Health

Too much focus on boosters, says FDA vaccine advisor

After FDA authorization and the CDC’s recommendation that all children ages 12 to 17 should receive booster doses of COVID-19, Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, reflects on the strategy American vaccine. Offit, who serves on the Food and Drug Administration’s Advisory Committee on Vaccines and Related Biological Products, is also examining some errors in communicating with the public during the pandemic.

Here is a transcript of his notes:

What we did recently is we recommended a booster dose for kids between the ages of 12 and 15. What percentage of children in that age group have been fully vaccinated? about 50%. This means that 50% have not been vaccinated. Does it really make sense to focus on more protection for people who are already protected from serious diseases? Or should we really devote our resources to protecting those who are completely unprotected?

If you work in a hospital, like I do, and you see kids between the ages of 12 and 15 come into the hospital, they’re not there because they didn’t get a third dose, they’re there because they didn’t get it. Get any doses. I mean, this is really, at least at the hospital level, a disease for the unvaccinated, and that should be our focus. I just feel like we’ve kind of given up on it, and this constant talk of reinforcement is a turn off in many ways.

The question is what do we want from this vaccine? If what we want from this vaccine is protection against serious disease, or the current two-dose mRNA vaccine strategy, or the two-dose strategy of J&J [Johnson & Johnson] A vaccine, which provides protection against serious diseases, up to the present for all age groups. If that is the goal, then we have achieved it. On the other hand, if the goal is to try and also protect against mild illness, which will wear off over time, then you can argue to give a booster dose, realizing that the mild illness protection you get from that booster will likely last 3 to 4 months.

I think there have been a number of misunderstandings regarding these vaccines. For example, a year ago, when in December, we considered the Pfizer vaccine and Moderna we are the FDA’s Vaccine Advisory Committee. What I saw was 95% effective against mild disease. That was noticeably high. The reason it’s high is because those were 3-month studies. In other words, most participants in those studies received their second dose recently. Therefore neutralizing antibodies were high and thus the efficacy against mild disease was high. There was no way it would have lasted. Neutralizing antibodies had to go down and thus protection against mild disease had to go down.

I think the second misunderstanding occurred on July 4 last year when thousands of men got together and celebrated the holiday in Provincetown, Massachusetts. Nearly 80% of them have been fully vaccinated. However, 346 of these men contracted COVID; The 346 men who were fully vaccinated developed COVID. Four of those 346 went to hospital, with an admission rate of 1.2%. that is great. This vaccine works well. The other 342 had mild illness or infection without symptoms. Those infections were called superinfections, and that’s [term] He should never have decided that we should use that.

The term “breakthrough” means failure. This is not a failure. What you want from these vaccines is that you want protection against severe diseases. For vaccines like the flu or rotavirus vaccine, the pertussis vaccine or the pertussis vaccine, you get excellent protection against moderate to severe disease, but not very good protection from asymptomatic or mild effects. That would also be true for this vaccine, and I think we inadvertently licked this one up by raising it to a level that’s almost impossible to get to.

What makes Omicron difficult is that although everyone is talking about how contagious it is, technically it is not the most contagious. The delta index of infection was between 5 and 9. So what the infection index means is that if the infection index is 5, for example, that means that if I had the infection and went on my usual day and came into contact with every susceptible person, I would infect five more people.

The infection index for omicron is likely to be somewhere between 3 and 5. There is no evidence that it is more contagious. Omicron’s problem is that it is, to some extent, an immune dodger. So even if you have been vaccinated, you may still have a mild infection. If you look, say, at Delta and Omicron in an unprotected house, you’ll find that they spread really evenly. However, if you look at Delta and Omicron in a home where people are vaccinated or even vaccinated and boosted, you are more likely to continue to have mild illness with Omicron, than you would have with Delta. And this is the problem of Omicron. Even people who are vaccinated can get mild disease. And that’s why you’re seeing this huge increase in cases, but you don’t see a large proportionate increase in hospitalizations and deaths.

  • Emily Hutto is Associate Video Producer and Editor for MedPage Today. She resides in Manhattan.

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