Booster shots and the current Covid-19 Delta wave

Switzerland is now offering a covid19 booster shot to to the 65+ and at-risk who has had their two covid19 vaccinations at least six months ago. It may soon be extended to all adults. I had my third shot last Thursday with no side effects (not even a localized sore spot) and was surprised to receive a Pfizer booster after being fully vaccinated earlier this year with the Moderna vaccine. The mRNA in both vaccines encode the same S-2P protein which differs from the covid19 spike protein by two amino acids only. These stabilize the spike protein so that it can train the immune system before it enters the host cell. I’ve been reading up on booster shots and will try to provide a brief summary below. If you want citations and more detail on the studies, see my professional blog here.

A large study of 1.14 million Israeli adults, aged 60 years and over who had received two Pfizer doses at least 5 months earlier, found that a third shot reduces the risk of infection by the dominant Delta variant by a factor of 11 compared to fully vaccinated people who have had two shots.  Receiving a different vaccine type as I did, further reduces the risk by around 30% or more. The booster shot lowers the risk of severe illness even more, by a factor of around 20 compared to those who have had two shots only.

Israel was the first country in the world to make available a third dose of the Pfizer vaccine to everyone aged 60 and over who had been vaccinated at least 5 months earlier. Since then, Israel has extended the booster program to the entire population. Booster doses per 100 people rose from zero at the end of July to over 40 per 100 currently.

Israel had a huge spike in infections this summer due to the combination of the highly infectious Delta strain, together with waning immunity in fully vaccinated people. Its clear from the following graph that the booster shots were definitely a game changer.  There was a very steep reduction in infections, hospitalizations and deaths among the people that got the booster shot. Israel went from over 11,000 new cases a day at the peak, down to a few dozen today. Before the booster campaign started hospitalizations were rising among vaccinated people whose immunity had waned, but the overwhelming majority of hospitalizations now are of people who are unvaccinated. During this period the fully vaccinated rate was fairly stable at a little above 60% of the population.

The same combination of waning immunity and Delta are now causing rising cases in Europe, as illiustrated in the following plot. Austria, Belgium and the Netherlands are currently the hardest hit (see graph below), with average daily new cases well over 1,000 per million, higher than any previous wave. In most of the countries on this graph, fully vaccinated rates are somewhere between 60 and 75%. That means around 25 to 40 percent of these populations are unvaccinated and their much higher susceptibility to infection is driving the latest surge in Delta infections.

Germany, Austria and the German-speaking region of Switzerland have the largest shares of unvaccinated populations in all of Western Europe. About one in four people over 12 is unvaccinated, compared with about one in 10 in France and Italy, and almost none in Portugal.

Governments are struggling to address this shortfall in vaccination levels. Austria has introduced a lockdown for anyone over the age of 12 who is not vaccinated and foreshadowed compulsory vaccination for all adults. Germany is considering new restrictions and in Saxony the unvaccinated are already barred from non-essential shops and other locations. The Netherlands has flagged that they will move to full lockdown for the unvaccinated but not the vaccinated. Switzerland has a referendum next weekend on whether to continue with the vaccine mandate which allows only fully vaccinated people to go to theatres, restaurants, gyms and other indoor public venues.

There were violent anti-lockdown protests in Netherlands a couple of days ago. Police in Rotterdam opened fire on the crowd and shot three protesters, after firing warning shots in the air. Can we continue to let such people cause wave after wave of infections, causing not only disabiliinty and preventable deaths in the vaccinated also, but limiting work, education and life opportunities for those doing the right thing and getting vaccinated?

Some commentators have raised the moral issue of whether it is just for people in countries like Switzerland to get booster shots, when the large majority of people in many developing countries still have no access to vaccination. Despite the best efforts of WHO to get the developed countries to provide funding for the purchase of vaccines for poor countries, there has been little response.

I totally support that initiative and would certainly vote for politicians who would make sure Switzerland steps up to help fund such efforts. However, if I did not accept a booster shot it is not going to get sent to a developing country so I see my duty to the community is to step up and have the booster to help end the current Delta wave in Europe. Perhaps there should be a popular initiative to force the Swiss government to provide more aid funding for vaccinations, rather than the one we will vote on next week, put up by anti-vax people to try to block action to safeguard us from further Covid waves and lockdowns.

A fourth Covid-19 wave hits Europe and Switzerland has a second referendum to end vaccine certificate requirements

Covid-19 cases rose by 7% and deaths by 10% over the last week in Europe, as it enters a fourth (or fifth) wave and currently accounts for about two-thirds of infections reported globally. Belgium and the Netherlands, which have fully vaccinated 73-74% of their populations, have the highest new case rates in Western Europe, almost double those of Britain. The fully vaccinated rate is Switzerland is 64%, higher than the USA at 57% but lower than Australia now at 69%.

I drove past the UN Palais de Nations yesterday, which had a crowd of around 2000 anti-vaccination protesters outside it, apparently concerned about loss of “freedom”.  The Netherlands has just reimposed a partial lockdown to address the rapidly rising case numbers and Switzerland won’t be far behind if the protestors have their way. I am way more concerned about the potential loss of freedom of association, ability to work and earn money, for students to attend schools and universities, ability to participate in social, sporting and cultural events etc etc than the freedom of a minority to be evidence-averse idiots who incubate the virus to continue to spread it and make life difficult for the vaccinated (who still have a small but non-zero risk of catching Covid from the unvaccinated in which it is spreading like wildfire).

Later this month, Switzerland will be holding its second referendum in less than six months on the Covid-19 law under which the government has made the Covid-19 certificate compulsory since September 13 to access indoor spaces (movie theatres, gyms, restaurants etc). This law was accepted by 60.2% of voters on June 13, and opinion polls indicate it will be accepted again. The Covid certificate has allowed the (intelligent) population to return to an almost normal social life. I’ve gone to the cinema, been training at the gym mask-free, and met up with friends for coffee, lunch or dinner.  All at risk if the anti-vax people get more support than before. The proposed revisions to the law also put other covid initiatives at risk. If passed, they would end government financial support for big events and end all government funding programs for the development of drugs or other important medical goods.

I find it impossible to understand or empathize with the anti-vax people who are prioritizing imaginary concerns in the complete absence of evidence over protecting the lives not only of themselves and those they love, but also others in the community. Millions of people have been vaccinated now, and we have a massive amount of data on side effects (rare and rarely severe or fatal) and the side effects of not being vaccinated (substantially higher risks of Covid-19 infection along with risk of long Covid or death). I can only think that it is one of the more appalling outcomes of the increasing partisanship and polarization in high income countries, in which large groups of the population have decided that those with differing political and social views no longer deserve to be considered human, and protection of their lives is of zero value. Fascism, concentration camps and the gulag lie just around that corner also.

While analogies are never perfect, and should not be over-interpreted, I can only think that the situation is analogous to one in which a substantial part of the drinking population decided that their hatred of more moderate drinkers and abstainers was such that they wanted to end drink-driving laws completely and be allowed to drive while drunk. The fact that they would be putting their fellow drinkers and families at risk did not offset the pleasure of seeing the “others” owned.

And any cognitive dissonance was ameliorated by their leaders and social media gurus who assured them that the evidence showing drink driving causes more car accidents is flawed and being pushed by a giant conspiracy involved the medical profession, public health professionals, scientists, news media and governments to take away their freedom to drive drunk.