I wrote yesterday and Jazz wrote this morning about the unusual friction within the public-health bureaucracy over whether boosters are needed or not. Typically the experts move in lockstep in their recommendations. Should you get vaccinated? Yes! Should you wear a mask around strangers? Absolutely! Should your child wear a mask in school? Unequivocally! — even though, uh, kids in Europe haven’t been wearing masks for most of the pandemic and the data supporting benefits from mask use by kids is thin.
They’re all usually on the same page. But not with boosters.
There’s a push among some scientists, most notably in the Lancet piece that was published yesterday, to argue that boosters aren’t needed so long as the vaccines are holding up well against severe illness. We should be diverting our manufacturing capacity to getting poorer countries vaccinated in hopes of staving off the next killer variant before it gets rolling. I expected Fauci to take that view too, insisting that vaccinating the world was a higher priority than giving Americans some extra protection which they may or may not actually need.
But to my surprise he’s gone the other way: America First, he told “Morning Joe” earlier today. Watch, then read on.
"You can have a program to give booster [shots]…if you put a considerable amount of resources and effort into getting lower and middle-income people vaccinated, and that's exactly what we're doing" –Dr. Anthony Fauci pic.twitter.com/jhIYkRbPMS
— Morning Joe (@Morning_Joe) September 14, 2021
That’s consistent with what he’s said in other interviews recently about how three doses rather than two may prove to be the proper vaccination course for COVID-19, just as it is for diseases like HPV. To build lasting immunity against certain viruses, your immune system needs three looks at them. And if that’s the case with the Delta form of the coronavirus then it’d be in our interest to give senior citizens that third look as quickly as possible.
Back up, though. What data is Fauci seeing that makes him so confident that boosters are in order? Politico reported today that not all of it is public, and some of the unpublished numbers on waning immunity are downright “alarming”:
The Israel data, which is set to be made public as soon as this week, shows that the Pfizer vaccine’s ability to prevent severe disease and hospitalization is waning over time — as is the shot’s protection against mild and moderate disease, the two sources said…
Although the CDC has published a series of targeted studies that suggest Covid-19 vaccines’ effectiveness against infection is decreasing, particularly in the elderly, the Israeli data is more comprehensive and more alarming, three sources who have reviewed the data told POLITICO on Monday…
Asked about the extent to which the Israeli data showed vaccine efficacy waning, Biden’s chief medical adviser, Anthony Fauci, said it was “enough that you would be impressed.”
Why should we care if protection against infection is waning so long as protection against severe illness is solid? Well, (a) more infection means a bigger wave this winter, which means more unvaccinated people exposed to dire risk, and (b) waning protection against infection suggests that waning protection against severe illness will soon follow. If it does, suddenly we’re looking at hospitals being overrun with older patients this fall and winter. Simply put, there’s a reason why the UK also just authorized boosters for adults aged 50 and over. Scientists in multiple countries are looking at the data and concluding that two doses isn’t enough in a world with Delta.
But what about yesterday’s Lancet piece arguing against boosters, which Fauci called “controversial”? Well, it was controversial. Ideally a decision on boosters would boil down to three questions. One: Are there benefits to giving a third dose? Two: Do the potential risks from a third dose, e.g., horrible side effects, outweigh the benefits? Three: Notwithstanding the cost/benefit analysis, are we hogging doses that would do more good overseas now? The Lancet piece didn’t seriously grapple with the cost/benefit analysis, choosing instead to argue that because the vaccines are still preventing severe illness we should focus on vaccinating people abroad.
One sentence acknowledges that for initial shots, benefits clearly exceed risks.
"Although the benefits of primary COVID-19 vaccination clearly outweigh the risks …"
2/n
— Paul Romer (@paulmromer) September 14, 2021
There is not a single sentence which claims there is evidence that the comparison goes the other way: risks > benefits.
So how then do the authors justify their opposition to boosters?
4/n
— Paul Romer (@paulmromer) September 14, 2021
In deciding between options A and B, the authors claim with no justification that option A wins if there is enough uncertainty.
Their entire argument is the type of "burden of proof" sleight-of-hand that one expects from lobbyists and lawyers.
6/n
— Paul Romer (@paulmromer) September 14, 2021
Scientist Eric Topol pointed out recently that there’s no question based on the Israeli data that immunity begins to wane after five months or so in senior citizens who’ve had Pfizer and that the booster restores vaccine effectiveness against infection and severe illness. The benefit is clear. With no evidence of serious side effects, why shouldn’t we give our 70 million seniors that third shot ASAP before Delta begins burning through their communities? As for the idea that that supply is better off being sent abroad, that’s a false choice, Topol argues. If seniors here don’t take advantage, those doses aren’t going overseas. They’re going down the toilet.
This is not about global equity, which the Lancet essay was clearly advancing. It’s not either or. There are 76 million vaccine doses distributed in the US, not given, that are not going to be sent OUS. https://t.co/k1hTZD8Cci
and well over 15 million have already been wasted pic.twitter.com/grPTh0fqSU— Eric Topol (@EricTopol) September 14, 2021
Doctors, nurses, and other health-care workers should also be made eligible for boosters as soon as practicable given that they’re exposed to Delta daily and will only see their exposure increase as we stumble towards winter.
Israel’s going to publish some of its data in the next 48 hours, before an FDA advisory panel meets on Friday to make a recommendation on boosters. Here’s a sneak peek of one key number from Israeli scientist Eran Segal. People with two shots were almost six times as likely as those with three to develop severe illness (and the unvaccinated were 23 times as likely), although thankfully that remains rare for all cohorts in that country at the moment.
New severely ill Covid-19 patients in Israel in the past week, per 100,000 people:
Vaccinated with 3 doses: 0.28
Vaccinated with 2 doses: 1.62
Not vaccinated: 6.4 pic.twitter.com/oJbN7qtp3j— Eran Segal (@segal_eran) September 14, 2021
