> Current vaccines with a booster are effective at preventing hospitalisations
From the second part of the article:
> Meanwhile, the latest research from South Africa, New York City and California show that the vast majority of people hospitalised by the COVID-19 Omicron variant are unvaccinated – but that they still experienced less severe disease than those infected with Delta.
Comparing the 3rd and 4th waves in SA, hospitalizations dropped by 72%, ICU admissions dropped by 89%, and deaths dropped by 90% in South Africa even though, per the article, "82% of those hospitalised during its Omicron-fueled fourth wave were unvaccinated."
Similar trends are being seen everywhere so I think it's legitimate to question the magnitude of any benefit from boosters vis-a-vis the hospitalization endpoint, particularly for people who are not in high-risk groups. Are the boosters really responsible for a meaningful reduction in hospitalizations among the already vaccinated, or is the reduction in hospitalization a result of the initial 2-dose vaccine series? Even the WHO casts doubt on the boosters here[1]:
> To date, the evidence indicates a minimal to modest reduction of vaccine protection against severe disease over the 6 months after the primary series. Waning of effectiveness against all clinical disease and infection is more pronounced.
Antibodies aren't the end-all and be-all of immunity and protection. There's plenty of reason to believe (and some data showing) that the cell-mediated immunity from the initial 2 shots is long lasting and provides substantial protection against bad outcomes, even against omicron. What cell-mediated immunity doesn't do is prevent you from getting infected. But, clearly, given the situation in places like the US and Israel, where boosters are being given, antibodies generated by original vaccine boosters aren't doing a great job at preventing infection either.
On a tangential note, I think a lot of people are concerned about long COVID but it's pretty remarkable that at this stage of the pandemic and vaccination campaign, we still don't have a clear answer as to whether vaccination even reduces long COVID risk, or by how much[2].
>Especially considering that the current booster shots are proven to be quite ineffective against the Delta and even less against the current Omicron mutation. Seemingly all of the risk, with none of the benefit.
Quite the opposite. The study in South Africa showed a 70% protection against hospitalisation from Omicron, the level is even higher for Delta.
There are unvaccinated, uninfected people...and then there is everyone else. Once you have been infected or vaccinated, the difference between is so small as to be academic. And as the authors note, the importance of natural infection increased over time, as the virus escaped the vaccines:
"Importantly, infection-derived protection was higher after the Delta variant became predominant, a time when vaccine-induced immunity for many persons declined because of immune evasion and immunologic waning."
To your other claim:
> other CDC studies suggest that natural immunity declines quicker than vaccine induced immunity
No. That's not what that study said. First, it followed symptomatic infection, not severe illness. As we're seeing now, Omicron pretty handily bypasses vaccine-induced immunity to cause minor illness.
Also, methodologically, the study you're citing was bad. It only gave credit for natural immunity to those people with confirmed infections, which was/is an underestimate, and made vaccines look more effective than they are. A substantial fraction of the "only vaccinated" group almost certainly had undiagnosed covid infection.
> Conclusions: History of primary-series vaccination enhanced immune protection against omicron reinfection, but history of booster vaccination compromised protection against omicron reinfection. These findings do not undermine the short-term public health utility of booster vaccination.
That last sentence seems odd.
From the full paper:
> These findings do not undermine the utility of booster vaccination in the short-term, but may point to potentially significant public health complexities requiring fine-tuning of booster vaccination to those who can best benefit from it, such as those most clinically vulnerable to severe COVID-19.
After following this stuff long enough, it's hard not to wonder if the authors actually believed that statement in the abstract or just put it in there because they didn't want to ruffle feathers.
The paper says pretty much nobody has a severe reinfection, and that a booster makes it more likely that you'll get reinfected. If severe reinfection is mostly out the window, then it seems plausible that the next best goal is reducing reinfections period.
Vaccine efficacy for 3rd dose, out of Ontario, is somewhere in the 30-40% range. In Denmark, secondary attack rate for 3 doses is essentially equivalent to being unvaccinated. This is the latest data we have.
In the UK, December 28, 2021:
> efficacy of a third dose of a COVID-19 vaccine waned significantly at the 10-week mark, leaving boosted individuals at risk of infection with Omicron....In a December 23 U.K. Health Security Agency (HSA) technical briefing, vaccine efficacy against symptomatic infection generally fell to around 40% some 2.5 months after a booster dose.
Also from the UK (January 6, 2022): vaccine effectiveness against symptomatic infection, 2-4 weeks after dose 3, is essentially equivalent to effectiveness after dose 2:
> data just released from Denmark (where 85% of infections are omicron) show no effect of the booster against being infected and no difference between 2 and 3 doses against severe disease except 3 doses better against severe disease for those >70.
The overall picture is of a vaccine that is temporarily elevating antibody levels, which then decline rapidly. But this isn't unexpected. It's exactly what we thought would happen. Moderna CEO, January 6, 2022:
> Bancel said the efficacy of boosters will probably decline over the course of several months, similar to what happened with the first two doses.
...but don't worry! Because the good news is that we have really solid data that after only two doses, even high-risk people remain well-protected against severe disease:
> Among 1,228,664 persons who completed primary vaccination during December 2020–October 2021, severe COVID-19–associated outcomes (0.015%) or death (0.0033%) were rare. Risk factors for severe outcomes included age =65 years, immunosuppressed, and six other underlying conditions. All persons with severe outcomes had at least one risk factor; 78% of persons who died had at least four.
> Why do you believe that you're any more at risk in this situation if you're boosted?
Covid spreads far more easily indoors. Breakthrough cases are becoming more common. Group immunity through boosters (or exposure) is more effective at preventing the spread of covid and reduces the chance that any one individual will catch COVID (and continue to spread it).
> Cell-based immunity remains intact without boosters and is key to preventing hospitalization/death.
Source? And further, preventing hospitalization and death is great - but we should aim to do better, preventing sickness, stopping the spread, reducing the chance of mutation etc which is what the vaccines (initial and boosters) enable.
ETA: in another of your comments you cited an article with this conclusion:
"Across the age groups studied, rates of confirmed Covid-19 and severe illness were substantially lower among participants who received a booster dose of the BNT162b2 vaccine than among those who did not."
and still somehow came to the conclusion that not getting boosted is better for society.
Maybe if youre boosted and its been 14 days but not greater than 45 days. But citation needed anyway. Natural immunity was not totally bypassed. South Africa kicked Omicron's ass with regard to case fatality rate.
> But until then, repeated boosters seem like the answer
I think this sort of group think mentality is increasingly detrimental.
I keep hearing that “we need to boost” without people really weighing up the nuances and tradeoffs for such a policy.
The reality is Israel has shown that second boosters don’t really improve immunity all that much [1]
That vaccine induced myocarditis rates are now higher than covid induced rates [2]
That healthy people statistically are less likely to have serious disease, especially so if they have had primary vaccination and that modelling suggests that the omicron wave in the west will be on the downtrend, following the UK, shortly. Inferring that most people will have been exposed to the virus and built their own immunity [3].
So given this information, and considering I had an adverse reaction from my vaccination, why would I listen to this idea that “boosters are the answer” when there is mounting evidence everywhere that this maybe isn't a good idea for everyone?
We need to shake this idea that they are the only sensible answer because they have had real costs for some people.
> Boosters for last year’s virus makes less sense.
The antibodies elicited in response to the booster, 6 months later, are different and more diverse in their neutralization capabilities than the ones elicited in response to the first shots.
Although it is likely an omicron-tuned booster would be more effective, time is of the essence and there is both evidence and a reasonable explanation as to why the original booster works. Specifically, the immune system is not static and also changes over time.
Here is a presentation by a virologist on the research his team performed that leads to this conclusion (amongst other lines of research) https://www.youtube.com/watch?v=LIcaSqQFrX0
> They show around 70-80% protection (with 3 doses for Omicron, 2 for earlier variants)
That protection level lasts for about two months and then nosedives to uselessness[0].
If we keep pumping people with boosters, the manufacturers and the media aren't going to be able to keep suppressing reporting about the resulting heart issues the mRNA vaccines cause in many people[1].
Again, the vaccines are astoundingly leaky and were designed for a variant of the virus that hasn't existed in any meaningful way for a while.
People with only natural immunity from any variant are shown to have much better protection than mRNA vaccinated and boosted people[2].
> I don't think that's true. Vaccination is still beneficial to infection.
The virus changed, thanks to Omicron not even the WHO agrees with that claim.
"Vaccine-induced immunity following a primary vaccine series is modest against infection due to Omicron in the months after vaccination, and wanes significantly over time. Vaccine-induced immunity against Omicron-related mild symptomatic disease, asymptomatic infection, and viral shedding is also modest and short-lived even following a booster dose."
> Yes the vaccine does improve outcomes BUT the hospitalization rate for unvaccinated people is still lower with Omicron than previous variants.
In this very specific demographic. Other countries will have different outcomes, as seen with the current state of the pandemic (looking at Europe, for example).
Correpondence published in NEJM regarding the landmark study that found that the first booster dose reduced Covid-related mortality by 90%. It turns out that it also reduced non-Covid-related mortality by a similar amount. So either the booster short is a magic elixir that reduces all deaths, or the boosted, as a group, were healthier at the outset.
In the response of the original authors they mention that
> However, boosters were generally not administered to hospitalized patients who were at high risk for death from any cause.
I think you can guess how it affected the hospitalization and death rates of the boosted vs. the unboosted. For some reason, this was not mentioned in the original study.
And the main point mentioned by the original authors in their response:
> However, a strong, unexplained association between the use of the booster and lower mortality not related to Covid-19 remains.
> During the B.1.617.2 (delta) wave in the United States, similar associations were observed between the use of mRNA vaccines and lower mortality not related to Covid-19 and mortality from any cause.
> And as it has now been widely reported, vaccinated can not only catch covid, they have the same viral load as unvaccinated and can infect others.
They have the same viral load if they get infected. But the mRNA vaccines still reduce the chance of being infected by about 80% (according to [1]), which in effect reduces the chance of infecting others.
> And the vaccine is waning off in 3-6 months.
Its effectiveness goes down, but it would likely take years for it to go to zero. Regardless, that's what booster shots are for.
> There's a huge population in the world which can't even get their first dose of vaccine while here we are giving out 3rd doses.
> This risk doesn't get reduced by 10. Which is why the booster is required.
Incorrect. There is no evidence of reduction in efficacy against severe illness or death.
As Paul Offit said in the New York Times article that I linked and quoted above, which you clearly didn't bother to read:
> Boosters are likely to provide the best protection against infection with Omicron. But for most healthy young people, the original two-shot series — or one dose of Johnson and Johnson — should be sufficient to prevent hospitalization and death, Dr. Offit said. If that’s the purpose of vaccination, then “these vaccines continue to hold up,” Dr. Offit said.
> Covid spreads far more easily indoors. Breakthrough cases are becoming more common. Group immunity through boosters (or exposure) is more effective at preventing the spread of covid and reduces the chance that any one individual will catch COVID (and continue to spread it).
I'm not aware of any data saying that group immunity through boosters has significantly stronger effect than boosting itself or than group immunity through the original vaccination. Care to share that? My priors are that group immunity among boosted individuals would be very mildly better, but I'm not aware that that study has been done.
When we evaluate policy decisions, we should base those decisions on quantifiable tradeoffs, not simply on whether there is benefit to a policy. At some point, the diminishing returns of marginally increased safety are not worth the societal costs. To me, given the current data, it seems we're at that point for vaccination.
As to the other comment thread, I'm happy to address any questions you have there, in order not to repeat the discussion here.
> Looks like the vaccine creates a broader set of antibody responses than natural infection does.
That was the theory, but it is not being borne out by the actual data. See below.
> If you want the population to be protected against the next wave of illness, this is the way to go.
The data coming out of the UK and Israel does not support this claim. Their populations are already vaccinated and boosted at percentages much higher than those in the US, but those vaccinated and boosted people are still getting infected and are still being hospitalized and dying in significant numbers.
If you are under 65 and not immune compromised, there's essentially no evidence for this claim.
If you are either of those things, there's some evidence that it takes your risk of severe illness (already low after vaccination), and divides it by another factor of ~20 [0]. That's great, but it's a tiny absolute effect, and we shouldn't over-sell it.
If you're under 65, there's essentially no evidence supporting widespread use of boosters, and the CDC ACIP was against recommending it for all people [1] (but was ignored by politicians). The WHO continues to ask rich countries not to give boosters to healthy young people, given lack of evidence. [2]
Not incidentally: your two tweets discuss infection, not severe illness. All current evidence is that you're well-protected against severe disease after two shots. Paper in the lancet as of last week found that boosters had a marginal impact on cellular immunity, with the primary benefit being antibody response. [3] Again, fine, but we know that antibody response wanes over time. It's completely unsurprising that you'd have more antibodies two weeks after vaccination. You'll have far lower antibodies 9 months from your third dose, too.
> a mRNA 3rd dose cuts your chances of bad outcome (severe illness, hospitalisation) from omicron or previous variants to a lot lower than 2 doses ever did.
Literally no evidence for this statement. We simply don't know anything about Omicron and boosters.
I just skimmed the concluding paragraph to see what this is about but this is patently false: "I recall a conversation with a family member some months ago, when Omicron was a big thing in the media. My family member, a retired boomer and avid consumer of CNN and Fox News and MSNBC was entirely unaware that exposure to covid itself was bound to confer natural immunity with equal or better protective effects than any vaccine."
Yea, post-infection immunity can generate all kinds of results, some better than the vaccine and some worse. Up to a third do not generate usable antibodies post-infection. Most importantly, to gain this protection, you must survive infection which may win you a ticket to being disabled with Long COVID or a ferry ride across the river Styx.
Of course, at this point it should be pointed out that the vaccine gives good results against hospitalization, but if you want ~70% protection from infection from Omicron for 10 weeks (declines after that, probably not to zero though), you need to be boosted.
From the second part of the article:
> Meanwhile, the latest research from South Africa, New York City and California show that the vast majority of people hospitalised by the COVID-19 Omicron variant are unvaccinated – but that they still experienced less severe disease than those infected with Delta.
Comparing the 3rd and 4th waves in SA, hospitalizations dropped by 72%, ICU admissions dropped by 89%, and deaths dropped by 90% in South Africa even though, per the article, "82% of those hospitalised during its Omicron-fueled fourth wave were unvaccinated."
Similar trends are being seen everywhere so I think it's legitimate to question the magnitude of any benefit from boosters vis-a-vis the hospitalization endpoint, particularly for people who are not in high-risk groups. Are the boosters really responsible for a meaningful reduction in hospitalizations among the already vaccinated, or is the reduction in hospitalization a result of the initial 2-dose vaccine series? Even the WHO casts doubt on the boosters here[1]:
> To date, the evidence indicates a minimal to modest reduction of vaccine protection against severe disease over the 6 months after the primary series. Waning of effectiveness against all clinical disease and infection is more pronounced.
Antibodies aren't the end-all and be-all of immunity and protection. There's plenty of reason to believe (and some data showing) that the cell-mediated immunity from the initial 2 shots is long lasting and provides substantial protection against bad outcomes, even against omicron. What cell-mediated immunity doesn't do is prevent you from getting infected. But, clearly, given the situation in places like the US and Israel, where boosters are being given, antibodies generated by original vaccine boosters aren't doing a great job at preventing infection either.
On a tangential note, I think a lot of people are concerned about long COVID but it's pretty remarkable that at this stage of the pandemic and vaccination campaign, we still don't have a clear answer as to whether vaccination even reduces long COVID risk, or by how much[2].
[1] https://www.who.int/news/item/22-12-2021-interim-statement-o...
[2] https://www.nature.com/articles/d41586-021-03495-2
reply