Covid Boosters and Public Health

 The news regarding covid vaccines continues to accumulate every day. The latest installment in the United States is whether or not boosters should be available based on data that shows declining levels of neutralizing antibodies after the initial vaccination effort early this year. The Biden administration announced that part of their plan to respond to the ongoing Covid-19 pandemic will be to provide boosters because of this finding. Cue the controversy.

We should first acknowledge that refusal of many Americans to get vaccinated contributed to the huge spike in cases, hospitalizations, and deaths from Covid-19 this summer. The CDC Covid Tracker puts the vaccination rate for the United States yesterday at 55.9%. The real story is the patchwork map of vaccine penetration with many states dismally below that and feeling the full effect of rampant SARS-CoV-2 transmission as a consequence. Idaho’s vaccination rate is 41.3% and their hospitals are in desperate straits, rationing care. Other states such as Florida, Texas, and Mississippi are being slammed because of vaccine refusal.

There is more than ample evidence that Covid-19 vaccines work; even with waning levels of neutralizing antibodies, the vaccines continue to prevent severe disease, hospitalizations, and death. Margan and I were on a CDC/IDSA webinar yesterday where Shane Crotty from the Scripps Institute explained how the long-lasting protection from Covid-19 we see is driven by memory B-cells, T-helper cells (CD4), and T-killer cells (CD8) generated from vaccination. I like to call these “sleeper” cells because they sit dormant but ready to respond if the immune system sees the spike protein from SARS-CoV-2 again. Crotty pointed out that his group has found T-cells that respond to smallpox 8 decades after vaccination and others have reported a similar result in survivors of the 1918 influenza pandemic 80 years after that event. 

At the moment, the easiest thing to measure in the lab, however, is the level of neutralizing antibodies. We have known that these wane after many diseases and immunizations in the past so this is no surprise. But the media in telling the story uses headlines such as this which makes people anxious. This is deceptive journalism no matter its source. Journalists themselves rarely write the headlines for their work. In the era of social media, this is worsened as many people read only the headline to a story and the purpose seems to be to get a “click” so that money can be made (clickbait).

Science is a messy process and when it is necessarily telescoped because of a deadly pandemic can become acrimonious and contentious. Hence stories such as these. As we have all been told and told to others, public health must follow science. This has led to criticism of Biden. But Jay Varma has a more realistic idea. Public health has a significant overlap with science but the word public is operative. Public health must take into account people and their needs first and foremost. Epidemiology and infectious diseases and virology and vaccinology are important, but policy enacted by our political leaders should only start with science. Rather than cherry-picking data to suit the scenario, a broad understanding of sociology, culture, history, and politics is necessary to craft reasonable policies. Scientists and physicians may not always agree with policy -- but we are not responsible for making it either. I am in agreement more here with the editorial board of the Wall Street Journal than with the editorial board of the New York Times (!!!) because public health is more than just the science behind it. Rochelle Walensky did make the correct call. Once again, let’s accelerate the parallel work of getting everybody on the planet vaccinated. We can walk and chew gum at the same time.