Thread by @MonicaGandhi9

ONCE YEARLY? Agree with most on here that 1) yearly vaccination needed but for older & more vulnerable (co-morbidities multiple, immunocompromised); 2) May not able to adapt mRNA vax quickly enough
FDA considers major shift in COVID vaccine strategy npr.org/sections/healt…

to new subvariants (e.g. our last bivalent is against BA4/BA5 but Omicron up to XBB1.5) & not clearly better due to adaptive power of cellular immunity (see thread on B cells) so any boost probably ok. Latter in line with @WHO endemic plan put out on March 30, 2022

Immunity works beautifully. Lancet ID 30 million people UK study shows who is still at risk after 2 doses of vaccine for severe disease (>80, immunocompromised, multiple 5 comorbidities) & needed boost. B cells adapt antibodies they make - B cell thread:

https://mobile.twitter.com/MonicaGandhi9/status/1613286521255219210

Seeing ? on yearly shot which is fair as lot of people who follow my twitter know immunology!
Why would older/vulnerable need? Lancet shows us which groups still at risk after 2 doses:
thelancet.com/journals/lance…
How long do T cells last? Half life LONG
pubmed.ncbi.nlm.nih.gov/33408181/

How long do B cells last? We don't know for COVID but this study found survivors of 1918 influenza pandemic who were 91-101 years old (9 decades later) and found their B cells (still intact) could still produce antibodies directed against the 1918 strain!
nature.com/articles/natur…

And finally, agree with #covidtwitter that FDA - like the WHO on 3/30/22 and the European equivalent of the CDC on 4/27/22 -trying to come up with a plan for endemic COVID management since 1) can't eradicate; 2) have excellent vaccines & therapeutics
sfchronicle.com/opinion/openfo…

BOOSTERS & IMMUNITY: Reposting this AMAZING article by the @BarouchLab on immunity, variants & boosters to inform discussion (see piece we wrote Lancet ID: thelancet.com/journals/lanin… too)
Dr. Barouch piece in @NEJM - let's consider our booster strategy
nejm.org/doi/full/10.10…