Friday, September 17, 2021


In the 1993 movie And the Band Played On about an earlier pandemic, epidemiologist Dr. Don Francis (Matthew Modine) challenges his boss, Dr. James Curran (Saul Rubinek): "When a house is on fire, you don't wait for scientific proof. You grab the first hose, and you start putting out the fire." 

I wonder whether anyone was playing that part in the internal FDA debate about boosters, a role that President Biden seems to have been sort of playing in his advocacy of booster shots against the FDA's painfully slow, seemingly so "business as usual" approach to vaccine accessibility and distribution. It is true that, now that this has become largely a pandemic of the unvaccinated, the government is practically begging people to get vaccinated and is at long last starting to mandate it (action that also should have been taken long ago). Yet we all can remember what it was like earlier this year, when the much anticipated vaccine was first produced, how slowly the vaccine was made available, how access seemed to be slowly - painfully slowly - dribbled out to one category after another of potential recipients. Then it was frightened people begging to get the vaccine, and sometimes having a hard time finding out how to get it, or having to wait until it was finally made available to their particular age or category. More recently, we have seen how long it took - way too long - to get the final full approval for the Pfizer Covid-19 vaccine (the only one which has as yet gotten such full approval). And even now there is still no approval for any vaccine for children, which has obviously seriously complicated the opening of school.

To be fair, by historical standards, it is true that we have made almost miraculously rapid progress from where we were a mere 18 months ago. It is also true that, unlike the efficacy of the vaccine in general, the efficacy of a booster shot seems to have been less certain. The data seems largely limited to the Israeli experience, which, however, does support making a third shot widely available. 

As I understand it, the two-shot regimen has proved quite effective against severe disease and death, but that the immunity to infection itself maybe waning, for which a third shot may be a remedy.

Maybe "booster" is not the best word. I can well remember receiving the Salk Polio Vaccine as a child as soon as it became widely available. As I recall, there was a three-shot regimen, followed eventually by a fourth shot. I don't remember whether the fourth shot was called a "booster," but I believe it quickly became the norm. Later, when the oral polio vaccine came out, that too required multiple (three, I think) doses. A few years ago, when I got vaccinated against shingles, that required two doses, spaced out over a set period of time. Multiple doses seem to be the way these things often seem to work. Maybe we should just think of this as ordinarily a three-shot regimen, especially if the goal is not just to avoid severe disease and death but also to minimize so-called "breakthrough" infections.

Given how long it will take to vaccinate the whole world and completely eradicate the disease, it may be much more likely that covid is going to become part of our regular human experience - like the flu. And, like the flu, we may find ourselves in need of a new shot every year. If so, the scientific and medical community needs to respond rapidly to the data of experience and so enable policy-makers and ordinary citizens to respond appropriately both to the ongoing threats and the possibilities vaccines can offer.

Meanwhile, I look forward to getting my third shot, my "booster," as soon as it is offered!


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