Long-term Covid-19 booster effectiveness: a population-based cohort study | Hacker News Reader

Long-term Covid-19 booster effectiveness: a population-based cohort study

thelancet.com

32 pointst0bia_s51 comments

While I don’t at all doubt the public health advantages of the Covid vaccine, I do have one reservation about the whole thing that I feel was never properly addressed: when I was growing up, I was taught the reason we make vaccines mandatory is because they confer herd immunity; that is, if 90% of people cannot catch or spread the disease because they are vaccinated, the other 10% are conferred protection as well because there aren’t enough remaining vectors for a disease to spread (any potential chain of infections peters out quickly rather than continuing). This reasoning made a lot of sense to me and I accepted mandatory vaccinations on that basis. I do feel that a kind of “bait and switch” happened where the Covid vaccine was initially presented as mandatory for the same reason, but then “prevents infection” was replaced with “significantly lowers the harm from infection”, and thus the new motivation for making it mandatory was “it stops the public health system from collapsing by dramatically lessening the cost and impact of each infection”. While that is a very good thing, it is still the case that we lost the original ‘herd immunity’ justification for mandatory vaccination, but never re-litigated the mandatory aspect of it on this new basis.

I’m unsure that “keeping the public health system afloat” actually justifies mandating medical decisions for individuals. I urge you before responding to note that I am unsure - it might have justified mandatory treatment, I was quite open to believing it did, but it remains an uncomfortable fact for me that we went ahead and kept it mandatory without anyone making those arguments.

(Posting this because that’s what this study shows: a small effect on preventing infection and a very large effect on reducing the severity of infection)

My understanding is that herd immunity can be seen differently for different things. As such, it gets really tricky really quickly, as some folks will be talking about the kind of immunity you can have for things like Measles, while others will be talking about Flu and such.

That is to say, a whole shit ton of talking past each other.

My own view is that looking at population level metrics usually means that you can't really view the individual level metrics at the same time. Way too easy to see confounding increases in personal risks from some protection that oddly leads to more damage at the population level.

Even without a 100% immunity granted, it still gives a herd immunity effect, the disease is far less effective spreading, either for not be able to infect as much people, or people not being severely impacted and being less contagious and for less time.

And lowering odds of getting severe adverse effects in the case of infection is a net plus for you.

Regarding the health system, you are not immune to everything. A saturated health system may not be available for you if you i.e. have an accident.

Even not caring about COVID that it spread more may affect you. You are part of a system.

>the disease is far less effective spreading, either for not be able to infect as much people, or people not being severely impacted and being less contagious and for less time.

This idea doesn't mix well with Covid's very high rate of asymptomatic cases (which may be even higher among the vaccinated).

>A saturated health system may not be available for you if you i.e. have an accident.

At least where I live (Wales, UK), asking citizens to avoid healthcare for several years to "Save the NHS" has resulted in an ongoing health crisis of unprecedented proportions.

>>the disease is far less effective spreading, either for not be able to infect as much people, or people not being severely impacted and being less contagious and for less time.

>This idea doesn't mix well with Covid's very high rate of asymptomatic cases (which may be even higher among the vaccinated).

Indeed. Isn't it counterproductive (and also contrary to the history of public health remedies) for a "vaccine" to only reduce symptoms but not reduce infectivity? Doesn't that cause people to go to work and school when they might not have otherwise?

>At least where I live (Wales, UK), asking citizens to avoid healthcare for several years to "Save the NHS" has resulted in an ongoing health crisis of unprecedented proportions.

"Save the NHS" has a long history pre-COVID19, too. <https://twitter.com/KulganofCrydee/status/833654730849136641>

>Doesn't that cause people to go to work and school when they might not have otherwise?

Hence the absurd situation where you "need" to get vaccinated to be a good person, but you also need to keep testing, in case you leave the house while infected.

People find this difficult to grasp, because of black and white thinking.

COVID vaccines significantly reduce how many people who get exposed to COVID actually get sick. They also reduce just how sick people get. Both of those reduce how COVID spreads, how much it impacts people's lives and how much it impacts society by people being sick.

But some people just have that black and white thinking where if the vaccine doesn't make you completely immune, it "doesn't work and it's all fake". If you get sick with COVID while vaccinated, you can't compare with alternate world where you weren't vaccinated and see whether it would kill you instead.

>COVID vaccines significantly reduce how many people who get exposed to COVID actually get sick.

The linked article says that Covid boosters, at least, are 26% effective. Personally, I don't call that a significantly effective treatment.

From the study:

> Booster effectiveness relative to primary series was 26·2% (95% CI 23·6–28·6) against infection and 75·1% (40·2–89·6) against severe, critical, or fatal COVID-19, during 1-year follow-up after the booster.

And then you write:

> Personally, I don't call that a significantly effective treatment.

I don’t think you’ve thought this through very well.

I'll quote OP again:

>>COVID vaccines significantly reduce how many people who get exposed to COVID actually get sick.

The boosters are 26% effective at preventing infection.

Sure, they do something if you are particularly at risk of having a bad time with Covid, but that low effectiveness at preventing infection means there isn't much argument that they did much to slow the spread of Covid.

I think a 75% reduction if getting a serious or lethal case of COVID is totally worth it, although, like the flu vaccine, it might make more sense for the over 65 crowd than the under 30 crowd.

>totally worth it

Exactly. That was sort of the point of my original comment, although unfortunately I think I only confused things by mentioning herd immunity.

Another way of making my point might be to say, there’s a “personal standard” (is it worth it for me to take it?) and a “mandatory standard” (is it worth abrogating individual self-determination to make everyone take it?). Influenza clears the “personal” standard for many, but it appears that it does not clear the “mandatory” standard in most jurisdictions, as it has not been made mandatory in most places. On the other hand, smallpox (~7,000 infections per million people before, 0 per million after) and measles (~3,000 per million before, ~1 per million after) are examples where the standard for “mandatory” is cleared with flying colors. My point is not to debate whether the covid vaccine clears the mandatory standard or not - my point is only that we didn’t have that debate.

At least in Germany the discussion about mandatority took too long.

And it was plenty discussed at that time.

But the Querdenker issue was too strong in comparison to a lot of other eu countries

I know we're only supposed to comment on the articles but I've tried 3 different computers, 4 browsers, and two IP addresses and I still just get a blank white page. Even with all javascript enabled, etc. The Lancet jumped the shark in late 2019 and has only been getting worse. Their website is literally not performing it's function to distribute text.

At least I could still get the full article at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10079373/

"Booster effectiveness relative to primary series was 26·2% (95% CI 23·6–28·6) against infection and 75·1% (40·2–89·6) against severe, critical, or fatal COVID-19, during 1-year follow-up after the booster."

That's not as bad as I thought it would be. The intramuscular's humoral) immunity against severe disease in the body serum and organs holds up pretty well. The protection against infection, which relies on upper respiratory mucosal immunity that injections into the arm don't give, are predictably low.

I really wish the USA was still funding vaccine research so that some of these intranasal booster trials could be sped up. I haven't heard much about India's approved iNCOVACC intranasal role-out (starting this past ~feb), but the papers on it's effectiveness against infection should be out soon.

Must be your settings - Do you have a misconfigured PiHole or something? it works perfectly fine for me.. direct link to the PDF maybe?

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2823...

Odd. The lancet link loads fine for me with all javascript (including first party) disabled.

In my experience, disabling all javascript fixes websites more often than it breaks them (most javascript only exists to create nuisances), so I leave it all disabled by default.

Same experience, firefox with noscript blocking everything, page loads fine.

https://web.archive.org/web/20230525154103/https://www.thela...

What does 26.2% effective mean in this context?

Against infection, which:

> Incidence of infection was defined as the first PCR-positive or rapid antigen-positive test after the start of follow-up, regardless of symptoms.

> all rapid antigen tests conducted at health-care facilities (appendix p 9). SARS-CoV-2 testing is widely available and performed extensively in Qatar, mostly for non-clinical reasons.1, 12 Most infections are diagnosed not because of symptoms, but because of routine testing (appendix p 3).

So they’re even capturing non-symptomatic infections, which you may not really care about. If a booster turned a symptomatic infection into a non-symptomatic infection, it would still be captured here and make it look like a booster failure. Not sure how well Qatar captured symptomatic infections.

Relative effectiveness. It means you were 26% less likely to get COVID vs those with the vaccine but no booster

Important to note that effectiveness is a relative term.

One thing they ought to track in these studies is infections in both the boosted group and control group. Effectiveness can wane for multiple reasons:

1. Antibodies want

2. Variants shift and the booster is less effective

3. The control group caught covid and gained immunity

If your control group gets infected and gains immunity, the booster will seem less effective. But it wasn't waning, unlike causes #1 or #2.

The study period ends Oct 2022. 2022 was the year most of the population caught sars-cov-2 at some point.

>>Booster effectiveness relative to primary series was 26·2% (95% CI 23·6–28·6) against infection

Sorry, maybe I'm an idiot, but what does this mean? "Effectiveness against infection" - does that mean that 26% of participants who got the booster did not contract corona-19?

> For example, an effectiveness of 40% means that incidence of infection in the three-dose cohort was 40% less than that in the two-dose cohort.

It’s a relative hazard ratio. % less likely to get COVID vs. the cohort with just the vaccine

It may be statistically significant improvement but I doubt that most rational, informed patients would consent to an experimental genetic therapy that reduced the likelihood of a flu-like illness by as little as 2.2% within a year.

I would be especially curious to know:

-if this was extrapolated, do the cohorts' infection rates eventually meet

-extrapolating further, would the boosted cohort rate even exceed the control, especially as natural immunity increases more quickly in the control

-the rate and seriousness of vaccine side-effects within the boosted cohort

-the cumulative rate and seriousness of vaccine side-effects with annual boosters

-serious injury and mortality from the vaccine in the boosted group vs serious injury and mortality from the disease in the control group

It's astonishing how successful the vaccines turned out to be given the circumstances in which they had to be developed.

Still too early to tell

Lol no. They've saved millions of lives and trillions of dollars with no downside except in the minds of weirdo antivaxxers that p-hack their way into obviously false beliefs.

Doesn't africa have really low vaccination rate at like less than 25% in most countries?

Contra dozens of studies showing the effectiveness and number of deaths averted in countries with strong public health reporting and organization, the existence of lower rates of disease in some African countries with low vaccine uptake is persuasive to you?

Africa also has a population that is very young: A combination of both high birth rates and low life expectancy. I'm not sure what point you're trying to make.

Yup. 60% of the continent’s population is under 25.

> All of the world's top 10 youngest countries by median age are in Africa, with Niger in first place with a median age of 15.1 years.

https://en.m.wikipedia.org/wiki/Youth_in_Africa

Maybe the point that since young people are at much less risk, it would have made sense to target the vaccines at the kinds of people that COVID was a threat to, and not quarantine us all and fire anyone who didn't want to take it.

So does China and other Asian countries

> Lol no

> weirdo antivaxxers

Good points, I'm sure you've put a lot of thought into this.

Every single public health professional in the world has, so I can just summarize. The modern world is pretty great.

> Every single public health professional

I beg to differ, but sure give it your best shot. Start with explaining the methodology behind the claim for "trillions of dollars saved", then continue with "no downsides".

The way you speak in absolutes is a sign you don't know what you're talking about.

Yes no thoughtful individual has ever used colloquial language good observation.

It's been roughly two years since the initial rollouts, and more since the clinical trials. When will it stop being "too early to tell"?

We (in the U.S.) are giving these to 5-year-olds. We don't know if there will be developmental issues, and we won't for quite some time. Remember, Pfizer wanted to hide their data for 70 years until releasing it. [1]

[1]: https://www.reuters.com/legal/government/paramount-importanc...

We don't know the long-term developmental effects of repeated infections either. There's no reasonable control group here.

> repeated infections

Do you mean infections with lower intensity? I still got infected second time with all the boosters. It was less intense perhaps, but not sure.

> Remember, Pfizer wanted to hide their data for 70 years until releasing it. [1]

Please attempt to be honest with your critiques. The FDA (not Pfizer) said that with current staffing and funding levels, and given the rest of their FOIA requests, it would take 75 years to scrub and release the patient files for PII. As is completely routine, a judge told them this needed to be a priority so they would have to turn over the files in under a year.

Since then, they've turned over 780,000 pages of records and the plantiffs attorneys are all dropping off the case since they realize there's nothing there and they're just completely standard patient charts as the FDA had previously told them.

https://storage.courtlistener.com/recap/gov.uscourts.txnd.35...

The first long term studies will be out in 2024

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