The rapid spread of the omicron variant worldwide is focusing new attention on whether a fourth dose of COVID-19 vaccine — in effect, a second booster shot for those already considered fully vaccinated — may be necessary.
The safety and effectiveness of a fourth shot is the subject of a new, first-of-its-kind study in Israel, ahead of much of the world in coronavirus vaccinations. There, 150 medical personnel who’d gotten a booster shot at least four months ago have received another.
The Israeli government is considering a recommendation to make the extra booster dose available to those seen as most vulnerable to the new COVID-19 variant because they’re at least 60 years old, or have weakened immune systems or work in health care.
In the United States, Pfizer CEO Albert Bourla said earlier this month that a fourth dose may have to come sooner due to omicron. Originally, the pharmaceutical company had projected it would take 12 months before another booster shot would be needed.
But Dr. Anthony Fauci, the chief medical adviser to President Joe Biden, said last week “it’s too premature to be talking about a fourth dose” in a recent radio interview because it’s not clear yet how much additional protection is provided by an initial booster shot.
“If the protection is much more durable than the two-dose, non-boosted group, then we may go a significant period of time without requiring a fourth dose,” Fauci said, according to CNN.
The Utah Department of Health’s immunization director, Rich Lakin, said the possibility of a fourth dose hasn’t come up yet as the state continues to push an initial booster shot as the best defense against omicron.
“It’s too soon. We actually haven’t even discussed a fourth dose at all,” Lakin said.
But he said omicron, “spreading like crazy wildfire” and already believed to be the dominant COVID-19 variant in the state just weeks after first being detected here, appears to be affected by the extra dose of antibodies a booster shot provides.
Even though the new variant is seen as producing milder cases, especially among the already vaccinated, the much larger number of infections means surges will strain medical resources, just as previous strains of the coronavirus did.
Dr. Kencee Graves, University of Utah Health associate chief medical officer, said booster shots are key to dealing with omicron, already causing record case counts in New York and other parts of the country.
“Getting your booster now is a really good move to help prevent illness from omicron. I think we don’t know what the future holds with further doses — or with further variants,” Graves said. “I think it’s hard to say what’s coming.”
Han Kim, a professor of public health at Westminster College in Salt Lake City, said until there is more information from Israel about the value of a fourth dose, it’s hard to say whether another booster is coming soon.
“I don’t think we have the data to justify it, especially in the U.S., where people are just starting to get boosters. I don’t think we need to be talking about a fourth dose yet. Maybe in the spring,” Kim said.
Anyone 5 and older can be vaccinated against COVID-19, but just over 58% of all Utahns are considered fully vaccinated — meaning it’s been two weeks or more since their second dose of Pfizer or Moderna vaccine or their single dose of Johnson & Johnson.
Free booster shots, first offered in September to older and medically vulnerable Utahns, are now widely available throughout the state to anyone 16 and older, at least six months after Pfizer or Moderna shots and two months after the Johnson & Johnson vaccine.
Only about a third of Utahns who are fully vaccinated have gotten a booster shot. The numbers are higher among Utahns 65 and older, with more than two-thirds of the nearly 85% who are fully vaccinated having received a booster shot
Lakin said the rate of booster shots administered in the state has plateaued after a quick start despite the new threat posed by omicron, while vaccination rates overall have “gradually declined” since early December.
That suggests to Lakin that, like him, some Utahns may have put off the shot until after the holidays because they feared an adverse reaction would affect their travel plans or celebrations. He said he’ll get his booster shot early next week.
Another factor, Lakin said, may be confusion over needing a booster dose after being declared fully vaccinated. Some health experts are advising that the booster shot should simply be called a third dose.
He also said it’s not clear how Utahns will view reports that omicron may cause milder cases of COVID-19 even though that “washes out” because the new variant is so much more contagious that many more people will get sick.
What could get more Utahns to seek out a booster shot is a new surge in cases, Lakin said. Already, Utah’s case counts are heading up again after dropping below 1,000, with 1,816 new cases and four additional deaths reported by the state health department Tuesday.
The rolling seven-day average for positive tests is 1,300 per day, with hours-long waits at some sites. Since Monday, 7,533 people have been tested in Utah for the virus with a total of 15,316 tests conducted.
In just a week, the omicron variant went from being seen as responsible for about 30% of the state’s COVID-19 cases to an estimated 65% as of Monday, the state health department said.
Utah, one of the nation’s hot spots for the virus last month, is bracing for another surge.
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