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Waning Immunity and COVID-19 Vaccines: How Worried Should We Be?

Curated by Claudia Shannon / Research Scientist / ishonest

In the United States, the Food and Drug Administration (FDA) has approved third doses, or “boosters,” of the Pfizer-BioNTech COVID-19 vaccine for people over the age of 65 years.

It also approved boosters for people with health conditions that put them at risk of severe COVID-19 and for people whose jobs expose them to a high risk of infection, including healthcare workers and teachers.

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The agency had already given the green light to boosters for individuals with severely weakened immune systems, such as organ transplant patients.

But is there any evidence to justify a more widespread rollout of booster shots in the general population?

A recent study found that serum levels of antibodies against the spike protein of the virus, which it uses to gain entry to cells, start to wane around 12 weeks after the second dose of the Pfizer vaccine.

The researchers discovered that by 6 months after the second dose, median levels of these antibodies had fallen to around 7% of their peak level, with a range of 2–25%. The researchers say that this decline is expected.

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Other work has shown that after having an mRNA-based vaccine against SARS-CoV-2, antibodies may not be circulating, but they are at peak activity within the lymph nodes by 12 weeks.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

Cells that remember

At first glance, this appears to represent a worrying loss of immunity, but antibodies are only one branch of the body’s adaptive immune system.

The adaptive immune system also includes cells that remember past infections or vaccinations and swing into action if they encounter the same infectious agent again.

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A recent preprint of a study reports that the number of immune cells known as memory B cells that recognize the virus actually increases 3–6 months after the second dose of the Pfizer or Moderna vaccine.

Remarkably, even though these vaccines use genetic material from the original variant of the virus, the B cells also recognized the Alpha, Beta, and Delta variants.

This is because the precursors of these B cells evolve over time in the body through a process of random mutation, which allows the mature cells to detect new variants of the virus as they arise.

The research also found two other types of immune cell primed to detect the virus in most individuals 6 months after their second dose of vaccine.

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Known as helper T cells (CD4+ cells) and killer T cells (CD8+ cells), these help ramp up the immune response and destroy infected cells, respectively.

Other benefits of boosters

In addition to reducing the risks for older adults, a campaign of booster vaccinations for vulnerable individuals may help slow the transmission of the virus through populations.

A 2021 modeling study suggests that minimizing transmission reduces the likelihood that more dangerous, vaccine-resistant strains of the virus will emerge.

Other countries are going further than the U.S. in their booster vaccination campaigns. In the U.K., for instance, everyone over the age of 50 years will be offered a booster.

However, some critics believe it is irresponsible to give third doses of vaccine to people who are not especially vulnerable while much of the world remains unvaccinated. As the World Health Organization (WHO) explained in a press briefing:

“Third doses should be prioritized for the vulnerable: those most at-risk populations when there is evidence of waning immunity against severe disease and death. They are not for the fit and healthy. […] [W]hen global supplies are so limited, when the world is in a place where billions of people have not yet received any doses, we must focus on administering first and second doses.”

Read more on: vaccines


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