SIB# 466- Are Booster Shots The Answer?
The Study: Considerations in boosting COVID-19 vaccine immune responses.
Overview: This is an opinion paper by an elite group of respected scientists in the field, includes two FDA vaccine reviewers who recently resigned their positions citing what they viewed as FDA’s rush to grant full approval to the vaccine. The authors make their case against widespread booster shots at this time stating, “Although the idea of further reducing the number of COVID-19 cases by enhancing immunity in vaccinated people is appealing, any decision to do so should be evidence-based and consider the benefits and risks for individuals and society.”
Key Points:
· The authors acknowledge that boosting could be appropriate for those who might have received “vaccines with low efficacy or those who are immunocompromised”, however they question whether boosting would be of benefit to those who did not respond to the initial vaccines.
· “Findings from randomised trials have reliably shown the high initial efficacy of several vaccines, and, less reliably, observational studies have attempted to assess the effects on particular variants or the durability of vaccine efficacy, or both.” (emphasis ours)
· They note that while some of the observational literature to date which has been used to “assess the effects on particular variants or the durability of vaccine efficacy” is peer reviewed, some is not and “it is likely that some details are importantly wrong and that there has been unduly selective emphasis on particular results.” (emphasis ours)
· Much of the rush to recommend boosters seems to revolve around waning levels of antibodies but as the authors note, “Even if humoral immunity appears to wane, reductions in neutralising antibody titre do not necessarily predict reductions in vaccine efficacy over time,” (emphasis ours)
· They also make the excellent point that even without any decrease in actual vaccine efficacy, “increasing success in delivering vaccines to large populations will inevitably lead to increasing numbers of breakthrough cases, especially if vaccination leads to behavioural changes in vaccinees.”
· While acknowledging the benefits of primary vaccinations, the authors express concerns over potential risks if boosters are “widely introduced too soon, or too frequently, especially with vaccines that can have immune-mediated side-effects” (such as myocarditis or Guillain-Barre syndrome) both of which have been observed in some cases following vaccination.
· They authors further question the ethics of widespread boosting stating that even “if boosting were eventually shown to decrease the medium-term risk of serious disease, current vaccine supplies could save more lives if used in previously unvaccinated populations than if used as boosters in vaccinated populations.”(emphasis ours)
Author’s Conclusions:
“If boosters (whether expressing original or variant antigens) are ultimately to be used, there will be a need to identify specific circumstances in which the direct and indirect benefits of doing so are, on balance, clearly beneficial.” (emphasis ours)
Reviewer's Comments: The evolution of the virus and our public response is moving at a rapid pace. Accordingly, I have decided to include some non peer reviewed publications (always to be clearly identified) which represent what I believe to be timely and responsible debate and dissent. I leave it to my readership, almost entirely made up of professionals, to make their own decisions regarding the content.
Reviewer: Mark R. Payne DC
Reference: Philip R Krause, Thomas R Fleming, Richard Peto, et al. Considerations in boosting COVID-19 vaccine immune responses. The Lancet. September 13, 2021.
Link To Full Text: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02046-8/fulltext