Bloomberg Editorial: The Case for Covid Vaccine Boosters in Shakier Than Ever

2,308 Views | 8 Replies | Last: 3 yr ago by plain_o_llama
Windy City Ag
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AG
Thought this was interesting and reflects KidDoc's comments on the strangely empty argument for the booster shot at this point.

The Case for Covid-19 Boosters Is as Shaky as Ever

Quote:

The Case for Covid-19 Boosters Is as Shaky as Ever

Unanswered scientific questions leave it unclear whether Biden's extra shots will make Americans safer, especially if the virus runs rampant where vaccination rates are low.

Scientists are raising serious questions about the wisdom of the push for Covid-19 boosters unveiled on Wednesday by President Joe Biden. It'll be hard to judge whether extra shots for the vaccinated will be helpful or counterproductive until more of the data behind the decision become available.
The officials announcing the decision to give shots to those vaccinated eight months earlier said it was justified by data on an increase in mild infections and speculation that this might evolve into something worse.

But it's not clear to some scientists that severe disease and death will indeed rise among the vaccinated even if there are more infections. And outside scientists haven't had a chance to analyze the data that the government used to infer the need for boosters. Additionally, some public health specialists dispute the ethics of the decision given the pressing need for doses elsewhere in the world.

In contrast, there isn't much controversy over a recommendation by the Centers for Disease Control that an extra shot is merited for a small number of vaccinated people with weakened immune systems cancer patients and people who have received organ transplants, for example.

Wednesday's general booster decision is different. It rests on data coming out of the U.S. and Israel showing that breakthrough infections among vaccinated people are on the rise. That fact has been interpreted to mean that the immunity conferred by vaccines is waning. But it could just as easily indicate nothing more than an inevitable rise attributable to the more infectious delta variant, which is now dominant but which hadn't been detected when the first rounds of vaccines were administered.

It's also risky to infer waning immunity by comparing those who got the vaccine early to those who got it later, because the first shots went to the oldest, sickest people.
Meanwhile, the World Health Organization and other global health bodies are arguing that the shots are more likely to save lives if given away to countries where health-care workers and the elderly still haven't had access to vaccines at all.

Eric Toner, a senior scholar at the Johns Hopkins Bloomberg School of Public Health, said he's confident that federal officials based their decision on data he just hasn't been able to see or analyze it yet. Neither has infectious disease expert Monica Gandhi of the University of California at San Francisco, but based on her understanding of the immune system and the way vaccines work, she's not convinced that protection against severe disease or death will wane. She said that first doses of vaccines trigger a temporary surge of antibodies that normally wanes over a period of weeks. Human blood would be thick as glue if it carried full antibodies to all the diseases that people are immunized against, she said.

The lasting protection comes not from the antibodies themselves but from T cells and memory B cells, which detect and kill infected cells and create new antibodies. Those cells can last for years or decades. They don't always protect against mild disease because it takes a few days for them to become activated, but they should prevent most people from suffering from the system-wide invasion that's characterized severe illness.

Gandhi posed another critical science question about the wisdom of an extra shot. All that are available now, she said, are shots created to fight the original variant, not the currently dominant delta. But human immune systems can make modified antibodies geared to attack the new variant. There's some flexibility in the new antibodies produced by the memory B cells, which hide away in lymph nodes and bone marrow after being activated by the initial shots.
It's not clear to her whether vaccinated people would be better off if given a booster dose that triggers production of antibodies geared to the old version of the coronavirus than they would be by letting the existing B cells go to work against the new one.

Wednesday's announcement also left open questions about the differences between the three vaccines approved for use in the U.S. There's some evidence that for two-shot vaccines, the ones made by Pfizer-BioNTech and Moderna, antibodies last longer if there's a longer interval between shots. (The Johnson & Johnson vaccine requires only one shot.) University of Pennsylvania vaccine expert Stanley Plotkin argued in a paper published in January that two-shot Covid-19 vaccines would work at least as well with longer intervals and could save more lives.
plain_o_llama
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Quite interesting coming from Bloomberg. Thanks for posting.
plain_o_llama
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There was a little more mainstream media pushback against the Biden Administration Booster plan:


Scientists question evidence behind U.S. COVID-19 booster shot drive

By Deena Beasley and Ahmed Aboulenein

https://www.reuters.com/business/healthcare-pharmaceuticals/scientists-question-evidence-behind-us-covid-19-booster-shot-drive-2021-08-19/

Aug 19 (Reuters) - The Biden administration's plan to provide COVID-19 vaccine boosters is based on concerns that a decrease in the vaccines' ability to protect against milder infections could also mean people will have less protection against severe illness, a premise that has yet to be proven, scientists said on Thursday.
U.S. officials, citing data showing waning protection against mild and moderate illness from the Pfizer-BioNTech (PFE.N), and Moderna (MRNA.O) vaccines more than six months after inoculation, on Wednesday said boosters will be made widely available starting on Sept. 20.

The additional dose will be offered to people who received their initial inoculation at least eight months earlier.
"Recent data makes clear that protection against mild and moderate disease has decreased over time. This is likely due to both waning immunity and the strength of the widespread Delta variant," U.S. Surgeon General Vivek Murthy told reporters.

"We are concerned that this pattern of decline we are seeing will continue in the months ahead, which could lead to reduced protection against severe disease, hospitalization, and death."
Data on so-called "breakthrough" infections in vaccinated people shows that older Americans have so far been the most vulnerable to severe illness.

As of Aug. 9, almost 74% of the 8,054 vaccinated people that were hospitalized with COVID-19 were above the age of 65, according to the U.S. Centers for Disease Control and Prevention. Almost 20% of those cases ended in deaths.

Based on available data on vaccine protection, it is not clear that younger, healthier people will be at risk.

"We don't know if that translates into a problem with the vaccine doing what is most important, which is protect against hospitalization, death, and serious disease. On that, the jury is still out," said Dr. Jesse Goodman, an infectious disease expert at Georgetown University in Washington and a former chief scientist at the U.S. Food and Drug Administration.

Several countries have decided to provide booster shots to older adults and people with weak immune systems. European Union officials said on Wednesday they do not yet see a need to give booster shots to the general population.

Other experts said the U.S. plan requires thorough vetting by the FDA and a panel of outside advisers to the CDC. A meeting of those advisers to discuss boosters set for Aug. 24 is being rescheduled, the CDC said on Thursday on its website.

The Department of Health and Human Services, which oversees the CDC and FDA, did not immediately respond to a request for comment.

Some experts questioned the focus on booster shots when around 30% of eligible Americans have yet to get even a first vaccine dose, despite new COVID-19 cases and deaths surging across the country.

"The more important thing, I think, at this point than boosters is making sure we get the vaccine in any arm that hasn't had one as fast as we can," said Dr. Dan McQuillen, an infectious disease specialist in Burlington, Massachusetts, and the incoming president of the Infectious Diseases Society of America.

All experts interviewed by Reuters also emphasized the need to inoculate the vast number of people around the world who have yet to access COVID-19 vaccines.

"You could end up in situation where you are chasing your tail, giving more and more boosters in the U.S. and Western Europe, while more dangerous variants are coming from other places," said Dr. Isaac Weisfuse, epidemiologist and adjunct professor at Cornell University Public Health.

"In reality you should be vaccinating the rest of the world to avoid new variants."
KidDoc
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AG
Good article thanks for sharing it. Lays out my concerns and frustration succinctly.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
plain_o_llama
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Perhaps it is little wonkish for most, but I continue to be curious about the who and why of the original announcement.



The LA Times doesn't seem too supportive:


'We sent a terrible message': Scientists say Biden jumped the gun with booster plan
https://www.latimes.com/science/story/2021-08-20/scientists-say-biden-jumped-gun-with-covid-vaccine-booster-plan


The Biden administration's plan to make COVID-19 booster shots available next month has drawn a collective scream of protest from some members of the scientific community.


As they see it, the announcement is rash and based on weak evidence, and they worry it could undercut confidence in vaccines while offering no clear benefit of controlling the pandemic.

Plus, more information is needed on potential side effects or adverse effects from a booster shot, they say.

Perhaps even worse, the announcement has fueled deeper confusion about what Americans need to do to protect themselves against COVID-19.


And later



Typically, any distribution of shots would occur after the CDC's Advisory Committee on Immunization Practices developed recommendations. But with the Biden administration's announcement about boosters, public health experts worry the message suggests the outcome is preordained.

"They've left them no choice," said Dr. Nicole Lurie, a former senior Health and Human Services official in the Obama administration and U.S. director of the Coalition for Epidemic Preparedness Innovations, the global epidemic vaccines partnership. "If there's no booster program, FDA gets blamed, and that's not appropriate."



The CDC position seems to be the following:
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html
ham98
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Big pharma lobbyists are big fans of semi annual boosters. Protect yourself by making Pfizer shareholders rich!
St Hedwig Aggie
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AG
To hell with the HHS secretary; maybe creepy Joe should put Kamala in charge of everything Covid! That could go so well!
Make Mental Asylums Great Again!
Harry Stone
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AG
Quote:

The lasting protection comes not from the antibodies themselves but from T cells and memory B cells, which detect and kill infected cells and create new antibodies. Those cells can last for years or decades. They don't always protect against mild disease because it takes a few days for them to become activated, but they should prevent most people from suffering from the system-wide invasion that's characterized severe illness.


this is a great article and she is spot on here. if we created a vaccine that can target killer T cells, we would have a long lasting vaccine.
KidDoc
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AG
Finally they released the data, as expected it is underwhelming and there is no evidence presented that a booster will really make any difference in vaccine efficacy (VE) with Delta or decrease the rate of hospitalization with COVID. The data shows a decrease in VE for Delta but it is relatively small and there is no mention about differences in hospitalization rates.

Obviously the CDC HOPES that boosters will provide more complete immunity vs Delta- and it may very well turn out to be the case-, but we have not historically had CDC guidelines based on best hopes. I can see why they made the recommendation but it feels premature and a bit panicked IMO.

I am not talking about boosters for elderly or immunocompromised- that is pretty clearly helpful- I'm talking about global boosters for EVERY adult.

New CDC studies point to waning immunity from vaccines (msn.com)

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
plain_o_llama
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KidDoc said:

Finally they released the data, as expected it is underwhelming and there is no evidence presented that a booster will really make any difference in vaccine efficacy (VE) with Delta or decrease the rate of hospitalization with COVID. The data shows a decrease in VE for Delta but it is relatively small and there is no mention about differences in hospitalization rates.

Obviously the CDC HOPES that boosters will provide more complete immunity vs Delta- and it may very well turn out to be the case-, but we have not historically had CDC guidelines based on best hopes. I can see why they made the recommendation but it feels premature and a bit panicked IMO.

I am not talking about boosters for elderly or immunocompromised- that is pretty clearly helpful- I'm talking about global boosters for EVERY adult.

New CDC studies point to waning immunity from vaccines (msn.com)

The following from the MSN/Politico article is kind of interesting. Normal finger pointing but there also seems like an effort to suggest the Booster plan was the CDC's doing.


Two senior administration officials said the CDC has kept its vaccine efficacy and breakthrough infection cohort data from other senior Biden officials. That has raised questions within the administration about why the agency decided to recommend booster shots.


The CDC's secrecy as it scrubbed and analyzed the data has frustrated some in the White House who have insisted for weeks that breakthrough infections are rare, based on initial findings from the spring. But that was before the Delta variant became the dominant form of the coronavirus in the United States.

In speeches, Biden has repeatedly emphasized that Covid-19 is a "pandemic of the unvaccinated," going as far in late July to assert that "over 99 percent of Covid-19 deaths had been among the unvaccinated."

Yet as reports of breakthrough mounted and scrutiny intensified, health officials have clamored for the more recent data on the proportion of serious infections found in vaccinated Americans.


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