Transcript of video
Booster shots Let’s discuss COVID-19 vaccine booster shots. Do you need a booster shot or not? This is a summary of my view. First, a disclaimer: I am not a practicing physician, this is not a medical advice. This is for informational purposes only. I will first speak about mRNA vaccines, then about Johnson & Johnson / Janssen, and then about Sputnik. This order of discussion is deliberate, because for Sputnik we have to extrapolate the logic we follow on other vaccines. 1/ If you had Pfizer or Moderna vaccine, the decision to boost or not depends on three factors: #1: Your age. If you are over 50, perhaps do get a booster. Follow Israel’s practice. Israel actually recommends boosters for all people over 40 years of age. Again, there might be geopolitical considerations in this. If Israelis have to run to shelters again, old and young will mix, so extra level of protection could be vital for the country. #2: Your lifestyle. If you travel a lot or spend a significant time in crowded spaces indoors, perhaps get a booster. #3: Your personal risk tolerance. If you can tolerate getting a COVID on top of background of two vaccinations, don’t get a booster. COVID infection on top of two vaccine shots might provide you with a better overall protection and a wider range of antibodies than a third booster shot. If you value having the least possible risk of getting COVID, if you are very worried about developing a “Long COVID”, which might or might not be a real disease, perhaps get a booster shot. 2/ If you had an adenovirus-based vaccine, here is what I would do. I am going to spend some time discussing J&J/Janssen vaccine, but bear with me, it has relevance for Sputnik booster dose reasoning too. #1. If you had Johnson & Johnson / Jannsen. Well, none of you probably had it. But I had J&J in November 2020 because I took part in a clinical trial. This is what I did recently. In July 2021, in Germany, I came to the mobile vaccination clinic, showed them my CDC vaccination record card and asked for another J&J/Janssen shot. Germans said: “We can give you a Pfizer shot and give you a European vaccination record card. But we cannot give you another J&J/Janssen vaccine shot because it’s not authorized.” I decided not to take a Pfizer shot and walked away. I then went to another vaccination site at a train station. So I got a German / European vaccination card right away. Which is great. But that’s not the only reason why I wanted another J&J/Janssen shot. This is my reasoning: #1. Adenovirus-based vaccines is a more proven technology. It’s more “natural”, if you want, to use a viral vector. So I was actually content with my J&J/Janssen vaccine shot, even though I am aware that in clinical trials J&J showed less efficacy than two mRNA-based vaccinations. #2. If you look at all childhood vaccines, and most of vaccines overall, they are all given as three or even four shots. Never one shot. So giving just one shot of J&J/Janssen has always been about a strategic market-driven decision. One and done – great marketing, and it works. But I always considered two shots as “normal schedule”. Hence I wanted a second dose o fJ&J/Janssen. And it’s a great protection from a severe disease. In fact, documents that Germans gave me as part of consent paperwork to sign, directly stated that J&J/Janssen vaccine protected 100% from serious COVID disease. While the same German consent paper said the protection from serious COVID by Pfizer (brand Vaxzevria) was 95%. We all fear severe COVID really, so that’s the protection that matters most, doesn’t it? #3 reasoning in favor of the second J&J/Janssen shot was that if, or more likely, when a new generation of modified vaccines comes out, I will have a chance to boost with an mRNA vaccine. But having two mRNA boosters just seemed too complicated for me. So I got the second J&J/Janssen shot, a new yellow German vaccination card to add to my CDC card, and I am happy. And recently the data came out that second J&J/Janssen shot boosts antibodies almost 9 times higher from the level seen after the first shot. Another important data that has just came out about J&J/Janssen is that antibodies do not really decline as time goes by, and that seems to be different from mRNA-based vaccines. Of course, one argument could be made that the level of antibodies after J&J/Janssen has never been as high as that from Pfizer or Moderna. You can look at it both ways. Also cellular immunity seems to stay pretty good from J&J/Janssen vaccine, and it’s perhaps the most important part of long-term immunity. So if I had an option to get J&J/Janssen vaccine, I’d take it again in preference to mRNA based vaccines. But perhaps it’s my bias because I got it. You decide. Now, let’s talk about Sputnik. By definition, Sputnik has two shots. Which is good. At this point in time many nations outside of Russia used Sputnik. So if Sputnik was not effective, it would have been noticed and made public. That’s the good news. Here is perhaps not so good news. Real world protection is not just about theoretical efficacy. It’s about manufacturing, and whether different lots of vaccine might have different quality. It’s about storage and human errors during administration. Here we don’t know everything. We do know that WHO found manufacturing issues at one of Sputnik-producing plants, and that’s what seems to hold up Sputnik’s approval by WHO. Apart from various conspiracy theories. So how do you know if the batch of Sputnik you might have had, was active and good? Well, you can check that! And that’s a reasonable thing to do. Go and do antibody test to S (spike) protein. That’s a specific test you can easily get. It’s advertised everywhere. See what your level of S spike antibodies is and that might help you make a decision on revaccination. However, it might not! Let me tell you why. First, what is a “reasonable” antibody level for protection. There are many papers on that and the problem is that there are very different laboratory tests used, so all numbers are not 100% interchangeable. Here is antibody levels from a recent JAMA (Journal of American Medical Association) paper. 688 health workers were vaccinated with mRNA-1273 – that is Moderna vaccine – (mean age, 43 years; 77% women; 22% previously infected with SARS-CoV-2), and 959 people were vaccinated with Pfizer (BNT162b2) (mean age, 45 years; 85% women; 13% previously infected). Higher antibody titers were observed in participants vaccinated with 2 doses of Moderna compared with those vaccinated with Pfizer (geometric mean titer [GMT], 3836 U/mL vs 1444 U/mL for Pfizer). Previously infected participants had higher antibody titers (GMT, 9461 U/mL) compared with previously uninfected participants (GMT, 1613 U/mL. Again, if you were infected and then vaccinated, then your antibody level is almost 6 times higher compared to people without previous COVID infection who were vaccinated. In both groups, those vaccinated with Moderna / mRNA-1273 had higher antibody titers compared with those vaccinated with Pfizer / BNT162b2 (previously uninfected: GMT, 2881 U/mL vs 1108 U/mL). Previously infected: GMT, 10 708 U/mL vs 8174 U/mL. To give you reference numbers for J&J/Janssen vaccine, a very recent paper on boosters showed that levels of neutralizing antibodies were in the range of 250 to 300. But again, assays could be different, and nuances matter here. However, for J&J/Janssen most recent data shows that antibody levels hold up very well after 6 months after the first dose. A J&J/Janssen booster administered six months after the first shot initially increased antibody levels ninefold. Antibody titers continued to climb to 12-fold higher four weeks after the second shot. I have just quoted a Wall Street Journal paper describing J&J booster shot results. So, you did S spike antibody level tests after having two Sputnik shots and, for example, your level is 1000. If we assume the same test and units. And it’s likely not to be the same. Is 1000 good or not? What if it’s 50? Is that bad? The real truth we do not know. I am sorry to disappoint. But having a higher or lower antibody titer may sway your view on getting a booster. If you have reasonable antibody titer a few months after vaccination with two doses of Sputnik, at least you know that your specific dose of vaccine was produced well and was kept at the right temperature and that you’ve got a vaccine and not a saline. Which we know happens on occasion around the world. So getting S Spike antibody levels before deciding on booster vaccination after two doses of Sputnik is one way of data-driven decisions. However, this data has its limits too. Because the level of protection from serious disease is what matters. And the antibody level required for protection from a serious disease seems to be substantially lower than the level required for protection from any COVID disease, and we now know that vaccinated people can transmit the infection. So all data is in flux and lots of arguments are being thrown around, as you know. Importantly, if you know you had COVID before getting two doses of Sputnik, you probably do not need any booster! This is what data shows that I cited above. That levels of antibodies after vaccination in people who had COVID before vaccination are very high. It might also likely be that having clinical COVID infection protects people from serious infection – and 90% protects from reinfection perhaps. So you‘ve got to have a very low tolerance to risk if you want a booster shot after having had COVID AND two shots of vaccine. Any vaccine, I think. Now, you had two Sputnik doses, you did not have COVID before, and you decided to get a booster. Which booster to get? If you have access to Sputnik only, get a Sputnik booster shot. But what if you have access to any vaccine? Here are two ways to think about it. If you believe about changing a technology, then get an mRNA vaccine. Moderna or Pfizer? There is a difference in the amount of active material each vaccine contains. Each BioNTech/Pfizer shot contains 30 micrograms of vaccine, compared with 100 micrograms for Moderna. That may give Moderna an advantage in signaling spike-protein production and a more robust T-cell and antibody response. So, if your pre-booster level of antibodies is kinda low, maybe boost with a Moderna? And if it’s high – perhaps use a Pfizer. But that is really all very speculative. Either one is great, I think. If you believe that changing a technology is not the best idea, and if you want to get a European vaccination certificate right away, then Johnson & Johnson / Janssen booster shot is your top choice. Because to get a European certificate you then have to get two mRNA vaccine shots, on top of two Sputnik shots. Might be too much. However, we know of people who got German vaccination certificates after saying they had two Sputniks and they got one Pfizer shot in Germany and it was written into their vaccination card. But they cannot get an electronic QR code, apparently. So think is how I think about boosters. You are most welcome to reach out via WhatsApp or email or website form and we will try to answer your individual questions about booster shots of COVID-19 vaccine. Again, all this is for informational purposes only and cannot be considered a medical advice. Remember, your health is in your hands, stay healthy!