Hit Me with Your Best Shot

Well, it looks like the pro-booster side has essentially won the argument, at least in the US, over whether boosters ought to be given for recipients of the Pfizer-Biontech COVID vaccine, six+ months after the second dose. My brother Suleman and I have (very incompletely) argued the case in favor of boosters here, here, and here. As front-line health care workers (he’s a physician, I worked in OR EVS), we got our first doses of the shot back in December 2020, and our second ones in January 2021. He works with COVID patients in a hospital, and I work in an increasingly crowded office. Neither of us had any sense of how much protection we were getting from the vaccine at this point.

Granted, there’s far more to be said on both sides of the argument, but the arguments against boosters have always struck me as less-than-compelling. So I’m gratified to see that, for practical purposes anyway, the issue has been decided in the right way. The Pfizer-Biontech booster is now being made available essentially for the asking. Suleman got his booster through his hospital; I got mine through my gym, affiliated with the Hunterdon Healthcare system.

Here I am receiving it in Lebanon, New Jersey at the capable hands of Abigail Recierdo-Edworthy, RN–who turns out (by sheer coincidence) to be a former philosophy student of mine from way back in 1999 at The College of New Jersey. “You had such a way with words!” she told me, evidently in tribute to my mad skills as an adjunct instructor in Phil 235, “Contemporary Moral Issues.” “You have such a way with needles,” I said in response.

Abigail now works in Occupational Health at Hunterdon Medical Center, where I worked in the OR until just a few months ago. Nice to be able to enact a “contemporary moral issue” in this very wholesome way, two decades after the fact.

And no–no side effects apart from a sore arm, 72 hours after the shot.

3 thoughts on “Hit Me with Your Best Shot

  1. Two interesting postscripts to this story:

    1. From the NY Times:
    2. From Reuters:

    Senegal Expects Waste of 400,000 COVID-19 Vaccines by Year-End

    By Edward McAllister
    December 14, 2021

    (Reuters) – At least 200,000 COVID-19 vaccines have expired in Senegal without being used in the past two months and another 200,000 are set to expire at the end of December because demand is too slow, the head of its immunisation programme said on Monday.
    African governments have been calling for more COVID-19 vaccines to help catch up with richer regions, where vaccine rollouts have been humming along for more than a year.
    Yet, as the pace of supply has picked up in recent weeks some countries have struggled to keep pace. Logistical problems, the short shelf life of vaccines that arrive from donors, and vaccine hesitancy have all kept doses from reaching arms.
    Up to 1 million COVID-19 vaccines expired in Nigeria last month, Reuters revealed.

    “The main problem is vaccine hesitation,” said Ousseynou Badiane, who is in charge of Senegal’s vaccine rollout. “The number of cases is decreasing. They ask: ‘why is it important to get vaccinated if the illness is not there now’?”
    Senegal has recorded more than 74,000 COVID-19 infections and 1,886 deaths, far below the numbers seen in many nations hit harder by the virus. The pace of infection has dropped off since a third wave in July spurred a spike in vaccine demand. The country occasionally records no new daily cases.
    But apathy hurts the vaccination drive. Senegal has administered nearly 2 million doses of vaccines so far, Reuters data shows, enough to fully vaccinate only about 5.9% of the population.
    It is currently vaccinating between 1,000 and 2,000 people per day, Badiane told Reuters, down from 15,000 during the summer. At this pace, it cannot use all the vaccines it has.
    “We are not optimistic” about using the other 200,000 doses before they expire at the end of the month, he said. “We don’t expect any demand increase before then.”
    He did not specify the make of the vaccines.
    Part of the problem is the short shelf life of vaccines that arrive from donors that include the United States and China. Senegal refuses to take vaccines with a shelf life shorter than three months, but even that creates difficulties.
    Badiane hopes the government can introduce some kind of restrictions on the unvaccinated to drive up inoculation rates, including the use of a health pass as many other countries have done.
    “Without the restriction, the population will not get vaccinated,” he said.
    Reuters Health Information © 2021

    • For reference, the population of Senegal is 16.7 million – about midway between the population of Pennsylvania and that of New York State.
    • 400,000 is roughly the population of New Orleans, LA, or Minneapolis, MN.

    In the meantime, if Biden was “ahead of the science” on the protective role of boosters, the science has caught up. Importantly, our observations so far are that the protective value of boosters appears to include Omicron.

    Anecdotally, a very large number of my COVID patients admitted to the hospital got the first two shots of Pfizer or Moderna, or one shot of J&J, but no booster. That contrasts with my prior experience before the current wave, when the vast majority of hospitalized patients were people with no vaccination whatsoever.

    Liked by 1 person

    • That’s about as obvious a vindication of your blog post here as can be imagined.

      I find it incredible that three months ago, “the experts” were so confident about telling us not to get boosters; now, we’re being told that we all ought to hurry up and get boosted.

      The reversal doesn’t seem to bother them. Then they wonder why their “Follow the Science” messaging isn’t getting through.


  2. Regardless of what the science was before and what it is now, the admonition against launching a robust booster plan in the US when it first was proposed never made any logical sense. We were between waves of a highly contagious disease which at that time had killed 600,000 Americans and whose resurgence was an absolute certainty. We knew the vaccine met a very high standard of safety. The two things we didn’t know were: 1) to what extent after our initial vaccination protocol does functional immunity against SARS-CoV-2 wane, and by how much? and 2) if immunity wanes, to what extent does a booster dose mitigate waning immunity? Those two unknowns impact on the magnitude of benefit from a booster campaign. We still don’t know the answers, because for reasons tied up in the complexities of immunology, we really don’t have good a priori ways of measuring these things. There really are no good predictors or surrogate markers. We’ll have an idea of the answer only after the boosting is done, provided we have some concurrent control group of people who didn’t get boosted.

    But having differing predictions about magnitude of benefit does not constitute a sound argument for blackballing the whole endeavor, which is what a lot of people in the public health community were trying to do at the time, using convoluted, tangential, and politically charged arguments about the under-vaccination of particular other countries. Faced with a deadly and widespread problem, you don’t withhold an intervention with a high probability of some benefit, and whose risk is known to be negligible, just because you’re not sure whether it’ll help a little or a lot.

    It’s troubling that “experts” from organizations like the WHO were using bad arguments to effectively put us in harm’s way by conjuring up images of harm done to other people far away, and then laying blame for those harms on the advocates of the US booster program. But it’s even more troubling when you consider the questions the press should be asking those same people about the tragic stories above, instead of writing throwaway articles about one official’s grandstanding diatribe. Telling the US to withhold boosters because the African population has low vaccination levels is analogous to telling GM to stop putting seat belts in its cars, because we could use the fabric to clothe people who only have rags. The pathos stops you in your tracks for a moment, but only long enough to momentarily distract you from the ultimate illogic and pointlessness of the argument.

    The mission of the WHO is not to ride Joe Biden about boosters. Its mission is to put together plans that work in the real world to ensure that people throughout the world don’t get sick and die of preventable diseases. This pandemic began two whole years ago, and the barriers to efficient vaccine distribution described in the two articles have been a known problem for decades before that. We now have even more real-world evidence that it was never really about supply, and that deployment and buy-in at the population level are the key drivers. We also know that the WHO has been totally ineffective at moving the needle at all, despite how much smarter they supposedly are than the rest of us about this stuff. Improving vaccine deployment has been basically the WHO’s core job for the past two years, and we seem to have little or no tangible work product. How is that not the story?


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s