Slow your sleeve roll, booster boosters

It appears that the rush to boost here in the United States is based on summaries of the emerging data in Israel. However, the raw data may tell a different story. The data we have from Israel suggest that boosters decreased the rates of infection in adults ages 60 and older during the month of August. But they show that only obliquely and the evidence is highly circumstantial. At least half of the signal is thought to be due to behavioral changes made by people who got a booster. There are other confounding variables that weaken the case for boosters, such as the demographics of those who received boosters compared to those who did not. But assuming that the overall signal is real, we still would need to know how long this protection lasts, and what the net gain is among younger people in comparison to any risks. The reality is that Israel has decided to boost everyone ages 12 and older based on guesswork. We have time to do better than that…

Given that so far all signals point towards the fact that the two-dose coronavirus mRNA vaccine regimens have the same ability to keep infected patients out of the hospital as the three-dose Pfizer regimen, we need to remind ourselves of why we vaccinated in the first place: not to end infections (though that would be nice), but to eliminate most of the horrifying implications of those infections, such as critical illness and death. We’ve achieved that. The booster campaign in the US has moved the goalposts, without evidence that doing so would be beneficial and safe for everyone. It’s good to see the FDA pushing back.