America’s Fall Booster Plan Has a Fatal Paradox

[SBFNews]

America’s Fall Booster Plan Has a Fatal Paradox​

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Arnold Jerocki / Getty

By Katherine J. Wu
AUGUST 25, 2022, 2:35 PM ET

America’s first-ever reformulated COVID-19 vaccines are coming, very ahead of schedule, and in some ways, the timing couldn’t be better. Pfizer’s version of the shot, which combines the original recipe with ingredients targeting the Omicron subvariants BA.4 and BA.5, may be available to people 12 and older as early as the week after Labor Day; Moderna’s adult-only brew seems to be on a similar track. The schedule slates the shots to debut at a time when BA.5 is still the country’s dominant coronavirus morph—and it means that, after more than a year of scrambling to catch up to SARS-CoV-2’s evolutionary capers, we might finally be getting inoculations that are well matched to the season’s circulating strains. Which is “absolutely great,” says Deepta Bhattacharya, an immunologist at the University of Arizona.

In other ways, the timing couldn’t be worse. Emergency pandemic funds have been drying up, imperiling already dwindling supplies of vaccines; with each passing week, more Americans are greeting the coronavirus with little more than a shrug. The most recent revamp of the country’s pandemic playbook has softened or stripped away the greater part of the remaining mitigation measures that stood between SARS-CoV-2 and us. Calls for staying up-to-date on COVID vaccines are one of the last nationwide measures left—which puts a lot of pressure on shot-induced immunity to combat the virus, all on its own.

The nation has latched on before to the idea that shots alone can see us through. When vaccines first rolled out, Americans were assured that they’d essentially stamp out transmission, and that the immunized could take off their masks. “I thought we learned our lesson,” says Saskia Popescu, an infectious-disease epidemiologist at George Mason University. Apparently we did not. America is still stuck on the notion of what Popescu calls “vaccine absolutism.” And it rests on two very shaky assumptions, perhaps both doomed to fail: that the shots can and should sustainably block infection, and that “people will actually go and get the vaccine,” says Deshira Wallace, a public-health researcher at the University of North Carolina at Chapel Hill. As fall looms, the U.S. is now poised to expose the fatal paradox in its vaccine-only plan. At a time when the country is more reliant than ever on the power of inoculation, we’re also doing less than ever to set the shots up for success.

In terms of both content and timing, the fall shot will be one of the most important COVID vaccines offered to Americans since the initial doses. Since SARS-CoV-2 first collided with the human population nearly three years ago, it’s shape-shifted. The coronavirus is now better at infecting us and is a pretty meh match for the original shots that Pfizer, Moderna, and Johnson & Johnson produced. An updated vaccine should rejuvenate our defenses, prodding our antibody levels to soar and our B cells and T cells to relearn the virus’s visage.

That doesn’t mean the shots will offer a protective panacea. COVID vaccines, like most others, are best at staving off severe disease and death; against BA.5 and its kin, especially, that protection is likely to be durable and strong. But those same shields will be far more flimsy and ephemeral against milder cases or transmission, and can only modestly cut down the risk of long COVID. And when partnered with a compromised or elderly immune system, the shots have that much less immunological oomph. Then say a new immunity-dodging variant appears: The shots could lose even more of their strength.

Vaccine performance also depends on how and how often the shots are used. The more people take the doses, the better they will work. But no matter how hard we try, this reformulated shot “is not going to cover everyone, either because they choose not to get it or won’t be able to access it,” says Katia Bruxvoort, an epidemiologist at the University of Alabama at Birmingham. People who haven’t yet finished their primary series of COVID shots aren’t expected to be able to sign up for the BA.5 boosts—a policy that Bhattacharya thinks is a big mistake, not least because it will disadvantage anyone who seeks a first brush with vaccine protection this fall. “The better the degree of breadth right at the beginning,” he told me, the better future encounters with the virus should go.

Most kids under 12 remain in that totally unvaccinated category; even those who have completed their initial round of shots won’t be eligible for the revamped recipe, at least not in this first autumn push. Among people who can immediately get the new booster, uptake will probably be meager and unbalanced. “Realistically, the boosters are going to be concentrated in the places that have been the least impacted by the pandemic” and in people who have already had at least one boost, says Anne Sosin, a public-health researcher at Dartmouth. Such widening gaps in protection will continue to offer the virus vulnerable pockets to invade.

Crummy uptake isn’t a new issue, and some of the same deterrents that have plagued rollouts from the start haven’t gone away. Vaccines are a hassle and can come with annoying side effects. And in recent months, even more obstacles have been raised. The wind-down of COVID funding is making it much harder for people without insurance or other reliable health-care access to get boosted. And after nearly three years of constant crisis slog, far fewer people fear the virus, especially now that so many Americans have caught it and survived. A year into the Biden administration’s concerted push for boosters, fewer than a third of U.S. residents have nabbed even their first additional shot. With each additional injection Americans are asked to get, participation drops off—a trend experts anticipate will continue into the fall. “There’s a psychological hurdle,” says Gregory Poland, a vaccinologist at the Mayo Clinic, “that this is over and done.”

The reality that most Americans are living in simply doesn’t square with an urgent call for boosts—which speaks to the “increasing incoherence in our response,” Sosin told me. The nation’s leaders have vanished mask mandates and quarantine recommendations, and shortened isolation stints; they’ve given up on telling schools, universities, and offices to test regularly. People have been repeatedly told not to fear the virus or its potentially lethal threat. And yet the biggest sell for vaccines has somehow become an individualistic, hyper-medicalized call to action—another opportunity to slash one’s chances at severe disease and death. The U.S. needs people to take this vaccine because it has nothing else. But its residents are unlikely to take it, because they’re not doing anything else.

https://www.theatlantic.com/health/archive/2022/08/omicron-booster-vaccine-only-plan/671233/