This Week in COVID-19 News: Is a Booster Dose Coming?

With the US federal government health agencies discussing plans for a booster dose for Americans and WHO’s call for a moratorium on these shots, a tale of two vaccine strategies is emerging.

There have been reports the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and other federal agencies are discussing plans for a booster dose rollout in the United States, specifically, they are looking to begin with Americans who are 65 years and older and those people who have immunocompromised systems, according to a NY Times report.

While not much is known at this point about the plan, the expectation that the rest of the US populace cannot be far behind, especially with the emergence of the delta variant, seems to be front of mind for many Americans.

Israel, Germany, and France have been reported to be looking at a booster dose strategy as well.

And in July, Pfizer-BioNTech announced they planned to seek an application for an emergency-authorized third (booster) dose and was going to submit real-world data.

Pfizer has maintained it has said all along there might be a need for a booster shot and that the emergence of the Delta variant has moved up the timeline. "I remember saying we believed, based on the data, we will need a booster eight to 12 months from second dose," Pfizer CEO Albert Bourla, stated on a conference call. "We have seen with Delta we might need it a little earlier."

For its part, Moderna has said In its final analysis of its phase 3 COVE study, the data demonstrated a 93% efficacy, with the efficacy remaining durable through 6 months after administration of the second dose. The company is actively developing booster shots. In a phase 2 study, vaccination with 50 µg of 3 different booster candidates induced robust antibody responses against the wild type D614G COVID-19 strain and against the Gamma, Beta, and Delta variants.

Yet, in the developing world, many countries have not received the first doses of the COVID-19 vaccine, therefore seeing an increase in both incidence and mortality rates. The World Health Organization’s (WHO) Director General Tedros Adhanom Ghebreyesu noted Africa as an example of the disparity in vaccine access.

He said that deaths from COVID-19 in Africa have increased by 80% and that in 5 of the 6 WHO region infections increased by 80%.

“Much of this increase is being driven by the highly-transmissible Delta variant,” Adhanom Ghebreyesus stated.

As such, Adhanom Ghebreyesus said he would like to see a moratorium on all COVID-19 booster vaccine shots including high-risk populations such as health-care workers and seniors—at least through September. He would like to see other countries who have not had access to even the first doses of the vaccines get an opportunity.

“We cannot and should not accept countries that have already used most of the global supply of vaccines using even more of it while the world’s most vulnerable people remain unprotected,” WHO Adhanom Ghebreyesus said.

“It’s not a binary choice,” Jonathan Greiner, MD, said in an interview with CNN this morning, when asked about withholding booster shots. He evidenced that seniors may have waning immunity and that health care workers (HCW) who may have had their vaccines 8 months ago, may need to have another booster shot, especially as HCW are likely going to be dealing with the ongoing surge in the United States.

“All regions are at risk, but none more so than Africa,” Adhanom Ghebreyesus said. “On current trends, nearly 70% of African countries will not reach the 10% vaccination target by the end of September.”

The WHO Director-General said the organization’s goal remains to support every country to vaccinate at least 10% of its population by the end of September, at least 40% by the end of this year, and 70% by the middle of next year.

There appears to be two distinct strategies going on: One of getting the first doses of vaccines to the developing world, and another of rolling out a booster dose for those countries that have received ful vaccination. The question remains do these two plans interfere with one another or can a vaccine rollout for both first doses and boosters exist without the former being left behind?