The primary beneficiary of universal boosters may be the unvaccinated

So far, the first evidence for universal boosters has largely been derived from a manufacturer-controlled trial and observational data from Israel, the UK, and the US VA system.

Although the original two-dose series trials showed high rates of protection against infection, some combination of the passage of time and the high transmissibility of the delta variant appears to have reduced this protective power.

The reduction, however, is one of the heights that were once soaring, to those that are only modest. The good news is that boosters seem to bring this infection protection back to its original heights, at least in the short term.

In addition, many of these discoveries are unique to Pfizer. The Moderna vaccine created double the Pfizer antibody response, and therefore did not fall so precipitously, while the single-dose J&J vaccine was determined last summer to be incomplete without a second injection.

To grateful recipients of the reminder who now share “boosted” messages on social networks, the third shots are widely regarded as a strong firewall against infections and serious illnesses. For those who are older or have complex health issues that appear to be the case.

For everyone else, however, experts increasingly describe boosters in terms of population health, as opposed to personal health.

In short, although they reduce the risk of infection for healthy people, the primary value of a third injection may have less to do with protecting those fully vaccinated than limiting the unknown risk they add. the considerable danger faced by the unvaccinated.

“I tell young and healthy people that the booster is more likely to help reduce the overall burden of infections in the community,” Dr Abinash Virk, Mayo Clinic infectious disease specialist, said during a call to the media recently.

“It may not be so much in terms of protection for them to get it, or to go to the hospital and die from it, but more for us to reduce the overall burden of infection in our society. country as a whole. “

Dr Abinash Virk via Mayo Clinic News Network screenshot

“Extremely low” breakthrough rates

Health officials emphasize that vaccination and indoor masking are the main tools in slowing the spread.

The unvaccinated have a 13- to 15-fold higher infection rate than the vaccinated, said Virk, while those with only natural immunity have a 5-fold higher rate of reinfection than those infected who subsequently have been vaccinated.

While the boosters have been adopted as a liferaft for the vaccinated, Virk, who supports them on advice from state health officials, describes the breakthrough rates as “still extremely low”, affecting only 1.8 % of people vaccinated.

Vaccination prevents people from going to the hospital, she adds.

“The (initial) protection against hospitalization, death and serious illness has remained extremely stable,” said Virk, “despite the effects of the delta and the decline in immunity.”

This is the backdrop to the complex case currently underway for universal boosters, including experts now weighing in to support third doses for all adults six months after their second injection.

“The first two doses continue to offer a high degree of protection against serious illness,” Mayo Clinic hematologist Dr Vincent Rajkumar recently said on Twitter.

“But because even small breakthroughs can spread infection to vulnerable, unvaccinated populations, we must try to reduce all cases.”

“Consider a healthy 30-year-old vaccinated woman,” like Dr Ashish. K. Jha, Dean of Brown University School of Public Health wrote Thursday, November 18 in The Atlantic.

“It is true that the benefits of a booster for her individually are modest: With waning immunity, she is at risk of getting a breakthrough infection when she encounters the Delta variant, but for her that would likely mean a few days of misery and hardship. full recovery, with a low (but not zero) risk of serious illness or long-term complications. “

But as a population health, Jha says, boosters are hard to dismiss.

This healthy 30-year-old woman might want to visit older relatives or hang out with an immunocompromised friend. Although her risk of spreading the virus if infected is low, it would be much lower if boosted. “

There are also dosing arguments. Rajkumar highlights data showing the effectiveness of the booster in preventing infection, but also the belief that “the first two doses were too close together and that a booster is needed for all adults”, to realize the vaccine’s initial untapped potential .

Recent studies support this view, says Virk, showing that the antibody response of a third shot far exceeds that of the second shot.

After the wide array of recently approved ones, all of this painstaking reasoning may ultimately only affect a small number of new booster recipients.

Third plans were already available to many Americans, groups chosen according to different criteria, some more widely adopted than others.

For those who are immunocompromised, who do not develop a robust immune response to the standard dose of vaccine, a third shot wouldn’t even be considered a booster, says Virk, but a baseline inoculation with a booster six months after shot three.

The boosters have also been recommended for people 65 years of age and older and those with chronic illnesses, groups where age or poor health may have caused them to produce an insufficient immune response to the second injection.

The boosters were also authorized for people belonging to high-risk populations and living in long-term care, groups authorized the use of the injections against the advice of a group of experts when the director of the CDC , Dr. Rachel Wolensky, rescinded their recommendation.

Now, those distinctions have dissolved into a general extension of eligibility to all adults.

It comes at a time when the health care system is under great pressure.

Virk says the Mayo Clinic in Rochester ICU and progressive care facilities currently have 70-94% capacity, while the healthcare system has 80-100% capacity, with 14% acute care and the intensive care space in most clinical settings currently treating COVID-19[FEMININE[FEMININE