically, its probably a lot easier to get an additional shot into 10 people like me who’ve already been vaccinated than one person who has heretofore resisted.  And, substantially increasing the immunity against Delta (plenty of evidence a third shot will do that) is well worth it.

Also, does Dr. Wolfe get a flu shot?  I suspect so, but there’s almost no chance it’s actually keeping him out of the hospital.  Getting the flu sucks even if you don’t get hospitalized… and a shot to avoid it?  Hell yeah.  Same goes for Covid.  A third shot will really help lots of already vaccinated people become substantially less likely to get a disease that often really sucks.  And, very importantly, to therefore not spread it to other people!

So, yeah, do everything we damn well can to get more Americans vaccinated.  And to manufacture vaccines like crazy and get them around the world, but, also, yeah, let’s boost the willing against Delta and substantially cut down on Delta.  

%d bloggers like this: