Are boosters “necessary”?

No!  But does the preponderance of the evidence indicate they would really help? Yes!  Does the preponderance of the evidence also suggest that giving 3rd shots to Americans who want them would have a trivial impact on global vaccine supply and have little impact on the rest of the world (which we really need to do all we can to get more vaccines to)? Yes!  So, let’s boost, damnit!

I really hate this new frame from the anti-booster crowd that vaccines aren’t “necessary.”  Hell, seat belts aren’t “necessary.”  That should not be the standard.  Would it very likely lead to a notable improvement in the US health situation vis-a-vis Delta and almost sure save American lives and prevent a ton of human suffering (even “mild” Covid which many vaccinated are experiencing as breakthroughs can really suck)?  Hell, yeah.  So, let’s boost.  

Here’s the take that really bugged me:

But for the general population, experts have been divided over whether boosters are necessary. Some argue that a third shot (or, in the case of Johnson & Johnson’s vaccine, a second shot) should really be considered part of the initial dosing plan, while others say there is no evidence that the vaccines are losing any strength at protecting people from hospitalization or death from Covid-19 — the worst outcomes that the shots were primarily designed to guard against.

“Even if boosting were eventually shown to decrease the medium-term risk of serious disease, current vaccines supplies could save more lives if used in previously unvaccinated populations than if used as boosters in vaccinated populations,” the paper states…

Pointing to the possibility of side effects from boosters doses, the authors write that “if unnecessary boosting causes significant adverse reactions, there could be implications for vaccine acceptance that go beyond Covid-19 vaccines.”

The FDA, meanwhile, is convening its vaccine advisory committee for a public meeting Friday to discuss Pfizer’s application for Covid-19 vaccine boosters, at which the topic of whether boosters are necessary is sure to come up.

Oh, come on!  We all know that 3rd doses would be better used as first and second doses in the unvaccinated.  But stop pretending this is an either/or to score ideological points!! And, please, enough of the vaccine credibility issues.  There’s no basis to expect that third doses should lead to substantially more adverse responses than we’ve seen with the first two doses.  

Meanwhile, Topol with data from Israel:

And, this unwarranted booster skepticism (especially in light of the data we’re seeing):

What the Israeli data show is that a booster can enhance protection for a few weeks in older adults — a result that is unsurprising, experts said, and does not indicate long-term benefit.

“What I would predict will happen is that the immune response to that booster will go up, and then it will contract again,” said Marion Pepper, an immunologist at the University of Washington in Seattle. “But is that three- to four-month window what we’re trying to accomplish?”

Honestly, I suspect Mandivilli (the NYT Covid reporter) is anti-booster.  It should not have been hard at all to find an expert with a far more optimistic take.  In fact, the only expert quoted here is this exceedingly pessimistic one.  Based on the many vaccines where the protocol is 3 or 4 doses, there’s actually plenty of reason to expect benefit to last well beyond 3-4 months.  Furthermore, these takes completely ignore the fact that it’s not just about waning immunity, but that the 3rd dose seems to be particularly helpful do to the fact that the vaccines just aren’t as effective against Delta (as discussed here).  

And, here’s Noah Smith making the case for Delta-specific booster.  In my conversation on this with BB, he points out that, if you pay attention there’s plenty of people talking about this, and even with mRNA vaccines it’s just got to take a while to test and transition.  But, that said, we really should be talking about this more.  Where, for example, is Mandivilli’s article interviewing all the relevant folks about exactly what would be involved in the manufacturing transition, what the hold-ups might be, and when, roughly, we should therefore expect Delta-specific shots (which would likely take us back pretty close to the levels of success we were having against Alpha, when life was so good).  Smith is right that this should very much be part of our national vaccine conversation and it’s frustrating that it basically isn’t.

Anyway, it may not be “necessary” but if I can reduce my family member’s protection against hospitalization from 90% protection to upper 90’s and increase my protection against a nasty flu-like illness from somewhere in the 70’s to the 90’s, sign me up damnit!

About Steve Greene
Professor of Political Science at NC State

3 Responses to Are boosters “necessary”?

  1. R. Jenrette says:

    Sign me up to!!

  2. itchy says:

    Anchoring bias: “A cognitive bias that causes us to rely too heavily on the first piece of information we are given about a topic.”

    One thing to remember in this conversation is that the designs of the current vaccine regimens were constructed based on best guesses in early 2020 with the goal of quickly achieving a significant outcome against a pandemic for which there were no treatments. These were not tablets from Moses.

    So the anchored assumption is that the regimen and dosage that was first tested in trials 16 months ago against the original virus is the default. Anything that deviates from this norm is “extra.” Therefore, adding another dose in fall 2021 is a “booster,” not a continuation of a regimen.

    In fact, the second doses of the mRNA vaccines — the ones that say we are “fully vaccinated” — are precisely intended as boosters, but we don’t refer to them as such, because they were delivered as a single package — “this is a two-dose vaccine.”

    If Pfizer/Moderna had initially stated that the protocol was two doses spaced a month or so apart, then a third dose 6-8 months later — and if they had included a third dose in their trials — no one would be questioning a third dose. Instead, all the anti-boosters would be scolding people who had not yet scheduled their very important booster; otherwise, they would not yet be fully vaccinated.

    And, by the way, I don’t recall any backlash against Americans receiving their second dose of mRNA vaccine under the argument that they were sufficiently protected with a single dose, and we should instead send their second doses to people who need a first dose.

    I do not mean to downplay the inequality that exists regarding access to vaccines worldwide. I support efforts to vaccinate the world, and I think nations like the US can and should be doing more. But I think it’s a false dichotomy to say that we can’t both offer boosters here and help other nations as well.

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