Saturday, August 14, 2021

Back in 1956 when my family was about to travel from Iran to India we had to get a series of shots. Some, like the plague series, were new to me. Others, like cholera and tetanus, were booster shots. The first booster shot hurt more than I expected, so I told my parents I didn’t want any more booster shots because they hurt more than “regular” shots. It was years before I realized they were just the same old shots by a different name.

Fast forward to 2021. I’m beginning to think the definition of booster shot is as fuzzy to the media and the experts as it was to me at the age of ten.

For example, headlines are proclaiming new booster shots today. However, the FDA News Release (link below) does not actually use the term “booster.” It simply uses the word “boost” in a quote from the Acting FDA Commissioner, “Today’s action allows doctors to boost immunity in certain immunocompromised individuals who need extra protection from COVID-19.” If it boosts, is it a booster?

The FDA states that this approval is an amendment to the original EUA for certain people to receive a third dose of the same Moderna or Pfizer vaccine to help their compromised immune system to resist COVID-19. It’s not a new or different vaccine. The authorization is specifically intended for people “who have undergone solid organ transplantation, or who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise.” That is, not for people over a certain age. Not yet.

But — why are some headlines saying that this isn’t a booster?

Anthony S. Fauci, M.D. NIAID

I followed the clues back to an interview with Dr. Anthony Fauci held by the CSIS on August 3, 2021. (link below). The answer is on page 15, where Dr. Fauci explains that giving one more dose of the original vaccine “is almost not considered a booster” because the immunocompromised group needs one more shot to get them closer to where most vaccinated people are already.

John Mascola, M.D. NIAID

“Almost not considered a booster” because it’s sort of part of the original series? In a recent video featured in several articles by the Wall Street Journal (link below), a reporter asks whether the second shot of a two-shot series of Moderna could be considered a booster shot. “One might look at it either way,” answers John Mascola, M.D., the Director of the Vaccine Research Center at NIAID. Not exactly clarifying the issue.

No wonder the headlines are confused. I think we can safely conclude that the word “booster” is a fuzzy term, not a scientific one, generally referring to a follow-up vaccination that reminds your immune system who the enemy is.

Several countries have already started to give a third dose of a two-dose vaccine. Facing a surge of Delta hospitalizations, Israel has just opened third doses to anyone over 50 who received their second shot more than 5 months ago as well as younger people in high-risk jobs such as health care. A recent Reuters report lists 17 countries that are giving or considering additional shots, including the United States, Brazil, France, Germany, Indonesia, Thailand, Cambodia, Russia, and the United Arab Emirates.

There is also research underway as to whether the third shot or a later shot could be different from the original vaccine, either as a smaller dose or as a vaccine modified to be more effective against new variants. For example, Moderna and the National Institutes of Health are researching the efficacy of a half-dose, a 50-microgram dose, which could make more doses available for initial doses or additional doses. The WSJ video interview with Dr. Mascola cites a preliminary pre-print Moderna study with vaccine modified to target recent variants. This is an ongoing study at this point. (“Preliminary Analysis,” link below).

Since it seems likely that delta will be followed by other fast-spreading variants in the future, it’s important to stay proactive and continue with research to cope with future waves of infection. The WHO has asked for a moratorium on third-dose vaccinations until the end of September in order to allow more low-income countries to get vaccinated. I hope this is a choice we don’t have to make. Variants can spring up in any country. In the interests of getting ahead of this fast-moving virus, we need to keep fighting on all fronts even if it takes an extra shot.

But before I call it a booster, I want to see if it hurts.

Today’s Notable Headlines

“U.S. FDA authorizes COVID-19 vaccine boosters for the immunocompromised,” Reuters, August 13, 2021. https://www.reuters.com/world/middle-east/us-fda-authorizes-covid-19-vaccine-boosters-immunocompromised-2021-08-13/

“U.S. FDA authorizes COVID-19 vaccine boosters for the immunocompromised,” USA Today, Aug. 13, 2021. https://www.reuters.com/world/middle-east/us-fda-authorizes-covid-19-vaccine-boosters-immunocompromised-2021-08-13/

“Israel set to become first country in world to offer COVID boosters to over-50s,” The Times of Israel, August 12, 2021. https://www.timesofisrael.com/expert-panel-said-set-to-recommend-covid-booster-shots-for-israelis-over-50/

“Covid-19 Booster Shots: When Might You Need One and Why?” Wall Street Journal, Video, Aug. 3, 2021. https://www.wsj.com/video/series/current-features/covid-19-booster-shots-when-might-you-need-one-and-why/9416AF9E-05AB-4BBD-84B2-02BAB3D74B73

“Israel to vaccinate against COVID ‘24/7,’ Bennett says,” The Jerusalem Post, Aug. 14, 2021. https://www.jpost.com/israel-news/israel-approves-booster-for-people-as-young-as-50-676625

“Factbox: Countries weigh need for booster COVID-19 shots,” Reuters, Aug. 5, 2021. https://www.reuters.com/business/healthcare-pharmaceuticals/countries-weigh-need-booster-covid-19-shots-2021-08-05/

“Stop Booster (Third) Shots For Delta Variant, Says WHO,” NDTV, Aug. 4, 2021. https://www.ndtv.com/world-news/stop-booster-third-shots-for-delta-variant-says-who-2502696

Additional Sources

“Coronavirus (COVID-19) Update: FDA Authorizes Additional Vaccine Dose for Certain Immunocompromised Individuals,” FDA, Aug. 12, 2021. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-vaccine-dose-certain-immunocompromised

“A Conversation with Dr. Anthony Fauci on the Antiviral Program for Pandemics,” Transcript, Online Event, Center for Strategic and International Studies, Tuesday, Aug 3, 2021. https://csis-website-prod.s3.amazonaws.com/s3fs-public/event/210803_Morrison_Fauci_Conversation.pdf?FGeH45h2cci6FE6UCnaLnVGBs3rzjTLd

“Preliminary Analysis of Safety and Immunogenicity of a SARS-CoV-2 Variant Vaccine Booster,” medRxiv May 6, 2021, https://www.medrxiv.org/content/10.1101/2021.05.05.21256716v1

Why am I doing this?

The coronavirus pandemic will be indelibly written on our memories just as the Great Depression or the Battle of Britain left their mark on past generations. I intend to journal the pandemic experience from three perspectives: as a retired medical technologist, as a historian (Ph.D., 2014), and an ordinary person living through an extraordinary world crisis.

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