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> Available evidence emerging from Israel and the UK shows a significant increase in protection against infection and severe disease following a booster dose in

> Available evidence emerging from Israel and the UK shows a significant increase in protection against infection and severe disease following a booster dose in all age groups in the short term So, I’ll admit I don’t understand the physiological mechanisms at play (is it just waning antibody concentration?) but what is the long term strategy here? Is there going to be annual boosters with vaccine passports? The governments are not exactly being transparent and I think it is time now that things are under relative control to start having adult discussions and public policy debates once more.

retrac 5y ago
Well, maybe three will actually do it. There's quite a few vaccines which require a course of three or even four shots to confer lasting long-term immunity. If you don't do the full course with repeat challenge it tends to fade after some months or years.
tjoff 5y ago
Surely the answer is: we don't know. And, we'll see. For now I feel short term is a reasonable focus.
- xdennis 5y ago
  Hundreds of million of doses have been administered and "we don't know, we'll see". Seems foolhardy.
  - kenhwang 5y ago
    "You can't produce a baby in one month by getting nine women pregnant." Sometimes understanding long term effects requires long term observation.
  - belltaco 5y ago
    The hundreds of millions of doses haven't been administered to the same person.
  - soneil 5y ago
    It's more .. not letting perfect be the enemy of good enough. The longevity of the vaccine has been the only real disappointment so far - the results have been otherwise fantastic. So do we give up fantastic results while we wait to see if they'll find something with better longevity?
bryan0 5y ago
We don’t know the long-term strategy. We’re literally looking at the data coming out of Israel month-to-month to determine how long the boosters will be effective.
- guerrilla 5y ago
  Why only Israel?
  - spullara 5y ago
    They have the highest vaccination rates the earliest.
    - guerrilla 5y ago
      Do you happen to know how they manage that ahead of the small northern European countries?
      - jsnell 5y ago
        They paid Pfizer a lot more per dose than other countries. There were also reports that they were willing to share data on outcomes more freely (or less bureaucracy) than normal.
      - bryan0 5y ago
        https://amp.theatlantic.com/amp/article/617780/ https://amp.theatlantic.com/amp/article/617780/ Basically they negotiated to be Pfizer’s testbed / data partner for full rollout of the vaccine.
      - ars 5y ago
        They are very very small, so when supplies were tight it didn't take many doses to fully vaccinate them, and then they are the lab test of the world. They are WAY smaller than even the small northern European countries. They also have a very integrated very high tech medical data system, with complete info on each person, medical history, doses, everything in one file.
mytailorisrich 5y ago
They've been saying from the beginning that vaccines only offer short term immunity and that the virus will be mutating (hence potentially making current vaccines ineffective) so that we might end up in a scenario similar to the flu. Now, I suppose that whether large scale booster programs, vaccine passports, etc will continue will simply depend on how widespread and serious the virus remains. So no-one knows for sure. We might end up with combined flu/covid vaccines recommended annually for the vulnerable.
- bryan0 5y ago
  coronaviruses do not mutate as quickly as influenza so it’s a bit of a different situation. The 3 dose mRNA + booster is all the same exact vaccine. That being said, maybe we will need annual boosters which we get with a combined flu shot.
  - mytailorisrich 5y ago
    > The 3 dose mRNA + booster is all the same exact vaccine Yes, currently it is. But that may change at any time.
  - tdrdt 5y ago
    They mutate 2 gnomes/month. So we already have thousands of mutations. But changes we call variants happen much slower. Still, the vaccins are based on the 2019 variant.
chrononaut 5y ago
The likely scenario is no one actually knows what the future will hold yet, so they're only basing policy on what they have learned thus far, and changing as the situation develops when it doesn't match their expectations. Not sure if there's anything else one can do.
mlyle 5y ago
> (is it just waning antibody concentration?) Two notable mechanisms: * The booster shot does increase antibody concentrations and recruits more memory B cells to make antibodies. * Each booster also significantly increases the diversity of the immune response. You get more antibodies against the antigen, and you also get many more antibodies against things kind of like the antigen. > but what is the long term strategy here? Is there going to be annual boosters That's a really good question. I personally believe (based on little evidence at this time) that each dose provides some small permanent increase in protection against infection, and a somewhat larger permanent increase in protection against severe illness. So as we go through this whole exercise, a greater proportion of the population is protected and people are less likely to be carriers. In turn, it becomes easier to leave things up to individual choice, as the overall baseline risk reduces and people's choice mostly affects their own health. > and I think it is time now that things are under relative control to start having adult discussions and public policy debates once more. Yes. Look, I don't want to wear masks forever indoors. I think it'd be great to normalize it for when we're feeling under the weather or it's flu season, but I also want to be able to see other peoples' faces and carry on normal conversations.
- throwaway894345 5y ago
  > So as we go through this whole exercise, a greater proportion of the population is protected and people are less likely to be carriers. I suspect we should also be vaccinating the wider world in order to minimize mutations which might nerf our vaccine and natural immunity. I’m of the impression that most of the world doesn’t hasn’t had even a single dose. That said, last I checked, the US had donated more vaccine than all other countries combined and committed itself to many times more donations than it had already delivered. Further still, it was committed to building out the logistics infrastructure to make sure those vaccines get delivered and in such a way that other polities (e.g., Europe) can donate via that same infrastructure. Now we just need other polities to step up their donations.
  - closewith 5y ago
    > I’m of the impression that most of the world doesn’t hasn’t had even a single dose. It's very unevenly distributed, but it looks like we're at ~55% with a single dose and ~43% fully vaccinated: https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html https://www.nytimes.com/interactive/2021/world/covid-vaccina...
AshamedCaptain 5y ago
There are vaccines for which after a couple boosters we consider the lifetime immunity to be acceptable; there are others for which we do not. Many variables at play (including actual infection rates, mutation rates, etc), so hard to predict.
13415 5y ago
Annual boosters for all volunteers or annual boosters for risk patients seem to be the most likely future strategy, depending on the approach of the local health authorities and the number of infections in the future. Just like with influenza, and it's probably going to be combined with the influenza shots.

retrac 5y ago

Well, maybe three will actually do it. There's quite a few vaccines which require a course of three or even four shots to confer lasting long-term immunity. If you don't do the full course with repeat challenge it tends to fade after some months or years.

tjoff 5y ago

Surely the answer is: we don't know. And, we'll see. For now I feel short term is a reasonable focus.

xdennis 5y ago
Hundreds of million of doses have been administered and "we don't know, we'll see". Seems foolhardy.
- kenhwang 5y ago
  "You can't produce a baby in one month by getting nine women pregnant." Sometimes understanding long term effects requires long term observation.
- belltaco 5y ago
  The hundreds of millions of doses haven't been administered to the same person.
- soneil 5y ago
  It's more .. not letting perfect be the enemy of good enough. The longevity of the vaccine has been the only real disappointment so far - the results have been otherwise fantastic. So do we give up fantastic results while we wait to see if they'll find something with better longevity?

bryan0 5y ago

We don’t know the long-term strategy. We’re literally looking at the data coming out of Israel month-to-month to determine how long the boosters will be effective.

guerrilla 5y ago
Why only Israel?
- spullara 5y ago
  They have the highest vaccination rates the earliest.
  - guerrilla 5y ago
    Do you happen to know how they manage that ahead of the small northern European countries?
    - jsnell 5y ago
      They paid Pfizer a lot more per dose than other countries. There were also reports that they were willing to share data on outcomes more freely (or less bureaucracy) than normal.
    - bryan0 5y ago
      https://amp.theatlantic.com/amp/article/617780/ https://amp.theatlantic.com/amp/article/617780/ Basically they negotiated to be Pfizer’s testbed / data partner for full rollout of the vaccine.
    - ars 5y ago
      They are very very small, so when supplies were tight it didn't take many doses to fully vaccinate them, and then they are the lab test of the world. They are WAY smaller than even the small northern European countries. They also have a very integrated very high tech medical data system, with complete info on each person, medical history, doses, everything in one file.

mytailorisrich 5y ago

They've been saying from the beginning that vaccines only offer short term immunity and that the virus will be mutating (hence potentially making current vaccines ineffective) so that we might end up in a scenario similar to the flu. Now, I suppose that whether large scale booster programs, vaccine passports, etc will continue will simply depend on how widespread and serious the virus remains. So no-one knows for sure. We might end up with combined flu/covid vaccines recommended annually for the vulnerable.

bryan0 5y ago
coronaviruses do not mutate as quickly as influenza so it’s a bit of a different situation. The 3 dose mRNA + booster is all the same exact vaccine. That being said, maybe we will need annual boosters which we get with a combined flu shot.
- mytailorisrich 5y ago
  > The 3 dose mRNA + booster is all the same exact vaccine Yes, currently it is. But that may change at any time.
- tdrdt 5y ago
  They mutate 2 gnomes/month. So we already have thousands of mutations. But changes we call variants happen much slower. Still, the vaccins are based on the 2019 variant.

chrononaut 5y ago

The likely scenario is no one actually knows what the future will hold yet, so they're only basing policy on what they have learned thus far, and changing as the situation develops when it doesn't match their expectations. Not sure if there's anything else one can do.

mlyle 5y ago

> (is it just waning antibody concentration?) Two notable mechanisms: * The booster shot does increase antibody concentrations and recruits more memory B cells to make antibodies. * Each booster also significantly increases the diversity of the immune response. You get more antibodies against the antigen, and you also get many more antibodies against things kind of like the antigen. > but what is the long term strategy here? Is there going to be annual boosters That's a really good question. I personally believe (based on little evidence at this time) that each dose provides some small permanent increase in protection against infection, and a somewhat larger permanent increase in protection against severe illness. So as we go through this whole exercise, a greater proportion of the population is protected and people are less likely to be carriers. In turn, it becomes easier to leave things up to individual choice, as the overall baseline risk reduces and people's choice mostly affects their own health. > and I think it is time now that things are under relative control to start having adult discussions and public policy debates once more. Yes. Look, I don't want to wear masks forever indoors. I think it'd be great to normalize it for when we're feeling under the weather or it's flu season, but I also want to be able to see other peoples' faces and carry on normal conversations.

throwaway894345 5y ago
> So as we go through this whole exercise, a greater proportion of the population is protected and people are less likely to be carriers. I suspect we should also be vaccinating the wider world in order to minimize mutations which might nerf our vaccine and natural immunity. I’m of the impression that most of the world doesn’t hasn’t had even a single dose. That said, last I checked, the US had donated more vaccine than all other countries combined and committed itself to many times more donations than it had already delivered. Further still, it was committed to building out the logistics infrastructure to make sure those vaccines get delivered and in such a way that other polities (e.g., Europe) can donate via that same infrastructure. Now we just need other polities to step up their donations.
- closewith 5y ago
  > I’m of the impression that most of the world doesn’t hasn’t had even a single dose. It's very unevenly distributed, but it looks like we're at ~55% with a single dose and ~43% fully vaccinated: https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html https://www.nytimes.com/interactive/2021/world/covid-vaccina...

AshamedCaptain 5y ago

There are vaccines for which after a couple boosters we consider the lifetime immunity to be acceptable; there are others for which we do not. Many variables at play (including actual infection rates, mutation rates, etc), so hard to predict.

13415 5y ago

Annual boosters for all volunteers or annual boosters for risk patients seem to be the most likely future strategy, depending on the approach of the local health authorities and the number of infections in the future. Just like with influenza, and it's probably going to be combined with the influenza shots.