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Harry Rakowski: Will we need vaccine booster shots for COVID-19?

Commentary

Canada is finally reaching highly protective levels of full vaccination. Why then do we need to consider whether booster shots may still be needed this year?

All approved vaccines have high levels of protection against hospitalization and death, their most important benefit. It therefore is not surprising that almost all hospitalizations and deaths in the U.S. and Canada are now occurring in those inadequately vaccinated (85 percent of bad outcomes are in those foregoing vaccination and the rest in those not fully vaccinated).

Vaccine protection comes in two important ways namely antibody production and memory T-cells. The most immediate protection is the vaccine antigen-induced production of antibodies able to bind and neutralize the viral spike protein.

These antibodies rapidly develop after vaccination and await exposure to the SARS-CoV-2 virus. If exposed they then neutralize the virus by binding to its spike protein, restricting cell entry via the ACE2 receptor thus preventing further replication and cell damage.

Antibody levels are easy to measure and have been shown to increase dramatically following a second vaccine dose. Maximum protection is achieved about two weeks after the second shot. Vaccine induced antibody levels are lower in older people and those who are immune compromised. Antibody levels also decay over time both from natural infection and following vaccination.

The key issue is at what point the decay in antibody levels reaches a critical threshold whereby adequate protection from infection and its complications is of concern.

The mutation of the virus into more infectious and dangerous variants of concern (VOC) has also made it more resistant to vaccine induced spike protein antibodies as they work best to neutralize the original rather than the mutated form of the viral spike protein.

The mRNA vaccines had about 95 percent reduction of infection risk for the original strain (almost complete protection against death) and only about 88 percent for the now dominant Delta VOC.

Recent Israeli data shows further slippage of protection over time in their early vaccinated population with recent 93 percent effectiveness against serious infection and 64 percent against breakthrough infection.

There is currently very little Delta plus (Delta plus an additional spike protein mutation) or Lambda VOC disease in North America and we don’t yet know if this will be a further issue (but hopefully not).

The combination of lower antibody production in some vulnerable groups, natural decay of levels over time and lower specificity and effectiveness in targeting VOCs has raised concerns about when vaccine boosters may be required to further ramp up antibody levels. 

Pfizer has already requested emergency-use authorization from the FDA to approve the use of a booster for a third vaccination dose in vulnerable people. While a modified vaccine targeting the Delta variant is being developed and tested, the proposed initial booster would be the current vaccine since in trials this has been shown to further increase antibody levels by a factor of five to 10 times against the Beta variant and likely also as effective against the Delta variant.

The proposed need for booster shots has raised concerns about pharmaceutical companies hyping the shot for financial reasons. As well there is concern particularly in the U.S. that talk of boosters will further increase vaccine hesitancy which is already a major risk for a developing fourth wave.

Current complication rates for vaccine induced blood clots, myocarditis and now Guillain Barre, a neuromuscular syndrome recently rarely associated with the Johnson & Johnson vaccine are low enough to still recommend primary vaccination for everyone. It is not clear whether these risks are amplified following a booster shot. The risk benefit almost certainly favours booster shots in high risk people at some point but not necessarily in low risk groups.

As always decisions about the need and timing of booster shots requires us to follow the science which is not yet mature. Studies of efficacy and safety of boosters are being carried out both by the manufacturers and independent bodies. Israel and France have allowed emergency use of boosters in highly-compromised people such as those who have received donor organs or cancer therapy. Other countries may follow their lead.

For now disease levels are low in North America, vaccines remain highly effective against all VOCs and boosters are not yet necessary except possibly for those at highest risk. As well our adaptive humoral based immunity from memory T-cells may provide longer protection even if antibody levels decline.

It is hopeful that if boosters are needed, for most people it would be offered a year or more after initial full vaccination. For those over 60 with risk factors it may be sooner. It is too early to be certain about timing and it awaits the outcome data and whether case rates start to rise dramatically in vaccinated people.

The boost we currently need is from life returning to a more normal level and focusing on primary vaccination for as many people as possible all around the world. We have to trust that the worldwide regulatory agencies will review the science as it becomes available and advise on when, if, and in whom booster shots may ultimately be appropriate.

Let’s hope our government has secured early options for them if needed.

Patrick Luciani: Is this the beginning of the end for communism in Cuba?

Commentary

Any Canadian who has visited Cuba and took the time to go beyond one of those insulated packaged beach resorts — subsidized by cheap Cuban labour — and is honest with themselves must conclude the country is an island prison inhabited with tortured souls begging to get out.

Cities like Havana are ghost towns with people.

And tightly controlled ghost towns at that. Cuba has more secret police per capita than the Stasi had in East Germany.

That’s why it seemed a miracle that thousands protested across the country recently crying out for food and freedom and suffering the highest per-capita outbreaks of COVID-19 in Central America.

And yet, many Canadians continue to romanticize the country for the simple pleasure of seeing Cuba stick it to the Americans. They don’t know the madness of the man who was willing to sacrifice every Cuban life and the outbreak of a nuclear war.

During the Cuban Missile Crisis in 1962, after the Soviet Union placed ICBMs, bomber planes and transferred thousands of Soviet troops to the island, the world waited in fear for 13 anxious days. U.S. President John F. Kennedy and Soviet leader Nikita Khrushchev finally agreed to disarm and pull their nuclear weapons from Cuba and Turkey.

When the agreement leaked out to the Cuban government, a furious Fidel sent a letter to Khrushchev demanding the immediate launching of a nuclear strike on the U.S., saying the Cuban people are “…willing to sacrifice themselves for the destruction of imperialism and the victory of world revolution.” Not that Castro asked the Cuban people whether they were willing to go along with this madness.

At that point, Khrushchev knew Castro was mentally unstable. This is the man our prime minister, who mourned his death in 2016, said, “While a controversial figure, both Mr. Castro’s supporters and detractors recognized his tremendous dedication and love for the Cuban people who had a deep and lasting affection for ‘el Comandante’.”

Cuba, 1958

Castro sympathizers live under the illusion that Fidel saved Cuba from an oppressive regime under President Fulgencio Batista, American capitalism and the mafia — right out of scenes from Godfather 2. As I have written before, and apologies to philosopher George Santayana, those who cannot remember the past aren’t condemned to repeat it but are condemned to having Hollywood teach it to them.

Cuba was not the basket case many Canadians believe before the Castro brothers and their pal Che Guevara took over. For a country supposedly suffering under Batista, Cuba’s economy continued to grow throughout the 1950s, with rising industrial and agricultural wages comparable to those in Europe. Workers were entitled to a one-month paid holiday and an eight-hour work day, while mothers were given six-week leave before and after childbirth. Before the revolution, the island nation had a rich literary and cultural life with 58 different daily newspapers and a capital city with more movie theatres than New York City. In the end, Batista did one thing the Castro’s never did: he won an election before taking power.

The Cuban government and Cuba defenders, such as U.S. Senator Bernie Sanders, have always banged on about Cuba’s high literacy rates under Castro. An exaggerated claim. Literacy rates were rising from 1900 and were at 80 percent before 1959. Castro never allowed an independent confirmation of his literacy progress.

One has to ask what it means to have an educated population when most of what people read is filtered through Marxist ideology. Today Cuba has 30 universities and institutes but limited access to modern textbooks, the internet, email, international media and academic journals.

Pre-revolution Cuba enjoyed Latin America’s highest per-capita consumption of meats, fruits and vegetables, along with higher ownerships of cars, telephones and radios. Today, waiters with graduate degrees take home leftover food scraps from the tourists they serve. When the Soviet Union collapsed in 1989, the poorest of the poor were reduced to eating stray cats and dogs. Today’s standard of living ranks with Albania and Sri Lanka.

When it comes to health care, it’s a country where you don’t want to be sick. It’s common for tourists to drop off bottles of Tylenol, bandages and other over-the-country medical supplies to local clinics and hospitals. And if you have the misfortune to end up in one, be prepared to bring your own bedding, towels and soap.

Keep in mind that Cuba had a reputation for a high level of health care and education before Castro. The medical school at the University of Havana has always attracted the best students for Central and South America. As I have noted in a previous article for the National Post, by the late ’50s, the country had more doctors per capita than the U.K. and the lowest infant-mortality rate in Latin America. Today, hard currency is earned by sending doctors abroad while their families are held back to discourage defections. But the best doctors find ways to leave Cuba, where even surgeons earn only $40 a month. Those who can’t end up driving taxis to make ends meet.

What about the embargo? For starters, it’s not an embargo. The last time U.S. embargoed Cuba was during the missile crisis. The U.S. forbids American firms from doing business with Cuba, but any country can do business with Cuba and many do such as China, Italy, Spain and Canada. The Cuban government could have avoided the wrath of the U.S. government if it had negotiated a deal to compensate U.S. firms after the revolution. Castro refused and the country suffered the consequences.

Beginning of the end?

Prime Minister Justin Trudeau eventually came out making a tepid statement about Cubans deserving freedom, respect and democracy while calling for both sides to come together “in peaceful and inclusive dialogue.” That PC word “dialogue” adds a nice sense of absurdity. Even Joe Biden flatly said that Cuba is a failed state and the communism was the cause and that socialism isn’t much better.

Is this the beginning of the end for communism in Cuba, or the end of the beginning, as Winston Churchill once said during the Second World War?

For the sake of the Cuban people, let’s hope it’s the former.