An expert panel to the US Food and Drug Administration recommended on Friday that Pfizer booster shots in the US should for the time being only be given to people aged 65 and older or to people at high risk of severe Covid-19 who have received their second dose at least six months ago.
As was done in Israel already in August, the panel decided to start with elderly people and those at risk as well as health care staff but decided with 16 votes to 2 against a Pfizer booster for people 16 and older after a daylong public discussion.
The American panel was of the opinion that there was not enough information in the US about the effectiveness of booster shots to younger populations and that not enough time had passed for observations. According to the panel, data from Pfizer and elsewhere still seemed to show that two shots protected against severe disease or hospitalization.
In Israel, evaluations show a decline in the effectiveness of the vaccine after 5 months. The overwhelming majority of seriously ill COVID-patients in the hospitals are unvaccinated people. By now, over 3 million people or about a third of the population across all ages besides children have received a third dose of the vaccine. The infection rate, however, is still high.
The American panel did not seem to question the Israeli results but basically looked at the situation in the US. Dr Sharon Alroy-Preis, who was consulted by the panel and is head of public health services at the Israeli Health Ministry, said in an interview on Saturday evening that she believes the US will make the third dose more widely available with time. “The US is three months behind us in terms of the vaccination campaign.”
She reiterated that the vaccines “lose their effectiveness over time and it’s not dependent on age, which is why we wanted to vaccinate everyone.”
Contrary to the US and most EU countries, where the rollout of the vaccination campaigns was slow in the beginning and only took up speed in April, the vaccination of elderly people in Israel started already in December, which might explain why the immunity protection among the elderly age group has decreased since then.
Belgium and the EU
In for example Belgium, Federal Health Minister Frank Vandenbroucke said on Tuesday that countries with less access to vaccines should be given coronavirus vaccines before Belgium starts giving a third dose to over-65s and people with underlying conditions.
For the time being, there are no plans to expand the scheme for a third dose beyond the group of 350,000 to 400,000 people with a weakened immune system in Belgium. Next week, they will start getting invited for third dose.
According to Vanderbrouck, who referred to an article in Lancet, there is insufficient scientific evidence today to justify a third shot to the general population. That article, however, did not relate to the latest more comprehensive study in Israel, experts in Israel say. The study, based on a group of more than 1 million Israelis aged 60 and up, showed a significant reduction in the vaccine’s effectiveness.
The European Centre for Disease Prevention and Control (ECDC) wrote in a technical report in beginning of September that there is no urgent need for booster doses of vaccines to fully vaccinated individuals in the general population but did not exclude it in the future depending on the results of scientific studies.
European Commission President Ursula von der Leyen did also mention booster shots in her state of the union speech in the European Parliament on Wednesday.
”We need to keep up the momentum. And Europe is ready. We have 1.8 billion additional doses secured. This is enough for us and our neighbourhood when booster shots are needed. Let’s do everything possible to ensure that this does not turn into a pandemic of the unvaccinated.”
The ECDC report mentioned that a number of EU countries are currently recommending the use of an additional vaccine dose or booster dose (i.e. third dose for two-dose schedule and second dose for single-dose schedule vaccines), In most cases, an additional dose seems to be recommended to people with a weakened immune defence.
The issue of starting booster vaccination while most countries in the world are lagging far behind in giving one shot, not to mention two shots, to their populations is controversial. WHO urged on Friday leaders attending the United Nations General Assembly to guarantee equitable access to COVID-19 vaccines.
“More than 5.7 billion vaccine doses have been administered globally, but 73% of all doses have been administered in just 10 countries. High-income countries have administered 61 times more doses per inhabitant than low-income countries. The longer vaccine inequity persists, the more the virus will keep circulating and evolving, and the longer the social and economic disruption will continue.”
Israel’s case for booster vaccination
In an article on Friday in the Economist, Israel’s new Prime-Minister Naftali Bennett, who decided on the booster campaign, motivated in some detail his decision and addressed also the equity issue. A third dose protects people, the economy and social wellbeing and, crucially, retains public trust in vaccines, he wrote.
“Sometimes, not making risky decisions can be more damaging than taking a calculated risk. Taking those risks is the responsibility of elected leaders.” Judging by the article, he took the decision, following the advice of experts, to avoid hospitals from being overwhelmed by severe cases and the economy from being lockdowned and closed as in previous waves.
“As prime minister, I had two options: either drag Israel into yet another set of lockdowns and further harm our economy and society, or to double down on vaccines as the central strategy, together with less restrictive measures such as a face-mask mandate in closed spaces and the ‘Green Pass’ scheme.”
That it was a calculated risk is clear since he also decided to open the new school year on 1 September despite the fact that the month is full of Jewish holidays when the schools anyway are closed. About half of the new cases are among children.
“Paradoxically, people with two doses can be at increased risk, because they think and act as if they’re fully protected, even when that protection may be waning,” he explained. “We knew that the vaccines worked and their side-effects were minor; we had seen that very clearly back in February. But their effectiveness over time and against new variants such as Delta was less clear.”
Addressing the global shortage of vaccines, he wrote that he believes that, “It’s crucial to do what we can to save lives in our own countries, while working together as a global community to help developing countries fight the virus. Global production of vaccines has to keep growing in order to satisfy the needs of all nations; the pandemic knows no borders.”
“But as global supply is steadily increasing, we have to acknowledge that availability of vaccines is not the only concern. We are constantly learning how best to use the vaccines against an evolving threat and it is crucial that the gains already made are not squandered with the consequent loss of public trust in vaccines.”
As regards one issue, he appears not to have changed the former government’s policy. The issue of supplying sufficient doses to Israel’s immediate neighbours, the Palestinians in the West Bank and the Gaza Strip, who share the same space, was not mentioned in his article.
Update: Belgium’s federal health minister Vandenbroucke said in an interview on Sunday that all people in residential care centres should also get a third vaccine dose. “They were all vaccinated at the beginning of the vaccination campaign and that was some time ago.”
The Brussels Times