Some health experts recommend delaying booster shots for the healthy: 5 takeaways

White House vaccine coordinator: 'Confidence in the vaccines is actually very, very high'

Algernon D'Ammassa
Las Cruces Sun-News

President Joe Biden has advocated for rolling out booster shots to every American who has completed a primary course of COVID-19 vaccine, beginning as soon as Sept. 20.

Medical experts, however, are still debating the merits of boosting immunizations for the vaccinated vs. focusing on delivering shots to the unvaccinated.

The Centers for Disease Control and Prevention currently recommends additional boosters of the Pfizer-BioNTech or Moderna vaccines only for those with compromised immune systems.

On Monday, medical journal The Lancet published a review of data from controlled trials and peer-reviewed studies indicating the three vaccines administered in the United States remain effective against severe disease from all major variants of the SARS-CoV-2 coronavirus, including the highly contagious delta variant that has driven spikes in infections this summer. 

Jasmine Serrano receives a vaccine shot at a vaccination clinic at the Hatch Community Center in Hatch on Saturday, July 24, 2021.

Among the review's authors are two vaccine regulators from the Food and Drug Administration who have recently announced their departure from the agency amid debate over the boosters. The paper's lead author is Dr. Ana-Maria Henao-Restrepo of the World Health Organization. 

Here are some takeaways from the review published in The Lancet:

Boosters for healthy people debated

WHO Director-General Dr. Tedros Adhanom Ghebreyesus called last week for a moratorium on booster shots for healthy people until poorer nations had received and distributed more vaccines for their own populations. 

The paper's authors argued that, while boosters may eventually be needed to address waning immunity over time or because of new variants, "current vaccine supplies could save more lives if used in previously unvaccinated populations than if used as boosters in vaccinated populations." 

World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus is seen at WHO's Geneva headquarters on July 3, 2020.

More research into several key questions would be required to determine the best strategy on booster shots, according to the paper.

For instance, would a dose of the same vaccine be better than a complementary dose of another vaccine? Are there risks to introducing boosters too early, or too often? Would side effects from unnecessary booster shots discourage vaccine participation? 

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The paper argued that devoting supplies and infrastructure to bring additional doses to healthy, vaccinated people prematurely could have unintended and harmful consequences. 

"If vaccines are deployed where they would do the most good, they could hasten the end of the pandemic by inhibiting further evolution of variants," the paper stated. 

"We have to do everything we can to get as many who are unvaccinated vaccinated," White House vaccine coordinator Dr. Bechart Choucair said in an interview with the Las Cruces Sun-News.

President Joe Biden speaks in the State Dining Room at the White House on Sept. 9.

Choucair did not comment on the Lancet report, but said, "Our medical experts, our public health experts believe that eventually we will need boosters … so we have to do both things.”

Repeating the Biden Administration's pledge to manage its pandemic response based on research and data, Choucair said the administration's vaccine team was prepared to implement recommendations expected soon from the FDA and CDC. 

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Data show vaccines performing well

Another reason the journal cited for taking more time with booster shots is that current vaccines continue to be highly effective against severe disease. 

The opinion is based on findings from randomized trials and observational studies consistently showing the vaccines to be highly effective against serious symptoms even in the case of breakthrough infections. 

While transmission of the virus and infection still may occur among the vaccinated, the authors wrote, "the unvaccinated are still the major drivers of transmission and are themselves at the highest risk of serious disease."

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Significantly, the findings also show that the vaccines are effective against the main variants currently prevalent, including delta. 

That buys time, the paper argues, for researching variant-based boosters, similar to the process for developing seasonal flu vaccines, before a more serious strain emerges. 

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Breakthrough cases are to be expected

As is typical with vaccines, some recipients may still be infected. 

Last week, a new Yale University study examining nearly 1,000 COVID-19 hospitalizations found that 54 had been fully vaccinated, meaning two weeks had elapsed since completing a course of vaccine. 

Of those 54, nearly half were asymptomatic and had been admitted for other issues. The 14 who experienced severe illness were elderly and presented with underlying conditions that can exacerbate the effects of COVID-19. 

As breakthrough cases have gained publicity in news reporting, they have also been used by anti-vaccine commentators to question their effectiveness. Researchers say breakthrough cases appear to be frequent because nearly 180 million Americans have been fully vaccinated, and a small percentage of infections will evade inoculation.

A vaccination clinic at the Hatch Community Center in Hatch on Saturday, July 24, 2021.

"Increasing success in delivering vaccines to large populations will inevitably lead to increasing numbers of breakthrough cases," the paper stated, noting that behavioral changes following vaccination — such as participating in crowded indoor events with non-household members including unvaccinated people — increase the likelihood of a breakthrough case.

Decisions will affect vaccine confidence

President Biden voiced frustration over vaccine hesitancy last week, saying to those who had chosen not to be vaccinated, "your refusal has cost all of us."

On the other hand, Choucair pointed to the rollout's success as a sign that "confidence in the vaccines is actually very, very high." 

"We have more than 75 percent of adults in this country (that) have received at least one dose," he said. "We have more than 178 million people in this country fully vaccinated. … The fact remains there are still about 80 million people who are still undecided about the vaccines; and for that group, we have to … make sure they have answers to their questions."

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The authors of the Lancet paper opined that decisions about booster shots would influence impressions among the unvaccinated. 

"The message that boosting might soon be needed, if not justified by robust data and analysis, could adversely affect confidence in vaccines and undermine messaging about the value of primary vaccination," the paper stated, and thus could discourage unvaccinated people from getting their initial shot. 

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Vaccinations protecting young children

The United States has seen a nearly five-fold increase in hospitalizations of children and adolescents over the summer, according to CDC data, with hospitalizations 10 times higher among the unvaccinated adolescents. 

In New Mexico, which has one of the nation's higher vaccination rates, the proportion of hospitalizations of children through age 17 have remained the lowest compared to older age groups, according to the state Department of Health. 

New Mexico Human Services Secretary David Scrase demonstrates proper mask-wearing during a virtual news conference from the state Capitol building in Santa Fe on Wednesday, July 1, 2020.

Last week, acting state Health Secretary Dr. David Scrase pointed to federal data showing states with lower vaccination rates have higher hospitalization rates for children, suggesting New Mexico's higher vaccine uptake was protecting children, especially those too young for vaccines.

Choucair concurred and pointed to the lower trend as a success by New Mexico.

"The more people that are vaccinated, the more we create a cocoon around those kids who are not eligible to get vaccinated yet," he said, adding: "In the states with the lowest vaccination rates, infections and hospitalizations for kids are up to four times as high as they are in states with high vaccination rates."

Whatever the CDC and FDA decide, a spokesman for the New Mexico Department of Health said the agency "is focused on the health and wellbeing of New Mexicans, and we expect to have enough supply to provide both boosters and primary vaccinations for the currently-unvaccinated (assuming, of course, that the FDA and CDC recommend boosters)." 

Read the 4-page paper from The Lancet here:

Algernon D'Ammassa can be reached at 575-541-5451, adammassa@lcsun-news.com or @AlgernonWrites on Twitter.