Why are reinforcers so important in the fight against Omicron

Updated 5 hours ago

Before 2020, most people didn’t think much about vaccinations unless they had a baby or were going on vacations to exotic lands. And before the summer of 2021, most people didn’t know what a booster was – all we hear now are booster boosters.

So why do we care so much about reinforcers now?

Let’s look at how we got here.

When we started rolling out a Covid-19 vaccine in early 2021, we had clinical trial data from each of the companies that instructed us on the timing of injections and the number of shots.

We knew that following this regimen would provide greater protection against infection with the virus and better protection against severe illness and death.

Most of the vaccines we’ve had in our lives required two or more doses plus boosters, so this was no different. We wondered when the alpha variant started appearing in early 2021 when we introduced the vaccines and were relieved that the data showed that protection against infection, severe disease, and death was still very high.

Just as we were hitting a high vaccination level in Ireland, topping league charts around the world and starting to open up, the Delta variant hit and we wondered again. Fortunately, the vaccines held up but we’ve seen evidence that the Pfizer and Moderna vaccines offer a higher level of protection than the Astrazeneca and Janseen vaccines against the delta variant.

The following data that emerged was not surprising to those who understood the immune system but was difficult for the general public to understand.

Immunity from the vaccines waned after four or five months and we didn’t have as much protection as we did after the second dose of our vaccine. This usually happens after all vaccinations. Primary antibody levels are high and decrease over time.

For most viruses, this diminished immunity may not matter much, mostly because you rarely get exposed to the virus due to low community levels. When was the last time you were exposed to measles or rubella? But looking at case numbers and transmission from the Delta community in the winter months, our exposure to Covid-19 has never been higher. Penetrating injuries have been on the rise here and the number of cases has risen.

Then the data soon emerged that the solution was to boost immunity with a third dose of the vaccine and the booster substance became a topic of debate all over the world.

Israel led the way and cemented its way out of the Delta Wave and proved to the world that the boosters worked. Other countries followed suit and we started to consolidate in Ireland a few months ago and after a slow start we finally ramped up. This was mostly driven by the arrival of another variant.

Three weeks ago, Omicron came onto the scene and quickly spread across the world with increased portability as a key property. The difference with this variant is that it is mutated to a much greater degree than the one that preceded it. Besides its increased transmissibility, vaccinations are best avoided as well.

Just what we didn’t need because we were on the way to cement our way out of the winter delta wave. After an alarming wait of just over a week, the data showed that Omicron was indeed vaccine evasive and that two doses would only give us about 30% protection against infection but some better protection against severe disease and death.

This percentage was as low as 13% with Janssen’s one-shot vaccine. Fortunately, the data also showed that the booster boosted this by up to 70-75% and we all breathed a sigh of relief.

As data from other countries emerged showing the Omicron is more transmissible than any other variant and the numbers over the water in the UK started to rise, all hands on the wheel were the emblem of the booster program here in Ireland.

So the big question is whether boosters will solve the Omicron acceleration problem as it gets more and more present here with each passing day.

The Center for Health Protection Surveillance said it estimates that roughly 35% of reported cases are now Omicron. No doubt it will be prevalent before Christmas Day. While the boosters will provide significant protection against severe illness and death, protection is less from an omicron infection. The ultra-transmissible Omicron will take full advantage of that gap in protection and super-injury will accelerate quickly.

Also, we won’t have time to support everyone before Omicron takes off and you will benefit from that too. Hopefully this variant will cause milder disease which may translate into lower hospitalizations and ICU admissions, but the sheer volume of potential cases could make this completely irrelevant and we may see hospital admissions and ICUs climb regardless of milder .

A small percentage of a large number is still a large number. We also don’t have specific information about what the infection looks like across a range of age groups and across different vaccine status, so there’s still a lot we don’t know.

But we know Ireland won’t be any different from any other country in terms of higher case numbers – we’ve been like the rest in previous fourth waves, this time it won’t be any different.

The most we can do is manage impact. An enhanced program will undoubtedly provide the best defense in reducing the impact of that increase on both our employees and our healthcare system, but it is still a race against time.

I think we’ve been in this race before, but this time our opponent is faster.