Are we on the brink of OVER-vaccinating in the fight against Covid?

OPINION: This article contains commentary which may reflect the author's opinion

Experts say the US, the UK, and other major economies may be on the verge of over-vaccinating their populations in the fight against Covid.

Israel has already announced their intention to administer another round of booster shots, which means the United States and the United Kingdom will eventually be forced to follow suit even though both nations say there are no plans to administer a fourth dose.

Scientists argue that rolling out vaccines every three to four months is simply not feasible or even necessary due to Omicron, which some believe will speed up the process of endemicity and end the days of sky-high hospitalization and mortality numbers.

In addition, they urged additional data on dosing gaps between boosters before moving forward with plans to administer fourth jabs. Experts claim that boosters are minimally beneficial because their primary function – preventing deaths and hospitalizations – has barely abated after a year and several variants of Covid, effectively meaning boosters are adding to already high immunity levels.

Virologist Ian Jones says descriptions of Omicron as a natural vaccine are accurate.

Based on this argument, Omicron is highly transmissible but milder than other variants, which means it can give an immunity boost without being as serious. Furthermore, some data suggest that infection rather than vaccination provides the best immune response in the long run.

Coming variants ‘may be even more mild’, Professor Jones told the Daily Mail. He added that the need for healthy adults to get booster shots could soon recede. Instead of pushing those every few months, he said annual ones for those most vulnerable ahead of the winter months would be ‘more feasible’.

Lawrence Young, a virologist from Warwick University, says vaccines should protect against severe illness much longer than they do against getting infected or becoming ill, suggesting that a booster shot every year will suffice to prevent Covid in the coming years.

Professor Simon Clarke, a microbiologist at the University of Reading, admits he does not see governments distributing Covid vaccines every three months for a very long time. He said: ‘Although after two-and-a-half months immunity starts to wane, that doesn’t mean it drops below being extremely effective.’

However, he told the Daily Mail that there was no way to measure the long-term effectiveness of the boosters until after the election. The data for the long term can only be collected over time; there is no crystal ball. We just don’t know what the optimum strategy is,’ he said.

According to other epidemiologists, repeat and multiple outbreaks of Covid each year may require boosters every four to six months, a prospect they described as ‘daunting’.

Omicron vaccines may be less effective, but they are certainly not redundant.

According to real-world data, booster vaccination efficacy plummets to around 40 percent after just ten weeks.

The two jabs still drastically cut hospitalization and death risk, even against Omicron, since even after some fading immunity, the immune system is still capable of fighting off viruses.

Experts believe that a third dose will even further enhance this protection.

It means a fourth dose may not be necessary yet for the entire UK and that ministers may only be advised in the coming months to administer extra doses to the elderly and immunocompromised.
Some experts have cautioned against giving out yet another round of vaccines so soon.

One of the government’s own advisers warned that if everyone received a top-up every three months, it would be impossible to ‘defeat’ Covid with vaccines. This would require the UK’s national health service to administer the equivalent of up to 50 million jabs every 90 days, or around 550,000 per day. Using Pfizer’s pricing model, an annual vaccination drive would cost roughly £4 billion (around $5.4 billion), based on a cost of around £20 ($27) per dose.

Ministers may approve plans to dispense universal Covid jabs – which experts hope will offer better protection and hold up against variations that emerge in the future – but they aren’t expected to be available for 18 months, England chief medical officer Professor Chris Whitty told MPs earlier this month.

Vaccine makers are quietly working on polyvalent Covid jabs, but they are in the early stages of development and will not be tested in clinical trials for a long time.

A fourth dose of Covid vaccines has already been approved for the use of vulnerable people, such as those with weakened immune systems, for fear that their immunity is already fading.

At this point, the US has not indicated any plans for additional boosters, with health officials stating that they needed more data to ascertain if a fourth dose would improve protection.

In a statement last week, the director of the National Institute of Allergy and Infectious Diseases said it was too early to discuss a fourth dose.

‘One of the things that we’re going to be following very carefully is what the durability of the protection is following the third dose of an mRNA vaccine,’ he said.

‘If the protection is much more durable than the two-dose, non-boosted group, then we may go a significant period of time without requiring a fourth dose.

‘So, I do think it’s premature, at least on the part of the US, to be talking about a fourth dose.’

Experts in the UK have also cautioned against offering the booster for a fourth time, stating that more data is needed on the long-term effects.

Experts on the UK’s Joint Committee on Vaccination and Immunisation (JCVI) are considering introducing a second round of boosters.

Professor Anthony Harnden, deputy chair of the JCVI, said that more data is needed. ‘We are in different circumstances to Israel and we need to see more data on waning immunity and vaccine effectiveness against hospitalization.’

Professor Jones said: ‘The vaccine response clearly wanes but it is not clear if the boosted response will wane in the same way or at the same rate.’

A regular booster to maintain immunity was neither feasible nor effective, he told the Daily Mail.

‘Boosting every 10 weeks or every time a new variant appears to be on the rise is not doable and in consequence, I think we need some sort of grading system for new variants to ensure we act appropriately and practically,’ he said.

It would make more sense to give the vulnerable a top-up vaccine before the peak winter illness season, December to February.

Prof. Jones said how the Omicron continues to develop will dictate whether all adults will need one.

‘If Omicron is an attenuated strain already on its way to endemicity then later versions may be even more mild and the need for vaccination for an otherwise fit adult might recede,’ he said.

‘You have to remember that making you very sick is no good to the virus at all, all it “wants” is to transmit, so virus evolution will tend towards a less severe strain which you will pass around as you will struggle on with work, etc much as we do for common colds.’

Professor Jones said that descriptions of Omicron as a ‘natural vaccine’ were true in general.

Even though any Covid variant boosts immunity, the fact that Omicron is highly transmissible yet milder actually works to boost immunity.

‘Whatever version you were infected with your immunity would be boosted,’ he told the Daily Mail. ‘That mild bit suits us because it means we can get immunity without, or with much less, risk.’

Yet he warned against any sort of ‘chicken pox’ style party where people intentionally try to catch the Omicron virus, saying we need to protect people who might become severely ill from it.

‘You have to be careful here not to stretch it to things such as chickenpox parties because there will always be a vulnerable minority and to encourage infection puts them at risk,’ he said.

According to a study conducted in South Africa of Covid death rates during the nation’s Omicron wave, there was hope that Omicron would usher in the end of the pandemic phase of Covid. The number of fatalities was only a quarter of what was seen in other surges.

An analysis of 450 records of patients hospitalized in Tshwane, in the Gauteng province that is at the epicenter of the outbreak, revealed that this highly-contagious variant has spread to the city. Their survival rate was compared to nearly 4,000 patients hospitalized earlier in the pandemic.

In the past month, 4.5 percent of those hospitalized with Covid died of the virus. Comparatively, the rate earlier in the pandemic was around 21.3%

Researchers from South Africa’s National Institute of Communicable Diseases (NICD) and the University of Pretoria participated in the study. The results show ‘a decoupling of cases, hospitalizations, and deaths compared to previous waves.’

Omicron could very well be a ‘harbinger of the end’ of the worst days of the pandemic and bring about the virus’s endemic phase, the team wrote in the International Journal of Infectious Diseases.

Commentators across the globe have seized on this finding and claimed that Omicron could act as a natural vaccine to make the virus endemic.

Dr. Pradeep Awate, a health official for the state of Maharashtra in India, told the Press Trust of India that even though Omicron is spreading more quickly than Delta, there have been few hospitalizations.

‘If this happens, Omicron will act as a natural vaccination and may help in its (Covid’s) progression towards the endemic stage,’ he said.

However, Dr. Clarke cautioned against labeling omicron a ‘natural vaccine.’

‘The immunity we’ve had from other variants doesn’t protect all that well against Omicron, so there is no reason to think it works in the other direction,’ he said.

Yet a recent study from the Africa Health Research Institute showed blood from people infected with the Omicron virus had 4.4-fold more antibodies when exposed to the Delta version.

Alternatively, other studies focused on the topic of cross-variant immunity revealed that antibodies made against Delta were less effective against Omicron.

Dr. Clarke added that even though Omicron is milder, it does not mean that it will remain so, saying: “The idea that viral evolution is a one-way street to the common cold is absolute bullsh*t.”

In regards to the idea of more boosters and how often, Dr. Clarke stressed the need for more data before determining the time gap between Covid jabs.

He said there will be an ‘optimum’ gap between boosters but ‘we just don’t know what it is yet’, adding that it ‘won’t be good’ if boosters are done too far apart or close together.

The doctor advised against making general statements regarding how Covid boosters are going to be rolled out in 2022, pointing out that despite an Omicron vaccine being in development, it might fail, or require two doses, similar to the initial Covid vaccine.

In the meantime, he did suggest that boosters will be used to keep immunity against infection topped-up through increased antibodies, as the government does not want to impose restrictions and minimize disruption.

‘Population-wide vaccination will drive down transmission, it won’t eliminate it, but it will drive it down across the population,’ he said.

‘And if you have lots of people who have more than the sniffles and are ill enough not to go to work, there is massive damage to public services and an economic slowdown.’

In addition, Professor Young said even though data showed that booster effectiveness against Omicron infection had declined, longer-term protection from severe disease remained good.

‘Preliminary data suggests that vaccine effectiveness against symptomatic infection with Omicron drops by between 15-25 percent after 10 weeks,’ he said.

‘Thus those older individuals who were boosted at the beginning of the booster campaign in mid-September may not be as well protected from symptomatic infection.

‘However, all current data indicates that booster jabs will protect from severe disease and that this should last for at least several months.’

In the coming years, he hopes this protection against severe disease will be sufficient to protect the elderly and other vulnerable groups from severe Omicron infections.

Prof. Young discussed immunity as a complex system, with different segments like antibodies rising in the short term after vaccination. In the meantime, other parts that are harder to measure, such as T-cells, provide longer-term protection.

‘The good news is that recent studies have shown that both vaccination and natural infection induce a strong and sustained T-cell response to Omicron and other variants,’ he said.

‘This might be the key to longer-term protection and the need for less frequent boosters.’

Furthermore, there are concerns that the UK may over-vaccinate people when so many in other parts of the world are not vaccinated.

Prof. Adam Finn, a UK vaccine adviser, previously told the BBC that over-vaccinating people while other areas of the world have none is ‘a bit insane, it’s not just inequitable, it’s stupid.’

In addition, Professor Young emphasized that it may be more important for the government to aid other countries with vaccine uptake than to offer all British citizens another booster, in order to prevent the spread of new variants.

As an example, he pointed to Africa, where Omicron was first identified and almost certainly emerged.

‘Virus variants will continue to be generated as long as the virus is allowed to spread particularly in countries where vaccination rates are low,’ he said.

‘This emphasizes the need to control the pandemic at the global level as well as locally and that it is in all our interests to support the rollout of vaccines across the world.

‘In a situation where around 73 percent of people in wealthy and middle-income countries have been vaccinated, this includes those who have had one, two or three doses, whereas only 12 percent are vaccinated in Africa, we have to consider the value and luxury of additional booster doses if such vaccines are not widely available.’

Similarly, Jeffrey Shaman, a disease modeler and epidemiologist in New York has called for tackling the Covid pandemic on a global level.

‘We may find ourselves in a different kind of endemic equilibrium in which boosting is needed every four-six months and highly effective therapeutics are needed to limit severe disease. All this would need to be available globally and equitably. This is a daunting prospect. And psychologically challenging,’ Shaman said.

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