Straight Talk about COVID-19 Vaccines

COVID-19 immunizations saved 235,000 American lives during the first nine months that those vaccines were available, from December 2020 to September 2021 (JAMA Network Open, July 6, 2022). Now, a year later, they have spared additional tens of thousands of us from premature death and long COVID.

Recent commentary (The Lancet Infectious Diseases, August 22, 2022) about Massachusetts is also encouraging. That state met the spring Omicron surge with its population 80% fully vaccinated against COVID-19 and had no excess deaths, even among infected older people, for the first time since the pandemic began. Measuring “excess deaths” in a population during different time periods often shows whether community health is improving or declining.
   
COVID-19 vaccines in the United States are not only effective, but safe. More than 609 million doses have been given so far in our country alone. These inoculations have undergone the most intense study and follow-up monitoring in history. Prior to authorization, they were tested in humans using scientific medicine’s gold standard of randomized, double-blinded, placebo-controlled trials.

This is the same rigorous process that all FDA-approved pharmaceuticals undergo before you and I are allowed to take them. Now, more than one year after their authorization, the Pfizer-BioNTech, Moderna, Johnson & Johnson, and Novavax COVID-19 vaccines continue to be monitored extensively, showing clearly, for example, that neither fertility nor pregnancy outcomes are affected.
   
The benefits of COVID-19 vaccination far outweigh the known and feared risks. As with any vaccination, some people have short-term side effects. Issues like headache, fatigue, muscle pain, and soreness at the injection site can last up to several days before disappearing. Very rarely, there are serious, or “adverse,” health events following COVID-19 vaccination, which can be due to the vaccine or to a coincidental problem not connected to the vaccine, such as an unrelated fever.
   
Our monitoring systems for COVID-19 vaccine safety have found four serious types of adverse events.  They are anaphylaxis (severe allergic reaction), thrombosis with thrombocytopenia syndrome (blood clots and bleeding problems found only with Johnson & Johnson doses, which led to that vaccine’s being relegated solely to cases where Pfizer, Moderna, and Novavax are not able to be used), myocarditis and pericarditis (inflammation of the heart muscle or its outer lining), and Guillain-Barré syndrome (damage to nerve cells). These conditions sound scary, but the most frequent of them, anaphylaxis, can be treated readily and occurs in fewer than five cases for every million doses administered.
 
So, you understandably ask, if the vaccines are so effective, why are boosters needed, and why are there so many breakthrough infections?

• Vaccines produce neutralizing antibodies that can block the virus that causes COVID-19 from entering our cells. When the virus does enter our own cells, this is called “infection,” whether or not symptoms develop. Neutralizing antibodies naturally wane over time, but in the first few months after vaccination, they help prevent infection and transmission of the virus to others. If your primary vaccination series was more than five months ago, especially if you are an older adult, your neutralizing antibodies have largely waned, and a booster, as with other vaccines for measles and tetanus, is needed to restore them and prevent breakthrough infection.

•  Another challenge is that the virus that causes COVID-19 mutates very fast, and its emerging variants can evade earlier vaccination-induced immunity and/or immunity from already having contracted COVID-19. These antibody-evading variants more easily enter our cells where the viral particles reproduce astronomically. Fortunately, when this happens to people who are up-to-date with vaccination and boosters, they are much better protected against serious illness, hospitalization, and death from COVID-19 than if they were not immunized.
   
As you read this, the FDA has just authorized updated, laboratory-tested boosters. They are “bivalent,” targeting both the original virus plus the Omicron BA.4 and BA.5 subvariants, to provide protection from breakthrough infection for longer than existing boosters do. Not only will an updated booster help our bodies make neutralizing antibodies to the currently dominant and highly infectious Omicron BA.5 subvariant for which the original vaccine was not designed, but it will also aid our second line of defense—B cells. B cells are made in our bone marrow. When the need arises, their long-term memories enable them to replenish antibodies that can be effective against old or new variants.
   
Expect updated boosters to be available after Labor Day for Americans aged 12 and over who had received boosters or their primary series of COVID-19 vaccinations at least two months ago. Everyone eligible is advised to get the new booster to stay safe during a likely winter surge. Heads up: this fall’s booster will be the last one given free of charge to the public because Congress blocked further Coronavirus funding earlier this year.
   
As COVID-19 evolves, science serves us well in keeping up with it. That is good.
 
Barbara Hemmendinger, MSS, a member of the Lycoming County Health Improvement Coalition and a retired family medicine educator, belongs to Let’s End COVID!.  She urges readers to consult their healthcare providers for more information about COVID-19 vaccines.
Published Sept. 3, 2022

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