Important new research on Pfizer vaccine's waning immunity

Discussion in 'Coronavirus Pandemic Discussions' started by CenterField, Oct 5, 2021.

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  1. CenterField

    CenterField Well-Known Member Past Donor

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    Two very important studies, one published on Lancet, the other one still pre-print, show that the Pfizer vaccine, while dramatically dropping in effectiveness against infection, does continue to have high efficacy against hospitalizations, regardless of the variant.

    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02183-8/fulltext

    https://www.biorxiv.org/content/10.1101/2021.09.30.462488v1.full.pdf

    So here's the bad: both neutralizing antibodies and T-cell-mediated immunity drop dramatically after six months.

    Here's the good: it's not because of the Delta variant so there is no need to adapt boosters to Delta; just giving a booster with the same vaccine should fix the problem.

    It's a bit disheartening that it seems like a booster every six months will be needed. Logistically speaking, if immunity lasted for 12 months it would be easier to combine flu shots and Covid-19 shots yearly.

    That's Pfizer. It does seem from other studies like Moderna is a bit more longer lasting.
     
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  2. Joe knows

    Joe knows Well-Known Member

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    I got to say after what I seen my wife go through I’m glad I got the shot. That said I’m not so sure I will be okay with taking this shot every year little lone twice a year. I really feel like it messed with me so to continue that would be a concern as well.
     
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  3. CenterField

    CenterField Well-Known Member Past Donor

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    I don't know, man... yes, this vaccine is what we call "reactogenic" with some impressive side effects for some people but they are mostly transient and harmless. We've discussed already alternative explanations for the side effects you've experienced. If it gets confirmed that the protection wanes, then you should consider the boosters. Israeli research has shown that a booster (3rd dose) doesn't introduce side effects any different than what people get with a second dose, and it bumps up the protection by 10-11 fold.

    We may need to learn how to live with this coronavirus and getting a booster every six months may end up being the way to go.

    The mRNA vaccines degrade and get eliminated from the body in 12 hours. Late reactions are more linked to reactions to the S protein they make, but do consider that they make a fraction of non-replicant S proteins while if you catch the virus, it's massive amounts of S protein.

    This is why, for example, certain people (mostly younger than 30) can have rare, mild and transient heart inflammation from the vaccine (the S protein is thought to have something to do with that), but the virus itself has been causing hugely more frequent, more serious, and longer lasting heart inflammation as the virus throws into your body massive amounts of S protein, as opposed to the vaccine's tiny amounts.
     
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  4. 557

    557 Well-Known Member

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    @CenterField, in the past I’ve voiced concerns about the use of a narrow cohort of antigen in these vaccines. I’ve been reading about how antigen affinity and dose are observed to affect T cell differentiation and memory.

    I’m becoming more convinced using such a narrow selection of S protein antigens was a mistake. We are either going to have to add more specific antigens and/or figure out how to get the antigen to remain in the body longer. We also know B cell differentiation depends on long term presence of antigen in the gut etc.

    As I’ve said before, I don’t think we understand the antigen/immune response interactions well enough to conclude small subunits are going to induce long term cellular immunity.

    I reserve the right to be wrong on this one, but the evidence keeps coming in supporting this.
     
  5. CenterField

    CenterField Well-Known Member Past Donor

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    The transient response elicited by the Pfizer (which is the under-dosed one) seems to support your concern. On the other hand, remember that we do have a whole virus vaccine, which presents all viral antigens, and it's the CoronaVac from Sinovac. However the CoronaVac has generally elicited weaker response than the mRNA vaccines, so that would go contrary to what you're saying.
     
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  6. Adfundum

    Adfundum Moderator Staff Member Donor

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    @CenterField
    If I've had the Pfizer shots, can I wait and get one of the other shots instead of a booster? How long would someone have to wait before they could switch to a different shot?
     
  7. 557

    557 Well-Known Member

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    Do you know if the whole virus vaccine is killed or attenuated? We have poor luck with killed viral vaccines in critters. Most are attenuated. The coronavirus vaccine we use is an orally administered modified live vaccine.
     
  8. CenterField

    CenterField Well-Known Member Past Donor

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    The short answer: we don't know. There is no evidence yet.

    The long answer:

    Adfundum, currently there is no approval from the FDA and the CDC to give a different shot as a booster for someone who had the Pfizer, so you might have some trouble obtaining this, legally. Some people have been just lying... they present to a pharmacy offering Moderna and pretend that they never had any of the Covid-19 vaccines before, then they refuse to show any documents saying they left everything at home; they give a false name, false address, and false phone number with no support from documents, and since the orientation from the CDC is to give the vaccine anyway even to undocumented people, they end up getting a Moderna booster, pretending that they just got over their hesitancy and decided to get a first Moderna shot. Obviously I don't recommend that; but yes, people are doing it. Last I checked, more than 1 million Americans had done that, even before the FDA and the CDC approved the Pfizer boosters. This is of course not recommended including because there is no safety data for this strategy and these somewhat fraudulent vaccinations would be outside of the VAERS reporting system (if something goes wrong, reporting the issue would make it clear that the person impersonated someone else in order to illegitimately obtain the vaccine - as of now this is not exactly a crime, but there's been talk of some effort to curb this kind of practice; we don't know if there'd be potential legal trouble for people caught doing that - nobody has been charged with anything yet, but again, that's not something I'd recommend; I'm very law-abiding).

    But hey, it's your life and your health so if you were to do something like this, who am I to judge?

    Now, what's the evidence that this strategy is sound? We don't have evidence yet. But it is coming. There is a study that is looking at this strategy, with the American-approved vaccines, such as, two Pfizers + 1 Moderna, two Pfizers + 1 J&J, etc. The study is supposed to conclude at some point in November, so we'll know more, then.

    Therefore, one way for you would be to wait for the conclusion of this study. Not only we'll know more, but maybe the FDA and the CDC will allow this strategy, based on that very study, if the result is very favorable to this strategy. Waiting, though, exposes you to the virus because it is pretty clear by now that the Pfizer immunity is fading. But maybe you're a very secluded, very non-exposed person and you can afford to wait.

    OK, so, that's that.

    But then, you might also consider the following:

    Evidence that we do have, points to the fact that a third shot of Pfizer for someone like you who got your basic vaccination from Pfizer, does restore the high immunity that this vaccine yielded at first, with a bump in neutralizing antibodies 10 to 11 fold.

    So, say, you have comorbid conditions, you got the Pfizer second dose more than six months ago, you are of a certain age, you are relatively exposed to infected people, and you live in a community with high transmission, then maybe it's not prudent to wait for the conclusion of this study and for the eventual approval by the FDA and the CDC of this mix-and-match strategy; likely you'd be better off just going ahead and getting a third Pfizer dose.

    I'm sorry if I can't give you an answer more precise than that. The thing is, this is a novel disease and these are new vaccines, so what we know is limited, and ever-evolving. Your question is a very good question but unfortunately we don't have the data to respond to it with a high degree of certainty.
     
  9. CenterField

    CenterField Well-Known Member Past Donor

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    It's killed, a.k.a. inactivated. Yes, they usually yield smaller immunogenicity than live attenuated vaccines (which do have the downside of not being indicated for immunocompromised people).

    Here are the Covid-19 vaccines that are made of inactivated whole virus: the ones made by Sinovac, Sinopharm, and Bharat Biotech. (My very early post on this in my State of the Vaccines thread, at a time when I didn't know much about these vaccines from China and India, incorrectly listed these as attenuated; but no, they are inactivated; I posted a correction shortly thereafter - I'm saying this, just in case someone gets the wrong idea from consulting earlier posts of mine).

    But yes, there are attenuated Covid-19 vaccines under development.

    There is a biotech in California called Meissa Vaccines that is developing a live attenuated Covid-19 vaccine, delivered by nasal spray.

    Another one, headquartered in New York, called Codagenix, is also studying a live attenuated Covid-19 vaccine that they named Covi-Vac. Here's a paper on it:

    https://www.pnas.org/content/118/29/e2102775118

    You'll also like this very informative paper:

    https://www.sciencedirect.com/science/article/pii/S0264410X21010380
     
    Last edited: Oct 5, 2021
  10. 557

    557 Well-Known Member

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    The modified codon idea is genius. Like ghosting a bacterial vaccine except better.

    I’m glad to see nasal administration is being pursued seriously. Our best new vaccines for bovine respiratory diseases are mostly nasally administered. I didn’t realize IgA was so good at neutralization. That’s a nice tidbit I’ve learned from Covid

    I’m guessing it may be hard to market an attenuated vaccine for Covid but I could be wrong. It’s accepted for influenza I guess and was for poliovirus. Good point the article made on concerns with VDPV from attenuated polio vaccines. I don’t think something like that would go over well now. :) But with the codon manipulation and other mutating techniques we ought to be able to avoid it.

    Thanks for the links. They are interesting.
     
  11. CenterField

    CenterField Well-Known Member Past Donor

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    I knew you'd like them. You're welcome.
     
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  12. CenterField

    CenterField Well-Known Member Past Donor

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  13. Adfundum

    Adfundum Moderator Staff Member Donor

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    Thank you. As always, you do a good job of explaining, and once again, I feel a little better having a clearer picture of things. I actually had not seriously intended to switch vaccines so the question was more out of curiosity. I'd read that the Pfizer shot was less effective overall, and wondered if people could/should actually switch to another. Plus, it's been more than 6 months since my last shot and I got a notice that I'm on the list for a booster.

    I don't spend any more time in public than is necessary, so that lessens my chances for getting the virus, but the immediate area here is dominated by people who are rather vocal about not getting shots or wearing masks. Things went crazy here after school started, and the hospital filled up quickly, but we're almost back to normal now. But I will get the booster, and can say it's an informed decision. Maybe in time we'll know more about switching vaccines.
     
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  14. independentthinker

    independentthinker Banned

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    It would be a very hard sell to have to get vaccinated every 6 months until further notice. Many who got vaccinated aren't going to put up with that.
     
  15. CenterField

    CenterField Well-Known Member Past Donor

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    A very interesting study out of Italy done with several million people, shows PRESERVED efficacy of the Pfizer shots there, unlike what has been shown in Israel and the United States. I posted a link to that, in another thread (I don't have it on me for this thread but it's in my recent posting history). The interesting point is that this was mostly true, in Italy, of healthier subjects; they were able to demonstrate that those with co-morbidities did experience a drop in efficacy.

    So, Italians eat a Mediterranean diet and are generally much less obese than their American counterparts. Obesity is known as a leading cause of a poorly functioning immune system, so this might be a partial explanation for these findings (I don't know what's the obesity rate in Israel; we lead the world with more than 40% of our adults being obese, not even counting the merely overweight).

    Another issue is that Italians seem to adhere more to masks than Americans do, a point the study did make, so part of the preserved efficacy might be that a two-pronged approach, masks + vaccines, is keeping more people safe from breakthrough infections.
     
  16. CenterField

    CenterField Well-Known Member Past Donor

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    @Adfundum

    As promised, there's been new data on the efficacy and safety of booster shots done with a different Covid-19 vaccine than the one used for the basic vaccination.

    This study has just been released pre-print.

    It looked at all 3 American-authorized/approved vaccines, and a booster with any of the three.

    So, subjects were randomly assigned to nine situations (basic + booster):

    Moderna + Moderna
    Moderna + Pfizer
    Moderna + J&J
    Pfizer + Pfizer
    Pfizer + Moderna
    Pfizer + J&J
    J&J + Moderna
    J&J + Pfizer
    J&J + J&J.

    https://www.medrxiv.org/content/10.1101/2021.10.10.21264827v1.full.pdf

    All six situations of mix (boosting with a different vaccine) were superior to match (boosting with the same vaccine the subjects had with the basic vaccination)!

    Safety-wise, no particular problem was seen with the mix strategy.

    The study is small. Only 50 people in each of the 9 situations.

    People who had the same booster of their basic vaccination, increased their antibody levels by a factor of 4 to 20 fold.

    The people who mixed had an increase by a factor of 6 to 76 fold.

    Particularly, people who got the J&J benefitted much more of an mRNA booster than of a J&J booster.

    Moderna basic vaccination had the best result. This is confirming once more a trend of Moderna being the best Covid-19 vaccine in the market.

    Impressive. I read a piece today lamenting how bureaucratic the FDA and the CDC are being. They are not showing a lot of creativity... they are only approving Pfizer boosters for people who got Pfizer, Moderna boosters for people who got Moderna, and J&J for people who got J&J, while the evidence is starting to show that mixing is advantageous.

    This study gave the participants the boosters 12 weeks after the end of basic vaccination.

    They observed for late side effects for one additional month; didn't find anything out of the ordinary. Two participants had a serious medical condition, but both conditions were considered to be unrelated to the vaccines. One was a case of rhabdomyolysis after a fall, and another one, a case of cholecystitis. Neither is known as a side effect of the Covid-19 vaccines.

    So this study, although small and still pre-print and non-peer-reviewed, is encouraging regarding the efficacy and safety of the mix strategy.
     
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  17. Adfundum

    Adfundum Moderator Staff Member Donor

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    Thanks, CF. I still have time to consider it all before I'm eligible for the booster. My provider sent a message telling me I had to wait until my birthday in a couple of months before they would offer it. But I do like the idea that the mixed vax has such an increase. And again, thanks for breaking things down for me. Very much appreciated.
     
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