scorecardA top emergency care doctor explains why she's not boosted - but she's making sure her mom gets a third shot before the holidays
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A top emergency care doctor explains why she's not boosted - but she's making sure her mom gets a third shot before the holidays

Hilary Brueck   

A top emergency care doctor explains why she's not boosted - but she's making sure her mom gets a third shot before the holidays
LifeScience4 min read
  • A top infectious disease doctor in New York says she hasn't gotten a third booster shot yet, even though she's eligible.
  • Dr. Celine Gounder is, however, recommending that her elderly mother get boosted, at least two weeks before holiday travel.

Dr. Celine Gounder is one of the leading infectious disease doctors in the US, and she takes care of sick patients at one of the nation's largest hospitals.

As a frontline worker at increased risk of catching COVID-19, she's been eligible to receive a booster shot of a COVID-19 vaccine for several weeks now. But she hasn't.

"I have not gotten a third dose," she told Insider. "I, personally, am waiting and seeing what the science shows on longer-term immunity and what might make more sense."

She's confident that her two initial shots are still providing her robust, long-term protection against severe disease, hospitalization, and death from COVID-19. There is only one person in her family who she has urged to get boosted ASAP.

Why she's more concerned about boosting her mom

"My mom is the only person in our family who, in my opinion, truly needs a third dose - is an elderly person," Gounder said.

Older people, who naturally have weaker immune systems, are generally in need of more frequent and stronger vaccinations. For now, there is limited evidence that extra shots are really necessary for all adults, especially in the immediate term.

Gounder told her mom to time her booster shot with her holiday travel plans.

"What I told her was: wait until two weeks before Thanksgiving, because we don't really know what this means long term," Gounder said. "Then you get your peak antibodies for Thanksgiving."

Studies have found that booster shots from Pfizer and Moderna tend to send people's antibody levels soaring to new heights, peaking about two weeks after their third jab. And according to recent data from Israel, there's evidence that boosters help curb the spread of the virus, at least for a little while.

Most people are still very well protected against severe COVID-19 for at least 6-8 months after vaccination, studies find

Gounder said she grows frustrated with younger folks she's spoken with who've decided to get boosted, and "tend to think that, by getting the boost, they are then forever protected and they don't have to worry about it again."

"These are not vaccines that provide sterilizing immunity," completely zeroing out the risks of infection and sickness in all its mildest forms, Gounder said.

She cites fresh studies that find memory B-cell responses, which can produce new neutralizing antibodies as needed, remain intact six to eight months after vaccination, even if antibody levels drop.

"What if you learn that getting a third dose at six months is not as good as waiting a year?" she said.

Dr. Rachel Presti, medical director of the Infectious Disease Clinical Research Unit at Washington University in St. Louis, is studying exactly that, by measuring people's memory responses to vaccination over time, along with her colleagues.

Presti says, generally speaking, for "people who are under 50" who've been fully vaccinated with Pfizer or Moderna, "it's not clear that you're getting a whole lot of bang out of another dose."

But Presti also thinks people can make their own decisions about boosts. For example, if a young person who got vaccinated "nine months ago" is traveling to visit elderly family over the holidays, or lives with someone who is immunocompromised, they may choose to boost "to sort of maximize" protection, at least for a while, she said.

Gounder isn't taking that approach. Pending results on studies like Presti's, Gounder is taking other proactive measures to prevent a coronavirus infection - masking up indoors, only outdoor dining, and generally avoiding socializing inside.

Boosting too early could interfere with our immune system's learning process, some new research suggests

Presti says it's pretty unlikely that extra boosting will do any harm, but some of her most recent research suggests that a person's lymph nodes are "still working on perfecting their immune response to the original vaccine six months after."

It's possible that interfering with that process, by boosting too soon, could be counterproductive.

"There is that little risk that if you are getting too many, they might not actually work," she said of too-frequent boosts.

The science here is still evolving - Presti says immunologists are trying to figure out the optimal timing for doses "as we go."

But she's pretty confident that some day, boosters will be recommended for all adults.

That's because many experts, Presti included, suspect the initial timing of first and second doses, spaced just three to four weeks apart, may have been too short to provide a truly lasting, robust immune response. In this sense, booster shots may come to be seen more as the final stage in an initial vaccination series.

"More space in between first and second doses would have been better, but even with what we got, it may actually still be fine," Gounder said.

The privileged are getting boosted - but that won't help to stop the virus spreading

Experts all agree that giving out extra shots isn't going to work very well if some people are still getting no shots at all.

"I think we do need to step back and just ask, what is it we're actually accomplishing?" Gounder said. "It's almost like people lining up to buy the new whatever it is."

Gounder laments that the US has favored this everyone-for-themselves approach to vaccination, treating booster doses like new iPhones, instead of public health tools.

"It is the most privileged who will get as much as they want, and the less privileged will not, the more vulnerable will not," she said.

Whether or not people realize it, that sets everyone back in the long run.

"If you give dose after dose after dose to an individual, but there's a lot of circulation of virus around them in the community, they are still at risk," Gounder said. "I think that still hasn't really gotten through."