The Biden administration's plan to offer a third dose of the coronavirus vaccine is scheduled to begin in less than three weeks. But despite the quickly approaching deadline, significant questions remain over the necessity of giving all Americans another shot.
Unlike hesitancy about the vaccine itself - which has garnered virtually unanimous approval across the scientific community - credible doctors and infectious disease experts are sincerely divided about whether there is enough data to support another shot for everyone. Meanwhile, the Biden administration has defended its booster plan despite the announcement raising eyebrows when it came before the regulatory authorization needed to start such a program, and now the pressure is on agency experts to make a decision before the scheduled Sept. 20 start date as the delta variant continues to drive infection numbers up.
Members of the Centers for Disease Control and Prevention's vaccine committee indicated during a meeting Monday that they need more data on booster shots before issuing a recommendation on their use. Advisory Committee on Immunization Practices member Beth Bell said that data doesn't yet show a significant decline in vaccine effectiveness against preventing severe cases of COVID-19.
"We have to remember that we're starting at a point that the data today doesn't show a remarkable reduction in the effectiveness of vaccines in terms of preventing hospitalizations and deaths," Bell said during the meeting.
The announcement caused confusion among some who immediately sought out a third dose believing that the plan was already approved and underway, according to one committee member.
In reality, the plan is subject to authorization from the Food and Drug Administration and the CDC's vaccine committee's recommendations. FDA has scheduled a meeting of its Vaccines and Related Biological Products Advisory Committee for Sept. 17, while the CDC's Advisory Committee on Immunization Practices is expected to meet again later this month.
The Biden administration has defended its plan by saying it wants to "stay ahead" of the virus. CDC Director Rochelle Walensky addressed concerns about the limited booster data, saying the vaccine committee didn't look at everything the U.S. health officials examined.
"The ACIP did not review international data that actually has led us to be even more concerned about increased risk of vaccine effectiveness waning against hospitalization, severe disease and death. They will be reviewing that as well," Walensky said at a press briefing on Tuesday. "But that is our own data as well as international data that has led us to be concerned that the waning we're seeing for infection will soon lead to waning that we would see for hospitalization, severe disease and death, which is why it's so critical now to plan ahead to remain ahead of the virus."
But Parker makes clear he isn't against giving Americans a booster shot.
"I think people sort of frame this as being pro- or anti-booster," he says. "I don't think that's correct. I'm not against boosting Americans if it's going to help save lives and reduce hospitalizations. I don't think anybody is in this debate."
The real question is whether healthy people need a booster shot, Parker says. If a booster shot is used to prevent only a mild infection in a healthy person, "that is unjustified," he says.
Parker says he was encouraged that members of the CDC's vaccine committee appear committed to the process despite the Biden administration's out-of-order booster announcement.
Still, experts want to see more data on booster shots.
"We haven't seen all the evidence yet that the federal government has quoted us to talk about boosting shots, and I think it will be absolutely crucial when that data is made available to the CDC, for example, and ACIP, that that is also amount of available to the community so that we can have these conversations in a way that helps them make an informed choice," Cameron Wolfe, an infectious disease specialist at Duke Health, said on a call with reporters on Wednesday.
Committee members and other experts also agreed that targeting the unvaccinated population to get them their first shot should take priority over the booster plan. Just under 62% of Americans have received at least one dose of COVID-19 vaccine.
The World Health Organization has been a staunch critic of wealthy nations offering booster shots.
"We're planning to hand out extra life jackets to people who already have life jackets, while we're leaving other people to drown without a single life jacket," Mike Ryan of WHO said during a press conference in August. "That's the reality. Science is not certain on this. There are clearly more data to collect."
While WHO officials said they agreed with the U.S. decision to give an additional dose to those who are immunocompromised, they said that prioritizing boosters for everyone in some countries over access to vaccines everywhere could lead to new variants arising.
But not everyone agrees with WHO. Parker says that the organization needs to respect the rights of countries who want to protect their populations first.
And White House press secretary Jen Psaki called the situation a "false choice," saying the U.S. can both implement a booster shot plan and send more vaccines across the globe.
Still, Biden should at least be raising the number of vaccines donated to other countries proportional to the number of booster doses secured, Parker says. He also criticizes the dosing approach to the booster shots as a "lost opportunity." If a smaller dosage for a booster shot could work to a similar degree as the full dosage, more shots could be extrapolated from the same supply
The booster proposal only applies to Pfizer and Moderna recipients for now. Johnson & Johnson recipients were not included, though U.S. health officials believe they will eventually need another shot as well.
"The reality, sadly, is that there's not visible data to the community yet that speaks to how effective they will be either going from a J&J boost to something else like Moderna or Pfizer, or data which we know is coming in a couple of weeks about using a J&J boost on top of the first J&J," Wolfe says.
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