What to know when we need COVID-19 booster shots

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Moderna has soared over the past year thanks to its coronavirus vaccine. Radek Mika / Getty Images

Should the United States start providing people with an extra dose of COVID-19 vaccines?

Proponents cite signs that protection is waning and data that a booster dose will help.

Others say the reinforcement is now unnecessary, because the shots still prevent hospitalization and death.

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The debate over whether the United States should release additional doses of coronavirus vaccines has reached its climax.

Pfizer and Moderna, the two drug companies that sell two widely used vaccines in the United States, have argued forcefully that booster doses will be necessary before winter. Some vaccine experts have been strong in saying they don’t need it yet.

“No vaccine, at least not in this category, will have an indefinite amount of protection,” Dr. Anthony Fauci, the country’s top infectious disease expert, said in an interview with NBC News on Thursday.

“What we do literally on a weekly and monthly basis is follow up on groups of patients to determine if, when, and who should get it,” he later said. “But right now, at this moment, other than those who are immunocompromised, we will not be giving boosters to people.”

Whether it’s the opinions of independent experts, recommendations from drug companies, or the latest research fueling the debate, there are compelling arguments for and against introducing booster doses to the general population of the United States.

It is not clear that there is a clear answer at this point, which makes it a good argument as well as a difficult situation for public health. The emergence of the delta variant, which partially reduces protection from vaccinations, increases the urgency of the situation.

Read more: We got an exclusive look inside Moderna Labs, as the biotech startup plans what comes after its groundbreaking coronavirus vaccine.

The narrow exception here, where both sides agree, is that some Americans need a boost now. Organizers have given good third shots to some people with severely weakened immune systems, hoping to further protect them from the coronavirus.

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Case in favour: Better safe than regret

A doctor checks the vital signs of a patient in the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, California on Jan. 3. Apu Gomes / AFP via Getty Images

We know that protection from coronavirus vaccines peaks a few weeks after people get their second dose of Pfizer or Moderna, and then gradually declines.

The critical unknown is how quickly it is diminishing and when we should care enough to act.

Vaccine developers Pfizer and Moderna recently said third doses should be rolled out between six and 12 months after the first two doses.

This is partly because data from the massive Pfizer study testing its vaccine shows protection against cases of COVID-19 symptoms dropping from 96% to 84% in six months. Moderna presented data showing that shot-produced antibodies are not as abundant and potent when exposed to circulating variants after about six months.

The companies also presented lab data showing that a third dose significantly increases the level of antiviral antibodies in people. These booster antibodies are also active in fighting the delta variant. This is important because there is more research indicating that neutralizing antibodies are closely related to protection against COVID-19.

Vaccine makers have a clear financial incentive to provide booster doses. Moderna, in particular, has seen its valuation soar from $7 billion to more than $160 billion through the pandemic, thanks to its work on a COVID-19 vaccine that is now bringing in billions of dollars.

Diminished protection reports spur booster shots

However, information from the UK, Israel and Mayo Clinic researchers shows that protection from vaccines appears to be declining, increasing the case for reinforcements.

Perhaps most shockingly, Israeli health officials said they saw protection against severe disease drop from 97% in April to 81% in July among people over 60. While this data has not been published or posted on a preprint server, it informs that country’s public health strategy.

Israel is in the midst of an aggressive booster campaign, making possible additional doses for everyone 50 and older and healthcare workers, among others. France and Germany are also working on booster plans that will begin giving third shots in September.

Much of the epidemic has been reduced to problems of response rather than anticipation and prevention. Signs are showing that protection is waning, and the booster shot shows promise for immune restoration. Why not try to increase the protection using the available tools?

The case against: Reinforcements Unnecessary, Selfish

Dr. Paul A. Offit speaks during a press conference in Philadelphia. Matt Rourke / AP Photo

Dr. Paul Offit, a longtime vaccine developer who is a member of the Food and Drug Administration’s Vaccine Advisory Committee, says it’s not yet time for a booster.

That’s because the goal of these vaccines is not to prevent every infection. Instead, the goal is to prevent people from being hospitalized with COVID-19 or dying. Offit said they’re still doing it very well.

When you take this perspective, some of the same worrying studies seem reassuring.

Take the Mayo Clinic study (and it should be noted that this is preliminary research).

While the sharp drop in the effectiveness of the Pfizer vaccine in July drew attention, the same study found that its effectiveness in preventing the worst outcomes of COVID-19 has stalled.

The shots are still working

Pfizer’s injection was 75% effective in preventing hospitalization, roughly in line with the previous month. Moderna’s vaccine was 81% effective by this measure.

Dr. Maria Elena Botazi. Courtesy of Maria Elena Botazi

In general, the Mayo results show that the vaccines work, said Maria Elena Botazi, a vaccine developer at Baylor College of Medicine.

“It’s still not really clear from the data whether it’s beneficial to have a third batch now if you’re a normal, healthy person with a normal immune response,” Botazi said. “We continue to see significant vaccine protection against the delta variant.”

Another good example is the outbreak in Provincetown, Massachusetts, which made headlines because most of those infected were also fully vaccinated. But the CDC’s analysis of a subset of those cases found that of the 346 fully vaccinated people who became infected, only four, or nearly 1%, were hospitalized and no one died.

“This is a vaccine that still works,” Offit said.

Much of the world still needs potions

If the outbreak increasingly sends fully vaccinated people to hospital, then you’ll know we need boosters. That’s not happening yet, Offit said.

Finally, giving boosters ignores the more pressing issue of getting more people to get vaccinated, Offit and Potazzi said.

The World Health Organization is appealing to rich countries to stop using boosters until at least the end of September so that other countries can vaccinate more of their populations.

“I would prefer to see more people protected from severe disease, deaths and hospitalizations, even if we all have unprecedented infections because that is what will stop this virus from continuing to mutate,” Botazi said.

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