Breakthrough Infections – Do Vaccines Work?
I am writing this article because I have received a number of questions regarding the topic. The question begins, “I have heard that there are people who are fully vaccinated testing positive for COVID19.” This is absolutely true. The question ends, “Does that mean that the vaccines don’t work?” The answer to that is a hard no. It, in fact, proves they work, but like many things in life, immunology and virology are complex subjects that require more details than we get in headlines and FB postings. Because it is important that we all understand this I’ll delve deeper but keep it as short as possible.
First, there is no vaccine that provides absolute immunity to all recipients, which is called sterilizing immunity. Oh, were it that simple. Vaccines provide a spectrum of immunity dependent upon many factors which start with the efficacy of the vaccine, but also include the health of the vaccinated, the strength of his/her immune system, the strain or variant of the virus you are exposed to, the quantity of virus you are exposed to, the manner in which you are exposed to the virus, and many other factors. It’s complicated. But let’s simplify it.
Vaccination provides immunity on a spectrum. At the one end of the spectrum some will have truly sterilizing immunity. Their immune system is so charged that when they are exposed to the virus it is neutralized and killed before it can infect a single cell. Sadly, this is not everyone. At the other end is someone with an immune deficiency due to old age or chronic disease and despite being vaccinated gets sick from the virus and dies. Everyone else is in between somewhere. Some will have a few cells infected but never experience symptoms or even test positive. Some will have enough cells infected that they will shed virus and test positive. Some will get sick to varying degrees but recover. A few will go to the hospital. A tiny number will die. Remember, when we first heard about the m-RNA vaccines and that they were 95% effective? Do you remember what they were 95% effective at? They were 95% effective at preventing SEVERE disease, not all disease. As I said, no vaccine prevents all disease. In the real world right now, yes vaccinated folks are getting sick and a handful are in the hospital, but over 99% of those in the ICU right now are unvaccinated. Nearly all deaths are unvaccinated. And consider twisting your head around this, for a time the more people who are vaccinated the more vaccinated people will test positive. Huh?! It’s simple statistics. Take it out to the end. If 100% of people were vaccinated that would mean that 100% of those testing positive would have been vaccinated. So until we reach that “herd immunity” at which point viral transmission is more or less quashed, there will be an increasing number of “breakthrough infections.” Stats. Your response to this might be, “OK, so what about this herd immunity thing? If we get enough vaccinated won’t that get rid of COVID19?” Actually, no it won’t. COVID19 is here to stay, but it will evolve into something else in time. But that’s another discussion.
In epidemiological terms, the purpose of vaccination is to slow the spread of the disease to hopefully below a certain threshold defined as the R0 value (R-naught). This is the average number of people that each infected person will spread the disease to. When the R0 is below 1, the disease will be controlled. There is much that goes into this R0 value but it starts with the innate transmissibility of the virus, and we have all heard that this delta variant (the current variant) is considerably more transmissible than the original alpha variant. Therefore, because we have the delta variant this means that many more unvaccinated people will get sick and that more vaccinated people will test positive than if we still had the alpha variant, which of course was the variant the vaccines were designed for.
In conclusion, breakthrough infections are normal and expected. You will hear about more and more of them. You will also continue to hear that nearly all of those with severe disease and death are unvaccinated, but not all. The media will make much of the exceptions, and the anti-vaxxers will exploit them to promote their nonsense agenda. Soon there will be boosters to protect against the new variants and those yet to come. I have predicted elsewhere that in the 4th quarter you will also hear of more kids getting sick than we are used to hearing about, due to the return to in-person school (which I support) combined with the more dangerous variants. So, please get your shot and help protect our most innocent.
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