In an op-ed in the Washington Post William F. Parker and Govind Persad question the Biden Administration’s plan to emphasize COVID-19 booster shots for Americans:
This decision is a mistake. Not only does it risk depriving millions throughout the world of the vaccine, but there also is no evidence that additional shots meaningfully reduce death or hospitalization from covid-19 for healthy Americans. Far better would be to wait for solid trial data on booster shots.
I point this op-ed out for two reasons. First, it mentions something I have mentioned from time to time in the past: the urgent need for the United States to subsidize vaccinations if not all over the world at least in Central and South America and the Caribbean.
But second I don’t think the decision is completely cut and dried. I honestly don’t know how effective booster shots for those already vaccinated will be in preventing serious disease and, if the authors are correct, no one else does, either. And even more importantly reducing the incidence of disease in Central and South America by ensuring that more doses of vaccine are administered there will not only reduce morbidity and mortality due to the disease in those countries but will also have some impact on reducing morbidity and mortality here. How much? Who knows?
Yesterday, my doctor recommended that I get the booster when its available, which brought the uncomfortable (for him, not me) observation that not having a spleen was not considered a priority in the initial vaccination and now it will be for the booster. I was fully vaccinated in late May, in eight months who knows? I kind of told the Doctor “meh,” but promised to watch CDC recommendations.
My understanding is doctors give an additional dose to certain immunocompromised patients if a subsequent antibody test shows a week response to a vaccine. Presumably they had suspicions that the vaccine may not be very effective for a given individual. But they just give an extra, and they don’t repeat.
The law of diminishing returns applies here. Another dose would almost certainly increase vaccine efficacy some, but we are probably chasing smaller and smaller margins.
The delta variant seems to be different enough that a new vaccine is warranted. I don’t see how another shot of the vaccine I got months ago would help, and I’m not sure I trust the CDC any more.
I don’t know if people saw this analysis of the application of Simpson’s Paradox to some of the more alarming data being bandied about:
https://www.covid-datascience.com/post/israeli-data-how-can-efficacy-vs-severe-disease-be-strong-when-60-of-hospitalized-are-vaccinated
One of the implications is that if the data is not broken down by age cohort, then we can’t tell whether or not a vaccine is waning.
Vincent Racaniello, writer of leading Virology textbook, on boosters taken from his twit account yesterday:
“Science tells us that most Americans do not need a COVID-19 vaccine booster.
1. With time, vaccine-induced antibodies wane but the same happens with all vaccines and infections.
2. It is not correct to conclude that COVID vaccine efficiency is waning. What is going down is protection against infection. Most human vaccines do not prevent infection.
3. Results of studies have shown that despite waning antibody levels, most fully vaccinated people are protected against severe disease, hospitalization, and death.
What we need to do is get everyone fully vaccinated!”
I guess he blogged it here, the diagram is helpful:
https://www.virology.ws/2021/08/19/are-covid-19-vaccine-boosters-needed/
“But as antibody and T cell levels decline, which is inevitable, we would be in the same situation we are in now – infections occur but hospitalization and death is prevented. Would we then enter an endless cycle of giving boosters every 8 months? That is not a smart way to end this pandemic. Rather, measures to ensure that 80% of the population is fully vaccinated must be deployed.
“The call for vaccine boosters in the US is another example of how some public health measures deployed during this pandemic are not based on science.”
I think getting everybody vaccinated is the best strategy, far better than boosters, but that is pretty much off the table isn’t it? We are contemplating directing our staff to not even ask if someone is vaccinated. The anger it stirs up when you ask an unvaccinated person can be pretty awful. At a minimum it generates nasty letters. It has also generated threats against staff.
Steve
The CDC doesn’t have the data (how screwed up is it that the CDC + FDA didn’t collect data about the long term effectiveness of the vaccines after the clinical trials?)
The CDC is relying on data from Israel and the UK that the vaccines are waning in effectiveness. I do trust that Israeli and UK biostatisticians compiling the data (they are in pre-print) look for issues like Simpson’s paradox.
At this time, boosters seem sensible. For everyone arguing that this will be solved if everyone is vaccinated — are they looking at the Israeli, UK case data — or even US states with high vaccination rates, like Washington?
Washington State — 72% of over 12 are vaccinated
UK — 87% of over 16 are vaccinated
Israel — 78% of over 12 are vaccinated
And all three are having a wave that is among the worse in terms of cases and hospitalizations. From that I am cautious in thinking a vaccinate everyone will work better then a strategy to boost.
Also, it isn’t a total surprise; other respiratory illnesses like influenza require boosters every year.
One last note; if boosters are required, it has interesting implications for the vaccines. It is widely believed the viral vector based vaccines (Oxford, J&J, Russia) are not suitable for repeated boosts. mRNA vaccines have cold chain issues for the developing world. And what about the implications for vaccines passports — imagine employers requiring employees to be vaccinated every 8 months…
Is it waning immune response or is it that Delta is different enough that the immunity is poorly sustained? Not really clear to me. Antibody levels drop after all vaccinations so not sure that alone tells us much.
With flu you are vaccinating against a different strain every year. The hope was that Covid, especially with the spike, would stay stable enough to not need to re vaccinate every year, but it is a new virus so who knows. I guess the difference is that we would be vaccinated every year for a virus that is (about)10 times as deadly as the flu. The military already requires yearly flu vaccinations as do most health care facilities. Wouldn’t be the end of the world, except for certain people.
Steve
Also think that the surge in RSV is not being covered very well. One of my junior residents is now a full professor at Texas Children which is a pretty awesome place. Great care. really hit hard by the double whammy of Covid and RSV which is well out of season. They are seeing kids who have both. I am worried that this fall we will see people with both Covid and flu.
https://www.keranews.org/health-wellness/2021-08-14/texas-children-and-childrens-hospitals-are-under-siege-from-two-viruses-rsv-and-covid-19
Steve
If there was exact knowledge how much it is Delta vs waning immunity; the CDC/FDA would have firmer footed with the booster recommendations.
And in either case; Delta being a different enough virus or waning immunity both argue for a booster.
My comment about needing everyone to vaccine once every 8 months is about as Sisyphean task as ensuring everyone follow isolation protocols after infection or close contact with a positive case. How many people don’t even see a healthcare professional once a year?