NASHVILLE, TN – Yes, you should. “One out of every 50 people who gets COVID-19 are most likely to die,” said Dr. Ben Neuman, Chief Virologist at the Global Health Research Complex at Texas A&M University. 

That’s a 2% infection-fatality rate. 

“A percentage of people who are vaccinated and get breakthrough COVID will also be hospitalized or die from COVID and as far as we can tell this will continue indefinitely. There is no data to suggest otherwise,” Neuman said. 

Last month, the CDC approved a Pfizer booster for people over 65 and people with weak immune systems. Approval for a half-dose Moderna booster is expected soon and the FDA will hold a meeting Oct.14-15 to consider Johnson & Johnson’s request to approve its booster. 

Briefing materials from CNN on boosters are available here:

Based on Federal Drug Administration’s (FDA) latest data, Neuman said that people are misusing the term “fully vaccinated”. 

“No one is fully vaccinated. What we have evidence for is waning immunity and there are different degrees,” he said. 

COVID-19 is a moving target. It is constantly evolving, getting faster and better at reproducing itself. After vaccination, protection decreases by 50% after about five months. The good news is that the protection against death remains constant at around 90%. 

As of September 2021, 99% of the COVID infections in the U.S. are the Delta variant. There are 40 Delta subtypes scientists are tracking. The effectiveness of the vaccines against Delta is about the same as against other variants. And the protection against Delta decreases at about the same rate as it does for other variants. 

“FDA data suggests there is a relatively small difference between people who are over 65 and under 65 in terms of how effective the vaccines are—the difference is between about 5-10%,” Neuman said. 

Dr. Ben Neuman is the Chief Virologist at the Global Health Research Complex at Texas A&M University. 

“We have also seen the benefit of a booster is very large regardless of age group. With a booster people end up with between five to ten times as much antibodies as they had at the peak after the second vaccine and they end up with as much 50 times as much antibodies as they had right before the booster. 

Based purely on the data it would look as though universal vaccinations and universal boosters are going to be beneficial,” he said. 

Neuman noted there are very few two-dose vaccines. People take three or more shots to build a durable immunity that will last for years or a lifetime. In other words, two shots gives reasonable protection but three or more provide certainty. “That’s a huge benefit,” he said.

Dr. Monica Gandhi, a professor of medicine at University of California San Francisco, thinks the coronavirus will become endemic in the U.S. and that’s actually good news but we won’t ever eradicate it. 

Smallpox has essentially been wiped out because vaccines were highly effective and it’s not like the coronavirus.

“COVID-19 has animal hosts, it’s infection looks like a lot of other respiratory infections. It can be spread before you even know you’re sick, so it doesn’t have a short period of infectiousness. We don’t know if you’re immune for life but we do have a highly effective vaccine.” Gandhi said.  

This image shows a person infected with smallpox. It has been eradicated worldwide. COVID-19, like the common cold, will not go away completely.

“Likely what will happen with COVID is that it will go the way of measles. It will go the way of pertussis. It will always be with us,” she said. She said COVID-19 will become endemic and that’s not at all what people mean when they talk about herd immunity.

T cells are the major immune defense against viruses. Vaccines increase T-cells and they work against severe disease with all the COVID variants. Vaccines also increase B cells, which go into your body’s memory. 

Antibodies wane over time but B cells “remember” to make more of them if you get re-infected. “The B-cells become the memory to make new antibodies if needed,” Gandhi said. 

She said the reason why there are more symptomatic breakthrough infections with the Delta variant is because of its higher viral load. Studies have shown that increasing the duration between doses lead to a higher number of antibodies and thus, more protection.  

Moderna shots have a higher a dose and they are given four weeks apart, whereas the Pfizer vaccine is given three weeks apart. In either case, B cells are pretty smart. They will adapt to any new variant that infects the body.

Monica Gandhi MD, MPH is Professor of Medicine and Associate Division Chief (Clinical Operations/ Education) of the Division of HIV,
Infectious Diseases, and Global Medicine at UCSF/ San Francisco General Hospital.

Gandhi said the global pandemic would spread until the world’s population gets vaccinated. Two weeks ago President Biden pledged an additional  $370 million to give Pfizer vaccines to poor countries on top of the $4 billion for COVID-19 vaccines he announced last February.

“We have about five doses for every American stored up,“ Gandhi said.

All rich countries have that many for each of their citizens while just 2.2% of the vaccines have been available to low-income countries. Gandhi noted three studies have shown that asymptomatic spread by vaccinated people is rare—all the more reason for a more equitable distribution of COVID-19 vaccines.

“The only way to stop people from being exposed to the virus is to tamp down transmission everywhere. We are not safe from variants until other people are safe,” Gandhi said.