Arguments for and against boosters

FDA panel reports, against boosters for all

https://www.washingtonpost.com/health/2021/09/17/covid-booster-shots-fda-recommendation/

Food and Drug Administration

Boosters for all (16:2)

Unanimously, a booster shot of Pfizer-BioNTech (18:0)

Six months (minimum) after vaccination

People 65 + and anyone at risk for severe illness

Final decision, may include occupational exposure

Centers for Disease Control and Prevention to advise next week

Administration wanted it for all 16 +

81 million had Moderna or Johnson & Johnson

Against boosters for all

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02046-8/fulltext

Enhancing immunity in vaccinated people is appealing

Should be evidence-based

Consider the benefits and risks for individuals and society

COVID-19 vaccines continue to be effective against severe disease, including that caused by the delta variant

CDC, Sara Oliver

Through July, adults 75 and older were 88%
protected against hospitalization

Decisions about boosting are informed by reliable science more than by politics.

Observational studies

Pfizer was a co-sponsor of the study

Current vaccine supplies could save more lives if used in previously unvaccinated populations

In favour for the immunocompromised, but ? different vaccine

Boosting might ultimately be needed in all

E.g. waning immunity or because variants expressing new antigens

Boosters may have immune-mediated side-effects such as myocarditis (more common after 2nd dose)

Implications for vaccine acceptance

Further reasoning

Even if humoral immunity appears to wane

Initial vaccine type still elicit humoral immune responses against delta

(rather than variant-specific antigens)

Indicates that delta has not evolved to escape the memory immune responses

There is an opportunity now to study variant-based boosters

Robust booster responses might be achievable at lower doses

For boosters for all

Israel

Protection had waned

Booster campaign started end of July

Sharon Alroy-Preis, director of public health, Israel’s Ministry of Health

Thousands of cases, doubling every 10 days

If we had not started boosters at the end of July, we would have come to the capacity of Israeli hospitalization capabilities — and gone beyond it

Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel

https://www.nejm.org/doi/full/10.1056/NEJMoa2114255

HTTPS://WWW.NATURE.COM/ARTICLES/D41586-021-02516-4

30th July to 31st August 2021

At least 5 months earlier

n = 1,137,804 over 60s

Confirmed infections, 4,439

Severe illness, 294

Booster group

Doubly vaccinated

Rate of confirmed Covid-19

Rate of severe illness

At least 12 days after booster dose

Nonbooster group

Doubly vaccinated

Rate of confirmed Covid-19

Rate of severe illness

Results, rate of confirmed infections

Lower in the booster group

Higher in the nonbooster group

By a factor of 11.3

Results, rate of severe illness

Rate of confirmed infection

Lower in the booster group

Higher in the nonbooster group

By a factor of 19.5

https://www.fda.gov/media/152205/download

Holding true down to 40 so far

Source