Scientists have found clues that the world’s leading COVID-19 vaccines offer lasting protection that could diminish the need for frequent booster shots, but they caution that more research is needed and that virus mutations are still a wild card.

Critical studies are underway, and evidence is mounting that immunity from the mRNA vaccines made by Pfizer and Moderna does not depend exclusively on antibodies that dwindle over time. The body has overlapping layers of protection that offer backup.

Pfizer and Moderna have fueled booster questions by estimating that people might need yearly shots, just like with flu vaccinations, and the companies are working to have some candidates ready this fall. But companies will not decide when boosters get used. That will be up to health authorities in each country.

Other experts say boosters may be needed only every few years.

“I would be surprised if we actually needed a yearly booster shot,” said Dr. Paul Offit, a vaccine specialist at the Children’s Hospital of Philadelphia who advises the Food and Drug Administration.

They point to ways the immune system remembers the coronavirus so that once original antibodies fade, the body’s defenses can swing back into action if a person is exposed again.

“I’m pretty optimistic. I wouldn’t rule out the need for boosters, but the immune response so far looks actually quite impressive,” University of Pennsylvania immunologist John Wherry said.

Antibodies that form after vaccination or natural infection do wane naturally, but there’s evidence that those levels remain strong for at least six to nine months after mRNA vaccination and possibly longer. They also appear effective against worrisome virus mutants, at least for now.

Scientists do not yet know what’s called the correlate of protection, the level below which antibodies cannot fend off the coronavirus without additional help.

Dr. Anthony Fauci, the U.S. government’s leading infectious disease expert, told a Senate subcommittee last week that vaccine protection would not be infinite.

“I would imagine we will need, at some time, a booster,” Fauci said. “What we’re figuring out right now is what that interval is going to be.”

To date, 62.8% of the adult U.S. population has received at least one dose of a COVID-19 vaccine and 133.6 million, or more than 40 percent, are full vaccinated. The rate of new vaccinations has slowed to an average below 600,000 per day, according to the Centers for Disease Control and Prevention. That’s closing in on President Joe Biden’s goal of 70% with at least one inoculation by July 4.

Infections and deaths continue to fall. The nation’s seven-day average for daily new cases fell to less than 17,300 on Tuesday, down from more than 31,000 two weeks ago. Daily deaths declined to 588, down from 605, according to data from Johns Hopkins University. In all, the virus has killed more than 595,000 people in the U.S.

So-called long-lived plasma cells are one of the body’s backups. Immunologist Ali Ellebedy at Washington University in St. Louis found that nearly a year after people recovered from mild COVID-19, those plasma cells had migrated to the bone marrow where they were continuing to secrete antibodies. That’s why although antibodies do diminish with time, they have not disappeared.

Now Ellebedy is hunting for the same cells in vaccine recipients, and while the research isn’t finished, he’s finding hints that they’re forming.

An even more important backup system comes in the form of memory B cells. If existing antibodies are not enough to stop the coronavirus, memory B cells are poised to churn out large numbers of new antibodies, Ellebedy explained. Numerous studies have found those memory cells after COVID-19 vaccination.

And if the virus makes it past those defenses, yet another immune branch — the memory T cells — jumps in to eliminate infected cells and prevent severe illness.

With different coronaviruses that cause common colds, people tend to get re-infected every two to five years, Wherry noted.

Based on natural immunity against those related viruses, “we are sort of expecting our immunity may decline,” he said. “But we don’t know. For these mRNA vaccines, we may be doing better than nature, better than a natural infection.”

So far, health authorities agree that the most common COVID-19 vaccines in the U.S. and Europe protect against the virus mutations that are currently circulating, though not as strongly as they guard against the original virus.

Why? The vaccines mimic the protein that covers the outer surface of the coronavirus, and only certain spots of that protein are mutating, said FDA vaccine chief Dr. Peter Marks. The mRNA vaccines in particular make antibody levels skyrocket after the second dose. Those levels are so high that they offer some protection even when the vaccine and the variant are not a perfect match.

With so many people still unvaccinated, opportunities abound for more mutations to occur. The biggest sign that a booster might be necessary would be a jump in COVID-19 cases in fully vaccinated people, especially severe illnesses and especially if the infections are caused by a new variant.

To get ready, people vaccinated a year ago as part of the first Pfizer and Moderna vaccine trials now are being enrolled in studies of additional shots — either a third dose of the original or versions that have been updated to match a variant that first emerged in South Africa. Moderna says preliminary findings are promising. More results are due this summer.

The National Institutes of Health also just began testing a system in which patients are given a different brand of booster than their original vaccination, to see if it is effective.

Most of the world’s population has yet to receive a first dose. With different countries using different kinds of vaccines, decisions on booster shots may vary widely. Already, the United Arab Emirates has offered a third dose to recipients of a Chinese-made shot, the first formal introduction of any kind of booster.

If boosters eventually are called for, they will not be needed all at once because antibodies fade gradually rather than disappearing suddenly.

“Even if we require boosters or get to the point where we see immunity waning a little bit, we still are going to be far better off than we were a year ago,” Wherry said.

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At the appointment, I said a traditional Jewish blessing; my nurse said, “Thank you, Jesus,” and injected me in the arm. I wept. It was the week of my birthday.

I was preparing for a heavy week of work over Christmas and New Year’s when I received the vaccine. Supplies were limited, so only the very front-line workers were eligible and we had to be discreet, because so many deserving folks had to wait. Yet the medical system was continuing to notice who our “front lines” really were — not just doctors and nurses, but also the housekeeping staff who scrubbed COVID rooms in the ICU, and the food service workers who kept all of us nourished, and many, many others.

A week or so later, more of the hospital staff was eligible. A few weeks after that, a vaccine was available to essentially any hospital worker who would take it. Soon, vaccine appointments were going begging: availability had outpaced demand.

Some of this was because our hospitals were getting better at vaccine administration: at staffing our sites and lining up eligible recipients, and at matching our supplies to our appointments. But it turns out that we were also zipping through the hospital because a lot of people were saying no.

You have to remember that this was back in January and early February, before the vaccine was available to the general population. The only people being offered the vaccines were workers at hospitals, mostly health care workers, whose livelihood depends on science. And perhaps even more shocking to me, the people declining the vaccine had been on the front line in the health care system most directly impacted by COVID-19 deaths. Reports last summer showed that the overwhelming majority of COVID-related deaths among health care workers happened in New York: 368 fatalities as of mid-September.

The people being offered the vaccine had been watching people in COVID units get sick and die, day after day, for just as long as I had. And they still said “No.” I couldn’t believe it.

To be honest, I still can’t.

Some who declined had already gotten COVID-19 and had laboratory evidence of antibodies. They didn’t feel there was evidence showing that the vaccine had any advantage over their native immune response. This made some sense to me, though the idea is strongly contradicted by CDC guidance, which is very clear that getting a vaccine is advantageous to people who have recovered from the disease.

But many people who never contracted the virus and had no immunity also turned down the vaccine, and I wanted to understand. I’m a chatty person — I make small talk with people pretty much everywhere. So I started to ask. When I bought lunch at the cafeteria, I slid my credit card into the slot with a “Thank you so much! Hey, did you get your vaccine?”

“No,” said the cashier worker. She looked at me, surprised. “You did?”

“Yep, I did. I’m one of the doctors here and I feel so much better since I got it.”

“Hmm,” she said. “No side effects? Huh. I just felt really pushed into it. I wanted to think about it.”

“I actually didn’t have any side effects, though you know, you can, though generally not serious. And I understand,” I said. “But you know this disease is just waiting to get us, especially where we work. Every day wait feels like a scary day, at least to me.”

“Yeah, maybe,” she said. “I’m thinking about it. “ I talked to the guy who works in house cleaning on Labor and Delivery. I have a nice conversation with him most Thursdays when I’m on call. Usually we talk about how his kid is doing in school or where he’s planning to go on vacation. I know he also works next door, at the converted COVID ICU, which has seen many deaths.

The first time, I asked him if he got his vaccine, and his answer was minimalist: “Yeah, I know. I gotta look into that.” I just said, “Yeah, I know. I just feel so much less guilty about bringing this virus home since I got vaccinated, you know? It’s not just us living under this cloud — it’s our families too.”

The second time, he started the conversation. He had done some research and found out that Dr. Fauci had gotten the Moderna vaccine. Our institution was offering the Pfizer version. “I’m going to wait for the Moderna,” he said “That Fauci guy knows what’s what.” I told him that Fauci would tell him to grab a vaccine, any vaccine, as soon as he could, but he shook his head at me.

The most recent time, he just waved at me, and I didn’t feel I should mention the vaccine at all. In the end, I’m a doctor at this institution, and he’s a member of the housekeeping staff. That is a power differential that no amount of small talk can eliminate. And if he didn’t want to talk about the vaccine, pushing him on that felt like using that power, even if I meant to protect him. So I waved back as I left, and I haven’t mentioned it with him since.

There are many opinions about vaccine hesitancy. A lot has been written about people of color, and the legitimate mistrust that medical trials have earned since the notorious Tuskegee experiments on Black people with untreated syphilis, in the 1930s. But talking about an almost century-old unethical experiment assumes that COVID-19 vaccine distrust is rooted in inequitable treatment of the past, and that’s not true. Unfortunately, that inequitable treatment is very much present. COVID-19 pandemic data about complications and deaths continues to demonstrate how much worse the pandemic has been for communities of color: not long ago but today. That well-deserved mistrust of medical treatments is real, and needs to be explored and addressed at length.

But the vaccine hesitancy I see isn’t unique to people of color. It spans ethnic, racial, and socioeconomic backgrounds. Some people come from a place of long-standing vaccine mistrust. Some are in the midst of a general crisis of faith about elections and media. Many others are likely responding to the steady erosion of trust in the government over decades, and then I would argue, an abrupt fall in the last year of a mishandled pandemic.

And I can see how it is hard to trust a government that responded to COVID-19 so badly it led to over 500,000 deaths, many of them preventable, and then offers you a new shot of miracle protection. I can see how that might seem too good to be true. I just am not entirely sure what to do about that.

But the diversity of vaccine hesitancy means that there’s no one story here. Everybody has their own reasons for saying no — legitimate or not, or a bit of each — and their own velocity of change toward vaccine acceptance. Some holdouts will be persuaded soon; some will not. Some will get their shot after more effective public health messaging, or when they see how the vaccine has real, immediate benefits — being able to hug their grandchildren again or travel without quarantine. And some will get their shots when work requires it, or when there are things they aren’t allowed to do if they aren’t vaccinated.

And some people won’t budge. We as society will have to decide how much to make that cost.

I started out as a proselytizer of vaccines. But I saw how my conversations hinged on my power as a white woman, as a doctor, as an employer. I saw how careful I had to be about that if I wanted to make ethical change on this issue; if I wanted people to have an unforced choice.

I still talk about vaccines, but more gently, more carefully. That doesn’t seem right, either; this feels urgent and lifesaving. But it’s so easy to cross the line into an overbearing bully, and I am trying to stay on the right side of that line.

And it turns out, change does happen.

A few weeks ago, I was in the COVID ICU, rounding on a pregnant patient with pneumonia who was finally recovering. I heard my name called by a woman around my height. I couldn’t place her identity under the scrub cap and mask, so it took me a good two minutes to realize that she was one of the clerks from our labor and delivery unit, finishing nursing school, and doing rotations in the ICU.

“I had no idea you were in school!” I said. “Good for you!” And maybe because I had just come from the bedside of a sick COVID patient, and because she and I had worked together for a while, I impulsively said, “You got your vaccine, though, right? Before starting this rotation?”

She shook his head and looked down. “Come on,” I said, a panicky note entering my voice. “No, really. COME ON. I’m worried about you. You are a Black woman, you CANNOT get sick. Look where you work. Look how many we’ve lost.”

She sighed: “I know you’re right, Dr. K. I’ll get there. I’m just not there yet. I need some time.”

I wanted to push it; I wanted to convince her. Instead, I bumped elbows, wished her luck, and told her we missed her upstairs.

I recently saw her again in the ICU, across the room. She waved, flashed me her ID, and pointed to the bright, fresh “I got the shot” sticker on the front. I have no idea what got her there, or when or why. But I smiled so big she could see it behind my mask. And she smiled right back.

Chavi Karkowsky • Contributor

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• The San Jacinto Campus Student Health Center, 1499 N. State St., San Jacinto, from 8 a.m. to 5 p.m. Wednesday, March 3. Register at https://outlook.office365.com/owa/calendar/MtSanJacintoCollegeHealthCenterSanJacinto@msjc.edu/bookings/.

• The Menifee Valley Campus Student Health Center, 28237 La Piedra Road, Menifee, from 8 a.m. to 5 p.m. Thursday, March 4. Register at https://outlook.office365.com/owa/calendar/MtSanJacintoCollegeMenifee@msjc.edu/bookings/. If this is your second dose of the Moderna vaccine, it must be at least 28 days since you received your first dose. MSJC received the doses from the state and continues to ask for more doses. The college district will announce additional vaccine dates if more doses become available. The vaccine is available only to those who have:

• not tested positive for COVID-19 in the past three months.

• no cold, flu or COVID-19 symptoms.

• no fever. You will be screened as you register and again when you enter the building for the vaccine. If you are not in Tiers 1a and 1b and still attempt to register, you will not receive the vaccine. Furthermore, this may result in disposal of the vaccine because of the guidelines on storage and expiration. Please be courteous of those in highest need of the vaccine by following the tier guidelines set forth by the state. If appointments are full, please email us at healthservices@msjc.edu to be placed on a waitlist. Waitlisted people may get called the day before or even the day of for last minute cancellations or no-show appointments. For more information on the tiers, please visit the Riverside County Public Health website.

MSJC • Contributed

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AMSTERDAM (AP) — The European Union’s executive commission gave the green light Wednesday to Moderna Inc.’s COVID-19 vaccine, providing the 27-nation bloc with a second vaccine to use in the desperate battle to tame the virus rampaging across the continent.

The European Commission granted conditional marketing authorization for the vaccine. The decision came against a backdrop of high infection rates in many EU countries and strong criticism of the slow pace of vaccinations across the region of some 450 million people.

“We are providing more COVID-19 vaccines for Europeans. With the Moderna vaccine, the second one now authorized in the EU, we will have a further 160 million doses. And more vaccines will come,” European Commission President Ursula von der Leyen said in a statement.

The EMA recommended the conditional authorization following a meeting earlier Wednesday.

“This vaccine provides us with another tool to overcome the current emergency,” said EMA Executive Director Emer Cooke. “It is a testament to the efforts and commitment of all involved that we have this second positive vaccine recommendation just short of a year since the pandemic was declared by WHO.”

The EMA last month granted the same conditional approval to a coronavirus vaccine made by American drugmaker Pfizer and Germany’s BioNTech. Both vaccines require giving people two shots.

The EU has ordered 80 million doses of the Moderna vaccine with an option for a further 80 million. The bloc also has committed to buying 300 million doses of the Pfizer-BioNTech vaccine.

Commissioner for Health and Food Safety Stella Kyriakides said that the vaccine authorization “will ensure that 460 million doses will be rolled out with increasing speed in the EU, and more will come. Member States have to ensure that the pace of vaccinations follows suit.”

German Health Minister Jens Spahn — who has in the past been critical of the slow pace of the EMA — said shortly before the announcement of the EMA authorization that he expected the Moderna vaccine to begin rolling out to EU nations next week. Germany would get 2 million doses in the first quarter and 50 million in all of 2021, Spahn told reporters in Berlin.

“The problem is the shortage of production capacity with global demand,” he said.

Spahn said that if further vaccines beyond the BioNTech-Pfizer and Moderna shots are approved in the EU, “we’ll be able to offer everyone in Germany a vaccine by the summer.”

He insisted that the strategy of bulk-buying for the entire bloc had been the right one as it had given manufacturers certainty to go ahead with production and ensured fair distribution among all the 27 EU countries.

Early results of large, still unfinished studies show both the Moderna and the Pfizer-BioNTech vaccines appear safe and strongly protective, although Moderna’s is easier to handle since it doesn’t need to be stored at ultra-frozen temperatures.

The EU agency gave the green light to use the Moderna vaccine on people age 18 year and above. It said side effects “were usually mild or moderate and got better within a few days after vaccination.”

The most common side effects are “pain and swelling at the injection site, tiredness, chills, fever, swollen or tender lymph nodes under the arm, headache, muscle and joint pain, nausea and vomiting,” the EMA said.

Cook stressed that EU authorities “will closely monitor data on the safety and effectiveness of the vaccine to ensure ongoing protection of the EU public. Our work will always be guided by the scientific evidence and our commitment to safeguard the health of EU citizens.”

The United States, Canada and Israel have already authorized use of the Moderna vaccine. The U.S. gave it the green light for emergency use in people over 18 years on Dec. 18, followed by Canada five days later with an interim authorization also for people over 18. Israel authorized the vaccine on Monday.

Moderna said Monday that it is increasing its estimate for global vaccine production in 2021 from 500 to 600 million doses. The company said it is “continuing to invest and add staff to build up to potentially 1 billion doses for 2021.”

Both Moderna’s and Pfizer-BioNTech’s shots are mRNA vaccines, made with a groundbreaking new technology. They don’t contain any coronavirus – meaning they cannot cause infection. Instead, they use a piece of genetic code that trains the immune system to recognize the spike protein on the surface of the virus, ready to attack if the real thing comes along.

The EU officially began giving out Pfizer-BioNTech vaccination shots on Dec. 27, but the speed of each nation’s inoculation program has varied widely. France vaccinated around 500 people in the first week, while Germany vaccinated 200,000. The Dutch were only beginning to give out vaccine shots Wednesday, the last EU nation to start doing so.

Austrian Chancellor Sebastian Kurz tweeted that approval of the Moderna vaccine “is another important step in the fight against the pandemic. This means we have more vaccine available in the EU and can fight the pandemic faster.”

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