Vaccination programs are currently rolling out not just nationwide but across the globe, vaccinating millions per day. And as many of us receive our chance back at normalcy, cities and states are following suit by relaxing social distancing and quarantine measures. Slowly but surely it seems, cities across the nation are waking back up. It very much feels as if we are seeing a global light at the end of this pandemic tunnel. But just as we feel so close to reaching that light, speculations on possible booster shots have thrown shadows across our paths. Does this mean we aren’t as near to the end as we thought? Some experts are discussing a possible need for booster shots as early as six months after vaccination, with others going even further and suggesting a need for annual COVID shots. Are booster shots a necessary step in returning to normalcy? If so, how do we protect ourselves in the interim between vaccination and booster?
So why might a booster shot be necessary in the first place?
The COVID-19 pandemic has now been raging across the globe for over a year. And the more time a virus is given to grow and expand, the more time it is given to mutate. Mutation of a virus doesn’t always mean something bad. In fact, many mutations may actually be harmless, maybe even helpful. A virus might mutate in such a way that it makes it less transmissible or less virulent. But viruses can also mutate to create new variants that can be much more harmful or dangerous than the original strain. For example, the variant that was discovered in the UK, B.1.1.7, is a more transmissible variant of COVID-19. More than 200,000 cases of B117 have been identified in the UK and it has spread to more than 50 countries, including the US. In fact, B117 is now the most common variant found in the US, and unfortunately with it having been exposed so far and wide, it looks as if it will be mutating again. There are new, more virulent and therefore more dangerous variants that have been found in the UK, India, South Africa, and Brazil. And each of these variants have spread to at least a dozen or more countries.
These variants are what make a possible need for a booster shot. These new strains are called variants because they have all undergone changes—variations—to their spike protein, the part of the virus which attaches to human cells. These spike proteins are also what the current vaccines were based off of. The current COVID vaccines were built around the original COVID-19 strain’s spike proteins and in the case of mRNA vaccines, it is those exact spikes the vaccines are teaching the body to replicate and protect itself against. But if the variants have different spike proteins, our bodies might have a harder time recognizing and mounting a defense against them. A booster shot, engineered to accommodate for these new variants, could help extend the protection of our vaccines.
But before we rush out in demand for booster shots, it’s worth noting most medical experts seem hesitant on definitively stating whether we will or won’t need a booster shot. Early testings are showing that the current vaccines have proven to offer substantial protection against these variants. And according to Dr. Anthony Fauci, the chief White House medical adviser, “We know that the durability [of the vaccine] is at least six months, likely a year.” Center for Disease Control director Rochelle Walensky has an even longer term confidence in the vaccines, “What we’re talking about is thinking ahead. What happens if in a year from now or 18 months from now your immunity wanes?” With how new the virus is and how much newer the vaccines are, there aren’t very many long term studies done on the length of efficacy of the vaccines. But there are studies currently being conducted to measure how well the vaccines hold up over time. And it might very well be the case that the vaccines we currently have will be sufficient for a lengthy amount of time without a majority of us needing any kind of booster. So while the heads of Pfizer and Moderna are leading the call for booster shots, many health experts are choosing a more cautious road. And there are logistical and ethical reasons behind their conservatism.
A large reason for their caution against booster shots is the current distribution of vaccines. Right now, the world’s wealthiest countries have captured the overwhelming share of vaccine supplies. Only 0.3 percent of the vaccine doses administered globally have been given in the 29 poorest countries, which are home to about 9% of the world’s population. Even with Moderna, Pfizer, and Johnson & Johnson ramping up production, making hundreds of millions of doses of vaccine per month, it is nowhere near enough to supply the world. About 11 billion shots are needed to vaccinate 70% of the world’s population, the rough threshold needed for herd immunity, according to Duke University. Yet, only a small fraction of that has been produced. If the major pharmaceuticals now turned their focus onto creating booster shots and then began pushing their manufacturing towards creating booster shots, during a time when there is still such a shortage of the original vaccines, only the wealthy countries would benefit. And the poorer countries would still be without any protection. How much protection can a booster shot offer to someone who had not received the original vaccination? And by this model, the booster shot is rendered useless as well to those in the wealthier countries. If COVID-19 and all its variants are still running rampant in the poorer countries, giving it time and supply to continue to multiply and mutate, then regular booster shots would become inevitable. But if the current vaccines were better supplied to the poorer countries, this kind of wider inoculation could possibly better protect all of us than a booster shot ever could.
There are many arguments on how this kind of health crisis can be solved. Some are arguing for the large pharmaceuticals to waive their vaccine patents and to release their manufacturing information so that more companies can help manufacture the precious commodity. But many international trade organizations oppose such ideas, including the European Union. A more likely route is to encourage wealthier nations in donating their supplies to the poorer countries, educating the wealthier nations that such a donation is in fact in their favor. The world is only vaccinated at the pace of its slowest nation. So the quicker the world is vaccinated, the quicker normal trade and normal life can return.
But these are all very big picture, meta arguments for and against booster shots. Let’s just assume the vaccine’s lifespan proves to be shorter than we anticipated and booster shots become necessary.
What can we do to protect ourselves?
Some countries may actually already be taking the steps to help lengthen the life of your vaccine, keeping you safer longer. Studies from the UK have shown that having a longer gap in between the two vaccine doses can increase the overall effectiveness of the vaccine and increase the protection term. In a study of 175 recipients, researchers waited 10-12 weeks between doses instead of the originally prescribed 3-4. The study found that peak antibody levels were 3.5 times higher in those who waited twelve weeks for their second shot than in those who waited only three. This kind of longer gap in between doses is also beneficial for countries facing a vaccine shortage. Implementing a longer wait in between doses can help as a country beefs up their vaccine supplies without any risk or loss of protection for their citizens.
But this kind of increasing of gap time between doses isn’t something a regular citizen can demand, if their country isn’t already implementing such a program. Is there something we can do ourselves to help boost our immune systems till a booster shot is needed or available? What about protecting one’s immune system?
There is a pervasive misconception on how immunity and our immune system works. Many people think that when they get a cold and they feel the symptoms of their cold—cough, fever, or fatigue—that that is a sign of a weak immune system. But in fact, that is exactly the sign of a normal immune response. Those are the symptoms of a body fighting back against an infection or virus. Immune systems shouldn’t be ‘stronger’; it should be balanced. Too much of an immune response is just as bad as too little. Allergic responses are an example of an immune response that has gone overboard.
The best way to have a healthy, balanced immune system is to follow some basic healthy lifestyle choices. Eating healthy, exercising regularly, and getting good sleep are the best ways to balance and maintain a healthy immune system. No amount of vitamins or extra supplements can replace good diet and good sleep.
But we can also protect ourselves beyond our natural immune responses. If you’ve been vaccinated, we are now afforded a bit more freedom than during the height of the pandemic. And we can use that freedom to better take care of ourselves. We can exercise or enjoy more of the outdoors, activities both good for our physical and mental health which will strengthen our body’s overall well being. And while we wait for either a booster shot or for wider global inoculation, we can follow the simple, common sense rules we’ve been following the last year. What kept us safe in 2020—social distancing, regularly washing our hands, mask wearing—is still some of the best ways to keep ourselves safe in 2021.
Testing methods have also improved since the start of the pandemic. If you near the six or twelve month mark of your vaccine and you are feeling nervous, better tests have been coming out regularly that can test for antibody levels. Finding out your protection levels can help better inform you on how to keep yourself safe.
And finally, in the thick of things in 2020, many of us had no idea when or if a vaccine was coming around the corner. And while we hoped and prayed for one, we all tried to do the best we could for ourselves and our neighbors—we followed quarantine measures, we wore masks, we social distanced. Even a year later, this is still all new terrain and no one yet can say for sure if a booster shot will be needed or necessary in the future. But we are already well-versed in how to protect ourselves in the interim if need be. If the era of COVID has taught us anything, it’s that we can’t predict the future. We can only focus on the now and do what is best for us in the moment.