The administration of Joe Biden has been working for weeks on plans to “boost doses” of the Covid-19 vaccine, as the Delta variant sparked a new pandemic wave across the country.
The debate erupted last month when senior officials from the Food and Drug Administration withdrew over their reported concerns that the decision-making process was being driven by politics rather than science.
Israel, on the other hand, has already moved forward with booster doses, with the majority of that country’s population currently eligible for a “third strike”, based on data showing that the effectiveness of the vaccine diminishes over time.
The country is even preparing for the possibility for patients to request a “fourth dose”, write foreign media.
The Biden administration is said to have been influenced by Israeli data and, for some time, it seemed as if the US would quickly follow the same path.
In a speech last month, President Joe Biden outlined a plan for every vaccinated American to receive a booster dose – pending FDA approval.
But that announcement was met with opposition from sections of the scientific community, who argued that the case for booster doses was unclear. At least not for everyone.
This argument has led the actions taken by the FDA and the Centers for Disease Control and Prevention in recent days.
The FDA, following the recommendation of the vaccine advisory board, approved a third dose of the Pfizer vaccine for people over 65 and people at higher risk because of their job or their medical conditions.
A CDC committee also recommended that “boosting doses” focus mainly on people older than 65 years.
After a debate, the committee did not specify the priority of people based on their work, but the CDC director rejected the panel and said high-risk occupational workers should be included.
Thus, a group of 18 scientists, including two FDA officials, presented their position in a paper published last week in The Lancet.
“Vaccines against COVID-19 continue to be effective against serious diseases, including those caused by the delta variant,” they wrote. “Therefore, the current evidence does not appear to indicate the need for additional doses in the general population.”
Other experts shared that assessment of the evidence.
There can be a weakened effectiveness against any symptomatic disease, but for most people, vaccines continue to do an excellent job of preventing hospitalization and death.
Thus, with the evidence so far, booster doses may make sense to some more than others.
This is because the vast majority of hospitalizations and deaths in the current wave are concentrated in unvaccinated people.
But the number of “progressive” infections among the vaccinated population is also increasing.
But how often does this happen? Is the effectiveness of the vaccine starting to decline, especially with the now dominant Delta variant?
A recent CDC study tracked new cases of Covid-19 and hospitalizations from early May to late July in New York State.
The study period covers the transition from the “alpha” to the “delta” variant, which became dominant in early July, but includes only a fraction of the recent increase in reported cases.
Vaccines against Covid-19 became somewhat less effective in preventing any disease as the delta variant took dominance, CDC researchers concluded.
In May, vaccines had an estimated 90 percent effectiveness in preventing new infections.
But by mid-July, estimated effectiveness had dropped to just under 80 percent. By that point, vaccinated people were more likely to become infected and feel sick.
And the study found that vaccines remained “resilient” to the most severe symptoms, with assessed effectiveness against hospitalization remaining stable at about 95 percent from the beginning to the end of the study period.
Another CDC study by July examined national data on whether Pfizer / BioNTech and Moderna vaccines are becoming less effective in preventing serious illness over time.
Like the New York study, he found that vaccines are extremely good at their most important job – about 90 percent effective in preventing hospitalization due to Covid-19.
Meanwhile a newer CDC study found a divergence between Moderna and Pfizer in preventing serious illness over time, with the former performing better than the latter, but overall effectiveness for both vaccines remained high.
Recent research outside the UK has generally reached the same conclusions: modest weakening in effectiveness against any symptomatic disease, but little (if any) against severe results for most people.
Exceptions to those extensive findings have been for people who have serious medical conditions, people who are impaired by immunity, and the elderly.
With that in mind, “I think you can take the argument that people who are at high risk for severe Covid-19 would benefit from a booster dose given at least six months after the end of their initial vaccine regimen.” , said Angela Rasmussen, a research scientist at the Organization for Vaccines and Infectious Diseases.
What are the risks of adopting too many booster doses too soon?
The case for giving everyone an extra dose immediately, six or eight months after their second dose, however, is less clear.
Data from Israel suggest that people taking a third dose have far more antibodies than people taking “just” two doses.
But the human immune system is complex.
The number of antibodies a person has may not tell you everything about their level of immunity against Covid-19.
So the question is where should the current vaccination be: Should it focus on third doses? Or should it go to unvaccinated people or send more vaccines to the poorest parts of the world, where vaccination rates remain much lower than in the US or Europe?
The WHO has specifically urged rich countries not to authorize booster vaccines until more people in the developing world get their initial vaccine regimen.
The authors of the Lancet paper argue that vaccinating those who are not vaccinated would help avoid future variants that may prove more elusive for existing vaccines.
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