Headlines that appeared around the world this week had some hearts sinking here in Israel: The World Health Organization was warning against repeated use of boosters.
It sounded like a negation of the Vaccination Nation’s prevailing wisdom. After all, this is the country that weathered Delta by introducing universal third shots before anyone else.
And for our half-million newly quadruple-vaccinated elderly and at-risk populations, it was easy to feel the news was a blow, shaking a newfound sense of security. Israel’s fourth dose campaign, the first widespread operation in the world, was unleashed in the hope of minimizing Omicron’s damage.
People were left asking whether, in retrospect, the boosting we’ve been championing is the best way to protect us. The WHO insisted that “a vaccination strategy based on repeated booster doses of the original vaccine composition is unlikely to be appropriate or sustainable.”
What is really driving the WHO’s position is less connected to our health outcomes and more about “the need for equity in access to vaccines across countries to achieve global public health goals” and concerns over “vaccine demand.”
Employees pack boxes containing vials of Covishield, a version of the AstraZeneca vaccine, at the Serum Institute of India in Pune, Monday, Nov. 22, 2021. (AP Photo/Rafiq Maqbool, File)
We’re in a global pandemic. Vaccine demand outstrips supply. This means that people in some parts of the world are lacking shots for initial inoculation — as vaccines of the very same type are used by some countries to boost citizens who already have some protection.
According to the WHO, using supply to try to keep some countries boosted while others are so far behind isn’t “appropriate or sustainable.” It’s an analysis on a global level as you’d expect from the World Health Organization (which opposed boosters on vaccine equity grounds since they were first administered).
Prof. Tomer Hertz (Ben Gurion University)
“The WHO is concerned about global health; that’s what they are supposed to be doing, but this doesn’t mean they have anything specific to say about the state of Israeli immunity,” Ben Gurion University immunologist Prof. Tomer Hertz told The Times of Israel.
If you’re Israeli and thinking about your health and the health of those around you, boosters do seem to be delivering the goods.
Research published in The Lancet medical journal in October found that, among Israelis, the third vaccine dose was 92 percent effective in preventing serious illness compared to those who received only two shots. When officials today criticize boosters, they are largely talking about doses beyond number three.
A medical professional with Clalit Health Services waves in his next patient to receive a coronavirus vaccine booster shot, at the Cinema City complex in Jerusalem, Monday, Aug. 30, 2021. (AP Photo/Maya Alleruzzo)
This is because the very strong protection of the triple as opposed to double vaccinated has created an increasingly popular opinion among doctors that the third shot shouldn’t be considered a booster at all, but rather part of the initial vaccination schedule.
Stanley Plotkin, inventor of the rubella vaccine and widely considered the world’s top vaccinologist, recently urged the US Advisory Committee on Immunization Practices to abandon the term booster for third shots, arguing that it’s clearly key to generating the initial immune response. When he speaks, doctors take notice.
A vaccination center in Safed, November 29, 2021. (David Cohen/Flash90)
But what about the 4th shot?
As for fourth shots, Hertz and others are getting started with large-scale studies that will take months, but initial very preliminary data seems to be optimistic.
A week after receiving dose number four, recipients had almost five times more COVID-19 antibodies in their blood, initial research from Sheba Medical Center suggests. New data, giving a snapshot of antibody levels a few weeks later, is expected from Sheba in the coming days, and unless antibody levels have dropped radically, will be interpreted as suggesting that fourth doses seem to add to the protection.
Epidemiologist Michael Edelstein (courtesy of Michael Edelstein)
Studies have shown that vaccines are less effective against Omicron, and could be even weaker against subsequent variants, but the leading epidemiologist Prof. Michael Edelstein of Bar-Ilan University’s Azrieli Faculty of Medicine says that administered at the rate Israel has adopted, they are doing their job well. This is especially the case when judged by the key variable of deterioration to serious illness, as opposed to infection when it doesn’t badly harm people.
Edelstein told The Times of Israel: “The effectiveness of three doses in keeping people out of the hospital is pretty good, around 90%, so most people don’t need further doses for now, as long as this is maintained. The exception is very vulnerable people who need extra protection at times of high transmission like now.”
A weakened immune response?
Some doctors have raised the possibility that repeated boosters could reduce the immune response to the vaccine.
Marco Cavaleri, head of vaccines strategy for the European Medicines Agency, said in a press briefing this week: “One of the concerns here is that if we have a strategy in which we give boosters, let’s say, every four months approximately, we will end up potentially having a problem with the immune response and the immune response may end up not being as good as we would like it to be, so we should be careful to not overload the immune system with repeated immunization.”
Hertz said that statements such as Cavaleri’s are really just flagging up a possibility that continued boosters won’t add protection and don’t suggest any sense of danger.
“I wouldn’t say we’re concerned about harming the individuals or reducing their immune response,” he commented. “The worst I expect to happen is it just wouldn’t really increase protection.”
Illustrative image: antibodies attack SARS-CoV-2 (iStock via Getty Images)
“The only real herd immunity is global,” read the title of an April analysis article in The Times of Israel. Ronen Ben-Ami, head of the Infectious Diseases Unit at Tel Aviv Sourasky Medical Center commented in the piece: “We talk a lot about herd immunity and the idea that if a percentage of a population is vaccinated it becomes protected.
“But given that all countries reside in the world, and the world isn’t immunized, herd immunity may only last so long,” he went on. “The lesson of 2020, learned well in Israel, is that the world is connected, and in a sense, the herd isn’t one country, the herd is the world.”
Now, nine months later, Ben-Ami’s boss Prof. Ronni Gamzu is one of the highest-profile doctors in Israel to translate this belief into a practical recommendation: Israel should donate vaccines.
Prof. Ronni Gamzu in September 2020, when he was coronavirus czar. (David Cohen/FLASH90)
Gamzu, CEO of Sourasky Medical Center and a former coronavirus czar, said in a recent press briefing: “If I were director-general of the Ministry of Health I would dedicate a portion of our vaccines [and] a part of our resources and capabilities, to Third World countries. I believe this is mandatory to any country in the Western world.”
Internationally, some prominent figures have gone further. Former British prime minister Gordon Brown said last month that the failure to distribute vaccines to poorer countries is a “stain on our global soul.”
Edelstein commented: “For Israel and other highly vaccinated countries, it’s not just a matter of altruism it’s also in our own self-interest to have the world vaccinated. Because if you look at the waves, whether it was Delta or Omicron, it started in Israel because someone came in from another country where there was not a lot of vaccination, and brought it back.”
There are, of course, ripostes to complaints against so-called vaccine nationalism, such as the suggestion that vaccines alone won’t solve the problem as developing countries also lack the infrastructure to administer them — but none of them change the fact that vaccine inequality poses a real challenge.
And so, while the WHO’s latest comments needn’t worry Israelis in relation to local policy, they highlight deep concerns about the situation internationally. Or in other words, instead of a local Israeli headache, we’re facing a global migraine.