Do you need a fifth? When will this end?

Is it always like that? Is the fifth, and soon the sixth, seventh, eighth corona vaccine coming? When does the new crown variant come out and the number of infections increases? After all, some experts, most recently DIVI president and intensive care physician Gernot Marx, already consider the fifth dose this fall to be appropriate. Provided that there is then an adapted vaccine that protects even better against Omicron BA.4 and BA.5 lines. At the end of September, the decision to approve the adapted funds from Biontech and Moderna was announced. Do vaccines provide an advantage with new variants? This is still unclear.

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So what can you expect in the long run? Politicians expect more vaccinations one way or another. Federal Health Minister Karl Lauterbach already recommends a fourth dose with previous vaccines, not only for the elderly, as recommended by the Standing Committee on Immunization (Stiko). But for everyone, including those under 60. In the first year of the pandemic, it was still said that one or two doses of the vaccine would be enough to protect yourself from the corona. This was expected to provide sufficient long-term protection against disease, death as well as infection. But then new variants of the virus appeared: alpha, delta, omicron. At the same time, protective blood antibodies have been shown to decline again over time. Get vaccinated once, end Corona forever? Unfortunately, this is not the case. Today we know: even vaccinated people become infected.

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Therefore, a booster vaccination was recommended at the end of 2021 to significantly improve immune protection. By mid-July this year, about 62 percent of people in Germany had opted for this amplifier. This offers advantages even today, even compared to the current dominant Omikron BA.5 line. You are not particularly well protected against infection and mild or moderate disease, even against Long Covid. But right before the worst – severe Covid-19 with weeks of intensive treatment and death. Not 100 percent guaranteed, but still relatively good. At least if you are a young, healthy adult.

Repeatedly vaccinate and / or infect against Corona?

That’s why most experts also assume that many people with basic immunization and a booster dose are prepared long enough for the coronavirus – and don’t necessarily need to be vaccinated again and again. A few months ago Charité virologist Christian Drosten explained at a federal press conference the underlying “general wisdom of infection epidemiology.” “In the long run, we won’t be able to vaccinate the entire population every few months to get population immunity or protect the community, however you want to express it,” he said. “This means that at some point in time the virus will have to cause infections in the population as well. And the virus itself has to update people’s immunity, say.

What he means by that: Corona is no longer disappearing and is still making its way around the world. But the starting position has become better than at the start of the pandemic. Most people have some basic protection against pre-vaccination and (in addition) infection, which prepares the immune system for corona infection regardless of weakening antibodies. Experts are optimistic that the virus will not completely escape this defense and weaken immunity to severe Covid-19. “A virus can’t just compromise some underlying immunity,” immunologist Carsten Watzl told RND a few weeks ago. And that’s why the infection is no longer as dangerous as it was at the beginning of the crisis.

Young, healthy, vaccinated: you can count on basic protection against crowns

It is true that Omicron has changed in such a way that many of the relevant antibodies no longer match, making people again more susceptible to infections. But there are also T cells. They are found in different areas of our immune system and they fight the virus in a completely different way. There, the Omicron is still about 80 percent similar to the original virus, Watzl explains. However, because vaccines provide poor protection against infection in the long run, it’s likely that breakthrough infections will recur. Immune healthy, younger people with no previous illnesses will get mild to moderate sickness – and refresh this basic protection again. Nevertheless, infection should not be provoked, experts emphasize at the same time. Because every infection carries with it some health risks – with consequences like Long Covid. And, as Watzl also explains: The fourth or fifth dose of the vaccine is also not immunologically harmful. So if you want to get vaccinated, you don’t have to worry about any negative effects on your own immune system in future vaccination campaigns.

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Now, a second booster dose with the previous measures may also temporarily increase immune protection. However, anyone who hopes to permanently avoid infection through regular immunization is likely to be disappointed in the near future. Stiko states in an epidemiological bulletin: With the already approved vaccines from Biontech and Moderna, two to four weeks after booster vaccination, the “maximum effectiveness” in preventing symptomatic omicron infection is achieved at around 70 percent. Effectiveness drops again after ten weeks. The effectiveness in preventing hospitalization also increases to over 90%. after booster vaccination, “but it drops significantly over time.”

The boosting effect of the fourth or perhaps fifth immunization with previous vaccines is therefore short-lived. At the moment, it does not look like vaccine updates will be approved in the near future that will provide solid protection against infection for more than a few weeks. Vaccine experts do not predict a significant improvement in protection against vaccine changes announced for the fall by Moderna and Biontech, and there are no research projects that would indicate a real breakthrough in new vaccine technologies in the coming months. For example, applications that are administered as a nasal spray or inhaler. Or universal vaccines that are effective against several variants or strains of the virus simultaneously. Especially since the coronavirus is mutating so quickly that vaccine research is constantly faced with new challenges.

Vaccine updates make sense for specific groups

Nevertheless, there is hope for a fifth vaccination and better vaccine updates in the months and years to come. Because there is not only an immune healthy young population. But also people for whom basic protection is less reliable. This can happen in older adults over the age of 60, people with certain pre-existing conditions such as immunodeficiency. Your immune system works differently. You cannot rely on primary vaccinations and single booster doses for adequate protection. For such groups, further regular booster courses may therefore be particularly worthwhile – especially to improve protection against severe Covid-19 and death. That’s why Stiko already recommends a fourth dose of vaccination with approved agents – rather than waiting for possible updates in the fall. About 22 percent of people over the age of 60 used it until mid-July.

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Such a procedure is known from other vaccinations. This has been the case for years with the flu vaccine, for example. Even this does not protect 100 percent and needs to be adjusted seasonally, as the pathogen changes very quickly and the vaccine loses its effectiveness quickly. Stiko generally does not recommend vaccination to all people, but to people with an increased risk of severe disease: the elderly over 60, pregnant women, chronically ill such as diabetes, people living in nursing homes. But also those who come into frequent contact with risk groups: for example, medical staff and people who deal with heavy public traffic at work.

Prepare yourself for the worst-case scenario

There is another reason why scientists are working on further vaccine updates and technologies. You mean a pandemic worst case scenario. The corona virus can grow in such a way that it moves away from Omicron. It could alter its properties in such a way that even the basic protection of those vaccinated in good immune condition would be severely compromised. According to experts, this is not the case at the moment. But it is possible. As the current summer wave shows once again: Corona can always change surprisingly in ways that hardly anyone could have predicted. So it is possible that vaccination is again mandatory for everyone to contain the virus. When? With what fabric? How often exactly? Nobody can estimate it at the moment.

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