As US Reaches Vaccine Milestone, Question of COVID Booster Shots Persists

UPDATED AT 1030 A.M. The World Health Organization just jumped into the discussion about the need for COVID-19 vaccine booster shots by in a dramatic way, asking for a moratorium to be placed on booster shots until poorer countries can catch up in terms of getting first and second doses into the arms of citizens. WHO Director Tedros Adhanom Ghebreyesus said that “I understand the concern of all governments to protect their people from the Delta variant. But we cannot accept countries that have already used most of the global supply of vaccines using even more of it,“ Reuters reports.

That sentiment was echoed by Katherine O'Brien, the WHO's director of immunization vaccines and biologicals, who told reporters: “We need instead to focus on those people who are most vulnerable, most at risk of severe disease and death, to get their first and second doses.“

Meanwhile, the the Washington Post sums up the moral implications of the push to administer booster shots to the vulnerable in the developed world this way: "As the coronavirus continues to infect and kill at alarming rates across the Global South, where vaccination levels remain catastrophically low, the decision by wealthy countries to give booster shots to their own people rather than donating those doses to poorer nations is deeply controversial. Advocates and experts, including at the World Health Organization, have called the move immoral."

The Associated Press reports that Tedros is directing his appeal to the Group of 20 large economies. “We need everyone’s cooperation, especially the handful of countries and companies that control the global supply of vaccinesThe G-20 has a vital leadership role to play as the countries that are the biggest producers, the biggest consumers and the biggest donors of COVID-19 vaccines.”

Tedros added that over 80% of the more than 4 billion vaccine doses administered around the world have gone to richer countries that have less than half of the world’s population. Richer countries have given out about 100 doses of COVID-19 vaccines for every 100 people. In poorer countries, the ratio is 1.5 doses for every 100 people.

“We need an urgent reversal, from the majority of vaccines going to high-income countries to the majority going to low-income countries,” Tedros said.

Infection Control Today^® (ICT®) has reached out to the Centers for Disease Control and Prevention (CDC) about a half hour ago for its take on this recent development, but the CDC so far has not responded.

POSTED AT 8:15 A.M. Israel announced last week that it will be the first country to offer COVID-19 vaccine booster shots to citizens 60 and older, and that effort officially began last Sunday. As Infection Control Today^® (ICT®) reported Monday, booster shots for older Americans might be something the United States will soon undertake.

“Booster shots are likely coming,” states the Johns Hopkins Coronavirus Resource Center. “The timeline is unclear, but manufacturers have begun announcing that additional doses could be needed.”

Other countries have already decided to administer booster shots. The Washington Post reports that Germany, France, and the United Kingdom are preparing to offer booster shots next month. (Booster shots reportedly are also being offered in Russia for people over 60.)

Last month, French President Emmanuel Macron announced that people with severe health problems, those over 75, and residents of nursing homes will be the first to be eligible for booster shots.

In the UK, the booster shots will also go to those whom medical experts consider to be the most vulnerable. The BMJ news feed (BMJ once stood for British Medical Journal) reported that the booster shots should be offered to “immunosuppressed adults aged 16 or over, people living in residential care homes for older adults, all adults aged 70 years or over, clinically extremely vulnerable adults aged 16 or over; and frontline health and social care workers.”

The BMJ article was published July 2 and comes replete with questions about just how any such booster shot program should operate. For instance, David Elliman, a consultant in community child health at Whittington NHS Trust in London said that “at the moment there is little clinical or laboratory evidence that boosters are needed, and JCVI [Joint Committee on Vaccination and Immunization] has understandably not committed itself yet. If a booster is needed, exactly how much benefit would it give and would it justify the resources?”

Apparently, British medical experts have answered those and other questions and Bloomberg News reports that the booster “shots would first be made available to extremely vulnerable and immunosuppressed adults, those ages 70 or older, residents of elderly care homes and front-line health workers…. Those eligible in the second stage would include people over 50 and household contacts of the immunosuppressed.”

Kevin Kavanagh, MD, a member of ICT^®’s Editorial Advisory Board, said this morning that “Israel was one of the first countries to vaccinate a majority of its citizens. They used a dosage schedule similar to the United States. Recent data from the Ministry of Health in Israel has shown that immunity is waning in those over 60 years of age who have received their second dose of the vaccine 5 months ago.”

The discussion about booster shots in the US occurs at a time when progress seems to be happening in vaccination efforts across the country. The US reached its goal of getting at least 1 dose of a COVID-19 vaccine into the arms of 70% of Americans. President Biden wanted to reach that goal exactly one month ago—on July 4.

But this success comes as the Delta variant burns through parts of the country where there are a lot of unvaccinated people. The Delta variant also seems to be taking aim at a younger demographic, as ICT^® reported yesterday. Sergio Segarra, MD, the chief medical officer of Baptist Hospital Miami, tells the Associated Press that “as quickly as we can discharge them they’re coming in and they’re coming in very sick. We started seeing entire families come down.”

The reality of the Delta variant seems to have convinced many people who were hesitant to get vaccinated to change their minds. ABC News crunched the numbers supplied by the Centers for Disease Control and Prevention over the last 3 weeks to find that “every state has reported an increase in its average number of first doses administered, with the national rate of Americans receiving their first dose up by more than 73%. Similarly, in the last week alone, vaccination rates have increased by nearly 20% in young Americans, ages 12-17, and by more than 25% in adults.”

The AP article also states that “in a major retreat in the Deep South, Louisiana ordered nearly everyone, vaccinated or not, to wear masks again in all indoor public settings, including schools and colleges. And other cities and states likewise moved to reinstate precautions to counter a crisis blamed on the fast-spreading [Delta] variant and stubborn resistance to getting the vaccine.”

In fact, there’s data that suggest the US has been doing much better in the vaccination effort than any other country. An article in U.S. News and World Report uses data collected by the research and statistics hub, Our World in Data, that show that the US is “the strongest performing country” in terms of vaccination rates. (The original article was published May 3, but a footnote states that the data were updated on July 20.)

Regarding booster shots, Kavanagh says that “in the United States our most vulnerable, along with nursing home residents, were given vaccinations early on in the pandemic. They are at risk of breakthrough infections with significant morbidity and mortality. Similar to the policy in other countries, I feel that the United States needs to administer boosters to our most vulnerable, before we see a repeat of last year's devastation in nursing homes caused by the Delta variant.”

But as the BMJ article alludes, launching a booster shot program comes with daunting logistical obstacles. The Johns Hopkins Coronavirus Resource Center states that “with the addition of booster doses, vaccination data reporting will need to expand to identify fully vaccinated populations. The dose number alone will not be sufficient to categorize people as fully vaccinated and the complications of additional shots necessitate vaccination metadata becoming more detailed. We can only properly track a country’s vaccinated population if information on all doses ever received is available.”