What Do COVID-19 Vaccine Boosters and Fully Vaccinated Have in Common?

As the COVID-19 pandemic enters its third year with millions of people successfully vaccinated, new immunizations terms are being tossed around without much clarity. 

‘People are now confused about what it means to be fully COVID-19 vaccinated', wrote Paul A. Offit, M.D. on April 13, 2022. ‘It is easy to understand how this could happen.’

As of April 17, 2022, the U.S. CDC’s COVID-19 data dashboard indicates that 65.9% of the eligible population is fully vaccinated.

And about 45.4% of eligible people have been 'boosted' and are now 'optimally' or 'up to date' vaccinated.

Dr. Offit’s Editoral was published by the New England Journal of Medicine, which is excerpted below:

‘As is true for all mucosal vaccines, the goal is to protect against serious illness — to keep people out of the hospital, intensive care unit, and morgue. 

Arguably, the most disappointing error surrounding the use of Covid-19 vaccines was the labeling of mild illnesses or asymptomatic infections after vaccination as “breakthroughs.” 

The term “breakthrough,” which implies failure, created unrealistic expectations and led to the adoption of a zero-tolerance strategy for this virus. 

Suppose we are to move from pandemic to endemic, at some point. In that case, we will have to accept that vaccination or natural infection, or a combination of the two, will not offer long-term protection against mild illness.

In addition, because boosters are not risk-free, we need to clarify which groups most benefit. 

For example, boys and men between 16 and 29 years of age are at increased risk for myocarditis caused by mRNA vaccines.

And all age groups are at risk for the theoretical problem of an “original antigenic sin” — a decreased ability to respond to a new immunogen because the immune system has locked onto the original immunogen. 

An example of this phenomenon can be found in a study of nonhuman primates showing that boosting with an omicron-specific variant did not result in higher titers of omicron-specific neutralizing antibodies than boosting with the ancestral strain.

This potential problem could limit our ability to respond to a new variant.

It is now incumbent on the U.S. CDC to determine who most benefits from booster dosing and educate the public about the limits of mucosal vaccines. 

Otherwise, a zero-tolerance strategy for mild or asymptomatic infection, which can be implemented only with frequent booster doses, will continue to mislead the public about what Covid-19 vaccines can and cannot do,’ concluded Dr. Offit’s Editorial, which was edited for clarity.

Paul A. Offit, MD, is Director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia. In addition, he is the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania.

And Dr. Offit is a member of the U.S. FDA’s Vaccines and Related Biological Products Advisory Committee.

PrecisionVaccinations publishes fact-checked research-based vaccine news.