The daily number of new COVID-19 infections in Israel climbed to 3,400 on Wednesday while a quarter of a million of people over the age of 60 have so far been vaccinated for the third time since the start of the booster campaign.
Booster shots had already been given to people with suppressed immune systems due to underlying conditions. The rise in infections which might put pressure again on the hospitals prompted the government to decide last week, following expert advice, that people aged 60 and over should also receive a third shot.
However, Israeli figures reported last week suggested that the Pfizer vaccine’s effectiveness in preventing severe symptoms among 60+ had only dropped to 81 % from 97 % in January. Pfizer itself announced that it believed that people need an additional dose to keep protection against the coronavirus high.
Pfizer did not reply immediately to a request from The Brussels Times to comment on the need and timing of booster campaigns. Besides Israel, other countries, including EU member states, have started or are planning such campaigns for a third vaccine shot starting in September.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said at his opening remarks at the media briefing on Wednesday (4 August) that rich countries should postpone any booster campaigns for the time being until more people in poor countries have been vaccinated.
“In late May, I called for global support for a “sprint to September”, to enable every country to vaccinate at least 10% of its population by the end of September,” he said and called for a moratorium on boosters until at least the end of September, to achieve this goal.
In fact, the extremely low vaccination rate in poor countries is not only due to limited deliveries via the WHO-led Covax programme to ensure vaccines to these countries because of the competition for vaccines with richer countries. Covax has been failing also because of distribution problems in the poor countries and lack of funding for the rollout of the vaccines.
Two unanswered questions
Is there scientific evidence for the need of booster vaccination? At the Commission’s press conference on Thursday, a spokesperson told The Brussels Times that the decision lies with the member states and referred to the latest update by the EU expert agencies, EMA and ECDC.
The two agencies strongly encourage those who are eligible for vaccination but have not yet been vaccinated to start and complete the recommended COVID-19 vaccination schedule in a timely manner. “Full vaccination with any of the EU/EEA-approved vaccines offers a high level of protection against severe disease and death caused by SARS-CoV-2, including variants, such as Delta."
By full vaccination, they mean one or two doses depending on the vaccine. “The highest level of protection is achieved after enough time (seven to fourteen days) has passed from the day of the last vaccine dose.”
They did not address the issue of a third shot but stated that “it may be advisable in some cases to consider reducing the interval between first and second doses, within the authorised limits, particularly for people at risk of severe COVID-19 who have not completed the recommended vaccine schedule”.
Is EU considering WHOs call for a moratorium on booster vaccination? The spokesperson declined to directly reply to the question and underlined that half of the vaccines produced in Europe had been exported to other countries.
She also referred to yesterday’s approval by the European Commission to sign its seventh Advanced Purchase Agreement (APA) with a pharmaceutical company to ensure access to a potential vaccine against COVID-19 in Q4 of 2021 and in 2022.
Under this contract, member states will be able to purchase up to 100 million doses of the Novavax vaccine, with an option for 100 million additional doses over the course of 2021, 2022, and 2023, once reviewed and approved by EMA as safe and effective. Member states will also be able to donate vaccines to lower and middle-income countries or to re-direct them to other European countries.
It is not entirely clear why the number in infections is climbing despite high vaccination rates and will soon result in a higher number of severely ill people at the hospitals. Common explanations are the still high number of totally unvaccinated people, the gradual reduction in the immune defence among vaccinated elderly people and the reduced effectiveness against the Delta variant which accounts for most cases.
The situation in Israel has led experts to announce that vaccinations are not enough and that restriction measures to curtail the spread of COVID-19 need to be introduced again, if a lockdown of the economy is to be avoided.
ECDC’s position
The European Centre for Disease Prevention and Control (ECDC) confirmed today (5 August) that it has not yet issued recommendations on booster vaccinations for COVID-19 “given the current lack of evidence that boosters are currently required as a measure for the general population”
In a written response to The Brussels Times, the agency wrote that it will continue to follow the emerging scientific evidence closely, including on the duration of protective immunity that vaccines confer overall and for specific vulnerable groups, for the current variants of concern and any others that might emerge in the future.
“Based on this and in discussion with national immunisation technical advisory groups (NITAGs), WHO and European Medicines Agency (EMA), we will look at the need for issuing guidance on booster vaccination in the near future.”
Booster doses may be needed in the future, in particular in certain parts of the population (such as elderly, immunocompromised, healthcare workers, residents in long-term care facilities), but there is not enough data as of yet to support this, ECDC summarises.
Booster doses should be considered if there is evidence of declining protection against illness or an escape variant (Variants of concern substantially impacting vaccine protection). Studies on kinetics of antibody response, heterologous boost, booster studies will be important to inform policy making. Any new evidence that becomes available on this topic will be rapidly reviewed.
Real world effectiveness data from Europe and other parts of the world, are of particular interest to supplement data from clinical trials investigating booster doses. ECDC is aware of decisions taken in various countries, such as in Israel and Germany, to include a booster dose in their vaccination programmes for the elderly or the medical risk groups.
“EMA is also engaging with vaccine developers to coordinate submission of these data. This should ensure that the regulatory steps to enable the possibility of using a booster dose can be undertaken as soon as possible should it prove necessary.”
Note: The article has been updated to include the response from ECDC.
The Brussels Times
