US decision to offer COVID-19 vaccine boosters to all divides experts

From late September all Americans will be offered a third COVID-19 vaccine booster shot, to be administered at least eight months after a second dose. The formal booster announcement comes as the World Health Organization (WHO) and other experts question the need for third shots in those already vaccinated when so many around the globe are still yet to receive even one dose.

The booster announcement came in the form of a lengthy joint statement attributed to eight US government public health experts, including director of the Centers for Disease Control and Prevention (CDC), Rochelle Walensky; chief medical advisor to the President, Anthony Fauci; acting commissioner for the Food and Drug Administration (FDA), Janet Woodcock; and Vivek Murthy, the US surgeon general.

“The available data make very clear that protection against SARS-CoV-2 infection begins to decrease over time following the initial doses of vaccination, and in association with the dominance of the Delta variant, we are starting to see evidence of reduced protection against mild and moderate disease,” the statement explains. “Based on our latest assessment, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout. For that reason, we conclude that a booster shot will be needed to maximize vaccine-induced protection and prolong its durability.”

The booster roll-out will commence from the week of September 20th. The recommendation is for a third shot to be administered no earlier than eight months after a person’s second dose. As with the original vaccine strategy, boosters will be initially prioritized for high-risk populations such as seniors and health care workers.

Over the coming weeks more details will be announced pending recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP). It is not yet clear whether the third booster will be limited to the same brand of vaccine as a person’s initial course, or whether a mix-and-match strategy will be suggested.

The announcement also notes those Americans administered the single-dose Johnson and Johnson COVID-19 vaccine will likely require a booster, and that advice is also expected to be offered over the coming weeks.

“Our top priority remains staying ahead of the virus and protecting the American people from COVID-19 with safe, effective, and long-lasting vaccines especially in the context of a constantly changing virus and epidemiologic landscape,” the statement adds. “We will continue to follow the science on a daily basis, and we are prepared to modify this plan should new data emerge that requires it.”

A presentation from Anthony Fauci accompanying the booster announcement laid out the scientific case for this third dose program. Citing several recent studies, Fauci noted we know antibody levels are associated with vaccine efficacy, and we know antibody levels seem to be waning in the six to nine months following vaccination. Research has also shown a third vaccine booster significantly increases antibody levels.

However, a large number of scientists and public health experts have pushed back on the plan to offer boosters to all Americans. While there may be evidence of vaccine protection against SARS-CoV-2 infection waning after six months, there is also evidence the vaccines still offer comprehensive protection from severe disease, hospitalization and death.

“I’m truly disappointed,” says infectious disease expert Muge Cevik on Twitter. “This decision in not justifiable at all looking at this data. We are going to use up millions of doses to reduce the small risk of mild infections in fully protected people with a tiny risk of hospitalization, while most of the world waits for a first dose.”

The WHO was even more frank in its criticism of the US booster announcement, labeling it “immoral”. After pushing for a global moratorium on vaccine boosters over the last few weeks, the WHO insists there is no evidence boosters are currently needed as vaccines are still very effectively preventing hospitalization and death. Mike Ryan, emergency director of the WHO, likened the booster program to giving people a second lifejacket when other people nearby are drowning.

"We're planning to hand out extra life jackets to people who already have life jackets, while we're leaving other people to drown without a single life jacket," Ryan said at a recent WHO briefing. "The fundamental, ethical reality is we're handing out second life jackets while leaving millions and millions of people without anything to protect them."

Underpinning the booster debate is the fact that many countries discussing third-dose strategies are struggling to exceed 60 to 70 percent total population vaccination rates. In the United States, for example, little more than 50 percent of the total population is fully vaccinated. Israel, a country that was widely heralded as a world vaccination leader earlier in the year has flatlined for months at around 60 percent of its total population fully vaccinated.

While children and teenagers yet to be offered vaccines certainly constitute a large volume of unvaccinated in these countries, rates of Delta variant infections in the young are skyrocketing, and large amounts of unvaccinated adults are still suffering severe disease.

In a recent editorial for StatNews, physician Matthew Harris welcomed booster shots for vulnerable populations such as the immunocompromised but suggested extra doses for generally healthy individuals may not be the best strategy for making everyone safer. Harris pointed out if we want to best protect those most vulnerable it is more important right now for the unvaccinated to be vaccinated than for the vaccinated to get an extra shot.

“What they [the immunocompromised] – and the rest of us – need is more people in the general population to be vaccinated, and quickly, because the Delta variant is more transmissible and severe than the earlier predominant strains of SARS-CoV-2 and the virus could outsmart current vaccines and mutate – again,” Harris says.

Source: CDC