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COVID-19 vaccines: Some answers to lingering doubts

COVID-19 vaccines: Some answers to lingering doubts
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Despite having written multiple books on fear and contagion, I am having difficulty accepting how the legitimate fear of an unpredictable and damaging virus does not automatically outweigh the irrational fear of a safe and effective vaccine. 

I understand the increasing role of social media in fanning the flames of some fears about the vaccine — and it seems this pandemic has turned many of us into self-appointed dogmatic experts of what might be wrong with a treatment or a vaccine, or why you might not need either. Too many non-doctors — and even some doctors without expertise in virology or public health — are constantly pontificating, while public health messaging, even from true experts, has often been conflicting or overly cautious and guarded.

But the fact is that the new coronavirus vaccines are simply incredible, and they are our best and only path out of this pandemic. Of course people have questions, but these questions have answers. Here are a few that I hear arising repeatedly: 

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Do I need the vaccine if I already had COVID-19?

This question has received a lot of attention lately, in part because our public health leaders have done a poor job acknowledging that COVID-19 provides natural immunity at least for some period of time. Unfortunately, too many of those protesting this omission have gone too far. The fact that you have immunity from the virus itself doesn’t automatically mean you wouldn’t benefit from the vaccine in addition. While a new study in Nature, published from Washington University in St. Louis, found that after having COVID-19, memory cells in the bone marrow persist, even after antibodies in the blood diminish, another study from Rockefeller University found that vaccination plays a crucial role in enhancing immunity, even among people who have already had the disease.

Ongoing research suggests that we may need just one dose of an mRNA vaccine for most who have recovered from COVID-19 to create a durable “superimmunity.” But Dr. Peter Marks, head of the Center for Biologics Evaluation and Research at the Food and Drug Administration (FDA), who I interviewed this week on SiriusXM cautions that immunocompromised individuals who had COVID-19 “might not have developed the kind of immune response, and you might want to think about whether vaccination could help boost the response they had into reasonable levels.” Marks said that there is emerging data that “cancer patients who have been getting chemotherapy, who have not made an adequate response after two doses, that maybe a third dose could be helpful.”

Will I need a booster and when?

Increasing evidence shows that the Pfizer and Moderna mRNA vaccines cover all the variants of COVID-19 that have appeared thus far. It is too soon to know when or if we will need boosters, but I suspect the latest research on memory immune plasma cells in the bone marrow means that it will be at least a year or two. But Dr. Marks is still concerned about the falloff in antibody levels in the blood, saying that “once those antibody levels fall below a certain level, perhaps we won’t be as well-protected, particularly against some of the variants."

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According to Marks, one question is whether "an anamnestic response — being exposed again — (will) make those jump up enough that they’ll fight off the virus, and we just don’t know the answer there yet." His conclusion: "At some point we may need boosters and if we do, we don’t know exactly when" — but it "does seem like there is probably long-term immunity.”

Should I vaccinate my 12-year-old?

This is a matter of personal choice for both you and your child. But in almost all instances the protection offered by the vaccine is well worth it, given its proven safety and effectiveness, and the fact that COVID-19 is not always mild or asymptomatic in children, especially with one of the emerging variants.

Regarding potential side effects, Marks is very reassuring about the remote possibility of heart inflammations, which he said have been very mild, self-limited and not requiring intervention. “It shows our safety surveillance is working,” he said. He also pointed out that it’s hard to know whether side effects were COVID-related or not. Regardless, he said he would have no problem vaccinating his own teenagers, if his kids were still in their teens. 

He also highlighted that COVID-19 has affected hundreds of thousands of children, and though not common, it has even caused deaths among youths. “No parent should ever have to lose a child to an infectious disease that we can prevent,” he said.

The bottom line is that everyone, including adolescents, should get vaccinated. Those who have had COVID-19 should get at least one shot. And as for boosters, no one should worry about them — chances are they won’t be needed any time soon. 

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, "COVID; the Politics of Fear and the Power of Science."