America’s first-ever reformulated COVID-19 vaccines are coming, very ahead of schedule, and in some ways, the timing couldn’t be better.
Pfizer’s version of the shot, which combines the original recipe with ingredients targeting the Omicron subvariants BA.4 and BA.5, may be available to people 12 and older as early as the week after Labor Day; Moderna’s adult-only brew seems to be on a similar track. The schedule slates the shots to debut when BA variants are resurgent in the United States—and when epidemiologists believe kids could start driving the next wave of infections.
The new boosters offer an important advantage over the existing vaccines: They seem to work against Omicron, which has become the predominant subtype in the U.S. and is estimated to make up about 60 per cent of new infections. (The original Pfizer and Moderna shots are effective against BA, though not as much.) But there’s a hitch: The further booster doses will initially be available only to people 18 and older—and that age limit could severely undercut their effectiveness.
The reason has to do with how quickly immunity from COVID-19 fades. A recent study found that people who had been infected with SARS-CoV-2, the virus that causes COVID-19, lost about half of their neutralising antibodies—proteins that stick to the surface of a virus and prevent it from infecting cells—after three months. Another study, published this week in Nature Medicine, found that people vaccinated with Pfizer’s original vaccine lost even more protection: Two-thirds of them had undetectable levels of neutralising antibodies six months after their second dose.
That means that come fall, most people in the U.S. will have waning immunity to Omicron, whether infected or vaccinated. The new boosters could help shore up that protection—but only if kids are included in the rollout. That’s because children are less likely than adults to have been infected with SARS-CoV-2 and, therefore, less likely to have residual immunity to Omicron. “If you give the booster only to people who were already infected or vaccinated, you’re not going to impact transmission very much,” says Thomas Inglesby, director of the Center for Health Security at Johns Hopkins University.
The problem is that, as of now, it doesn’t look like kids will be able to get the new boosters this fall. Clinical trials for both Pfizer’s and Moderna’s shots are ongoing in children as young as 12. Still, those studies won’t wrap up until after school starts—and even then, it could take weeks or months for the U.S. Food and Drug Administration to review the data and give the green light. In the meantime, the new vaccines will be available only to adults.
That’s not necessarily a death sentence for the booster strategy. If enough adults get vaccinated, they could help tamp Omicron transmission by providing a sort of “herd immunity”—a wall of protection that stops the virus from reaching vulnerable people. But it’s far from clear that that will happen. Recent polls suggest that most Americans don’t plan to get vaccinated with any COVID vaccine, let alone a booster shot requiring them to return for a second dose. And even if adults do get vaccinated, it might not be enough to make a dent in transmission if kids continue to spread the virus.
The bottom line is that if kids can’t get vaccinated this fall, the new booster strategy could be another example of the U.S. government’s haphazard response to the pandemic. “We don’t have a well-designed plan for rolling out these boosters,” says Inglesby. “It’s just unclear what we’re trying to accomplish or how we’re going to do it.”
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