For the majority of Americans, the coronavirus has evolved into a manageable threat, comparable to the flu, and therefore requires minimal or no precautions. However, for older individuals and those with compromised immune systems, the virus remains a significant risk.
Currently, around 300 people in the United States are still dying daily from COVID-related causes, with the majority being adults over the age of 70 or individuals who are medically frail or immunocompromised. This raises the question: should older individuals and those with medical vulnerabilities receive another booster shot at this time?
This is a complex issue that federal health officials are grappling with. The United States is home to approximately 53 million adults aged 65 and older, accounting for about 16% of the population. Additionally, there are 7 million Americans who have weakened immune systems due to an illness or medication.
While infection with the coronavirus may be an inconvenience or mild illness for younger, healthier adults, it can lead to severe disease, hospitalization, and even death for older individuals and those with compromised immune systems. Dr. Celine Gounder, an infectious disease physician and senior fellow at the Kaiser Family Foundation, believes it is reasonable to administer booster shots to immunocompromised individuals and those in nursing homes every six months, but does not advocate for annual boosters for everyone.
Some Americans who received their latest boosters in the fall are inquiring with their doctors about the timing of their next dose. Both Britain and Canada have already recommended additional shots for older adults and those with compromised immune systems, starting in the spring.
It remains unclear whether the Food and Drug Administration (FDA) will follow suit. In an effort to simplify the vaccination guidelines, the FDA announced in January that they aim to transition to a single shot offered each fall for all Americans, similar to the flu vaccine.
Dr. Ofer Levy, director of the precision vaccines program at Boston Children’s Hospital and an FDA advisor, acknowledges the diversity among Americans in terms of age, risk, and perception of risk. He suggests that ideally, high-risk individuals should consult with a healthcare provider to determine if an additional vaccine dose is necessary.
Immunity against infection significantly declines after just a few months in vaccinated individuals. For those with weakened immune systems, the protective effect of a booster shot administered in the fall fades quickly, to the point where they no longer have an advantage over those who did not receive a booster, according to Dr. Jeremy Faust, an emergency medicine physician and health policy expert at Brigham and Women’s Hospital in Boston. Faust emphasizes the need for immunocompromised individuals to receive a repeated dose of the vaccine.
Data on the effectiveness of bivalent boosters, released last fall, is limited compared to the original version of the vaccine. Furthermore, there is currently no data on the optimal timing for the next round of additional vaccines, which makes some experts hesitant to recommend another shot for any population, including the most vulnerable.
Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an FDA advisor, highlights the importance of providing data-based recommendations rather than asking individuals to trust the expertise of federal health officials blindly.
The FDA has not commented on the possibility of offering boosters more frequently than once a year, stating that decisions will be based on emerging data in the United States and globally.
Even if the FDA were to authorize another booster shot this spring, it is unclear how many individuals would choose to receive it. Currently, only 16% of Americans and 42% of adults over 65 have opted for bivalent shots.
Dr. Eric Rubin, editor-in-chief of The New England Journal of Medicine and an FDA advisor, emphasizes that the key issue lies in convincing people to actually get the boosters, as their effectiveness depends on widespread uptake. Dr. Camille Kotton, who treats immunocompromised patients at Massachusetts General Hospital in Boston, adds that many of her patients are not up to date with their vaccines, often due to lack of awareness, confusion, or a desire to move on from the pandemic.
Overall, this complex issue of booster shots for older individuals and the medically vulnerable requires careful consideration and gathering of additional data to ensure evidence-based recommendations.
This article originally appeared in The New York Times.
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