Opinion | Why Experts Can’t Seem to Agree on Boosters

And on that fact: everyone wishes he was stronger. While research outside of Israel is seen by some as sufficient to support a second booster, Dr. Borio sees methodological shortcomings that limit its usefulness in shaping public policy decisions. “Understandably, these kinds of population-wide observational studies are not randomized, they’re not done in a controlled environment, and there are a lot of confounders,” he said.

For some, time considerations also loom large. Right now, coronavirus infection rates in the United States are near two-year lows, though some areas are seeing increases. While there is concern about the next wave of new cases caused by the Omicron BA.2 subvariant, in most cases, BA.2 appears to cause relatively mild illness in vaccinated people. Recent figures from the Centers for Disease Control and Prevention also suggest that most people who get vaccinated, and especially those who got their first booster, remain well protected against serious illness. Considering the impact of a booster can be short-lived, some say US authorities should wait a bit longer before firing another shot.

“It’s not about whether I’ll ever need another booster, I think everyone eventually will, but now is the time and for whom?” said Dr. Gili Regev-Yochay, director of the Infection Prevention and Control Unit at Sheba Medical Center in Israel.

Dr. Regev-Yochay has studied the efficacy of the fourth vaccine against Covid. While she strongly supports a first booster for all adults, she said the evidence supporting a second booster at this point is shakier when it comes to people who don’t have major risk factors. She also pointed out that parts of the world are still trying to get the first doses of the vaccines. “We should save these resources for the people who really need them,” she said.

Some experts say new variants are sure to emerge, and with them may come a more pressing need for reinforcements formulated to attack them. Pushing a second booster now could reduce the public’s willingness to get those later shots.

It’s also a theoretical possibility, though far from certain, that driving people back could reduce the effectiveness of upcoming vaccines. “When you are faced with a variant that is resistant to protection against serious disease and you really need a variant-specific vaccine, you may be less able to respond to it,” said Dr. Paul Offit, director of the Education Center on Vaccines at Children’s Hospital of Philadelphia and FDA advisor “I’m over 65, but otherwise healthy, and in no hurry to get a fourth dose.”

There are even more plausible arguments for or against reinforcements. Some say that the prospect of additional injections may deter the unvaccinated from receiving their first doses (which, it is worth emphasizing once again, is supported by all credible experts). Meanwhile, others say the extra shot could offer protection against prolonged covid or other infection-related health risks. “These kinds of considerations may all be correct, but they are also in tension with each other,” said Dr. Robert Wachter, chairman of the department of medicine at the University of California, San Francisco.

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