Israel to Offer COVID-19 Booster Shots to Older Citizens

Updated 7/29/21 1:30 p.m: Israel announced today that it will begin offering booster shots to its older citizens. Israel is the first country in the world to make this move, offering the COVID-19 booster shot to people aged over 60 to stop the spread of the Delta variant in that country. Those in that age group will be offered a third shot of the Pfizer/Biontech COVID-19 vaccine starting on Sunday. As reported today in Contagion^®, Infection Control Today^®’s sister publication, a “confluence of three factors—Pfizer’s earnings, a new dominant variant, and a decreasing immunity against COVID-19—are all coming together to incentivize the pharmaceutical company to make the case for a booster shot.” Apparently, Israel didn’t need much convincing. Vaccine efficacy in prevention of infection drops from 75% for those recently vaccinated to 16% for those who received their second dosage in January. The vaccine is still very efficacious for the prevention of hospitalizations and severe COVID-19. Below is a slide from the Ministry of Health of Israel. It should be noted that a similar decrease in efficacy is seen in those less than 60 years of age and even in those with asymptomatic and mild infections can still develop long COVID.

Source: Ministry of Health of Israel

Israelis over 60 who received their second vaccine dose at least 5 months ago will be offered the booster shot. Israeli Prime Minister Naftali Bennett said “gives your body very strong protection. Get the booster shot; take care of yourselves and those near you,” the Israeli newspaper Haaretz reports.

Bennet said that “reality proves the vaccines are safe, Reality also proves the vaccines protects from severe morbidity and death. And like the flu vaccine that needs to be renewed from time to time, it is the same in this case.”

Haaretz: “'There’s competition between the vaccines and the pandemic,' the prime minister said, arguing that having more vaccinated people would let Israel remain open and avoid the need to impose further restrictions.President Isaac Herzog will get his booster shot on Friday morning, two days before it is available to the general public.”

Contagion^® reports that the Delta variant was recently reported to be 83% of cases in the US, and has spread quickly over just a couple of months. Contagion Editor-in-Chief Jason Gallagher PharmD pointed out in a recent tweet that “ending 5/22 Alpha 69.1%, Delta 3.1% Ending 7/17 Alpha 8.3%, Delta 83.2% That's <2 mos. The fitness of Delta is incredible.”

Recent data about just how immune the vaccines can make someone and for how long has caused concern among some Israeli health officials. In a report in the Wall Street Journal, the findings showed reduced efficacy in the Pfizer vaccine.

“The findings, which are preliminary and based on a small sample, suggest that after two shots the vaccine was 39% effective at reducing the risk of infection and 40% effective at reducing the risk of symptomatic disease during a period when the Delta variant dominated cases in Israel, according to the country’s Health Ministry,” the Wall Street Journal reported. “The vaccine was 91% effective at preventing severe illness in the same period between June 20 and July 17, the ministry said.”

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Posted 7/29/21 8 a.m.: The Ministry of Health of Israel has released data which indicates there is significant concern regarding the Pfizer and BioNTech vaccines in the prevention of COVID-19 infections and symptoms. Overall, they found that after 2 doses of the vaccine the effectiveness in the prevention of infection with the Delta variant was 39% and the prevention of symptomatic disease was 41%. The good news is that hospitalizations and severe COVID-19 were reduced 88% and 91%, respectively. Thus, we all need to become vaccinated.

Source: Ministry of Health of Israel

A relatively small study recently published in the New England Journal of Medicine confirmed our fears that long COVID-19 can occur in patients with vaccine breakthrough infections. The study reported 39 health care workers with SARS-CoV-2 breakthrough infections. Eighty-five percent of the infections were from the alpha (UK) variant. Nineteen percent had persistent symptoms at 6 weeks or longer. These symptoms included: “….a prolonged loss of smell, persistent cough, fatigue, weakness, dyspnea, or myalgia.”

Thus, combining these two reports, there is a strong argument for obtaining a vaccine booster, especially in those who are at high risk. Prevention of hospitalizations and death is of paramount importance, but so is the prevention of long COVID.

Further looking at the Israeli data reviews there appears to be a waning of effectiveness against the Delta variant over time. In the diagram below (with the dumbbell data distribution), as the data regarding the administration of the second dosage progresses from January to May (vertical axis) the Delta breakthrough infections (right side of graph) lessens. However, the main observation is that once immunity takes hold, the infections by the alpha variant (in May—middle graph) almost disappeared. But in late June and July, the Delta variant emerged and markedly decreased the vaccine’s ability to prevent breakthrough infections.

Source: Ministry of Health of Israel

Surprisingly, as indicated by anecdotal reports, the young are not spared. The data indicates there are more breakthroughs in those who are below the age of 60 than above.

Source: Ministry of Health of Israel

mRNA vaccines are excellent vaccines, but they were made using the wild-type virus (or the original virus). Their effectiveness with the Delta variant appears to be waning. And with even more problematic variants in the wings, such as the kappa (Delta plus) and lambda variants, this is not good news.

If one remembers, the initial goal for vaccine approval by the U.S. Food and Drug Administration was a 50% efficacy in the prevention of symptoms. We may currently be close to missing this objective.

The Israeli data appear to be in marked contrast to that from England, which was recently reported by Bernal, et al. They concluded that the Pfizer and BioNTech vaccine was 88% effective in the prevention of symptomatic disease from the Delta variant. Thus, the Israeli data and this analysis needs to be confirmed. A good first step would be for the Centers for Disease Control and Prevention to release its data on reinfections so all can evaluate it.

If the data from Israel holds up, then all those vaccinated need to wear high quality medical grade masks and even the vaccinated can spread the virus, preventing the achievement of herd immunity. Even more important is to slow down the spread of this virus which will also slow down its mutations. The following should be considered:

1. Everyone (regardless of vaccination status) needs to wear an N-95 mask in public settings, and we need to avoid indoor public spaces, especially if there is poor ventilation.
2. We need to upgrade workplaces and schools with proper ventilation and air sanitization.
3. Similar to the protocols enacted in Germany, all workplaces should test employees (regardless of vaccination status) at least weekly; and in schools testing of all (regardless of vaccination status) staff and children at least twice weekly. Pool testing can be implemented to conserve resources and staff.
4. With previous variants, outdoors was much safer because of rapid dissipation of viral aerosols. However, infection with the Delta Variant produces up to 1000 times the number of virons as the Wild-Type of virus increasing the risks of aerosolization, and within six feet spread by large droplets can still occur.
5. Every county and region in the United States needs to enact and follow the same strategies. We are too mobile of a society and every county and region will have pockets of under vaccinated individuals which gather together.

Finally, we need to allow our pharmaceutical vaccine development and production to catch up with the virus. And above all we all need to get vaccinated, some of us with a booster, to avoid hospitalization and death from COVID-19, and at the same time to wear a mask and follow public health strategies to avoid long COVID.