COVID-19 vaccine booster shot spark global debate

Lately, several countries across the globe have either approved a third shot of COVID-19 (booster shot) or are in the process. The most recent of which is the United States. While France Germany and the United Kingdom are now planning to provide a booster shot to certain categories of people.

In August, public health and medical experts from the US Department of Health and Human Services (HHS) released a press statement regarding the US plans to authorize COVID-19 booster shots.

It was by Dr. Rochelle Walensky, Director of the Centers for Disease Control and Prevention (CDC); Dr. Janet Woodcock, Acting Commissioner, Food and Drug Administration (FDA); Dr. Vivek Murthy, U.S. Surgeon General; Dr. Francis Collins, Director of the National Institutes of Health (NIH); Dr. Anthony Fauci, Chief Medical Advisor to President Joe Biden and Director of the National Institute of Allergy and Infectious Diseases (NIAID); Dr. Rachel Levine, Assistant Secretary for Health; Dr. David Kessler, Chief Science Officer for the COVID-19 Response; and Dr. Marcella Nunez-Smith, Chair of the COVID-19 Health Equity Task Force.

The COVID-19 vaccines authorized in the United States continue to be remarkably effective in reducing the risk of severe disease, hospitalization, and death, even against the widely circulating Delta variant, the statement read.

However, it added that several vaccines are associated with a reduction in protection over time, thus, a booster shot might be needed to ensure necessary protection.

According to the statement, scientists have been studying the scientific data from the United States and around the world to understand how long this protection will last and how we might maximize this protection. 

“The available data makes 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. 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 statement added.

“We have developed a plan to begin offering these booster shots this fall subject to FDA conducting an independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines and CDC’s Advisory Committee on Immunization Practices (ACIP) issuing booster dose recommendations based on a thorough review of the evidence. We are prepared to offer booster shots for all Americans beginning the week of September 20 and starting 8 months after an individual’s second dose. At that time, the individuals who were fully vaccinated earliest in the vaccination rollout, including many health care providers, nursing home residents, and other seniors, will likely be eligible for a booster. We would also begin efforts to deliver booster shots directly to residents of long-term care facilities at that time, given the distribution of vaccines to this population early in the vaccine rollout and the continued increased risk that COVID-19 poses to them.

Nevertheless, they also said they expect a booster dose might be needed for people who received the Johnson & Johnson (J&J) vaccine, awaiting further data. 

“Our top priority remains to stay 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. 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.

Moreover, they stressed the need to increase vaccination rates in the US and across the globe, as it limits cases of severe disease, hospitalization and death.

Several studies showed that people who have weakened immune systems were not able to receive full protection from their COVID-19 vaccines. 

Unlike their healthy counterparts, immunocompromised vaccine recipients might not produce enough antibodies after two doses of the vaccine, which increase their vulnerability, especially amid the spread of the Delta variant. 

Accordingly, US authorities have prioritized these groups, putting them on top of the list of booster shot recipients for both Moderna and Pfizer/BioNTech vaccines. 

The US plans to start provision of the booster shot, on the condition that at least eight months have passed since they received their second shot.

To date, only immunocompromised people are eligible for the booster shot in the United States. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) says these doses, for now, should go to only those who are immunocompromised and who received the mRNA vaccines made by Pfizer or Moderna.

Who are in the vulnerable and immunocompromised group?

• Patients who had organ transplants 
• Patients who had stem cell transplants within the past two years
• Patients undergoing active cancer treatment for tumors or blood cancer and are undergoing chemotherapy that affects the immune system
• People with severe primary immunodeficiency
• People who have advanced or untreated HIV
• People undergoing active treatment with high-dose corticosteroids or other drugs that may suppress their immune response.

To date, healthy people are not yet eligible for a booster shot if they do not fall in the above criteria. However, if you received a Moderna or Pfizer vaccine, you will be eligible for a booster shot eight months after your second dose.

However, there is a difference between a third shot for immunocompromised people and the booster dose for other categories according to several scientists.

Boosters shots are taken by people who have already had a good response to the vaccine but they started to weaken as time passed. While a third dose is mainly refering to people whose immune systems weren’t able to fully respond to the initial vaccines.

In the US, federal health officials say they expect boosters to begin the week of September 20.

The CDC recommends that a booster shot should be of the same type as the initially received vaccine. However, it says that if no matching doses are available it would not be harmful to mix with a different vaccine type, yet, the booster shot should be given at least 28 days after the second dose of the vaccine. 

Although CDC recommended a third shot for immunocompromised people, to provide them with better COVID-19 protection, it warned that they still would not be as protected as healthy people. 

According to the data produced from different medical research, most participants who had any immune response to the first two doses did better after a third dose, but some people didn’t. 

Accordingly, the CDC recommends that immunocompromised people should always take extra precautionary measures to protect themselves from contracting the virus. Namely, always wearing a mask, maintaining social distance, avoiding crowds, especially if they are around unmasked people who may be unvaccinated. 

About 2.7% of U.S. adults are immunocompromised, a group that encompasses people that are undergoing cancer treatment, living with HIV, or are organ transplant recipients, among others, according to the CDC. 

Some scientists believe that eventually, all people will need a booster shot of the COVID-19 vaccine. However, studies are still underway to fully understand the situation. 

The good news is that people who are healthy should still have ample protection from their COVID-19 vaccines. While some healthy, vaccinated people do get COVID-19 infections, they are much less common than in unvaccinated people and they are much less severe. This is why it’s important for people who haven’t received their vaccine yet to get it right away.

Some scientists disagree

On the other hand, many scientists disagreed with the US authorities decision to widely distribute Covid-19 vaccine booster shots in the US in September. 

They explained that the FDA and CDC data are not compelling enough to take such a decision at the current time.

They dubbed the push for booster shots as premature. They argued that despite the reduction in protection that takes place over time, the vaccine still remained effective in preventing severe disease, hospitalizations, and deaths.

For example, the New York study released by the CDC showed there were 9,675 infections among fully vaccinated adults, compared with 38,505 infections among unvaccinated adults during the period examined. Among the fully vaccinated people who were infected, 1,271 were hospitalized, accounting for roughly 15% of all Covid-19 hospitalizations.

According to a prominent vaccine researcher at Johns Hopkins University, Dr. Anna Durbin double dose vaccine recipients are still highly protected against severe disease, hospitalization, and death, which is the purpose of vaccinations in the first place.

She added that unless there is a huge hike in the number of severe disease, hospitalization, or deaths among the vaccinated population, there is no need to consider booster shots.

She explained that although the antibodies count may drop, resulting in a rise in breakthrough infections, the body has other mechanisms, like T cells, that may protect someone from getting seriously sick.

“The data are showing that yes, we are seeing breakthrough infections but, the infections are mild or moderate colds,” Durbin said.

The World Health Organization (WHO) has called for a moratorium on COVID-19 boosters until the end of next month, with the aim of ensuring that at least 10% of people in all countries are vaccinated before extra doses are handed out.