Israel Was the First to Launch a COVID Booster Shot Drive. Will It Help and Are There Any Risks?

The jump in the number of Israel's COVID infections as well as Health Ministry data showing a decline in the effectiveness of the vaccination led experts to recommend the move

Ido Efrati
Ido Efrati
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A man receives his third dose of a coronavirus vaccine at Ichilov Hospital in Tel Aviv, Israel August 2021.
A man receives his third dose of a coronavirus vaccine at Ichilov Hospital in Tel Aviv, Israel August 2021. Credit: REUTERS/Nir Elias
Ido Efrati
Ido Efrati

In a world first, Israel began administering third doses of the COVID-19 vaccine over the weekend to Israelis 60 and over. The country’s four HMOs are scheduling appointments for the new booster shot at a fast pace. Here is everything you need to know about the campaign.

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Why was a third shot decided on now?

Medical professionals deliberated over the issue for weeks, and it was a major topic considered by the official panel of epidemic experts that advises the Health Ministry. Initially, opinions were divided over the need for a booster, particularly because the experts were under the impression that the two doses of the Pfizer vaccine that Israel began administering to the public in December at a fast clip were still effective against the highly contagious delta variant. In addition, the third shot was not part of the emergency use protocol that Pfizer obtained, although the company issued a recommendation several weeks ago regarding the third dose.

So what has changed?

What is different now is the jump in the number of infected Israelis as well as the number of hospitalized patients, including many who have been vaccinated for COVID-19 – as well as Health Ministry data showing a decline in the effectiveness of the vaccination in preventing infection and preventing hospitalization and serious illness. That led some experts to conclude that the time had come to administer a third shot to people at higher risk of serious illness if they contract the coronavirus.

At a meeting last week on the matter, most of the members of the pandemic advisory team recommended that the third dose be given to older adults. Opinions were divided, however, regarding the bottom age of the range at which to start the vaccination program – with some recommending age 60 and others as high as 70. The final decision to begin at age 60 was made by Health Ministry Director General Nachman Ash and the team of experts in light of figures showing waning effectiveness of the vaccine among patients 60 and over who were vaccinated in January. It declined on average from 97 percent in April to 81 percent in July.

How will a booster shot help?

The third dose is expected to increase patients’ immune systems’ awareness of the coronavirus (not necessarily regarding the delta variant). It is also expected to induce a vaccine-based “memory” in the body and its ability to identify and more strongly respond to the protein profile of the surface of the virus. The delta variant is more contagious than previous variants. That means that a smaller quantity of virus is necessary to cause infection. Therefore, the spread of the delta variant requires a more vigilant response by the immune system and the production of a higher level of antibodies. The assumption is that giving a third dose of the vaccine to older adults can boost the immune system in the event that immunity weakens over time, as well as boosting the vaccine’s response, even if it has not waned, among populations at increased risk of serious illness if they are infected.

Israeli President Isaac Herzog receives the third dose of the coronavirus vaccine, today. Credit: Chaim Tzach / GPO

“The expected benefit of giving the third dose is based on research conducted by the vaccine manufacturers and others around the world that administering a third shot ... creates a booster effect in the level of antibodies, in their quality (improving their ability to neutralize the virus) and the time that they remain in the body,” the Health Ministry said in a statement. “As a result, there is an increase in the ability to protect against the virus. The need for a booster is known in connection with vaccines as well. Because this is a new vaccine, the existing information on the [side] effects following administration of the third vaccination is limited. The existing information shows that the effects resemble those following the second dose.”

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Are there risks involved in the third dose?

According to the experts who took part in the discussions, there are no risks from a third dose, certainly not any that are greater than the risk from getting the coronavirus itself. More than 4,000 Israelis with compromised immunity have been given the third shot so far without any unusual side effects or reactions.

Which groups will receive the third dose other than those 60 and over?

Third coronavirus vaccine given at Beilinson Hospital, Israel, July 2021.Credit: Beilinson Hospital spokesperson

Heart, lung and liver transplant recipients; people with rheumatological or autoimmune diseases who are being treated with Mycophenolate mofetil, Abatacept, Predisone (regular use of 20 mg a day); and people with multiple sclerosis treated with Fingolimod or Ocrelizumab. In addition, patients with malignant blood diseases may receive a third dose upon the recommendation of their hematologist.

The decision to give a third dose to immune-suppressed patients was made after mounting evidence that these patients develop insufficient levels of antibodies and that some could develop higher levels following a third dose.

What about cancer patients more generally?

The Health Ministry has directed that a third dose not be given to oncology patients with solid tumors such as breast cancer, lung cancer or colon cancer. But that’s because tests performed in Israel on hundreds of cancer patients found that 90 percent of those being treated with chemotherapy developed antibodies after being vaccinated and that their antibody levels remained high even several months after they were vaccinated.

Is an antibody test recommended before getting the third shot?

There is no recommendation that an antibody test be performed prior to a third dose. Israel decided to administer the third dose in part based upon the results of serological testing that showed that, among certain population groups, the level of antibodies in their blood was too low to create effective immunity. Serological tests that will be carried out on a sampling of patients who receive the third dose will help provide an answer to whether the third dose actually increases the level of antibodies and strengthens the immune system.

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