Messaging Muddle: Pushing Vaccination as COVID Vaccines’ Effectiveness Wanes

Infection preventionists and public health officials are in a messaging nightmare. How do you tell someone that the vaccine’s protection is waning and they have to wear masks and at the same time encourage them to be vaccinated? The answer is simple, tell them the truth. If you do not, the virus will prove you wrong and you will lose credibility with your patients and the public. Here is what we know.

The narrative that mRNA vaccines provide good protection against severe disease, is somewhat misleading, since severe disease is defined as hospitalization, and one must be critically sick to be hospitalized with COVID-19. We are running out of beds and in many areas triaging resources with patients waiting in ambulances for hours for admission to a hospital. I know of several of my friends (I run with the above 60-year-old crowd) who have developed breakthrough infections, have a severe protracted illness with shortness of breath, myalgias, fever and loss of appetite; and are still being treated at home. My afflicted friends may also face the risks of long COVID-19 which can occur in 10% to 30% of those who develop mild to moderate infections, even in those who were previously vaccinated.

However, the mRNA vaccines do markedly reduce the chances of hospitalizations from critical disease and death. This is a huge plus. If our hospitals become overrun with COVID-19, other patients needing treatment for heart disease and cancer will not be able to receive care and may become collateral damage. In addition, although spread can still occur in those vaccinated, it is likely to be much lower than those who are not, thus, providing a degree of community protection.

The exceptions to this high degree of benefit are in those who are immunocompromised, have an organ transplant or in some of the elderly. According to Israeli data, the Pfizer/BioNTech mRNA vaccine effectiveness is waning in those who are over the age of 60 and have been vaccinated over 5 months ago, with 8.6% of breakthrough infections resulting in hospitalization and 2% in death.

In the prevention of symptomatic disease, effectiveness drops to 42%, explaining what has happened to some of my close friends who received the vaccine early on.

mRNA vaccines provide important protections, not only for the individual but also for the community. The University of California San Francisco analyzed breakthrough cases in their employees and found that “unvaccinated people remain five times more likely to become infected than people who are vaccinated, and 25 times more likely to be hospitalized.” Data from the Health Ministry of Israel reported that those over the age of 60 who were not vaccinated were six times likely to develop severe COVID-19 than those who were vaccinated. Younger unvaccinated patients were 3.2 times more likely to develop serious COVID-19 than vaccinated residents. Although, the magnitude of the results found in these 2 reports appears to be different, it needs to be remembered that the time elapsed from last dosage of the vaccination is not controlled for. Israel was one of the first countries to vaccinate its population and is the first to report waning of protection in older patients who were some of the first vaccinated.

Thus, vaccines are not a panacea, but an important layer of armor. There is also hopeful news from the United Kingdom, showing the Delta surge is subsiding. It is estimated that 90% to 94% of the public has some immunity to the coronavirus and 70% of Britons are still wearing masks in public places.

Combining all of these reports shows that to control this pandemic we need to enact multiple layers of prevention including effective masking, vaccinations, upgrading ventilation systems and social distancing.This virus is endemic.It is here to stay, and new variants are waiting in the wings to cause another surge with reinfections and breakthrough infections.If we do this, we will be able to start to learn to live with this virus, we cannot simply wish it away.