We’ve seen second COVID-19 boosters recommended for the elderly and people with underlying health conditions – but what about the general population? Will another booster shot be recommended to everyone in the fall to ward off a winter flare-up? Or will the next recall campaign be aimed at those most at risk of developing a serious illness?
These are the main questions that vaccine experts are currently asking. Advisory Committee on Vaccines and Related Biologicals of the Food and Drug Administration recently met to discuss the next round of boosters. The panel agreed that while there is a strong need to develop a plan before the fall and winter, there is not enough data to know who would benefit from another booster. The committee also did not decide whether an upcoming booster would be an already approved vaccine or one of the updated vaccines currently being tested. The advisory group will meet again on June 28.
Infectious disease experts generally agree that developing a recall strategy is a complicated task. The usefulness of reminders varies greatly depending on people’s age and risk factors, so we could very well see the next round of reminders limited to those at risk. Vaccine scientists must also consider that a booster strategy for everyone may not make sense today, but we could very well find ourselves in an entirely different situation in September.
“The solution is not just to launch vaccines on everyone. It’s really about having a meaningful understanding of the goals of the immunization program and what we can expect from vaccines,” Isaac Bogochinfectious disease physician and scientist at the University of Toronto, told HuffPost.
Experts expect COVID boosters to be recommended for some, but not all
Bogoch said that to determine if, when and how boosters will be needed, it’s crucial to start by looking at the objectives.
Current vaccines have waning protection against infection and onward transmission, Bogoch explained, but they continue to be safe and highly effective in preventing serious outcomes like hospitalizations and death.
Health officials will have to decide whether they want boosters to prevent hospitalization and death (which early vaccines still do in most people) or to prevent symptomatic COVID (a more difficult feat), Arjun says. Venkatesh, physician and Associate in Emergency Medicine of Yale Medicine Professor at Yale Medical School.
The effectiveness of vaccines varies from person to person. Immunocompromised people and older adults decline earlier, making these people good candidates for booster doses, Venkatesh said.
“The reason we want to boost older adults first is that in many ways the vaccine — their first two doses — didn’t work as well as it did in younger people,” Venkatesh said. This second booster helped at-risk groups get “as vaccinated” as healthier individuals who only received two doses.
It’s reasonable to expect the next round of boosters to be recommended for vulnerable people ahead of the next wave of the pandemic this fall, Bogoch said.
Venkatesh also thinks we’ll see recall campaigns targeting at-risk populations more than general recall recommendations. It is not uncommon for recall campaigns to be rolled out for certain groups – we already do this for shingles, pneumonia and flu shots.
When will the general population receive another booster?
Trials have shown that a fourth dose currently available vaccines do not provide significantly more protection against mild or asymptomatic infections than a third dose in healthy people under age 50, according to Supriya Narasimhan, division chief of infectious diseases and hospital epidemiologist and medical director of infection control at Santa Clara Valley Medical Center.
“The increase in vaccine efficacy was small and short-lived, therefore the benefit of an additional dose is not considered significant,” Narasimhan said, noting that the benefits of a fourth dose were much more pronounced in people over 60 years of age.
At this time, it is not known if and when the general population should receive an additional booster dose.
“It’s going to be based, in large part, on when we start to see young, healthy people at risk of hospitalization or death – because that’s the outcome we’re trying to prevent – or when we’re seeing young, healthy people have decreasing levels of antibodies” that put them at risk, Venkatesh said. That would suggest it’s time for everyone to get another chance.
Bogoch suspects recall campaigns will vary from place to place. The UK recently suggested that its fall recall campaign would be limited to the elderly and more vulnerable. Quebec, on the other hand, has already made a booster dose available to anyone over the age of 18 who wants it. Bogoch wouldn’t be surprised if health authorities elsewhere end up saying that anyone who wants a dose can get it.
What about updated versions of the COVID vaccine that target new variants?
Last week, Moderna announced its omicron-specific booster was well tolerated and demonstrated a more robust antibody response against omicron variants than the original COVID vaccine. The company hopes to submit preliminary data soon. If authorized, the injections will be available in late summer, with booster options in the fall.
Pfizer is also working on a drop booster, although little data has been released on this. The FDA recently started again permission for the Novavax vaccinebut the move is still being considered as a booster.
It’s hard to predict when newer versions of COVID vaccines will be available, Bogoch said. Even though they have been developed and are being tested, this does not mean that they will be recommended for everyone. Vaccine scientists and health officials will first need to determine whether new vaccines help people regain protection against infection and onward transmission — and, if so, to what extent, Bogoch said.
“Something like this is fully expected to still protect against severe protection, hospitalization and death – but can we regain protection against infection and onward transmission and can we do it? in a sustainable way that does not diminish in a few months?” Bogoch asked. These questions have not yet been answered.
Venkatesh suspects that, like the flu, we will eventually have annual COVID vaccines. At some point, we may switch to different types of vaccines – like intranasal vaccines that can help fight transmission and pan-coronavirus vaccines that can target different types of coronavirus at once. But we won’t see them in 2022, Bogoch noted.
For now, experts want to err on the side of caution when it comes to boosters and prioritize them for people who need them the most while tracking how current shots hold up in the rest of the population.
“It is important that we are careful and timely in deploying additional boosters for the general population, as the increase in protection is likely to be small and short-lived, particularly in those with hybrid immunity due to infection. and vaccination,” Narasimhan said.
Experts are still learning about COVID-19. The information in this story is what was known or available at the time of publication, but advice may change as scientists discover more about the virus. Please consult the Centers for Disease Control and Prevention for the most recent recommendations.