Dayton doctors answer reader questions: Why do the vaccinated care if others are unvaccinated?
Local experts quoted in this article are: — Dr. Roberto Colón, chief medical officer at Premier Health's Miami Valley Hospital. — Dr. Michael Klatte, chief of infectious disease at Dayton Children's Hospital. — Dr. Jeffrey Weinstein, patient safety officer at Kettering Health.
Q: Colin Powell was fully vaccinated against COVID-19 but he still died of coronavirus. Does that mean the vaccines are ineffective?
Colón: Unfortunately, no vaccines are 100% effective and sadly, this is an example of an infrequent occurrence of vaccinated individuals who do not survive an infection. Patients with weakened immune systems such as persons undergoing treatment for cancer are more susceptible to these breakthrough infections because the protection achieved from vaccines is either lower than in healthy individuals or weakens faster than other people.
Weinstein: Vaccines are highly effective at preventing COVID-19 infections and even more effective at preventing hospitalization and death. In Colin Powell's case, he was at high risk due to his age (84) and underlying diagnosis of cancer, which factored into his death.
Q: If the coronavirus vaccine is effective, why do the vaccinated care if others choose not to be vaccinated?
Klatte: We know that unvaccinated individuals are much more likely to be infected with COVID-19 compared to those who are vaccinated. The longer the virus circulates in the population and the more people it's able to infect, the greater the odds are that it develops genetic mutations, allowing it to evade immunity produced by immunization (as well as immunity generated by prior infection). The more genetic mutations the virus develops, the greater the possibility of the virus also developing resistance to our currently effective treatments. Stopping the virus from circulating is key — and this is best achieved through vaccination.
Colón: Because these vaccines are not 100% effective, being exposed to more infected individuals in the community increases the exposure unnecessarily. This is particularly significant to our older individuals and those with weakened immune systems who may be more likely to have breakthrough infections. Additionally, having people remain susceptible to infection because they have not been immunized raises the risk of another variant emerging that could be more likely to evade protection from vaccines or previous infections. The goal should be to ensure as many people are immunized against COVID-19 as quickly as possible.
Q: If coronavirus vaccines are effective, why are additional/booster shots recommended?
Weinstein: Through time, the effectiveness of many vaccines wane and then booster shots are required. The tetanus vaccine is a good example — booster shots are needed every 10 years. Currently, booster doses of the COVID-19 vaccines are recommended for certain age groups and at-risk groups because the protection may be less after many months.
Klatte: The primary goal of vaccination is to prevent severe disease, hospitalization and death due to COVID-19. Preventing symptomatic illness and preventing infection entirely are secondary aims of COVID-19 vaccination. During the time between when COVID vaccines were first made widely available to the public and now, we've seen the emergence of the highly infectious Delta variant. We've also seen gradually decreased vaccine effectiveness against prevention of symptomatic illness in people who were vaccinated earliest — including health care and other essential workers, people over 65 years of age, and those with underlying risk factors for severe disease. There has also been a small increase over time of the number of people over 65 years who were vaccinated earliest and who have been hospitalized due to COVID-19 infection. For otherwise healthy individuals under 65 years, the initial vaccination series continues to provide excellent protection against severe disease, hospitalization and death.
Colón: The need for boosters is not uncommon with vaccines. Many of us have been getting routine boosters since our childhood. Boosters are needed when the amount of protection decreases over time and are necessary to act as a reminder to our immune system to maintain protection, against COVID-19 in this case.
So FWIW, I would think that the government (and employers) have broad legal rights to mandate requirements for public (and employee) safety and health. I don’t think these mandates have to go through a legislative process to become law. But I’m sure the mandates are written down and available online as they are in my state (Oregon).
