At-Large Councilmember Christina Henderson has a lot of questions about upcoming changes to COVID-19 vaccines. How easy will it be for parents to make appointments when children ages 5 to 11 become eligible for vaccination as soon as next month? Why are local concerns about vaccine booster shots centered on potential access issues for unvaccinated folks when D.C. Health says there are no anticipated supply issues? What’s going on with third shots in the general population, given that last month, the Biden administration announced plans to roll out these booster vaccines for most vaxxed Americans by Sept. 20?
Her tweets reflect questions many of her constituents have already been asking themselves about what the vaccine news means for them and their families. Late last month, City Paper reported on the state of COVID in local kids amid a rise in children’s hospitalizations and parent concerns about the return to school. (At the time, vaccines for students aged 5 to 11 were not expected until late fall or early winter).
The first two questions around young children’s vaccine rollout in the District—and Pfizer-BioNTech’s release of a first batch of data showing their vaccines are safe and effective for this age group—provoke more questions than answers.
Boost Your Knowledge
With the matter of vaccine boosters, some residents—like officials confounded by the White House rollout plans and lack of FDA approval—might glimpse in the third-shot wait “yet another challenging and confusing message that doesn’t universally apply,” as Michael Fraser, executive director of the Association of State and Territorial Health Officials, told the Washington Post.
The FDA’s independent vaccine advisory committee on Friday voted against the Pfizer booster for Americans at large 16 and older, stating safety and effectiveness data were not all there. The FDA authorized the third shot for folks 65 and older or those with immunocompromising conditions, then, through an unofficial poll, endorsed the booster for healthcare workers and others at high risk of exposure. On Sunday, National Institutes of Health Director Dr. Francis Collins said teachers, who work with a largely unvaccinated group, should be part of the priority group. It’s unclear which other types of workers qualify as vulnerable for the purpose of boosters. And D.C. officials have not yet announced plans to give the third shot to all residents who received the Moderna or Pfizer vaccine more than 8 months ago.
But boosters have become the hottest vaccine debate topic for a reason other than confusion: data. The FDA and CDC might not yet have sufficient evidence to approve the additional shots for most folks. D.C. needs that approval before healthcare workers can officially start poking fully vaxxed residents outside the priority group. (Unofficially, folks like WAMU host Kojo Nnamdi have gotten anecdotal accounts of some District residents outside the priority group already getting a third shot.) But epidemiologists and immunologists have some thoughts based on the research so far, starting with the most trusted COVID voice in America:
“I believe, as a scientist who’s been following it, that ultimately the real proper regimen will turn out to be the original two shots plus a boost,” Dr. Anthony Fauci said on Sunday. “But you want to do that according to what the data tells you.” The White House chief medical advisor had clarified in a CNBC interview Friday that the administration’s Sept. 20 booster plans were always contingent on the FDA authorization.
Let’s hear what other experts had to say about the data at a recent roundtable on the topic hosted by the Center for Health Journalism at the University of Southern California:
It’s not all about the antibodies, everybody
When many of us consider our immune system’s ability to defend us against COVID-19 and its most transmissible, high-load viral strains, we tend to think only in terms of waning levels of antibodies, says Dr. Monica Gandhi, professor of medicine and associate division chief of the division of HIV, infectious diseases, and global medicine at UCSF/San Francisco General Hospital. Just imagining the vanishing spike in antibodies many months after a shot is enough to spike up our blood pressure.
But Gandhi, whose lab has studied immune memory (the quantity and quality of memory cells) from COVID infections in both vaccinated and unvaccinated folks, says there’s more to our immunity than we think. What gets lost, she says, is that “there are really these multiple layers of memory that all act together to control the infection.” Getting COVID-19, like other viruses, induces long-lived plasma cells in the body, which in turn produce antibodies locally for life, though COVID variants could dampen their protection.
Your superhero cells are pretty “incredible”
But that’s not all, folks: The B in memory B cells, with help of your T cells, should stand for blueprint. Memory T cells, some of which induce long-lived plasma cells, help memory B cells patrol the body for the same or similar virus they previously encountered. If they find it, memory B cells get rapidly reactivated to make antibodies and control that infection, even if it takes a little bit of time, Gandhi says.
“It’s like a blueprint for a house,” adds Dr. Marion Pepper, associate professor of immunology at the University of Washington. “If you do extra work over here, the house is going to adjust, and so those memory cells produce adaptive antibodies that look like what they need. Or don’t.”
Pepper referenced the animated film The Incredibles to explain why antibodies aren’t the be-all in shielding us. The forcefield isn’t a one-layer-and-done deal; there are one or two backups in case our first line of defense is down. “If you see, in ‘The Incredibles,’ [the forcefield] is … sent out to protect the family. But once the infection gets beyond these antibodies, if they wane, if there are holes in this forcefield, there’s this whole team of superheroes that’s left underneath that forcefield,” Pepper said.
Being fully vaxxed is not 100 percent effective … and that’s OK
Gandhi thinks part of the White House’s rationale for wanting to administer boosters to the at-large population was based on not fully examined data that came out of a COVID cluster identified in Provincetown, Massachusetts, in July. The data showed “just a single point in time that the vaccinated and unvaccinated could have the same viral load, at least [as] measured by an inadequate measure,” Gandhi says, “but you really need microbiologic data to see if that viral load is truly infectious.” The concern around the delta variant, after all, is largely due to its high transmissibility and viral load.
Breakthrough cases have been one source of vaccine hesitancy, but experts remind us that no vaccine is 100 percent effective—they’re just really, really effective at protecting against severe illness.
“If it comes down past the idea that you can actually block transmission completely,” Gandhi says, “it means to me that there is not a complete acceptance in the United States … that this is going to be an endemic virus, [which] means that you actually live with a virus, like we live with rhinovirus and animal virus. But what we can’t live with is severe disease. It’s actually why we shut down society.”
What about Mu, too?
The experts are still studying the Pokémon-sounding new “variant of interest,” mu, which was first identified in Colombia in January and designated as B1621. While the new viral strain has only been identified in about 0.1 percent of cases worldwide as of early September, it has been found in at least 43 countries and has mutant properties that may allow it to evade vaccine protection. Before we panic, says Dr. Dhruv Khullar, a physician and assistant professor of health policy and economics at Weill Cornell Medical College, what we need to look out for in upcoming research about the variant are three factors:
•Lethality (how likely you are to be hospitalized and/or die if you contract it)
•Immune evasion (how likely it is to get past our screening system in ways that prior variants didn’t)
•Transmissibility (how likely is it to spread from person to person; delta, for instance, has been found to be more than eight times more infectious than the original Wuhan COVID strain. Khullar sees this factor as the most important.)
Wait (for the FDA) and See
While some of the nation’s top experts in immunology are seeing the need for boosters for the general population more than others, none are recommending boosters to all Americans 16 and older yet. Sometimes it’s best to thank our memory B cells and remember to wait and see what the research tells us.