Do I need a COVID booster?

Your Pandemic Questions Answered

The sometimes maddening back and forth of CDC COVID guidelines has left many Americans scratching their heads. Do we mask up? When does someone need a booster, if at all? And, what does the Delta variant mean for us moving forward?

As a precision-medicine scientist and physician who has built my career on providing precise care, hunting down clear answers thanks to my insatiable curiosity, I too find the CDCs response frustrating at times.

Yet with diligence and consideration for the people around us, we can keep ourselves and our loved ones safe.

What is motivating the vaccine booster discussion?

There are two key scenarios that could determine whether and when people need COVID vaccine boosters:

  1. If vaccine-generated immunity wanes over time
  2. If a variant emerges that can “escape” the immune response

Companies have been preparing for the possibility of either scenario with two strategies. Firstly, some are opting for a third “booster” shot to amp up the existing dose. New data from Pfizer indicates the vaccine’s effectiveness declines to 65% after 4-6 months, undermining the individual’s immunity and herd immunity as a whole. In fact, protection can fall from 96% to 83% in the first two months alone.

Since Israel predominantly relies on Pfizer, the country recently announced its plan to roll out booster vaccinations for those 60 years young and up to counteract the decline in efficacy.

The second strategy companies are considering is a variant-specific booster. This Delta variant is not unexpected. It’s been clear that new strains were in our future and will likely continue.

As the likelihood of COVID vaccine boosters rises, the market is sure to grow and see new players step up to fill that gap. Pfizer is leading the way in filing for authorization of a third dose, and Moderna announced the company was developing a variant-specific booster earlier this year. J&J will likely follow suit.

How much of the current conversation is driven by the Delta variant?

When Pfizer came on the record last month to say folks may need a booster, the CDC and FDA were quick to say that fully vaccinated Americans didn’t need a booster at this time. But things are changing rapidly given the bump in the Delta variant, which can overwhelm low antibody levels and effectively “breakthrough” immunity. This puts individuals at risk and, by consequence, threatens herd immunity.

What makes Delta so concerning is how easily it’s transmitted. According to Dr. F. Perry Wilson, a Yale Medicine epidemiologist:

“In a completely unmitigated environment—where no one is vaccinated or wearing masks—it’s estimated that the average person infected with the original coronavirus strain will infect 2.5 other people. In the same environment, Delta would spread from one person to maybe 3.5 or 4 other people.”

Who are the most at risk of the COVID Delta variant?

In short – the unvaccinated. Deniers are putting everyone at risk, which is clear because we are not witnessing recurrence of the disease in people who already had it. Rather, the recent surge of COVID cases is almost entirely among the unvaccinated population. Over 97 percent of those hospitalized are unvaccinated.

When should I get re-vaccinated, if at all?

Recent data strongly suggests that those who received J&J are at a higher risk of catching COVID. If you received the J&J vaccine, you should get vaccinated a second time with Moderna or Pfizer.

The single-dose vaccine does not provide as much protection against infection since it was not made to react to the same “spike” component of the virus as Pfizer and Moderna. Even when looking at the original strand of COVID rather than the new aggressive variants, J&J is 66.3% effective, while Pfizer and Moderna are 95% and 94.1% effective respectively.

If in doubt, I recommend folks get an antibody test to determine if they are still protected. If your antibody count is low, you should consider getting the booster.

What can I do to protect against the Delta variant?

  1. If you are not vaccinated, you should make an appointment for a two-dose vaccine, Moderna (preferably) or Pfizer, as soon as possible. Even partial vaccination provides some protection and reduces the risk of hospitalization.
  2. If you are unvaccinated or partially vaccinated, you should always wear a mask in public. You may still choose to wear a mask even if you are fully vaccinated because it’s unclear how long protection lasts person to person. Ideally, you should wear a mask that will block the transmission of COVID-19, like N95.
  3. If an area is crowded, you should wear a mask, as you don’t know the status of those around you. This applies even if you have been fully vaccinated.

When will COVID end?

There is no easy answer to this question – COVID has presented many unique challenges, and it’s difficult to pinpoint when the pandemic will “end.”

But what I do know is that we should not stop living life to the fullest. Many people spent much of 2020 on hold, and while we need to stay safe, we can’t repeat that. As long as you wear a mask that fits well and prevents disease, practice social distancing, and get vaccinated then we can continue to enjoy life.

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