Two weeks ago, a friend asked me how many COVID shots I’ve gotten so far. And for a short and wonderful moment I forgot.
I told them “three” before shaking my head. “No, actually, four.” I had no trouble remembering when I had my last shot (September). But it took me a while to schedule all the doses that came before it.
By this point in the pandemic, many people must have lost track. “I think that’s a really good thing,” says Grace Lee, MD, a pediatrician at Stanford University and chair of the Centers for Disease Control and Prevention’s Immunization Practices Advisory Committee. Now that many Americans have had multiple shots or infections, she tells me, the question is no longer, “How many doses have you cumulatively taken?” It’s “Are you up to date for the season?”
The face is subtle, but it indicates a rethinking of the coronavirus vaccination model. We are in the moment of defining the relationship with these snapshots, when people are trying to commit – to normalize it as a routine part of our lives. in ACIP . September meeting, CDC officials note that we are “changing the way we think about these vaccines,” and trying to “get a more regular schedule.” If COVID shots are here forever, we can at least take the trouble to count them.
Dose counting was more convenient early in the vaccine rollout, when it seemed like two shots (or even one) would be enough to attract Americans.”fully vaccinated“And out of the danger zone. As more footage followed, it was often announced with a confusing ending: what some initially described as The booster It was later relinked as The first booster After the second it was recommended for certain groups. But with immunity to infection more fragile than some hope, and a virus rapidly mutating beyond the reach of antibodies, these ordinal traits no longer make sense. Until our vaccine technology becomes more robust or resistant to change, for most of us, repeat doses will be a staple in the future — and it won’t do anyone much good to say “I’m in shooting mode #15,” Angela Shen, a vaccine expert at Children’s Hospital, told me. in Philadelphia, or “I’m on shot 16”.
Numbers certainly matter when they are small: It will still be important for people to count their first few shots, for example, especially those without a history of infection. But after that initial set of viral protein exposures, the total number becomes moot. In most cases, about three vaccinations Or infection—preferably vaccines, which are safer and easier to track accurately—should be “enough to fully charge the immune system’s battery” for the first time, says Richie Joel, an immunologist at the University of Pennsylvania. Additional COVID shots will only help as much as they can recharge the battery To the maximum capacity When he starts losing his juice. Avnika Amin, a vaccine epidemiologist at Emory University, says vaccine scheduling becomes a matter of “how long it has been since the last immune-conferring event,” no matter how many exposures the body has.
People who are they Immunocompromised You may need Four or more shots to prove that primary immunity charge, and theirs (maybe smaller) peak capacity. But in the end, the threshold effect they encounter – the point of “reducing returns” – is similar, says Marion Pepper, an immunologist at the University of Washington. Looking at how much vaccinations And the infections Now the US has logged in, telling me the majority of Americans “could stop counting”.
If we were to shift our focus to timing shots, rather than counting them, we would have to schedule our shots smartly. Several prominent figures have already come out and said that annual doses are the best option. Albert Burla, CEO of Pfizer, has been pushing this idea Where early 2021; Peter Marks, who heads the Food and Drug Administration’s Center for Biology Evaluation and Research, has been Provide the same font for many of months. Even President Joe Biden has Annual approach supportednoting in a statement issued in September that the advent of the bivalent shot heralded a new phase in vaccination against the Corona virus, as Americans receive a dose “once a year, every fall.”
This plan is not unreasonable. The shots should come with at least some regularity, as the variables continue to emerge and the immunity to infection decreases. But repeat the dose prematurely using a dose with similar ingredients, and the body—Still jumping from the previous doseIt may destroy a vaccine before it has much effect, making it as useful as charging a battery that’s already running at 95 percent. SARS-CoV-2 antibody levels It drops sharply in the first six months After the vaccine dose, the rate of discharge then slows down. It’s as if the immune system is going into “energy saving mode,” Joel told me, which means there might not be much difference between being revaccinated twice a year or just once. Plus, living year-round with lower levels of antibodies isn’t as alarming as it might seem. Although antibodies could be rather Useful agent For our level of protection, especially against infection, they don’t draw The full defensive image: T cells And other fighters tend to stay longer, keeping Prevents severe disease. (immunodeficiency and the elderly You may still need more surgeries to boost immunity against COVID.)
The optimal speed of vaccination against the coronavirus will also depend on the speed at which the virus spreads variants. Shen tells me that the annual schedule works for the flu, but “we know the rhythm of the flu.” SARS-CoV-2 It has not yet settled into a predictable seasonal pattern; Its waves haven’t descended until the coldest of months. The degree to which we, as hosts of the coronavirus, reduce transmission is also somewhat important. Having more viruses puts more pressure on vaccines to work specifically When there are not many other mitigation measures in place. Amin told me that if all this talk of “once a year, every fall” turns out to be another frivolous recommendation, it could undermine any subsequent messages.
All this being said, the fall regimen may continue because it’s the easiest method. Uptake of the flu vaccine is far from perfect, but the messages about it are “simple and clean,” says Rupali Lemay, a behavioral scientist and vaccine attitude researcher at Johns Hopkins University. after dosing Twice in four weeks As infants, people are required to have an annual dose, and that’s it. Compare that to the more complicated days of the COVID vaccine, when people can’t take a dose without accounting for age, health status, number of previous doses, brand of vaccine, time since their last dose, and more. “This is an absolute burden,” LeMay told me. Complex schedules burn people off – or discourage them from attending at all. This fall, when the divalent shot appeared, it was a worrying percentage of Americans They don’t even know they’re eligible.
Promoting COVID vaccines with the same direct frequency as flu vaccines will make it easier for people to sign up for both at once, and perhaps eventually, to get them In the same syringe. Li Chen said that vaccines tend to ride each other’s tail. “In the fall, there’s a bump in other routine vaccinations,” she said, “because people are already there to get the flu shot.” It would also make a big difference if the COVID vaccine prescriptions were changed Everyone at the same timeas they do with the flu.
If we were to move from the numbering of the doses to their timing, we might as well take the opportunity to ignore the term booster like that. LeMay told me that some people don’t understand what that means, or turn to a logical question by default –How many boosters will I need? Plus, booster Science may not fit anymore. “When we start updating the formulas, it’s not really a boost anymore,” Amin told me. This is not how we generally talk about flu vaccines: I certainly can’t tell you how many “boosters” of that vaccine you’ve received. (I don’t know, maybe 14 to 15?) Switching to the terminology of “seasonal shots” could make coronavirus vaccination more routine.
Well, if anyone has to ask: It’s (count them: one, two, three) four doses of the vaccine so far. But most importantly, I got the last shot available to me.