Recently the world reached a milestone of one year since COVID-19 vaccines were first authorized by the FDA and other regulatory agencies around the world. Vaccine protection against COVID-19 has proven to be extremely effective, especially against severe disease, hospitalization and death. Having the virus offers some defense against future illness, but protection after infection is less predictable than protection after vaccination. Protection against COVID-19 from both infection and vaccination wanes over time.
Both booster shots and "hybrid immunity" (a combination of vaccination and infection) significantly increase our bodies' defenses against COVID-19. The increase in protection that hybrid immunity and boosters provide is especially important when you factor in virus variants – such as the highly infectious delta variant and the newly discovered omicron variant that is spreading worldwide. People with immunity that comes only from infection are more susceptible to new variants.
In the case of omicron, much remains to be learned. Scientists have already observed that omicron contains more mutations than other variants of concern, including the delta variant. These mutations may make it easier for the virus to pierce through our immunity shields, whether from vaccination or prior infection. In South Africa, where the variant was first identified, early signs indicate that reinfection rates are higher from omicron than from previous strains of the virus.
"Reinfection, especially very early on, is rare," said Diego Hijano, MD, of St. Jude Infectious Diseases. "But as we have new variants and time lapses after having the infection, it can happen. In addition, there is clear benefit to getting vaccinated, especially as we have new variants emerging in different parts of the world."
Immunity conveyed from vaccination or infection is critical to protecting yourself against severe illness from COVID-19. However, vaccination – including a booster shot – is the most reliable way to ensure protection. When someone recovers from COVID-19, hybrid immunity with all recommended doses of vaccine provides even broader cross-protection against emerging variants.
Both clinical trials and real-world evidence from more than 8.4 billion vaccine doses given worldwide show that side effects from vaccination are generally mild and disappear within two to three days. Severe side effects such as allergic reaction, myocarditis and blood clots are extremely rare.
The outcomes of the disease itself are less easy to predict. Pre-existing conditions such as high blood pressure, diabetes and obesity can complicate the course of COVID-19. When it comes to heart inflammation, research has shown that the risk of myocarditis in people with COVID-19 was 6 – 34 times higher compared to people who received an mRNA vaccine.
A year after immunization against COVID-19 began, some people are concerned about unknown long-term effects. Decades of research shows that side effects from vaccination generally occur within six weeks. There is no plausible mechanism that allows vaccines or any of their components to cause health problems years after being administered.
“The concept that vaccines have to have years of research comes from the need to vaccinate enough individuals to detect very rare side effects and not because these side effects appear many years after receiving the vaccine,” Hijano said. "In the case of COVID-19 vaccines, with over 8.4 billion doses administered globally and over 484 million in the U.S. alone, no additional rare, unexpected side effects will be observed."
Conversely, prolonged symptoms following COVID-19 infection are well documented and have been shown to disrupt peoples’ lives for months after infection. When a cohort of low-risk health care workers with mild COVID-19 was assessed eight months after infection, one in 10 still had at least one symptom that was disrupting their work, social or home life. While the most common long-term symptoms from the virus are fatigue, respiratory problems, and loss of smell and taste, patients have also experienced persistent shortness of breath or difficulty breathing; chest or joint pain; fast or pounding heartbeat; depression or anxiety; and memory, concentration or sleep problems.
In the U.S., more than 790,000 people have died from COVID-19. Worldwide, that number is more than 5 million. In contrast, five deaths appeared to be linked to thrombosis that occurred after people got the Johnson & Johnson vaccine. We now know how to recognize and treat people who develop these blood clots, which means that future deaths related to this very rare side effect can be prevented. “Statements claiming that deaths after vaccination equal or exceed those caused by the virus are inaccurate, misleading and irresponsible,” Hijano said.
The bottom line: get vaccinated
Medical experts worldwide, including infectious disease physicians at St. Jude, emphasize that the risk of severe illness and death from COVID-19 far outweighs any benefits of immunity from infection.
Whether or not you've been infected with COVID-19, vaccination is your best line of defense against the virus. Vaccines are also the fastest and best way we can protect our St. Jude patients.
"The recommendation continues to be for everyone to get vaccinated, including boosters, even if you had COVID-19," Hijano said.