Breakthrough Infections Don't Signal a Failure of COVID-19 Vaccines

As the virus evolves, the efficacy of vaccines is changing. We still need them to save lives.
Eric James Beyer

It's fair to say that some of the confusion surrounding the pandemic is understandable. We can't even definitively say how it began

Uncertainties accounted for, there is a well-defined line that separates truth from absurdity regarding the virus, and COVID-19 vaccine reticence is one of the more disheartening effects of the proliferation of widespread misinformation campaigns in online spaces.

As with any substantive and important issue discussed on the internet, it has too easily been reduced to a simplistic and exploded caricature of itself and then rocketed around the world by social media tools designed to elicit emotional responses to drive engagement and increase profit.

To be fair, vaccine skepticism is not only the result of malicious political agendas and 24-hour news cycles that thrive on sensationalism. While the United States has a history of anti-vax sentiment that has blossomed in wealthy, white sections of its society, minorities in the country have shown themselves to be even more suspicious of the jab, for different reasons. One can hardly blame them. Institutional bias and outright racism have long been a hallmark of the United States’ medical system. 

All of which make it even more vital that the most up-to-date and accurate medical information maintain a firm footing online. When the wrong information on something vital like vaccines propagates, it’s no longer a matter of difference of opinion — people can get hurt.

The latest noises being made regarding the ineffectiveness of COVID-19 vaccines are not entirely unique, but they are just as baseless. As the world adjusts to living with Sars-CoV-2, we’re seeing how different vaccines stand up against it and its variants as time passes. As the number of those vaccinated around the world grows, breakthrough infections among this population are likewise growing. 

Israel as a COVID case study

Israel’s response to the coronavirus can help us understand the bigger picture when it comes to COVID vaccines and their efficacy. Early in the pandemic, the country benefited from a proactive vaccination campaign resulting from a deal it struck with Pfizer in which Israel would give the company access to its centralized collection of medical statistics in exchange for millions of doses of the vaccine. The idea was to use the information to assess when and how herd immunity might affect the spread of the virus. 

A doctor's white glove-covered hand holds a vial of the COVID mRNA vaccine.
Source: Spencer Davis/Unsplash

Today, just over 62 percent of its population (and 78 percent of those eligible to be vaccinated) are fully vaccinated against the illness, with 67 percent being at least partially so, giving it one of the highest vaccination rates in the world. Why, then, is the country seeing a recent wave of infections, as much as 6,000 new cases per day? Surely, vaccine skeptics claim, this is a sign that the medical innovation doesn’t work. 

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That assertion doesn’t long stand up to scrutiny. It also clumsily attempts to paint a complex medical issue in binary tones. The Pfizer-BioNTech vaccine continues to display excellent protection against severe illness from the virus, exhibiting an effectiveness of 84 percent as of late July. It’s useful to remember that, for medical treatment of any kind, such an efficacy rate is incredibly good. 

Those calling the vaccine ineffective are engaging in what’s known as the base-rate fallacy. If there is a highly-vaccinated population, it’s more likely that any infections that do happen will occur amongst this group. The number of infected people may go up, but that number will still be low compared to an unvaccinated population. 

That said, Israel’s infection rate is on the rise and it will be important to follow the country as a valuable case study in how the vaccine operates over time. As of August 10, their infection rate is less than half of what it was in pre-vaccine January.

What has changed is the ability of the Pfizer vaccine to prevent infection, with that efficacy rate falling to roughly 39 percent, according to Israel’s Health Ministry. Further grey-ing the picture is the rise of the Delta variant, which is more resistant to vaccines, and against which the Pfizer shot is faring less well. What all of this means is that those with the Pfizer shot may still catch the virus, but remain well-protected against it causing any serious health issues if they do. 

Pfizer has already begun providing booster shots of its vaccine in the coming months to combat the virus' variants. According to Yale Medicine, the Moderna vaccine’s effectiveness against the Delta variant is roughly two times lower than against the original strain, while Johnson & Johnson’s ability to fight off mutant strains remains unclear. The organization rightfully stresses that these observations and results are all still being actively monitored. In other words, things are likely to change as we learn more and more about how to better push back the pandemic.

Viruses are experts at proliferating, and this is one of the reasons why Sars-CoV-2 has mutated as many times as it has. Keeping pace with this and adapting our strategy against it will always be subject to update, just like any good scientific process is. That is a sign of modern medicine’s strength, not its fallibility. 

A nurse in a Moscow hospital sits exhausted on the floor with her mask around her neck.
Source: Vladimir Fedotov/Unsplash

None of this — the rising number of breakthrough infections, the malleability of medical approaches to combat them, the fact that viruses mutate — is to discount the life-saving value of any of the vaccines that fight COVID-19. Arguing that current developments, which will ultimately give us better insight into how to fight the virus, are evidence the vaccines don't work, is nothing less than short-sighted and reckless. 

What countries like Israel really show us is that a world-wide pandemic is about as complex as any reasonable person might expect it to be. Clambering to distort any one particular statistic or case regarding the virus only serves to create confusion and uncertainty regarding an issue that is literally life or death for millions of people around the world. 

In an era where information and social interaction are being increasingly siloed and manipulated by individuals and groups with profit and power-driven agendas, such misrepresentation of the facts crosses over from the realm of criminal irresponsibility into outright culpability. 

Why the virus loves inequality

Much of the legitimate debate surrounding COVD-19 vaccines now surrounds the role of booster shots and their potential necessity. France, Germany, and Sweden are among the countries expected to implement a third-shot program for the elderly and those deemed vulnerable or high-risk, while the US-based Centers for Disease Control and Prevention and Federal Drug Administration have stated there is no current need for the fully-vaccinated to receive them.  

Rest In Peace posters of Dr. Li Wenliang, one of the early whistle blowers of COVID-19
Posters of Dr. Li Wenliang, who raised awareness about COVID-19 in its early days. Source: Adli Wahid/Unsplash

Expect those estimates to change. Dr. Anthony Fauci, the chief medical advisor to President Biden, recently said that a third vaccine shot is needed for the immunocompromised. That consideration is likely to eventually extend to people who are considered healthy, depending on how the vaccines perform in the long run. 

One public discourse to be had surrounding the vaccine, one in which doubt and skepticism could play healthy roles would be about these booster shots. Much has already been made of the wildly uneven rollout of the vaccine on an international scale. The wealthiest countries in the world are getting vaccinated more than 20 times faster than the poorest. More skewed still is the fact that the least-wealthy 52 countries have access to 2.6 percent of the world’s vaccination supplies, despite hosting over 20 percent of the world’s population. 

It’s for exactly these reasons that the World Health Organization has called for a moratorium on booster shots by wealthy and developed nations until the rest of the world’s population can catch up. 

“We cannot accept countries that have already used most of the global supply of vaccines using even more of it, while the world’s most vulnerable people remain unprotected,” said WHO Director-General Tedros Ghebreyesus in a statement on August 4.  

The morality behind that sentiment is hard to refute, but it will be difficult for developed nations to put a halt to vaccinating the vulnerable within their borders if only for political reasons. 

The numbers, however, are hard to confront. Only 1.2 percent of people in low-income countries around the globe have gotten at least one shot of the vaccine. The International Monetary Fund released a report in April of this year that outlined some of the more grim realities the pandemic has brought about. Over 90 million people around the world have been pushed into extreme poverty due to the virus, with low-income households and young women being hit especially hard by things like school closures.

The IMF report warns that the toll the pandemic is taking on educational opportunities in these countries is likely to exacerbate income inequality, and explicitly urges international collaboration to ensure affordable and universal vaccine distribution. 

Figures like Mamta Murthi, the World Bank’s Vice President for Human Development, are among those calling for rich nations to do better. Speaking on The Development Podcast earlier this month, Murthi laid bare her feelings on how these countries have failed to do their part in vaccinating the world. 

“The situation that we see right now is absolutely unacceptable. Because a large part of the world remains unvaccinated. And this is a danger for all of us. First of all, we need to increase the supply of vaccines in the short term, there simply aren't enough vaccines for everyone. The second thing is that the vaccines that do exist have been pre-purchased and pre-committed to countries that have more than enough to vaccinate their populations. So we need to release these doses from surplus countries and give them to countries that don't have enough doses.”

We all have a responsibility to navigate the pandemic as calmly and as discerningly as possible. That means choosing to be careful about where we place our skepticism and our confidences. If we're going to doubt anything, we should doubt the system that implicitly but firmly reinforces the idea that our lives are worth more than those who happen to live in countries with worse economies than our own. 

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