Why Are We Still So Confused About COVID?



This is what it is like to be a layperson in the Years of COVID.

“So my primary care doc said the vaccine loses effectiveness after six months.”

“That’s what my pharmacist said, too. But nobody’s saying anything about a new booster.”

“If you’re healthy, you don’t need a booster anyway, right?”

“But I don’t want Long COVID! I read a study that said with every COVID infection, your chances increase. I’d get a booster to avoid that—but my pharmacist said there aren’t any new ones.”

“Mine said it’s considered a seasonal vaccine now, like flu shots.”

“Seasonal vaccine” sounds great, easy to remember, one and done every autumn. But then I read that COVID’s spikes occur, “unlike flu season, not in a predictable pattern.” There are spikes mid-summer, spikes late fall or early winter, never at quite the same time or for the same constellation of reasons. The virus is still too new to settle into a seasonal pattern. And the influenza model may never fit SARS-CoV-2 smoothly, as Dr. Ali Ellebedy, a Washington University researcher who holds an endowed professorship in immunobiology and pathology, reminded us last fall.

We want COVID to act like the old, familiar flu. But no matter how much we force that comparison, it thrives and thumbs its nose at us, a bratty neighborhood kid still up to mischief in July.

Sighing, I call a local pharmacist. She, too, says the vaccine is now considered seasonal and only necessary annually, every fall, as long as I am not immunocompromised. I search the CDC site, which tells me that “vaccination remains the best way to protect yourself and your loved ones”—but seems to suggest that unless adults are immunocompromised, they do not need another booster. A week later, I check back and find a new table suggesting that if I received a booster before September 12, I should now receive one dose of updated 2023 – 2024 vaccine.

My booster was September 22. Now what do I do? It will wear out on March 22, right? And was mine already the updated version, and has there been another update? I call Dr. Ellebedy.

“First,” he says gently, “where does the ‘six months’ come from? It’s definitely not something proven. It’s more common that responses can wane within six months for influenza.”

So my COVID vaccine will stay strong?

“Any vaccine will wane,” he says. “The question is, is that waning very concerning.” To me it is, I stop myself from blurting. “It depends on what we’re looking for,” he continues. “Protection from severe illness or a block from even getting infected? In late 2023, we had a large wave of SARS-COVID, but hospitalizations and deaths were not as high. We have accumulated immunity that is blocking severe illness but not infection.”

Okay, but—he is still speaking: “That could be because these vaccines are intrinsically imperfect.” What? After I felt so noble racing out to get them? “It’s a swiftly mutating virus, and its path of entry is from our nose to our lungs,” he explains. “These vaccines, while very effective in generating systemic immunity, are not as effective at that portal of entry.”

He gives me a marvelously clear, simple analogy: think of yourself as a castle. The protective antibodies are clustered around the king’s throne, in the interior. But the walls of this castle get thinner as you move to the exterior, and the outermost walls (like our schnoz) are easier to breach. By the time the antibodies reach the periphery, their potency is diffused—one reason Ellebedy would love to see a new vaccine that is intranasal.

But the waning and the diffusion are not, he says, so concerning—not when you compare them to the real problem.


Omicron is already old news. Its great-great-great-whatever descendant, JN1, has spread across 90 percent of the globe. And we have no vaccine specifically tailored to match JN1—which is dramatically different even from its most immediate predecessors. This year’s update is protective, but it is not a perfect match.

This is why Ellebedy does not share my worry about previous vaccines wearing out. You can have antibodies stronger than Superman, but if they match a different version of the virus, they have already lost a chunk of their protective capacity. They might keep the virus from killing you, but they probably will not block infection. No COVID vaccine can be relied on long-term, the way we can rely on vaccines for viruses that never mutate. The need for boosters is a practical matter, not a conspiracy to destroy the citizenry.

But we are bored with boosters, or hostile to vaccines in general. Pfizer’s bold expectations crashed: the government had options to buy 1.6 billion doses and has so far bought 900 million—which includes 500 million purchased at a discount to be shared with other countries. The company’s third-quarter revenue in 2023 was down 42 percent from 3Q in 2022, and vaccine sales were down 70 percent.

If not enough people get vaccinated, will companies stop trying to keep up with the variants?

“That is always the problem,” Ellebedy says, his voice tight.

In other words, we could wind up living or dying or becoming chronically ill at the pleasure of the CEOs, just as we do with antibiotic resistance and crazy insulin costs and many other health problems. Consider this, reported as business news: “During a recent investor call, a Pfizer official could spin the recent reports that the virus can hide from Paxlovid into good news, predicting that, as with the vaccine, patients may need multiple courses.”

People will ask for all that Paxlovid if they are sick enough, and that guarantees profit. But one modified vaccine after another? Variants can be gentler than their ancestors, but they can also be more wily. Some incubate faster. Some replicate faster in the upper respiratory tract, which means that anyone infected sheds a lot more of the virus, increasing contagion.

As for SARS-COVID being a cold-weather virus comparable to flu, “it’s common sense to think of it as worse in the cold months,” Ellebedy says, “but SARS has proved abnormal in that sense. From a public-health perspective, the waves are not typical.”

When I sputter about how confusing the various guidelines are, he says ruefully, “I always have sympathy for those who are trying to write guidelines. This has been the most challenging—” he breaks off. “It’s a conundrum. The ideal would be to keep matching the virus with a new vaccine. The problem is, we are always a few months behind. The mRNA vaccines are quicker, but we are still behind. Hopefully in the future, we will have a much faster way.” And corporations willing to use it.

Meanwhile, the Washington Post reported that the CDC plans to relax the five-days-after-symptoms-begin guidelines for those already infected, saying there is no need to isolate if you are free of fever for twenty-four hours and have mild or improving symptoms. I think back to what I memorized not that long ago: stay home for ten days, to avoid contact with those who might be at high risk. Have we stopped worrying about those among us who are old or immunocompromised, because urging that threw a match on the political bonfire? Are we pushing annual, seasonal boosters only because they are more convenient? Are we falsely equating COVID with influenza because that normalizes it? And are those of us who worry about contagion for everybody’s sake—and trust medical science—going to wind up deprived of updated protection because so many Americans shun the vaccine?

Our healthcare system runs on profit. It could use some fortification. Also, a few towers, so we can see farther into the future. And maybe a moat, to keep out the misinformation. By the end of 2022, false alarms and bogus reassurances had already earned Robert F. Kennedy Jr.’s Children’s Defense Fund and three other not-for-profits more than $118 million. And their revenue continues to rise.


Read more by Jeannette Cooperman here.