Dear Editor
I read your news item (1) where you cover the doubts expressed by an expert on the need for an annual flu-like booster approach for COVID. I very much welcome and support the call for strengthening the pandemic preparedness. He points out the potential differences between COVID and flu vaccines. However, he does agree that it is important to get boosted although as science stands today, we do not know how often we should get boosted. Countries are using their established systems and processes to develop and implement their COVID vaccination policy for the year 2023. In the United Kingdom the Joint Committee on Vaccination and Immunisation (JCVI) has just provided its interim advise (2) to the government on the COVID-19 vaccination programme for 2023. Final advice on a spring booster programme is also expected shortly. According to the JCVI “The COVID-19 vaccination programme continues to reduce severe disease across the population, while helping to protect the NHS” and this is their rationale behind their recommendation to continue boosting the population.
The United States Food and Drug Administration (FDA) has released the briefing document titled “Future Vaccination Regimens Addressing COVID-19” (3) which is being considered by the Vaccines and Related Biological Products Advisory Committee Meeting on the 26th of January 2023. The briefing document provides the rationale for the proposal for periodic population boosting. Data from vaccine effectiveness studies provide “preliminary real-world evidence that support the use of the bivalent mRNA boosters. Although the beneficial effect associated with a reduction in hospitalization and death in these studies is most apparent in older individuals, younger individuals appear to also benefit with a reduction in symptomatic disease and health care utilization. Though perhaps not identical, this pattern of response is analogous to that observed with annual influenza vaccination, a well-accepted intervention in individuals 6 months of age and older” (3).
The paper goes on to discuss the difficulties and complexities on coordinating and agreeing the vaccine strain composition changes. These include lack of well-established, highly coordinated infrastructure and governance for global semi-annual vaccine composition evaluation and recommendation as the one currently exists for flu vaccine. Furthermore the diversity of vaccine manufacturers and the complex global vaccine supply chain will further hinder any coordinated global effect. One of the key issues the US committee will be addressing is what should be the procedure for routine periodic strain selection?
The disastrous repercussions of delaying boosting include risk of infection, ongoing disease spread, increased prevalence, morbidity, hospitalization, and mortality. Statistical modelling (4) indicates instituting regular, population-wide booster vaccination updated to predominant variants has the potential to substantially reduce COVID-19. The other argument put forward for regular boosting is that this will partly suppress the level of infection and circulating virus and there by reduce the risk of variants emerging. Modelling results further show that boosting at least on an annual cycle markedly diminish the long-term risk of infection. One also needs to consider the cost and logistics of implementing a population based intervention. An annual booster with the appropriate update might be our best chance of keeping the virus at bay and protecting our population and the health system.
There will be competing priorities and various interests as huge sums of money are involved; US government has spent $30 billion on COVID vaccine (5). It is likely that developed and wealthy nations will adopt the periodic boosting approach and it is essential that there is scientific and political consensus to take the populace along with us to ensure maximum coverage to secure the best value for the taxpayer.
Dr Padmanabhan Badrinath, Retired Consultant in Public Health Medicine
badrishanthi@hotmail.com
Disclaimer: The views expressed here are the professional views of the author and in no way represent the views of any organisation the author has been associated with at present or in the past.
References:
1. Mahase E. Covid-19: Annual flu-like booster approach may not be appropriate, says expert on infectious disease BMJ 2023;
380 :p196 doi:10.1136/bmj. Available from: https://www.bmj.com/content/380/bmj.p196
2.. GOV.UK. JCVI advises an autumn COVID-19 vaccine booster. JCVI makes interim recommendations to government on
the COVID-19 vaccination programme for 2023. UKHSA [Internet]. [cited 2023 Jan 25]. Available from
https://www.gov.uk/government/news/jcvi-advises-an-autumn-covid-19-vacci…
3. FDA Briefing Document Future Vaccination Regimens Addressing COVID-19. FDA [Internet]. [cited 2023 Jan 25]. Available
from https://www.fda.gov/media/164699/download
4. Townsend JP, Hassler HB, Dornburg A. Infection by SARS-CoV-2 with alternate frequencies of mRNA vaccine boosting. J
Med Virol. 2023 Jan 5. doi: 10.1002/jmv.28461. Epub ahead of print. PMID: 36602045. Available from
https://onlinelibrary.wiley.com/doi/10.1002/jmv.28461
5. Kates J, Cox C, Michaud J. How Much Could COVID-19 Vaccines Cost the U.S. After Commercialization? KFF [Internet]. [cited
2022 Dec 7]. Available from https://www.kff.org/coronavirus-covid-19/issue-brief/how-much-could-covi…
cost-the-u-s-after-commercialization/
