Why Wait 8 Months for a COVID-19 Booster Shot?

Why 8 months? As the delta variant fuels yet another COVID-19 surge in the United States and evidence mounts of increased breakthrough infections causing increased hospitalizations, that’s 1 of many questions public health care officials need to address.

The Biden administration announced this week that booster shots will begin to be rolled out on September 20 and—as with the case with the first 2 doses—the boosters will first be offered to those who need them the most: the elderly, with a special emphasis on nursing home residents, and health care workers, including infection preventionists (IPs). Boosters will be offered to those who’ve gotten the 2-dose Pfizer/BioNTech, and Moderna vaccines. The plan still needs to be approved by the Food and Drug Administration (FDA), though that approval appears to be a given.

The vaccines are still very effective, public health officials say. Even without the booster shots, they offer protection against severe illness and death. Until just yesterday, hospitalizations would have been included in what the vaccines cut down on and they still are, but now there’s a caveat.

The New York Times crunched some data and under a carefully worded headline—headlines need to be carefully worded these days to avoid fostering either panic or apathy—the newspaper noted that some—some—data indicate that breakthrough infections are causing more hospitalizations.

The Times headline: “In a Handful of States, Early Data Hint at a Rise in Breakthrough Infections.” In the article, the newspaper reports that in 6 states “breakthrough infections accounted for 18% to 28% of recorded cases in recent weeks. Breakthrough infections accounted for 12% to 24% of COVID-related hospitalizations in the states.”

This has not gone unnoticed by federal public health officials. At a press briefing this Wednesday, U.S. Surgeon General Vivek Murthy announced that “booster shots to fully vaccinated adults 18 years and older [will be offered]. They would be eligible for their booster shot eight months after receiving their second dose of the Pfizer or Moderna mRNA vaccines.” Murthy added that the fully vaccinated “still have a high degree of protection from the worst outcomes of COVID-19—severe disease, hospitalization, and death—so we are not recommending that you go out and get a booster today. Instead, starting the week of September 20th, fully vaccinated adults could begin getting their booster shots 8 months after their second shot of an mRNA vaccine.”

But again, how did public health officials decide that boosters should be given at 8 months prior to the last dose? Why not 7? Or 6? Or 5? (Infection Control Today^® emailed that question to the Department of Health and Human Services but has not yet received a response.)

As ICT^® reported, Israel—which launched its booster shot program in the beginning of August—is offering booster shots to people 60 and older who’d had their second dose of vaccine 5 months prior.

Kevin Kavanagh, MD, a member of ICT^®’s Editorial Advisory Board analyzed and translated the data by the Ministry of Health Israel and about 3 weeks before the US announced its booster shot plan wrote that the US should begin a similar program immediately.

Kavanagh said in an email to ICT^® that “with the Israel data email ICT^® published showing that individuals greater than 60 years old and 5 months out from full vaccination plus the recent New York Times data showing that between 12% to 25% of hospitalizations are breakthrough infections, one must ask the question: Why wait 8 months for boosters? This underscores the importance of using the vaccine as a layer of armor and not a panacea. Those vaccinated at the same time need to wear N95 masks and avoid indoor settings.”

Meanwhile, as IPs and other health care professionals will attest, the frontlines bear the brunt of a full-on COVID-19 surge. On the CNN show At This Hour, Aileen Marty, MD, an expert in infectious disease and disaster medicine, said that “I have boots on the ground, and I can tell you exactly what’s happening. Right now, in Miami-Dade County, 20% of the people in hospital are people who are fully vaccinated.” Marty praised the decision on booster shots and the work of Murthy, Rochelle Walensky, MD, the director of the Centers for Disease Control and Prevention, and Anthony Fauci, MD, President Biden’s chief medical advisor.

“But,” she said, “we very much need to be giving these third doses to those individuals who absolutely didn’t get an initial first rise, that’s the group that was talked about last week, and we need to give boosters to those of us whose immunity is waning.”

On the same program, Peter Hotez, MD, PhD, the dean of tropical medicine at Baylor College of Medicine, said that “we’ve been watching this out of Israel now for a few weeks where they have shown the protection against infection has gone down from 95% down to 40% to 50%. They made the statement they haven’t seen the breakthrough hospitalizations. Although I tend to concur with Dr. Marty anecdotally. We’re hearing about quite a number of breakthrough hospitalizations.”