Some Vaccines Last a Lifetime. Here’s Why Covid-19 Shots Don’t. - WSJ
Why don’t Covid-19 vaccinations last longer?
Measles shots are good for life, chickenpox immunizations protect for 10 to 20 years, and tetanus jabs last a decade or more. But U.S. officials are weighing whether to authorize Covid-19 boosters for vaccinated adults as soon as six months after the initial inoculation.
The goal of a vaccine is to provide the protection afforded by natural infection, but without the risk of serious illness or death.
“A really good vaccine makes it so someone does not get infected even if they are exposed to the virus,” said Rustom Antia, a biology professor at Emory University who studies immune responses. “But not all vaccines are ideal.”
The three tiers of defense, he said, include full protection against infection and transmission; protection against serious illness and transmission; or protection against serious illness only.
The effectiveness depends on the magnitude of the immune response a vaccine induces, how fast the resulting antibodies decay, whether the virus or bacteria tend to mutate, and the location of the infection.
The threshold of protection is the level of immunity that’s sufficient to keep from getting sick. For every bug, it’s different, and even how it’s determined varies.
Windows of immunity for selected vaccines
Hepatitis A
Human
Papillomavirus
Tetanus
Typhoid
Influenza
Covid-19
0 year
5
10
15
20
Sources: San Francisco Department of Public Health (hepatitis A); National Institutes of Health (human papillomavirus); Centers for Disease Control and Prevention (tetanus, typhoid, influenza, Covid-19)
“Basically, it’s levels of antibodies or neutralizing antibodies per milliliter of blood,” said Mark Slifka, a professor at Oregon Health & Science University.
(T-cells also contribute to protection, but antibodies are easier to measure.)
A threshold 0.01 international units per milliliter was confirmed for tetanus in 1942 when a pair of German researchers intentionally exposed themselves to the toxin to test the findings of previous animal studies.
“One of them gave himself two lethal doses of tetanus in his thigh, and monitored how well it went,” Dr. Slifka said. “His co-author did three lethal doses.”
Neither got sick.
A threshold for measles was pinned down in 1985 after a college dorm was exposed to the disease shortly after a blood drive. Researchers checked antibody concentrations in the students’ blood donations and identified 0.02 international units per milliliter as the level needed to prevent infection.
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Covid Vaccine Efficacy Numbers, Explained
Covid Vaccine Efficacy Numbers, Explained
Recent studies have shown that the effectiveness of Covid-19 vaccines is decreasing, though experts say the shots still work well. WSJ explains what the numbers mean and why they don’t tell the full story. Photo illustration: Jacob Reynolds/WSJ
With these diseases, the magnitudes of response to the vaccines combined with the antibodies’ rates of decay produce durable immune responses: Measles antibodies decay slowly. Tetanus antibodies decay more quickly, but the vaccine causes the body to produce far more than it needs, offsetting the decline.
“We’re fortunate with tetanus, diphtheria, measles and vaccinia,” Dr. Slifka said. “We have identified what the threshold of protection is. You track antibody decline over time, and if you know the threshold of protection, you can calculate durability of protection. With Covid, we don’t know.”
Historically, the most effective vaccines have used replicating viruses, which essentially elicit lifelong immunity.
Measles and chickenpox vaccines use replicating viruses.
Non-replicating vaccines and protein-based vaccines (such as the one for tetanus) don’t last as long, but their effectiveness can be enhanced with the addition of an adjuvant—a substance that enhances the magnitude of the response.
Tetanus and hepatitis A vaccines use an adjuvant.
