Protection against Severe Illness versus Immunity—Redefining Vaccine Effectiveness in the Aftermath of COVID-19

Author:

Roche Renuka1,Odeh Nouha H.2,Andar Abhay U.3,Tulapurkar Mohan E.4,Roche Joseph A.5ORCID

Affiliation:

1. Occupational Therapy Program, School of Health Sciences, College of Health and Human Services, Eastern Michigan University, Ypsilanti, MI 48197, USA

2. Ph.D. Program in Immunology and Microbiology, Department of Biochemistry, Microbiology & Immunology, School of Medicine, Wayne State University, Detroit, MI 48201, USA

3. Baltimore County, Translational Life Science Technology, University of Maryland, Rockville, MD 20850, USA

4. Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA

5. Physical Therapy Program, Department of Health Care Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA

Abstract

Anti-SARS-CoV-2 vaccines have played a pivotal role in reducing the risk of developing severe illness from COVID-19, thus helping end the COVID-19 global public health emergency after more than three years. Intriguingly, as SARS-CoV-2 variants emerged, individuals who were fully vaccinated did get infected in high numbers, and viral loads in vaccinated individuals were as high as those in the unvaccinated. However, even with high viral loads, vaccinated individuals were significantly less likely to develop severe illness; this begs the question as to whether the main effect of anti-SARS-CoV-2 vaccines is to confer protection against severe illness or immunity against infection. The answer to this question is consequential, not only to the understanding of how anti-SARS-CoV-2 vaccines work, but also to public health efforts against existing and novel pathogens. In this review, we argue that immune system sensitization-desensitization rather than sterilizing immunity may explain vaccine-mediated protection against severe COVID-19 illness even when the SARS-CoV-2 viral load is high. Through the lessons learned from COVID-19, we make the case that in the disease’s aftermath, public health agencies must revisit healthcare policies, including redefining the term “vaccine effectiveness.”

Funder

Eastern Michigan University

Maryland Industrial Partnerships

Veterans Affairs BLR&D Merit Award

Publisher

MDPI AG

Subject

Virology,Microbiology (medical),Microbiology

Reference169 articles.

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3. COVID-19: Who Declares End of Global Health Emergency;Wise;Bmj,2023

4. Lenharo, M. (2023). Who Declares End to COVID-19’s Emergency Phase. Nature.

5. Critical Supply Shortages—The Need for Ventilators and Personal Protective Equipment during the COVID-19 Pandemic;Ranney;N. Engl. J. Med.,2020

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