Questions about the purpose and expectations of the third coronavirus vaccine have been preoccupying experts around the world, and provoking debate in the medical-scientific community, both at the epidemiological level and at the ethical and strategic level in connection with the global response to the epidemic.
A review published Monday by an international group of scientists in The Lancet, one of the world’s most prestigious medical journals, says that none of the data on coronavirus vaccines so far provides credible evidence in support of boosters for the general population. It adds that whatever advantage the third dose might provide does not outweigh the benefit of using those doses to vaccinate the billions of people around the world who are still not protected.
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The publication comes just as Israel has given nearly a third of its population (31 percent) a third dose of the vaccine, two months after it launched the booster shot campaign despite it not being backed by any evidence or recommendations by any leading health organization. Israel was spurred by June’s outbreak of the delta variant of the virus, which posed the first test to the vaccine’s level of protection.
Although at that point 55 percent of the Israeli population had been vaccinated, within weeks the virus spread, with vaccinated people also getting sick and the number of seriously ill climbing persistently. Since then, data has accumulated in Israel indicating that after five months, the vaccine’s effectiveness in protecting against infection and hospitalization wanes significantly.
In the Lancet article, the scientists, include some at the U.S. Food and Drug Administration and the World Health Organization, cast doubt on the need for a third shot, certainly for children. They said that all the vaccines available, not just those based on mRNA technology, like the Pfizer vaccine, are very effective in preventing serious illness caused by any of the variants known to date, even after several months have passed. They may not be quite as effective against infection, but in terms of preventing serious illness their effectiveness is still 85 percent or more, the scientists say.
The article makes a brief reference to Israel, based on the data issued by the Health Ministry from between June 20 and July 17, which indicated that the vaccine’s effectiveness against serious illness among those vaccinated in January was 86 percent, among those in February – 91 percent, and among those in March – 94 percent. The article criticizes the publication of this data and is largely dismissive of it.
However, the authors did not relate to the more comprehensive study published by researchers at the Gertner Institute and the Health Ministry on August 27, which shows significant deterioration in the vaccine’s effectiveness, and findings based on a group of 1.14 million Israelis aged 60 and up, showing that those receiving the booster are 15 times more protected 12 days after getting the third shot than those who only received two doses of the vaccine.
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“The important and updated data from Israel wasn’t quoted in the article,” says Prof. Eyal Leshem, an infectious disease expert at Sheba Medical Center at Tel Hashomer. “We definitely see a weakening of the vaccine against serious illness. The researchers do refer to studies from other countries, but since Israel was their first to vaccinate large numbers in January then naturally the weakening of the vaccine would be felt here more than in other countries.”
Nevertheless, Leshem sees the logic in the scientists’ argument. “We’ve seen even in August that two doses are still highly effective in preventing serious illness, reaching a range of 80 percent to 85 percent, compared to 95 percent in a situation of maximum protection. That’s why, from a global perspective, the researchers argue that as long as the rate of effectiveness in preventing serious illness is so high, this is not the time to begin administering a third dose. It’s correct to argue that at the global level if all the wealthy countries give a third vaccine to say, a billion people, it will block or delay the ability of the world’s poorest and sickest people to get the first dose,” he says.
Prof. Hagai Levin, formerly chairman of the Israel Association of Public Health physicians, says, “We need to pay attention to professional arguments and the arguments about the allocation of resources. It is clear that in terms of global good, administering a first dose to a 70-year-old person in India takes priority over a third dose for a 12-year-old in Israel. But what about Israel’s perspective? Perhaps there is justification for a third dose for an Israeli 12-year-old. To decide we need exact data on the risk of serious illness and death among 12-year-olds who got only two doses. I would assume that when my son, who is now 15, will get to six months after his second dose, I would prefer he got a third dose. But the questions need to be asked, and answers need to be given.”
While there is agreement as to the need to protect the elderly population and that there is justification for giving a third dose to this group, Israel has been vaccinating children with the third dose. According to Leshem, the Israeli government was facing a fourth outbreak of Covid-19 and had to choose between imposing another lockdown, whose health and economic costs are enormous, or to give the booster and raise the effectiveness of peoples’ protection to 95 percent.
“It chose the booster, because the damage from it, from Israel’s perspective, is much lower than the benefit,” Leshem says. “What the government also did, and for this it’s being criticized, is to recommend the booster to the whole population, not just those at risk for serious illness, out of concern for preventing infection and reducing the spread of the illness – and these two goals were achieved.”