I had a chance to get a booster shot. I passed.
The science is clear that the data are still too murky.
Everyone needs a coronavirus vaccine.
Immunocompromised people and the "oldest old" need an additional dose.
As for the rest of us? We need more data.
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In July, I flew out to California to visit family for 3 weeks. It was also a chance for me to finish some research on vaccines, excess deaths in young adults, and do some writing.
While I was there, I was asked to help an acquaintance with a compromised immune system try to get a 3rd shot of the Pfizer coronavirus vaccine. We went around to several pharmacies and pop-up vaccination centers in the area in an ill-fated attempt to help him get a 3rd dose of the Pfizer coronavirus vaccine. (This was before the US Food and Drug Administration authorized a 3rd dose for people with weakened immune systems, including people who take medications to prevent organ transplant rejection, and certain subsets of cancer patients, among others.)
By then, I had seen enough data to know that people with profoundly suppressed immune systems who had received two doses of the mRNA vaccines (and probably those who had received one dose of Johnson & Johnson’s adenovirus-based vaccine) too frequently did not generate adequate immune responses to the usual 2-jab series. Their antibodies and T cell levels were often way too low, which indicated that they remained at high risk of developing severe illness, being hospitalized, or dying if infected with SARS-CoV-2. A 3rd dose seemed to make a big difference. While the studies were not large enough to detect clinical differences, the idea made sense and it only applied to a small number of people.
We failed to get a 3rd dose for my friend. No vaccine distribution site would allow a 3rd dose. The sites could see the first two doses in the California state database. They did not want to get into trouble. They were waiting for the FDA to authorize 3rd doses for immunocompromised people.
Suddenly, I had a realization. Even though I could not manage to help a person who genuinely needed a 3rd dose, I myself could get a booster dose! I had been vaccinated twice, but in Massachusetts. But these California vaccine workers had no record of my vaccination status, and they had no way of getting it. I didn’t have my vaccine card with me—and even If I did, I certainly wasn’t going to show them! I simply could have just said I wanted my 1st dose and rolled up my sleeve. They never would have been the wiser.
Here’s why I didn’t.
As yet, I have no way of knowing what the risks and benefits of a 3rd dose for someone like me are. While we know that antibody levels fall over time and that the Delta variant evades those antibodies a little better than its predecessors, we do not have good “correlates” to the most important outcomes. Do lower antibody levels in the face of Delta really reduce the risk of developing severe illness, hospitalization, and death for healthy people in their early 40s like me? We don’t know.
Meanwhile, is it possible that a 3rd dose of the vaccine could cause a clinically important adverse event, like myocarditis? It’s reasonable to worry about this. When I queried the CDC’s Vaccine Adverse Reporting System just now, I found that myocarditis has been reported 2.4 times more often after the 2nd dose of a Covid-19 vaccine than after a 1st dose. Also, the lengths of hospitalization in cases of myocarditis after 2nd doses have been over twice as likely to exceed 3 days (10% of cases) compared to hospitalizations after the 1st dose (4.5% of cases). If myocarditis after the 2nd dose of a coronavirus vaccine is both twice as common and twice as likely to cause a hospital stay lasting 4 or more days, what might we see after 3rd doses? Nobody really knows.
Of course, the risk of vaccine-related myocarditis is quite age-dependent. While I emphasize that myocarditis after coronavirus vaccination remains rare, the risk is by far the highest in people ages 18-29, more frequently occurring in males; around 80% of the cases have been reported in males under age 50. Meanwhile nearly 80% of Covid-19 deaths (almost all of which have occurred in unvaccinated people) have been in people ages 65 and over.
Assuming myocarditis is the most substantial side effect we need to worry about, I’d speculate (and this is a straight-up guess) that if any statistical decrease in vaccine effectiveness is detected among people over 65—and maybe even among those ages 50 and up—the benefit of a 3rd dose is indeed likely to far exceed any associated vaccine-related risks. But if you want me to opine on what we might see in people under 50, I’m going to disappoint you, because I haven’t the foggiest idea. I’d just be throwing darts in the dark.
That’s why I decided to do the right thing and not bamboozle the wonderful vaccine workers in California. Not to mention, I don’t think I could live with myself being a “do as I say, not as I do” type of doctor.
So, I’m waiting for the science on boosters, just like we waited for the science on the original vaccine protocols that led to FDA authorization. It’s the smart thing to do. And it’s the right thing to do.
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Where do you come down on boosters? Do you have questions or concerns? Leave a comment!