On the second booster


Senator Francis N. Tolentino

On April 22, 2022, the Department of Health (DOH) issued Department Memorandum No. 2022-0154, which provides for the Interim Operational Guidelines on the administration of second Covid-19 vaccine booster doses to Immuno-compromised Population (ICPs) ages 18 years old and above.
On April 25, 2022, the government started the administration of the second Covid-19 vaccine booster shots. According to reports, the DOH’s initial rollout targets around 7,000 to 13,000 ICPs. Local government units would later take the lead in expanding the rollout within their localities.

Under the DOH Interim Operational Guidelines, the ICPs shall comprise of individuals in an immunodeficiency state, with HIV, active cancer or malignancy, transplant recipients, undergoing steroid treatment, patients with poor prognosis/bed-ridden patients, and other conditions of immunodeficiency as certified by a physician. This second booster shot may be administered at least three months after the third dose or first booster dose.

Earlier this year, countries like the United States, Israel, and South Korea, among others, have already authorized the administration of a second booster dose. This is in recognition of worldwide studies on the waning immunity and protection of the Covid-19 vaccine over time.

Of note is Israel – the first country to launch a major second booster campaign in January 2022. Within four months of administering second booster doses, studies on the effectivity and safety of a second booster have surfaced.

In one study this month published in the New England Journal of Medicine, the subject of which were more than 1.2 million people aged 60 and older, researchers found that following the administration of the second booster dose, the rate of Covid-19 infection was two times lower than after a third dose. Notably, however, the protection waned in about 1.5 months. The study also noted that the rate of severe disease was reported to be four times lower compared to those who have received only one booster shot. Despite this discrepancy, both groups of first booster and second booster recipients resulted in low hospitalizations due to Covid-19.

In another study released this month published in the same New England Journal of Medicine, the subject of which were 1,050 healthy young healthcare workers in Israel, results showed a significant drop in antibody levels five months following the administration of the first booster shot. The second booster then provided for increased levels of antibodies. However, researchers concluded that a second booster dose of a healthy young healthcare worker may only have marginal benefits in comparison to the benefits that the first booster shot would bring. The initial response to the second booster compared to the peak response to the first booster did not result in a considerable difference in humoral response or levels of omicron-specific neutralizing antibodies. Notably, vaccine efficacy was estimated to be higher for the prevention of symptomatic disease.

Like the first booster jab, these studies have concluded that the second booster is immunogenic and safe.
What can we learn from these peer-reviewed studies? One, that a second booster jab appears to prove highly effective and beneficial as protection against Covid-19 for individuals aged 60 years and older.

Two, for the healthy and young, the second booster jab may not provide the same significant benefits that a first booster provides, but still contributes added protection nonetheless. I note, however, that the study only compared the initial response to the second booster with the peak response to the first booster. As such, we may have to wait a little longer to see studies on the second booster’s full benefits on this group. Lastly, it is of importance to reiterate that that second booster is immunogenic and safe.
As of April 18, 2022, the DOH, as seen in its National Covid-19 Vaccination Dashboard, recorded more than 66.99 million completely vaccinated individuals in the Philippines. However, out of the 66.99 million, only 12.97 million have received their first booster dose. This is only 19.36 percent of the completely vaccinated persons.

As we rightly move towards administering second booster shots for the ICPs, the government should focus on promoting not just the complete vaccination of all persons in the Philippines, but also the administration of the first and second booster doses to the entire vaccinated population to ensure continued protection and immunity. Lest we forget that the key to transforming a pandemic to an endemic is protection through immunization.