Much ado about boosters
Published Jul 26, 2022 12:05 am
UNDER THE MICROSCOPE
Dr. Raymund W. Lo
The buzz nowadays is there are 27 million doses of Covid-19 vaccines set to expire this month. Most were bought by private companies, which are now fretting about the losses that the expiration will incur. The question is why are these vaccines being allowed to expire when there is still a need to address the vaccination gaps in the country?
Currently, there is still low vaccine acceptance in many regions. First-booster uptake is still low among the fully vaccinated. We still have to immunize the two to six year age group. Our second booster drive is still not hitting its targets.
Vaccine hesitancy is prevalent, thanks in no small measure to the Dengvaxia scare. However, we must address the issue of the limited roll-out of second boosters. Here, the problem is not vaccine acceptance but the restrictive qualifications for second shots. The only groups qualified to receive second boosters are the health care workers (A1), seniors (A2), and a fraction of the persons with co-morbidities (A3).
These are persons with specific immunocompromised conditions, but that’s a very small fraction of A3.
A lot of the other A3 population are clamoring to have the second booster, fearing that they’ll fall severely ill with Covid if they contract it. Many are diabetics, hypertensives, or are not in very good health. Who is to say they are not qualified for second boosters when immunity is not readily quantifiable in these individuals? In fact, many have not sought medical care due to the fear of Covid and thus may already be in various states of immunodeficiency. I certainly see a lot of seemingly healthy individuals testing poorly for immune functions.
Let’s look at the literature on second boosters. Israeli studies demonstrate substantial reduction in hospitalization and deaths with second booster in ages 60 and above. There is reduction in breakthrough infections as well. Unfortunately, the study was confined to this age group only. A May 2022 Lancet study shows a greater increase in antibody levels with second boosters compared to the first booster (16-fold vs. 12-fold increase). There was a five-eight-fold increase in cellular immune response against the wild type and the Delta variant. It cited a good safety profile as well. In South Africa, a study showed 92 percent effectiveness for second boosters versus 82 percent for first boosters. In another study, relative vaccine effectiveness for second boosters was 62 percent against severe Covid-19 and 74 percent against Covid-related deaths. All studies cited very low risks.
How about country recommendations? The US CDC recommends second boosters for those 50 and older, the immunocompromised, and those aged 18 and older who had J&J shots. The European Center for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA) recommend second boosters for aged 60 and up, plus people with medical conditions putting them at risk for severe disease. Chile and Brazil are giving second boosters to reinforce less effective Chinese vaccines.
The World Health Organization (WHO) recommends second boosters for immunocompromised individuals but does not specify certain medical conditions. So, why are we restricting it to very few immunocompromised states?
With all these in mind, can we reconsider giving second boosters to the entire A3 group, age 50 and over and those who had Sinovac and Sinopharm shots? It will really be a shame to let all those vaccines expire when so many are willing to get second boosters but are not allowed to. If we’re talking about benefits versus risks, surely there will be quite a few lives saved by second boosters compared to the very low risks of adverse reactions, which are mostly mild. After all, they will be signing consent forms indicating their willingness to have the shots.
The truth is, I know many who have told me that they have had four, six, or even eight shots. These were taken early on when the first recommendations on boosters were starting to be announced. Others considered their first two shots of Sinovac as ineffective (poor antibody production) and so went ahead with four more shots. This is also a possible reason why official figures for first boosters are low. In other words, many have had their first and second boosters under the radar of government agencies.
The restrictions on second boosters are sending the wrong signals to the public that there may be something wrong with Covid vaccines in spite of the fact that they have very good, nay, actually excellent safety profiles all over the world. This will fuel more vaccine hesitancy while the specter of the Dengvaxia controversy still hangs over us.
Dr. Raymund W. Lo
The buzz nowadays is there are 27 million doses of Covid-19 vaccines set to expire this month. Most were bought by private companies, which are now fretting about the losses that the expiration will incur. The question is why are these vaccines being allowed to expire when there is still a need to address the vaccination gaps in the country?
Currently, there is still low vaccine acceptance in many regions. First-booster uptake is still low among the fully vaccinated. We still have to immunize the two to six year age group. Our second booster drive is still not hitting its targets.
Vaccine hesitancy is prevalent, thanks in no small measure to the Dengvaxia scare. However, we must address the issue of the limited roll-out of second boosters. Here, the problem is not vaccine acceptance but the restrictive qualifications for second shots. The only groups qualified to receive second boosters are the health care workers (A1), seniors (A2), and a fraction of the persons with co-morbidities (A3).
These are persons with specific immunocompromised conditions, but that’s a very small fraction of A3.
A lot of the other A3 population are clamoring to have the second booster, fearing that they’ll fall severely ill with Covid if they contract it. Many are diabetics, hypertensives, or are not in very good health. Who is to say they are not qualified for second boosters when immunity is not readily quantifiable in these individuals? In fact, many have not sought medical care due to the fear of Covid and thus may already be in various states of immunodeficiency. I certainly see a lot of seemingly healthy individuals testing poorly for immune functions.
Let’s look at the literature on second boosters. Israeli studies demonstrate substantial reduction in hospitalization and deaths with second booster in ages 60 and above. There is reduction in breakthrough infections as well. Unfortunately, the study was confined to this age group only. A May 2022 Lancet study shows a greater increase in antibody levels with second boosters compared to the first booster (16-fold vs. 12-fold increase). There was a five-eight-fold increase in cellular immune response against the wild type and the Delta variant. It cited a good safety profile as well. In South Africa, a study showed 92 percent effectiveness for second boosters versus 82 percent for first boosters. In another study, relative vaccine effectiveness for second boosters was 62 percent against severe Covid-19 and 74 percent against Covid-related deaths. All studies cited very low risks.
How about country recommendations? The US CDC recommends second boosters for those 50 and older, the immunocompromised, and those aged 18 and older who had J&J shots. The European Center for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA) recommend second boosters for aged 60 and up, plus people with medical conditions putting them at risk for severe disease. Chile and Brazil are giving second boosters to reinforce less effective Chinese vaccines.
The World Health Organization (WHO) recommends second boosters for immunocompromised individuals but does not specify certain medical conditions. So, why are we restricting it to very few immunocompromised states?
With all these in mind, can we reconsider giving second boosters to the entire A3 group, age 50 and over and those who had Sinovac and Sinopharm shots? It will really be a shame to let all those vaccines expire when so many are willing to get second boosters but are not allowed to. If we’re talking about benefits versus risks, surely there will be quite a few lives saved by second boosters compared to the very low risks of adverse reactions, which are mostly mild. After all, they will be signing consent forms indicating their willingness to have the shots.
The truth is, I know many who have told me that they have had four, six, or even eight shots. These were taken early on when the first recommendations on boosters were starting to be announced. Others considered their first two shots of Sinovac as ineffective (poor antibody production) and so went ahead with four more shots. This is also a possible reason why official figures for first boosters are low. In other words, many have had their first and second boosters under the radar of government agencies.
The restrictions on second boosters are sending the wrong signals to the public that there may be something wrong with Covid vaccines in spite of the fact that they have very good, nay, actually excellent safety profiles all over the world. This will fuel more vaccine hesitancy while the specter of the Dengvaxia controversy still hangs over us.