New guidance emerges for COVID-19 booster shots

With COVID-19 on the rise across much of the country, pandemic experts at a White House briefing last week urged everyone over 50, healthy or not, to get a second booster shot.

In March, federal regulators authorized a second booster dose at least four months after the first for anyone over 50 as well as for younger people with compromised immune systems. They said a second booster would be especially beneficial for those 65 and up as well as for those 50 to 64 with chronic underlying health conditions.

In other words, they stopped short of a blanket recommendation that all people 50-plus should get a second boost. In recent days, however, authorities have shifted their guidance and adopted a tone of greater urgency. They’ve cited the growing dominance of omicron subvariant BA.5 — the most transmissible strain of the pandemic so far — and increasing numbers of infections and hospitalizations.

“If you’ve not gotten a vaccine shot this year, go get one now,” Dr. Ashish Jha, White House COVID-19 response coordinator, said at the briefing, speaking directly to those 50 and up. “It may save your life.”

Yet the science behind a second booster isn’t settled, with one vaccination expert voicing criticism of what he described as “booster mania.”

Why boost again now?

Each new variant that becomes dominant transmits a bit more easily than the dominant variant before it, Dr. Anthony Fauci, chief medical adviser to President Joe Biden, said at the briefing.

BA.5 “substantially evades neutralizing antibodies induced in people by vaccination and infection,” he said, though it hasn’t been shown to cause more severe illness.

With more transmissible variants, COVID-19 hospital admissions are double what they were in early May, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention.

Even as COVID-19 hospitalizations are dipping and cases plateauing in Clark County, levels of the virus — and the chance of getting infected — remain high locally, according to state and federal data.

Should they become infected, people who are twice-boosted are better protected against serious disease, Walensky said. She presented data that people who got a single booster shot were four times more likely to die from COVID than those twice boosted.

Some experts who in March didn’t see a clear need for a second booster in healthy people have been convinced by the current wave of infections.

Dr. William Schaffner, an infectious disease professor at Vanderbilt University, said in an interview that he and many colleagues saw a compelling need for a second booster “as BA.5 came on the scene and began to run rampant,” resulting in increasing hospitalizations.

Do I need to boost if I’ve had COVID?

Federal officials advised people who’ve had a COVID-19 infection to get a second booster.

Data shows that even those who were infected relatively recently with the original omicron variant BA.1 are at risk of being infected by new omicron subvariants, Fauci said.

“But the overall principle is that we know immunity wanes with coronaviruses, whether that is (from) natural infection or vaccination,” he said. “And so, if you’ve been infected or vaccinated and your time comes for a boost, that’s when you should go and get the boost.”

Recently recovered from COVID-19, family practitioner Dr. David Weismiller said he plans to wait 90 days before getting a second booster dose. Authorities have generally believed that antibodies from an infection begin to wane after 90 days, said the professor at UNLV’s Kirk Kerkorian School of Medicine.

However, with the newly circulating variants, the window for reinfection may be smaller than 90 days, some authorities have said.

Should I wait for the newly formulated booster?

Pharmaceutical companies Moderna and Pfizer-BioNTech are formulating new bivalent booster shots that target omicron subvariants BA.5 and BA.4 as well as the original strain of the virus.

If all goes according to plan, the new boosters are expected to roll out beginning in October. A decision by the Food and Drug Administration last month to have the bivalent boosters target the omicron subvariants, instead of the original omicron variant they were working on, could make the wait longer.

Federal officials recommend that eligible people not wait for the reformulated booster. Getting a second booster now won’t preclude a person from getting a bivalent vaccine in the fall, Fauci said.

“Particularly if you’re in a high risk group, get the the currently available booster now,” said Schaffner, who serves on a vaccine advisory panel to the CDC. “And in the fall, you’ll have to roll up your sleeve and get that updated vaccine when it becomes available.”

There’s plenty of opportunity to get infected between now and the fall or winter, he said, noting that the bivalent vaccines don’t even exist yet.

Will everyone under 50 be able to get a 2nd booster?

At the briefing, officials acknowledged that discussions are ongoing about whether people under 50 without compromised immune systems should be authorized to get a second booster. Before such an authorization, both the CDC and the FDA would need to weigh in on the question.

The public hasn’t shown keen interest in second boosters. Nationwide, only 28 percent of people over 50 who’ve gotten a first booster have gotten a second, Walensky said. Of people 65 and older who got the first boost, 34 percent got a second.

“We acknowledge there’s a gap between what the recommendations are versus what the reality is” in terms of heeding booster recommendations, said Dr. Cort Lohff, chief medical officer with the Southern Nevada Health District. Statistics on second booster shots in Clark County were unavailable last week.

Lohff, who is 56 and in good health, said he is considering getting a second booster “soon” in light of the strengthened recommendation from federal officials. He advises others to do the same.

“Vaccine is one of the best tools we have to try to prevent serious disease,” he said.

What’s the argument against a second booster?

Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, favors a booster strategy that targets older and sicker people, rather than the current approach he has described as “booster mania.”

“I think we’ve crossed the line from the original goal of the vaccine, which is to prevent against serious illness” to attempting to thwart even mild illness, he said.

He is unconvinced by the CDC showing higher rates of death in the single-boosted than in the double-boosted, saying the risk for the former remains, “very, very small.” He wants to see more data on the single-boosted who have died, including whether they were over 75 and immunocompromised.

A second booster for healthy people under 75 is “low risk, low gain,” he said.

A potential risk is that unneeded doses can exhaust the immune system, said Offit, who serves on a panel that advises the FDA on vaccines. The body may lock into its response to the virus and respond less effectively to new strains.

“You can’t say, ‘well, you know, it can’t hurt,’” he said. “My mother could say that when she gave me chicken soup, but you can’t say that with a biologic.”

Contact Mary Hynes at mhynes@reviewjournal.com or 702-383-0336. Follow @MaryHynes1 on Twitter.