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Pandemic Journal

Dr Robert Hess: Long Covid After Vaccination

Dr Robert HEss

Dr Robert Hess – 03/23/2022

Dr Robert Hess: Long Covid After Vaccination

In rare cases, coronavirus vaccines may cause Long Covid–like symptoms.

As mentioned the symptomatology of this condition can be very similar to the side-effects and possible long-term consequences of vaccination. While preliminary data suggests that getting yourself vaccinated significantly reduces your risk of succumbing to Long Covid, there have also been cases where vaccination has caused Long Covid-like symptoms – and for a lengthy period of time.

 

We always take a balanced view, so that our clients are optimally informed and can weigh up the available information accordingly. There are no official figures, nor have there been any large-scale studies on this phenomenon as yet, but the symptoms, the link to vaccination and the accounts given by those affected are currently being investigated by the National Institute of Health (NIH) and other researchers around the world.

Previous studies have been too limited in scope and have not allowed 100% conclusions to be drawn about whether any of the vaccines have caused some rare form of long-term health problem and, if so, by what mechanism.

Long Covid-like symptoms such as fatigue, brain fog, insomnia, headaches, blood pressure fluctuations and various others are currently being investigated for a possible link to the administration of a COVID-19 vaccine. A number of scientists and research institutes are looking into this matter, among them neuroimmunologist Avindra Nath, clinical director of the Neurological Diseases Institute of the U.S. National Institutes of Health (NIH). In the specialist journal Science, he posited “temporal associations” between vaccination and Long Covid symptoms, but he would not be drawn on whether there was an “etiological association” (i.e. a causative link). Studies conducted by Nath on around 30 case reports have so far remained unpublished, but publication is expected soon.

Much remains unclear about Long Covid, especially the cause of its non-specific symptoms. It is broadly assumed that there is an underlying persistent immune dysregulation, in other words a defective immune response. Some candidates for further research are beta-interferons, immunoglobulins, mini blood clots and autoantibodies.

The Science article also explores the role of autoantibodies – their importance is recognized not only in acute CoV infection, but also in Long Covid. According to recent studies, autoantibodies can be detected up to six months after infection, and as Harald Prüss, a neurologist at the German Center for Neurodegenerative Diseases (DZNE) and at the Charité Hospital in Berlin, writes in an as yet unpublished paper, they are capable of damaging brain tissue.

Experiments on animals have suggested that antibodies targeting the SARS-CoV-2 spike protein – the same protein that many vaccines use to trigger a protective immune response – could cause collateral damage. While searching for antibody therapies for COVID-19 in 2020, Harald Prüss and his colleagues discovered that, of the 18 antibodies they identified with strong efficacy against SARS-CoV-2, four also attacked healthy tissue in mice – an indication that they could trigger autoimmune problems.

Initial clinical data point in a similar direction. Last year, researchers testing people infected with SARS-CoV-2 found unusually high levels of autoantibodies, which can attack the body’s own cells and tissues. In the May 2021 issue of Nature magazine, immunologists Aaron Ring and Akiko Iwasaki and their colleagues at the Yale School of Medicine reported finding autoantibodies in acute COVID-19 patients that were targeting the immune system and brain. They are now investigating how long the autoantibodies persist and the extent to which they can damage tissues. In January of this year, Cedars-Sinai Medical Center cardiologist Susan Cheng and protein chemist Justyna Fert-Bober reported in the Journal of Translational Medicine that autoantibodies can still be present up to six months after infection, although the researchers did not link their persistence to long-term symptoms.

To find out whether such autoantibodies harm humans, scientists at the German Center for Neurodegenerative Diseases (DZNE) are testing cerebrospinal fluid from Long Covid patients for antibodies that react to brain tissue obtained from mice: if there is indeed a reaction, these antibodies could also attack human neural tissue. Prüss and his team have published a paper in which they describe finding autoantibodies in at least one third of these patients, which are capable of attacking mouse neurons and other brain cells.

In August 2021, a group at Northwestern University reported in an advance publication that, in patients with neurological complications after COVID-19, a subset of T cells is persistently activated, similar to how it would be in persistent SARS-CoV-2 infection, suggesting an aberrant immune response or a lingering virus.

Scientists investigating possible side-effects are faced with a dilemma: their work risks stoking opposition to vaccines that currently seem to be “safe and effective” (this statement cannot be made with 100% certainty. After all, we have only been vaccinating for about 2 years and we are therefore rather cautious with these statements). “You have to be very careful about associating COVID-19 vaccines with complications,” Nath cautions. “People can draw the wrong conclusions. The implications are enormous.” Complex and persistent symptoms like those experienced by most sufferers are even more difficult to study, because patients often don’t have a clear diagnosis.

At the same time, understanding these problems could help those who currently suffer from them and, if a link is found, help in the development of the next generation of vaccines, perhaps identifying the ones that pose a high risk of serious adverse events. “We shouldn’t be averse to adverse events,” is how William Murphy, an immunologist at the University of California, sums it up. In November 2021, he suggested in The New England Journal of Medicine that an autoimmune mechanism triggered by the SARS-CoV-2 spike protein could explain not only the Long Covid symptoms but also some rare vaccine side-effects, and he called for more basic research to investigate possible links. He also maintains that it is more important to reassure the public that everything is being done in research to understand vaccines than to just say everything is safe, an assertion that we also endorse.

In the meantime, many affected people feel they have been let down by the health care system. The issue is sadly neglected, poorly defined and also politically sensitive, so family doctors and hospitals have not yet taken any initiatives. Many would like to see a network of specialist outpatient clinics for people with Long Covid and Long Covid-like symptoms, sharing their knowledge and experience.

Long Covid symptomatology after vaccination seems to be rare so far. Nevertheless, this is a topic that needs to remain in focus and be subjected to greater in-depth investigation. Overall, there are still too many unknowns and therefore there are currently no approved and effective therapies on the market. Nevertheless, we are able to take preventive action. We have already adapted our prophylactic measures in this regard, and we will also revise our supplements. We are one step ahead in this regard and we have put together effective options exclusively for our clients.

If you have any questions about Long Covid or specific symptoms, please do not hesitate to contact your consultant. We will continue to monitor this issue closely and to update our knowledge.

 

Pandemic Journal

Dr Robert Hess: Updates and Revises

Dr Robert HEss

Dr Robert Hess – 02/04/2022

Dr Robert Hess: Updates and Revises Section 4 of its Prophylactic concept.

In the current circumstances, it is more important than ever to maintain a clear overview. The number of vaccinations and infections, the virus variants in circulation and the available vaccines, the course taken by an infection, possible side-effects and the administration of various drugs against severe COVID-19 – these are all factors that make our efforts to provide comprehensive protection more complex, requiring close attention and detailed documentation. Protection of the organism as a whole remains our priority, which is why we are now broadening the scope of our prophylactic concept and scheduled check-ups.


In the last two years, our immune system has been through a lot – it has had to adapt and evolve, to adjust and play a supportive role in meeting the new challenges of either infection with COVID-19 or injection with an mRNA vaccine. To complicate matters, a pandemic is a fast-moving and generally unpredictable state of affairs that may drag on over months and years. Right at the start of the COVID-19 pandemic, I placed great emphasis on accurate documentation of the vaccination and infection status of my clients in order to ensure that data is systematically processed and that possible sequelae are spotted. The information we have gathered will now be evaluated and incorporated into our amended prophylactic program.

With this specific focus on prevention, we aim to identify and monitor potential long-term effects of SARS-CoV-2 infection. Long covid and post-covid are both sequelae of the disease, but they describe a very broad and elusive picture of diverse symptoms. As the pandemic has progressed, it has become increasingly clear that infection with SARS-CoV-2 can have long-term health consequences, even if the course of the disease itself is mild or is asymptomatic and therefore goes unnoticed. For this reason, I pay special attention to the sequelae of COVID-19 with the aim of defining these terms more precisely for our clients in the future.


At the same time, we also have to consider the possibility that certain symptom manifestations might instead be associated with vaccine damage and the long-term consequences of repeated vaccinations. More and more studies are producing information about the effects of the spike protein and about endothelial damage. However, we are surprised that there are no large-scale studies on possible carcinogenic effects or immunomodulatory changes so far. We will continue to keep this on our radar.

This specific focus on prevention in relation to the COVID-19 pandemic also shifts attention to the internal organs, where we are primarily looking at the kidney, liver, coronary arteries and the bronchial and neurological systems. Likewise, our prophylactic recommendations will also cover the relevant techniques and diagnostic methods. For example, we consider echocardiography (ultrasound examination) in cardiac and coronary artery diagnostics as no longer sufficient for our requirements and would therefore favor diagnostics based on a cardiac MRI scan.

In conclusion, I would like to inform my clients that we now intend to shorten the intervals for preventive care planning. This has the advantage that continuous monitoring of our clients and the availability of individualized data allows us to intervene at an early stage and thereby prevent damage in the long term.

Pandemic Journal

Dr Robert Hess: Weekly Omicron Update

Dr Robert HEss

Dr Robert Hess – 12/20/2021

Dr Robert Hess: Weekly Omicron Update

Our Situation report in the run-up to Christmas

The Omicron variant continues on its triumphant march around the globe. According to the World Health Organization, the mutant has already been detected in 89 countries, and more are being added to the list every day. Even in places with high immunity rates, the spread is rapid, and the number of confirmed Omicron cases is doubling every one and a half to three days in some countries. If it continues at its current rate, Omicron will be the prevalent form of SARS-CoV-2 in Europe in around two to four weeks. The UK is one of the first countries to be hit hard – Omicron is already the dominant form there, constituting 60% of new cases. Worryingly, a new study from England does not give much hope for the new variant leading to a significantly milder course of disease.

 

How well a person is protected against Omicron depends on many different factors, for example age, previous illnesses and underlying conditions, vaccination status and length of time since last dose administered. The risk of infection has risen dramatically in Europe, where the transmission rate of Omicron is between 2.5 and 4.3 times that of the Delta variant. For individuals without a basic level of immunity, this presents a huge problem. But it has now become apparent that even double vaccination does not provide sufficient protection against Omicron. The immunity afforded by antibodies against the variant is significantly weakened, as has been confirmed by several recent studies.


According to these studies, double vaccination offers almost 70% protection against the disease taking such a severe course that hospitalization is required. However, the level of protection against actual infection is generally significantly lower than with other variants – some studies estimate it to be as low as 33%.


How will the booster jab perform against Omicron?
Many scientists and virologists warn against inflated expectations and are agreed that even a third dose of vaccine will not provide 100% protection against infection. Although the protection against Omicron increases from a double to a triple vaccination, it is still 4.8 times lower than with the Delta variant. Despite the public exhortations from politicians to the effect of “Get vaccinated and all will be fine again”, this is patently not so. We conclude this from cases of triple-jabbed individuals who have become infected and then gone on to infect others. Particular caution is advised for those who come into contact with high-risk groups.


To predict the growth of the Omicron variant and estimate the degree of immune escape, scientists in the UK analyzed data from all PCR-confirmed SARS-CoV-2 cases in England and published them a few days ago. The results revealed that hospitalization and asymptomatic infection indicators were not significantly different for Omicron, suggesting that there little change in severity compared with Delta. On the one hand, this means that Omicron does not cause worse disease or have higher severity than Delta, but on the other hand, it also means that it is not milder than Delta, as had been initially hoped.


The conclusion we draw from this is that the role played by vaccination status is significantly reduced in terms of immunity to Omicron. The weighting previously given to vaccination is substantially lower than before, so it is now all the more important to take general measures to optimize the immune system. We would therefore once again urge our clients to adhere even more strictly to the recommendations made by us. This includes the personalized elaboration of concepts and measures, as well as the intake of the individually adjusted supplements for the modulation and optimization of the adaptive immune system.


We expect that Delta will have been largely supplanted by Omicron in most countries of Europe by mid to late January 2022. In the United States, this may take a little longer, but it is also the inevitable outcome. It is not yet possible to form a definitive opinion about what will happen in the next few months, with so much being in the realms of speculation, but for the first time, the Omicron variant holds out the theoretical prospect of worldwide herd immunity.

Pandemic Journal

The SARS-CoV-2 T-Cell immunity analysis

Dr Robert HEss

Dr Robert Hess – 07/09/2021

The SARS-CoV-2 T-Cell immunity analysis is to be integrated into the Covid-19 Immunization Program for Dr Robert Hess clients with immediate effect.

So far, we have been testing only one of the two immunity pillars, namely antibody production. In addition to checking the full range of antibodies, we go far beyond the generally applied classification to differentiate between the neutralizing antibodies and identify efficacy classes – low, medium and high – plus ADE antibodies which may even have the undesired effect of amplifying an infection. From now on, we will also be measuring the second Covid-19 immune pillar – namely T cell immunity – in great detail. For this purpose, we have upgraded our Covid-19 Immunization Program with the inclusion of the new SARS-CoV-2 T-Cell immunity analysis.

This supplementary CE-certified blood test facilitates the cellular immunological detection of a SARS-CoV-2 infection. Protection against Covid-19 afforded by vaccination is also shown in detail. It works by testing specific cellular immunity after a SARS-CoV-2 infection, as well as detecting immune reactivity against endemic coronaviruses, also referred to as background immunity.

The importance of the cellular immune response is as follows: an infection with or a vaccination against the SARS-CoV-2 virus should result in an activation of the adaptive immune system. Alongside the production by B lymphocytes of virus-specific antibodies, the stimulation and multiplication (clonal expansion) of virus-specific T lymphocytes is a central feature of this immune response. In the course of the acute immune response, the T lymphocytes first differentiate into effector T cells, which are actively involved in the elimination of virus-infected cells (CD8 killer T cells) and in controlling the function of other immune cells (CD4 T helper cells). The effector T cells are detectable as early as 10 to 14 days after infection or vaccination or after the onset of symptoms.

In the later stage of infection and after an individual has survived Covid 19 or alternatively been vaccinated against the disease, memory T cells should form and persist in the body, theoretically ensuring the maintenance of immune protection in the case of reinfection. If an individual is then exposed to the virus, the memory T cells can instantly trigger efficiently organized immune responses. In a coordinated response with neutralizing antibodies also present in the blood, the virus should then be rapidly repelled. Consequently, the detection of SARS-CoV-2-specific T cells is of particular importance with regard to the further spread of the virus and potential infection or reinfection.

Immunological diagnostics is a highly specialized field. The analysis of virus-specific T-cells in the context of routine laboratory diagnostics is no trivial matter due to the complex activation modality of these cells. Because T-cells are present in the blood only in low frequency or numbers, highly sensitive procedures are required for their detection.

The ELISPOT method, on which our SARS-CoV-2 T-Cell immunity test is based, provides a sensitive and specific analysis of T cells in the blood samples submitted by our clients. This cell culture test is based on the release of messenger substances from the immune system (cytokines) by single cells after stimulation of lymphocytes with virus fragments (peptides).

The fluorescence-based version of the ELISPOT method used for this test allows for the simultaneous detection of two different cytokines – interferon-y (IFN-y) and interleukin-2 (IL-2). While the production of IFN-y is characteristic of effector T cells, IL-2 is primarily secreted by activated memory T cells.

The ratio of T cells detected – active (IFN-y producing effector T cells) compared with residual (IL-2 producing memory T cells) – indicates the status of the T cell response and thus the current status of potential SARS-CoV-2 T cell immunity:

The confirmation by this cell function test of prior Covid-19 immunization succeeds significantly more often than with the serological determination of antibodies, as SARS-CoV-2-specific antibodies are not always detectable even with a PCR test following an infection. This is equally true in the case of an asymptomatic SARS-CoV-2 infection.

Two different peptide pools are used to stimulate the lymphocytes in this test. A positive T-cell indication after culture with the SARS-CoV-2 specific peptide mix is not only to be regarded as proof of a previous viral contact; with our current state of scientific knowledge, it can also be assumed that there is an existing cellular immunity, which gives the affected individual at least temporary immune protection. This is especially applicable in cases where IL-2-producing memory T cells are found in this test.

In addition, several studies have demonstrated the existence of cross-reactive memory T cells in Covid-19 patients and non-exported individuals which are derived from the immune response following infection with one of the endemic coronaviruses (HCoV-NL63, -229E, -OC43, -HKU1) related to the SARS-CoV-2 virus. Current thinking is that the presence of these T lymphocytes, which can be activated upon either infection with or vaccination against SARS-CoV-2, confers background immunity. This results in affected individuals becoming only mildly ill or not at all after infection or vaccination against SARS-CoV-2. To estimate the extent of such a putative cellular basic immunity, which is carried by the above-mentioned cross-reactive T cells, our test includes a stimulation of the lymphocytes with a PAN-corona peptide mix specific to the endemic coronaviruses.

Within the framework of our laboratory diagnostics for the Covid-19 Immunization Program, this new test is now available as an innovative cell function test that usefully supplements acute diagnostics by means of SARS-CoV-2 PCR (direct virus detection) as well as serological diagnostics with the detection of SARS-CoV-2-specific antibodies (IgG, IgM).

This analysis is to be introduced as standard in the Covid-19 Immunization Program for Dr Robert Hess clients with immediate effect.

Pandemic Journal

How long does the protection afforded by vaccination last?

Dr Robert HEss

Dr Robert Hess – 06/19/2021

How long does the protection afforded by vaccination last? This is a vital question that can only be answered when enough time has elapsed for results to come in.

There is one thing we can be certain of, however, namely that the protection afforded by vaccines does not live up to the claims made by their manufacturers. We strongly disagree with the assertion that “vaccine protection will remain at the same high level for approximately one year, so that we can get into an annual vaccination cycle like the one we have for influenza.” This is the reason why we set up our SARS-CoV-2 Antibody Profile Monitoring for Premium clients at the start of this year, measuring levels of SARS-CoV-2 antibodies as well as T-helper cells specific to SARS-CoV-2 and thereby covering both pillars of the immune response.

There are as yet no clinical studies to refer to, so we are in completely uncharted territory here. It is a matter of great concern to us that some of our clients who have been fully vaccinated for several months now appear to have built up little if any immune protection. In the circumstances, this monitoring of antibodies makes a lot of sense, and various scientific institutes have approached us to draw on our experience in this field.

Immune protection is, of course, also a subject of concern to the wider population, and many people, fearing that the immune protection they have gained from vaccination may already be weakening, are already asking for a third booster shot. The fact is that not a single scientific body has ventured an opinion on the matter. This means that Dr Robert Hess is entering completely new territory. We will not be making any general recommendations, as the individual situation of each client is different. The structure of each immune system is also highly individual with regard to natural immune response, vaccine-induced antibody levels and exposure to mutation events dependent on geographic location. We will therefore only make recommendations about booster jabs or next generation vaccines tailored to the individual client. We believe that it is simply impossible to devise a vaccination scheme in which the intervals specified are valid for everyone. This simply makes no sense. Consequently, a universal recommendation is completely out of the question.

Dr Robert Hess has also gained insight into the workings of the T-cells. First indications are that that they prevent severe infections, but not to the extent that has now been claimed in various scientific publications.

Furthermore, we also have to consider the special needs of so-called “low responders” or “non-responders” to the vaccines among our own clientele. We have to assume that such cases are more frequent than has been surmised so far. Low responders and non-responders are individuals who have acquired minimal or zero immune protection through vaccination. Among our clientele, we also have non-vaccinated Covid-19 survivors of whom around 25% have not built up any protection at all. This is a significant difference compared to measles, for example. The immunity of those who have recovered and those who have been vaccinated clearly decreases, and the curve falls away dramatically after about three months. The idea that there are people who cannot become infected has been absolutely refuted. Most people who have not been vaccinated will probably become infected at some point, but whether they end up as symptomatic or asymptomatic cases is another question. This is essentially what characterizes respiratory viruses in contrast to HIV, for example. There are people who are immune to the AIDS virus due to certain genetic polymorphisms which, by the way, we also measure as standard for our Premium clients. This is not the case with the novel coronavirus, unlike the Spanish flu, with which it is repeatedly compared: it has to be emphasized that the history of SARS-CoV-2 so far clearly points to each successive mutation event being more infectious and/or more dangerous.

The current prognosis of the Task Force of Dr Robert Hess still holds true: the pandemic is going to persist for a very long time, and the prospect that the virus will be with us forever is becoming more and more likely. This is because recovered and vaccinated individuals can still be carriers of SARS‑CoV‑2 and because the virus is mutation prone. There is also the potential for the animal kingdom to act as a reservoir for the disease – it is not yet known which animals can become infected with SARS‑CoV‑2 and spread the virus. From the case of the mink farms in Denmark, which we reported on in great detail a year ago, there are now very alarming statistics on how dangerous it is when animals also become infected. If we assume a similar regime as with influenza (bearing in mind that we have only moderate control over this less aggressive virus), then we will need to have an annual cycle of vaccination, because the previous year’s vaccines are never a perfect fit for the pathogens currently in circulation. This will definitely be the case with SARS-CoV-2 as well. Every year, the death rate from influenza in a medium-sized country such as Germany is around 10,000, sometimes even higher. In the more severe influenza years, for example on the American East Coast, the intensive care units are stretched to capacity. And if we add Covid-19 to the equation, hospital systems worldwide will have to be restructured.

As Dr. Robert Hess mentioned already, the level of protection depends on the sum total of antibodies, which obviously forms part of our monitoring. The antibodies are all directed against the spike protein, but not necessarily against the same regions. Many different types of antibodies are formed, which our monitoring classifies according to their effectiveness. In the case of a second infection, antibodies can even amplify the symptoms. However, the more antibodies there are in total, the greater the probability there will be some that also protect against mutations. The crucial question here is how high the antibody titer must be to protect against infection. In professional circles, we call this the “correlate of protection”, a figure that is usually defined by the WHO. Hepatitis provides a precedent: when the concentration of antibodies falls below a certain value, vaccination is called for; as long as it remains above that value, vaccination is not required. This is how the disease is managed. No such value exists for SARS-CoV-2, as no studies have been done on this so far. From our own SARS-CoV-2 antibody monitoring, we assume an average value of at least 3,000 BAU per mL, where BAU refers to binding antibody units with the relevant average efficacy classification.

Among the low responders and non-responders, there is a large group of people who take medications that suppress the immune system, or who have a donor organ and take drugs that prevent the immune system from rejecting it. This inevitably has the consequence of making pathogens difficult to fight off, but at the same time, the reaction to vaccine antigens is also weakened. This is a situation that affects patients who have to take anti-cancer drugs that affect the functioning of the immune system. Some of these medications can almost completely eliminate the B lymphocytes, which are important for the formation of antibodies. This is because the immune response occurs in several parallel pathways. The reaction to antigens produced to counter pathogens or derived from vaccination depends on how well the individual pathways work. One level is the antibody response, for which the above-mentioned B lymphocytes are indispensable. For example, rituximab, which is prescribed to alleviate certain types of cancer or arthritis, prevents the formation of B-lymphocytes and as such is a drug that needs to be taken into account here. Furthermore, there are steroids and antimetabolites that inhibit cell division and thus impair immune function in various ways. Added to which, there are the calcineurin inhibitors, such as cyclosporine and tacrolimus, which alter the T-cell response, namely that part of the immune response that may offer a certain long-term protective effect.

In non-responders with rheumatic diseases, their treatment usually involves a smaller number of immunosuppressive drugs. The dosage and effect are therefore less significant than with immunosuppression in organ transplant recipients or certain tumor patients. Nevertheless, a reduced effect is also to be expected here. The same applies to allergy sufferers who occasionally take antihistamines or use sprays and creams containing cortisone. There is definitely a reduced effect here, though by no means as drastic. We have already observed this with our Premium clients in the analysis of their antibodies.

In answer to the question of whether there is at least a T-cellular immunity in the case of a poor antibody response, we have evidence to support this, but not nearly as definitively as has been suggested in scientific publications over recent months. There have been indications that some immunity is gained, but at a far lower level than assumed. In our opinion, T-cells offer virtually no protection against actual infection, but they do make a severe course of disease less likely.

We already mentioned that we are working to build up T-cell specific immune response alongside antibodies. This development is eagerly awaited.

The question of whether mRNA or vector-based vaccines are preferable for the low-responder groups arises regardless of the reasons for their immune system deficiency. Ultimately, we have to assume that congenital immunodeficiency is a contributory factor with low-responders, irrespective of the risk groups just mentioned. This is confirmed for us on the one hand by the data derived from our own Premium clients, and on the other hand by the data that has come to us from the UK. To date, it has been shown that higher antibody titers can be expected after a first vaccination with an mRNA-based vaccine than after a first vaccination with a vector-based vaccine. As regards T-cell level, however, the situation is exactly the reverse: a higher value can be observed after a first vaccination with a vector-based vaccine. We should soon have the relevant data for the second vaccination. We see here that the combination of a first vaccination with a vector-based vaccine and second vaccination with mRNA can produce up to 10 times more antibody titers than if a vector-based vaccine is administered twice. As far as T cells are concerned, the combination of both principles also seems to be very effective. And that is why the best strategy for booster vaccinations has to be clarified with some degree of urgency. Our vaccinated clients have almost exclusively received an mRNA-based vaccine for both jabs.

Regarding the question of how a program of booster vaccinations might look, there are a couple of options available: on the one hand, a next-generation mRNA vaccine which also increases T-cell stimulation, and on the other hand (depending on the results in those affected), it may be possible to switch to a vector-based vaccine for the booster.

In conclusion, we can say that individualized vaccination schedules would be the optimal route to go down. I see it as my job to develop a long-term individual vaccination scheme.