Antibodies play an important role
Blanket jabs? Is there a different way?
A different approach

The emergence of Omicron has felt like a major step backwards for all of us. The rush to booster jabs, further restrictions on our freedoms and more antigen lateral flow testing feels like a bad sequel to Christmas 2020.

The definition of insanity is doing the same thing over and over and expecting different results. So, what can we do differently? Surely, we should be using all the tools at our disposal. Antibody testing provides a solution alongside antigen and PCR testing to reduce our restrictions and return us to whatever normality now looks like.

Antibodies play an important role; but we all respond differently

antibodies and virus moleculesAntibodies play an important role; but we all respond differently to vaccines and our antibody levels change over time

It’s mystified me that antibody testing hasn’t played a greater role so far. It’s possible that Governments have not wanted us to know our antibody status; with their focus, quite rightly, being on population herd immunity through vaccination.

A Lancet article(1) back in March 2021 showed how variable all of our responses are to vaccines, demonstrating that we all respond differently and our response changes over time. Is your vaccine response negative, slow waning, rapid waning, persistent or delayed?  Do you have a strong persistent antibody level following infection, or after a booster, or low or no antibodies at all?

The role of antibodies in our immune response appears to be without question and the levels of antibody response seem increasingly important to measure and monitor. Biotechnology company Moderna(2) announced this week that preliminary data suggests its half-dose booster shot increased antibody levels against the Omicron coronavirus variant and a larger-sized dose of the booster increases antibody levels even more. The company noted that this dose increased antibody levels 37-fold, compared with the levels seen when a fully vaccinated person does not receive a booster, and a 100-microgram dose increased antibody levels 83-fold.

Booster jabs – blanket jabs for the foreseeable future or is there a different way?

Back in February 2021, research(3) indicated that a single standard dose of vaccine provided 76% protection overall against symptomatic COVID-19 in the first 90 days after vaccination with protection not falling in this time frame. At the time, the analysis suggested that it was the dosing interval and not the dosing level which had the greatest impact on the efficacy of the vaccine. The study found vaccine efficacy reached 82.4% after a second dose in those with a dosing interval of 12 weeks or more (95% confidence interval 62.7% to 91.7%). If the two doses were given less than six weeks apart the efficacy was only 54.9% (CI 32.7% to 69.7%). However, the Omicron variant seems to have changed the picture considerably; Dr Susan Hopkins, the UKHSA’s chief medical adviser, said in December 2021(4) “I think what we’re seeing is that if you’ve had two doses more than three months ago, then it’s not going to prevent you from getting symptomatic disease.”

We now appear to be going “hell for leather” on booster jabs with the interval between doses now set to 3 months after the second dose of vaccine(5). As at 20 December 2021(6) nearly 30 million members of the public in the UK have now had three vaccine jabs.

There seem to be a number of clear issues for me: vaccines impact varies and is dynamic, it changes and wanes over time; but varies according to the individual.  How many more booster jabs do we need? Can we make it more targeted? Can we use antibody testing alongside antigen and PCR testing to limit the restrictions on our freedom?   Does a vaccination certificate show what we think it shows (immunity) or should we be measuring the response to the vaccine (or infection or both) via rapid on-site antibody testing?

A different approach to testing

If COVID-19 is endemic and we need to learn to live with it, from a testing perspective, we need to change our approach, and try to reduce the guesswork.

Regular lateral flow antibody testing alongside regular lateral flow antigen testing.

Check whether you have COVID-19 using a lateral flow antigen test but also check regularly (maybe once a fortnight?) that you have antibodies. This will indicate whether you can be “out and about” with limited risk of infection or reinfection. This could remove the need for to lockdown for many people. In the event you have low antibody levels, then you get a booster.

In this way we make the vaccine programme dynamic and we keep the maximum number of people we can with high levels of immune protection at any one moment in time. This reduces the risk of spread of COVID-19 and the impact it will have on our lives and livelihoods.

We should also be using all other potential testing technologies at our disposal; onsite PCR is a great example of something that can be performed there and then at the workplace, school or airport. Let’s use this technology to allow people to go to work, to school, to travel, to live more.

Finally, it would be great if the UK Government and the devolved administrations supported the UK diagnostic industry; surely this has to make sense in terms of employment, tax, supply chain security etc.

Let’s support the great diagnostic companies in the UK who have developed these technologies, whether it’s lateral flow antigen (e.g. Avacta, Vatic, Mologic/Omega, Novacyt), lateral flow antibody (e.g. Abingdon Health, Novacyt) or near patient PCR (e.g. Genedrive, QuantumDx).

Authored by Abingdon Health’s CEO, Chris Yates

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