Will we all need COVID vaccine booster shots?

As more and more people are fully vaccinated around the world, attention has turned to whether or not booster vaccines will be required to maintain immunity and to protect against emerging variants of the COVID-19 virus.

A booster vaccine is designed to strengthen our body’s immune response to an antigen or “foreign invader” that it has been primed to respond to by a previous vaccine. These are commonly used to protect against diseases such as tetanus and polio, where, after time, our immunity against the antigen wanes. Boosters are usually a shot of the same vaccine again, just given at a later date.

Scientists are still studying how long immunity provided by the COVID-19 vaccines lasts, and whether or not they are effective against the new variants of the virus which have already emerged.

We do know that the current batch of vaccines trigger our immune systems to produce cells which protect against severe illness from COVID-19. These include “killer” T Cells, which recognise virus-infected cells and kill them, and so-called “B memory” cells that remember the virus and call the immune system into action should it attempt to infect a person after vaccination. The idea is that these B memory cells will stimulate an immune response that will neutralise the coronavirus before it is able to make you unwell, or at least severely unwell.

We must not let the debate about boosters lead to wealthier countries holding onto millions of doses ‘just in case’. The sooner the world is vaccinated, the less risk of variants emerging and the sooner we can all be safe from the virus. Dr Amir Khan

On July 8, Pfizer-BioNTech announced that it plans to apply for emergency authorisation for a booster dose of its vaccine, stating: “We continue to believe that it is likely, based on the totality of the data we have to date, that a third dose may be needed within six to 12 months after full vaccination.”

Pfizer is just the first to apply for this authorisation: All the COVID-19 vaccine manufacturers are looking into whether booster shots will be needed. After meeting with Pfizer representatives in the US, the Centres for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) released a joint statement saying: “People who are fully vaccinated are protected from severe disease and death, including from the variants currently circulating in the country such as Delta. Americans who have been fully vaccinated do not need a booster shot at this time. FDA, CDC and NIH (National Institutes for Health) are engaged in a science-based, rigorous process to consider whether or when a booster might be necessary… We are prepared for booster doses if and when the science demonstrates that they are needed.”

So far, research shows that the immune response from the existing COVID-19 vaccines remains strong for at least eight months. It is, of course, important to remember that COVID-19 vaccines only really got under way in December 2020, so data about their long-lasting effectiveness is still being gathered and it is likely that as time goes by, we will see that their effects last longer than this.

Many people compare the need for annual booster shots of the COVID-19 vaccines to annual flu shots which many people already receive, but there is a subtle difference. The mRNA COVID vaccines (Pfizer and Moderna) are far more effective than the annual flu vaccine; they can reduce severe illness from COVID-19 by up to 95 percent whereas flu vaccines reduce the risk of illness by between 40 percent and 60 percent. Therefore, the need for COVID booster shots is probably less urgent.

Elsewhere in the world, the European Medicines Agency and the European Centre for Disease Prevention and Control agree that there is not enough data to recommend booster shots for the COVID-19 vaccines at this moment in time. In a statement on July 14, they said: “It is currently too early to confirm if and when a booster dose for COVID-19 vaccines will be needed, because there is not yet enough data from vaccination campaigns and ongoing studies to understand how long protection from the vaccines will last, also considering the spread of variants.”

Health officials in Thailand, Bahrain and the United Arab Emirates have already offered booster shots for people vaccinated with the Chinese Sinopharm vaccine and the vaccine from AstraZeneca. There is a concern that these vaccines may be less effective against the Delta variant and a booster shot may help, though we have not seen any data to show this is true.

The Oxford-AstraZeneca vaccine has been shown to reduce symptoms caused by the Delta variant by 60 percent and to reduce hospitalisations from the Delta variant by 90 percent. There has been no evidence released on variant efficacy by Sinovac Biotech Ltd with regards to their vaccine.

So far, research shows that the immune response from the existing COVID-19 vaccines remains strong for at least eight months.

The UK is taking a different stance on boosters, with the new Secretary of State for Health suggesting that booster shots will be offered by the autumn, based on interim advice from the Joint Committee on Vaccination and Immunisation (JCVI).

In order to measure how long a vaccine will last, it is possible to measure the number of neutralising antibodies in the blood of a vaccinated person to see if it wanes over time.

Assuming the data from studies is correct and new variants do not emerge, it already appears from studies that the vaccines’ ability to stimulate levels of antibodies that protect against severe illness and hospitalisation is much longer-lasting than their ability to protect against getting any symptoms at all. So, a country which is planning an approach that involves “living with the virus” in endemic numbers may simply wish to keep people from getting seriously ill from COVID in order to reduce the burden on hospitals. Countries that want to achieve a level of protection which prevents anyone from getting any symptoms at all will require antibody levels in vaccinated people as much as six times higher. This is why different countries are taking different approaches to offering booster shots.

Of course, all approaches to containing the virus will have to change if a new variant that can evade the vaccines emerges. Then, the need for a “tweaked” booster that has been adapted to neutralise the new variant becomes more urgent. So far, this has not happened. While some of the current batch of variants that have emerged around the world seem to diminish the overall efficacy of the vaccines a little, they do not render them ineffective altogether.

The bottom line is more real-world data is needed, and policy should be driven by data and not pushes from drug companies. The urgency right now is not getting boosters into the arms of those already fully vaccinated, but of getting those across the world who are yet to receive any vaccine at all a jab. We must not let this debate over whether boosters may be required lead to wealthier countries holding onto millions of doses “just in case”. The sooner the world is vaccinated, the less risk of variants emerging and the sooner we can all be safe from the virus.

Prenatal tests developed by the Chinese military being used to collect personal data

A test taken by millions of pregnant women around the world, which has been developed in collaboration with the Chinese military, is being used to collect genetic data without the women’s consent, according to an investigation by Reuters.

The prenatal blood test, developed by the Chinese BGI Group, is offered to millions of pregnant women to screen for abnormalities such as Down Syndrome in early pregnancy. It is used in at least 52 countries including the UK, other countries in Europe, Canada, Australia, Thailand and India, but not the United States.

BGI uses leftover blood samples sent to its laboratory in Hong Kong and genetic data from the tests for population research, the company confirmed to Reuters. Reuters found the genetic data is then stored at the government-funded China National GeneBank in Shenzhen, which BGI operates.

The US government has expressed grave concerns that the amassing of such data could give China an economic and military advantage in the future. Science has shown us that there are proven links between genes and certain human traits, and having access to such large quantities of genetic information could theoretically pave the way for China to genetically engineer human traits in people in the future or even genetically modify bacteria and viruses to affect people in different ways.

[Jawahir Al-Naimi/Al Jazeera]

The US National Security Commission on Artificial Intelligence (NSCAI), led by former Google chief executive Eric Schmidt, has said that China is making strides towards global leadership in biotechnology and artificial intelligence. China’s Ministry of Foreign Affairs said the reporting in this article reflected “groundless accusations and smears” by US agencies.

BGI has confirmed that it stores the data but has not said how many women it has collected genetic data from. It also told Reuters that “personal information” about the women had not been stored.

Reuters reports that the data has been used to examine the prevalence of certain viruses in Chinese women and, more worryingly, to single out Tibetan and Uighur minorities to find links between their genes and their characteristics.

Clearly, there is an issue of consent here, with many of the women from whom samples were taken only likely to think they are consenting to the prenatal tests they have agreed to. Those who may have consented to some research being done on their samples are unlikely to know that their genetic information could end up in China or be used for military purposes.

This debate goes to the heart of testing for scientific purposes and takes the notion of what is in our best interests into the murky waters of politics and military affairs.

In the doctor’s surgery: Asking patients to wear a facemask

When the UK lifted all legal COVID restrictions from July 19, my medical practice in Bradford, northern England, braced itself for some difficult conversations.

It is no secret that wearing a facemask to protect others has become a divisive subject and I frequently have to insist that my patients wear a face covering during consultations with me. I, of course, extend them the same courtesy by wearing mine. This was easy when wearing a facemask was a legal requirement. Now, however, the UK stance is that face coverings are “recommended” but not mandated, meaning I may not be able to insist on my patients wearing them.

My job involves me sitting in a room seeing many people who are unwell and could be harbouring the virus. They may be in that room for only a few minutes, but I will be spending at least 10 hours a day there. The windows open only a fraction for confidentiality reasons, making good ventilation almost impossible.

I will also be seeing many clinically extremely vulnerable patients, so minimising the amount of virus floating around my room in aerosol particles is very important in order to keep them safe.

Be warned, if you want to see me as your doctor you will have to wear a mask Dr Amir Khan

Wearing a facemask – if you are not exempt from doing so for medical reasons – does no harm at all, despite the many falsehoods circulating online. Furthermore, facemasks, alongside other social distancing measures, do help to reduce transmission of the coronavirus.

So, can I still insist that patients wear a mask and can I refuse treatment to those who decline to do so? The vast majority of people are sensible and will put a mask on. But there is a minority who will not, despite my best efforts to persuade them otherwise. Here, it will be a case of weighing up the illness they are presenting with against any risk posed to me, my patients and my staff. Of course, if they are very sick and insisting on not wearing a mask I will have to treat them regardless, but I feel well within my rights to decline treatment to those who are only mildly sick or are coming in with a chronic illness until they wear a face covering. It may lead to some uncomfortable standoffs between me and a minority of my patients, but I will be of no use to anyone if I become sick and I will feel terrible if one of my vulnerable patients becomes sick because I was not prepared to stand my ground.

So be warned, if you want to see me as your doctor you will have to wear a mask. I imagine this will be the same for my clinical colleagues up and down the country.

Reader’s question: Is it safe to celebrate Eid?

Often known as “big Eid”, the second of the two major Muslim celebrations is right around the corner – with Eid-al-Adha falling on the 10th day of the Islamic lunar calendar’s 12th month, Dhu al-Hijjah, this week. With last year’s Eid-al-Adha marred by the global pandemic, will it be any different now that many people will have had both doses of a coronavirus vaccine?

Traditionally, Eid is a day of celebration, when family and friends meet to socialise and share meat from an animal that has been sacrificed in the name of God.

For those people yet to be fully vaccinated, however, it would serve well to be cautious. The emergence across the world of the highly transmissible Delta variant means the number of people becoming infected in many countries is rising, and this will inevitably lead to increased hospitalisations and death.

If this applies to you, think about meeting a small number of people outdoors rather than inside. The coronavirus is mainly transmitted via the airborne route, meaning tiny particles containing the virus which have been coughed, sneezed or breathed out by an infected person can linger in indoor spaces without fresh air for hours and infect others.

[Jawahir Al-Naimi/Al Jazeera]

If you are unable to meet outdoors, make sure you open a window or outside door to allow fresh air in and blow away some of these infected particles. Wash your hands regularly and make sure you use your own prayer mat. If you are travelling on public transport or going to the shops, wear a face covering to protect others.

It is vitally important that if you have any symptoms that could be COVID-19 – no matter how mild – you do not go to the mosque or to the homes of others. Instead, get a COVID-19 test. Some people believe that whether or not you contract the virus is down to the “will of God” and although that might be true, we all have a role in protecting ourselves and others from becoming sick, a notion supported by Islamic scriptures.

Even if you have been fully vaccinated, you should still be cautious. Although the vaccines are highly effective, they are not 100 percent effective. Meet people in well-ventilated spaces, wash your hands regularly and wear a face covering where appropriate. Try to avoid the traditional Eid hug as this will breach social distancing guidelines. Remember, some of the people you may be meeting could be clinically vulnerable and have a weak immune system – or they may come into contact with others who do – meaning even if they have been fully vaccinated they are still at some risk of contracting the virus and becoming seriously ill.

It is tough because many Eid celebrations over the past 18 months have been curtailed by the coronavirus pandemic, but to ensure our loved ones are around to celebrate future Eids, we should all be as COVID-cautious as possible, while still enjoying ourselves.

And now, some good news – Moderna to start trials of mRNA flu vaccines

On July 7, Moderna announced a new trial to examine the effectiveness of a new type of flu vaccine based on the same mRNA technology used in its COVID vaccine. The company plans to enrol 180 healthy participants in the study and will target the flu virus variants that the World Health Organisation (WHO) recommends for this year.

The mRNA flu vaccine is designed to prevent multiple strains of influenza with much higher efficacy than current flu vaccines, according to Moderna’s statement. The end game, it says, is to eventually come up with a single vaccine that protects against both the flu and COVID.

There are already a number of different types of flu vaccines but they are mainly based on dead versions of the virus or viral particles which are used to trigger an immune response in the vaccinated person. Nasal spray versions of the flu vaccine – usually given to children – normally contain a weakened version of the virus that cannot give someone the illness but can trigger a good immune response. These are adapted each year depending on which strains of the flu virus are predicted to cause the majority of infections that year.

Current flu vaccines are between 40 percent and 60 percent effective. WHO estimates that there are up to 650,000 deaths each year from flu around the world, so if Moderna can manufacture a more effective vaccine it may be able to save a large number of lives.