This only makes sense if you assume Israel’s booster schedule was optimal, that doing it any earlier would result in worse outcomes.

But clearly Israeli health officials don’t think that. They’re scared of Delta and seem to regret waiting this long.

What am I missing?

— Aaron Sibarium (@aaronsibarium) August 17, 2021

Whatever he’s missing, I’m missing it too. NIH chief Francis Collins said this morning that there are scientific reasons why you wouldn’t want to get a boost too soon: “You probably do want to wait at least six months after your initial immunization to give that immune system a chance to mature the diversity of antibodies that it can produce, and then you hit it with the booster.” Fair enough. So … why are we waiting eight months instead of six? Particularly since Sibarium’s right about the timetable in Israel:

One [Israeli] slide suggests that for those 65 years or older who got their second shots in January, the vaccine is now only about 55 percent effective against severe disease. But researchers noted that the data has a wide margin of error, and some said other Israeli government data suggested the decline in efficacy was less severe.

“It shows a pretty steep decline in effectiveness against infection, but it’s still a bit murky about protection against severe disease,” said Dr. Peter J. Hotez, a vaccine expert at the Baylor College of Medicine in Houston, who reviewed the data at the request of The New York Times.

Six months after being fully vaccinated, senior citizens in Israel had already seen their immunity from infection cut nearly in half. Again: Six months, not eight. A recent study in the U.S. by the Mayo Clinic found efficacy against infection even lower in July, at 42 percent. And although the vaccines remain strong in keeping recipients out of the ER, that’s beginning to soften too. Collins said to Hugh Hewitt today of Israeli seniors, “you’re starting to see a little bit of a trend toward some of those requiring hospitalization,” adding that “that’s the same thing we’re starting to see in the U.S. data.” Then why wait another month or two before making seniors eligible for a boost instead of doing it now, knowing that a new wave of a hyper-contagious variant is en route in the fall?

Here’s the latest data from Israel. Middle-aged people there who were fully vaccinated in late February are already seeing infection rates creep up towards those of the unvaccinated. Under the new U.S. policy, someone who’s 59 and was immunized in mid- to late February is still two months away from a booster with Delta already prevalent in the U.S.

Israel data showing the decay of vaccine efficacy over time. Y-axis is cases per 1000 from July 7 to Aug 10, for unvaccinated, and for people vaccinated at different times

Cases are higher in those vaxed earlier

Despite world-data caveats, this seems quite compelling pic.twitter.com/5aNz48AC8F

— Eran Segal (@segal_eran) August 17, 2021

Collins told Hewitt today that at least three studies suggest Delta infections produce more serious cases in adults than prior strains did, which is a bad development as immunity begins to wane in the 65+ group here. That being so, I don’t understand why there isn’t more urgency to get seniors protected before the fall wave begins in earnest. Last year cases in the U.S. began ticking gradually upward towards the eventual winter peak as early as late September; it took an extra few weeks for the trend to reach New York but cases there were rising by the end of October. I have relatives in their 70s in New York right now who won’t be eligible for boosters until mid- to late October under the Biden administration’s eight-month timetable, potentially meaning that they’ll need to wait until after the new wave has begun and take their chances with infection in the meantime.

And of course there’s no guarantee that this year’s wave won’t begin earlier due to Delta’s much greater transmissibility. In fact, we have waves raging in Florida, Arkansas, Louisiana, and other southeastern states as I write this, placing millions of vaccinated seniors at fair risk of infection and at smaller but nonzero risk of hospitalization. Many of them are already six months past their second dose. Why ask them to wait another month or two and try to dodge the virus until they’re eligible for a booster instead of giving them the shot now?

Is there a supply issue, with the feds worried that making all seniors immediately eligible might create another shortage? If so, I haven’t heard anything about it. Or is it more a case of the feds drilling down on the fact that, while protection against *infection* is waning, protection against serious illness remains sturdy? In the end, the goal of the vaccines is keeping people out of the hospital and they’re still doing that, even without a booster.

But again, that raises the question of why boosters should be held back if we have enough supply right now. There’s value in protecting people from infection, after all, even if they’re already largely protected from severe illness. For one thing, a “mild” case of COVID can be not so mild in reality. Many seniors will get very sick while they’re waiting the eight months for their third shot, albeit not sick enough to land in the ER. Beyond that, there’s obviously great public benefit in reducing infection rates among any group since higher immunity means they’re less likely to pass the virus on to others. Render the seniors incapable of being vectors of transmission via a booster and you get a weaker wave for everyone nationwide this fall.

I feel like we’re going to end up with the epidemiological equivalent of a Kabul evacuation here, where the feds take their sweet-ass time in making sure that everyone’s protected and suddenly the enemy overruns the whole country, forcing a change of plans on the fly. If we get Delta outbreaks all over the U.S. in the next few weeks, panicky bureaucrats are inevitably going to move up the timetable for boosters from eight months to six out of desperation to get seniors immunized before the variant reaches them. Why not plan for that worst-case scenario now by following a six-month schedule anyway?

We’ll end with a little good news:

Two of the hardest hit states in this wave, Nevada & Missouri, appear to be at plateau or beyond. pic.twitter.com/g3KvWQvkSQ

— (((Howard Forman))) (@thehowie) August 16, 2021

It’s not just those two states. Florida, Louisiana, and Arkansas have also seen slightly fewer cases in the last few days than they did in the days before, which may mean they’ve reached their peaks as well. Fingers crossed. Here’s Scott Gottlieb worrying that the feds are moving too slowly on boosters for people in nursing homes, at least.

"We certainly see indications that cases are peaking in the south…the big unknown is how big of a wave of infection is the north going to sustain." Fmr. FDA Commissioner Scott Gottlieb on the potential impact of Covid in September and October. pic.twitter.com/kHsaqp4T8c

— The News with Shepard Smith (@thenewsoncnbc) August 17, 2021