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COVID-19 Vaccine Booster Injections: What’s All The Noise About?

Mark Jansen, M.D., vice president and chief medical officer at Arkansas Blue Cross and Blue Shield, explains COVID-19 boosters.

You may have been hearing all the discussion about COVID vaccine boosters. So, if the vaccines are so effective, why are they talking about booster injections? Let me unwrap this a bit.

Dr. Mark Jansen
Dr. Mark Jansen, Chief Medical Officer

We all get DPTs as kids.  The “T” is to help protect against tetanus.  It would be great if those childhood immunizations carried us through the rest of our lives. Unfortunately for tetanus protection, they don’t. If one steps on a rusty nail or gets cut with a rusty knife, there is the potential that tetanus spores (think seeds) may be carried into the wound and with it, the risk of contracting tetanus. Tetanus causes your whole body to go into a big muscle cramp to the point you can’t even take a breath.  No one wants that!

The current COVID vaccines provide good immunity against serious illness, hospitalization, and death. But no vaccine offers “sterilizing immunity”.  If they did, no one with a normal immune system would get COVID at all. No “breakthrough” infections after being fully immunized.  So, while the immunizations are really good, none are perfect.

For a vaccine to work, the immune system needs to be properly functioning. It needs to “see” what’s in the shot then react to the antigen in the shot to make antibodies. Antibodies are one of the things the body makes to protect against the actual disease if one is exposed. There are other parts of the immune system that also get in the fight, “T” cells and “B” cells, but these are hard to measure so most of the discussion guiding thinking about boosters revolves around antibody levels.  If they fall too low (or never came up at all after a vaccine), then the person is more susceptible to infection.

Sometimes, certain folks have medical conditions that prevent their immune system from working properly. These would include “autoimmune” conditions like lupus. In this condition, the immune system gets confused and attacks parts of one’s own body.  Drugs used to treat this condition can help turn off the unwarranted attack but can also harm the person’s ability to fight off other infections.  If someone is being treated with an “immunosuppressant” medication and receives an immunization, the suppressed immune system may not make antibodies to the vaccine.  The same holds true for organ transplant patients who take medicine to keep the body from “rejecting” the transplanted kidney or heart.

We now know that persons with these issues may not make enough antibodies after the standard vaccines, so the U.S. Food and Drug Administration (FDA) has authorized COVID booster shots for this population.

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