Do you need a vaccine booster and other questions swirling around COVID

More people are becoming immunized against COVID-19, fewer people are seen wearing masks (especially outdoors), and greater normalcy is returning to our daily lives in most parts of the country. Yet, as a doctor, I continue to receive questions or hear concerns about the safety and efficacy of vaccines and how we should act.

Much of this is because of the evolving information being provided, the confusing and sometimes contradictory or misleading advice and reports that many Americans have read or heard, and the continued politicization of COVID variants, vaccination, masking and other public health recommendations.

A few of the most common questions I hear, and the answers I give:

Should I worry about my vaccine wearing off, and should I take a booster?

Currently no compelling evidence exists that vaccine-induced immunity has worn off, although Pfizer is expected to summarize its unpublished data from Israel to Drs. Anthony Fauci of the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH) Director Francis Collins, Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, Food and Drug Administration (FDA) acting commissioner Janet Woodcock, Surgeon General Vivek Murthy and others, which reportedly show that over time its vaccine has shown decreased effectiveness at preventing mild — not severe — cases. 

Vaccine-induced immunity is measured in various ways, including T cell response, memory B cells in the bone marrow, and neutralizing antibody to the spike protein of the virus in the blood. It may turn out that having a booster is prudent to compensate for a potential waning immunity in the elderly and high-risk groups, as Pfizer suggests, and to retarget the vaccines toward the predominating delta and lambda variants. Today, being fully vaccinated with current vaccines offers substantial protection against all variants in terms of preventing infection, severe illness and decreasing spread. 

Is there a good reason to force any group to be vaccinated? Will it help keep businesses and schools open?

Taking a vaccine is a personal decision, with the caveat that you also are protecting others by being vaccinated since it decreases not only your chances of becoming ill with COVID but of spreading it to others. So I am reluctant to recommend making it mandatory. 

Having said that, a strong argument can be made for mandating this vaccine for health care workers because of the risk of spreading COVID to ill or immuno-compromised patients. It is disturbing that a substantial number of health care workers have irrationally refused to take the vaccine. 

Beyond this group, compelling anyone to take the vaccine is very problematic, especially given that the vaccine is still being used under an FDA Emergency Use Authorization. Although Pfizer and Moderna have submitted applications to the FDA for full licensure, the FDA hasn’t approved them yet, a process that can take six months or more. A lot of pressure is on the FDA to move more quickly in this case but, until that happens, it is very problematic to try to mandate vaccines. 

Should I continue to wear a mask in school if I am too young to be vaccinated?

Last week I spoke with Dr. Danny Benjamin, professor of pediatrics at Duke University and principal investigator of multiple studies on the question of COVID spread in schools. He told me that multiple trials in North Carolina, Nebraska and Utah all found that the rate of COVID transmission from an infected child at school is less than 1 percent, and he believes that mask-wearing played a crucial role. The CDC has now released guidelines that mask wearing is not necessary provided that a child is fully vaccinated and can maintain three feet of distance. 

I agree with this but remain concerned that state and local governments will perpetuate mask mandates on children too young to be vaccinated. There are concerns about rashes, dizziness, headaches and carbon dioxide retention among youngsters wearing masks for long periods, not to mention continuing socialization concerns and difficulty concentrating. 

Is it safe to take the vaccine if I am a young teen?

This question has received far too much politicking and far too little cost/benefit analysis, in my opinion. The overly publicized risk of myocarditis (inflammation of the heart muscle) is still very rare, less than 1 in 100,000 cases. Overall, the risk of COVID complications — including rapid heart rate, tachycardia, long-term lung issues and problems concentrating mentally — are far greater. 

We need to focus more on vaccine-hesitant adults getting shots, but teens should not be exempt — especially with the delta variant emerging, which appears to target younger people, as we are now seeing in Los Angeles County and elsewhere. I think dosing and second-dose scheduling needs to be reexamined. 

Yet, if I told you that I have a drug which could cure your teen’s sore throat but that there was a 1 in 10,000 chance of a major complication occurring, would you allow them to take it? (That drug, by the way, is penicillin.)

Why is there so much vaccine hesitancy? 

The politicization of the vaccine and the excessive media focus on rare complications has fed vaccine hesitancy and anti-vaccine mythology. This is a tragedy which has slowed our exit from the pandemic. 

I think it was a mistake for President Biden not to praise the work of the previous administration in creating and marketing these vaccines, and choosing instead to criticize the rate and method of distribution, which caused a backlash among Republicans. 

In reality these are very safe, effective vaccines, at least compared to live-virus vaccines (including those for smallpox, polio and measles) which have stamped out massive outbreaks of other viruses. In fact, the MRNA vaccines against COVID are not live-virus types; they simply signal your cells to make proteins from the virus that trigger a robust immune response — clearly as safe as (if not safer than) introducing an actual weakened virus into your body. 

As Dr. Fauci has said, “there are some people who are just waiting for more information, for more data, but I can’t see how they need more data … we have hundreds of millions of doses that have been distributed … and maybe its just pushing back on scientific authority … whatever their reason they’re only hurting themselves, potentially their families, and clearly their communities.”       

Should I wear a mask if I have been vaccinated?

CDC guidelines are clear that you don’t need a mask when vaccinated. Dr. Fauci clarified his own remarks on this in an interview with me on SiriusXM last week, saying: “If you are a healthy person, you really don’t have to wear a mask indoors or outdoors because the protection that’s afforded to you by the vaccines that we have available, particularly the MRNA vaccines … you’re really very, very highly protected.” 

Fauci went on to say that you might consider wearing a mask in an area where the vaccination level is low or there’s a high level of virus that is increasing in the community, particularly the delta variant — “depending on your personal situation, you might. Such as an elderly person who may not actually have a full robust protection.” I agree with this assessment. 

The science also shows that natural immunity from having COVID provides a significant amount of protection in most cases and that a single dose of an MRNA vaccine amplifies this protection greatly.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”