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Vaccine Experts Share Their Thoughts: should you get a booster shot? What Would A Plan B Look Like?

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With COVID cases returning in dangerously high numbers, ministers are considering cutting the waiting time for COVID-19 booster vaccines from 6 months to 5. What do the virologists have to say about this? Plus the latest on what a Plan B would look like. The Freelance Informer reports.

Prof Jonathan Ball

The ONS’s “Coronavirus and the social impacts on Great Britain: 22 October 2021” Bulletin has reported that around 9 in 10 (91%) adults who have received two doses of a COVID-19 vaccine would be very or fairly likely to have a booster vaccine if offered. 

Pfizer Inc. and BioNTech SE have announced topline results from a Phase 3 randomised, controlled trial evaluating the efficacy and safety of a 30-µg booster dose of the Pfizer-BioNTech COVID-19 Vaccine in more than 10,000 individuals 16 years of age and older.

In the trial, a booster dose administered to individuals who previously received the Pfizer-BioNTech primary two-dose series restored vaccine protection against COVID-19 to the high levels achieved after the second dose, showing a relative vaccine efficacy of 95.6% when compared to those who did not receive a booster.

These are the first efficacy results from any randomised, controlled COVID-19 vaccine booster trial, said Pfizer in a statement.

Who can get a COVID-19 booster vaccine in the UK?

Booster vaccine doses will be available on the NHS for people most at risk from COVID-19 who have had a 2nd dose of a vaccine at least 6 months ago.

This includes:

  • people aged 50 and over
  • people who live and work in care homes
  • frontline health and social care workers
  • people aged 16 and over with a health condition that puts them at high risk of getting seriously ill from COVID-19
  • people aged 16 and over who are a main carer for someone at high risk from COVID-19
  • people aged 16 and over who live with someone who is more likely to get infections (such as someone who has HIV, has had a transplant or is having certain treatments for cancer, lupus or rheumatoid arthritis)

People who are pregnant and in 1 of the eligible groups can also get a booster dose.Information:

If you’re not sure if you have a health condition that puts you at high risk, see who is at high risk from COVID-19.

How and when to get your COVID-19 booster vaccine

You’ll be offered a booster dose at least 6 months after you had your 2nd dose.

Most people will be invited to book an appointment at a larger vaccination centre, pharmacy, or local NHS service such as a GP surgery.

People who work for an NHS trust or a care home will usually get their booster dose through their employer.

You can book your COVID-19 booster vaccine online if you had your 2nd dose at least 6 months ago and you are:

  • a frontline health or social care worker – you do not need to wait for an invite
  • aged 50 and over and the NHS has invited you to book
  • aged 16 and over with a health condition that puts you at high risk from COVID-19 and the NHS has invited you to book

If you have not received an invite but it’s been 6 months and 1 week (190 days) since your 2nd dose, you can try to book your appointment online without an invite.

Book your COVID-19 booster vaccine appointment

Which COVID-19 vaccine will I get?

Most people will be offered a booster dose of the Pfizer/BioNTech vaccine or Moderna vaccine. This means your booster dose may be different from the vaccines you had for your 1st and 2nd doses.

Some people may be offered a booster dose of the Oxford/AstraZeneca vaccine if they cannot have the Pfizer/BioNTech or Moderna vaccine.

Will a COVID booster shot stop me from becoming ill?

“The impact of vaccines on severe disease can not be overstated – the evidence is clear – people who are fully immunised are far less likely to become ill,” said Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham.

“But vaccine immunity wanes over time,” he said, “and this undoubtedly is contributing to the high levels of virus circulation.  Giving a vaccine boost will help reduce virus circulation and the likelihood of disease.”

Ball suggests the key question is ‘does this boost have to be given after 6 months or can it be just effective after 5 months or maybe even sooner’?

“As far as I recall, this was one of the things that the UK’s CoV-Boost trial was going to assess, but I am not aware of the trial data being in the public domain.  Given JCVI advice, one might assume that the 6-month gap gave the best boost, but without seeing the data we can not be sure. 

“As someone who has spent most of his life studying antibody responses to virus infections, I wouldn’t be surprised if good boosting was seen with a shorter interval.  And the benefits of using a shorter interval – getting the overall levels of immunity raised in the wider population – will undoubtedly slow the virus down and protect more people.  If we have the doses, and the means to administer them, then I think it makes sense to increase the number of people eligible for that boost.  Vaccines really are the best way of keeping on top of this virus,” he said.

As someone who has spent most of his life studying antibody responses to virus infections, I wouldn’t be surprised if good boosting was seen with a shorter interval. 

Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham.

This period last year, before vaccination, when the number of cases was between 40,000 to 50,000 per day the UK was seeing 1000 to 1500 deaths per day; with the same number of cases now we are recording between 100 and 130 deaths per day, many of which are still unvaccinated, according to Dr Clive Dix, former Chair of UK Vaccine Taskforce.

“We know that in the UK the vaccines are protecting against death and severe disease. We also know that the antibody levels are declining with time and the question is does that mean the protection is also decreasing.  As the immune response in the elderly is never as strong we need to ensure they are still protected from severe disease and death. 

“It is, therefore, essential to vaccinate the elderly with boosters as an insurance policy as the government has indicated, and I believe everyone who is eligible i.e. 6 months on from their second dose should then get the vaccine as soon as possible.  Once we are certain that we have protected the vulnerable in our society we should not be fixated by case numbers,” said Dix, who is now CEO of C4X Discovery, a drug discovery company.

I also believe we should increase the campaign to persuade those unvaccinated to be vaccinated.

Dr Clive Dix, former Chair of UK Vaccine Taskforce

What would a Plan B look like?

Prof Jim Naismith, Director of the Rosalind Franklin Institute, and Professor of Structural Biology, University of Oxford, has confirmed that the SAGE minutes as published neither call for plan B now nor urge sticking to Plan A.

He also said that the minutes confirm that SAGE does not expect the daily hospital admission to reach Jan 21 levels under plan A.

“The minutes outline that if the government decides to implement plan B, then what measures and how they should be implemented are being analysed,” said Naismith.

“The minutes suggest that the government at that time of the minutes has not yet established what things would trigger plan B.

“An important message here is that Delta has made it harder to bring spread under control, especially since the UK has decided to have high levels of infection.

“The minutes warn of the danger of further, more rapidly spreading mutants or the risk of vaccine escape; both are risks but not currently reality.

The director said he would draw attention to:

  • SAGE emphasis on the risks to pregnant women (and their unborn children) from covid19.  Pregnant women (and their unborn children) are considerably safer being vaccinated; not being vaccinated runs a higher risk of serious illness.
  • SAGE emphasises that Government messages about people with coughs and sneezes staying home will protect lives.

“The later two points could be usefully emphasised by the press.”

Dr Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said that the SAGE notes that in addition to working from home which would have the biggest effect on reducing Covid-19 spread, SAGE also notes that a culture of ‘presenteeism’ among office workers is likely to be contributing to wider prevalence of cold and flu, and comment that these respiratory illnesses should be treated similarly to Covid-19 by staying at home. 

“Reducing presenteeism would fit well with the government’s manifesto commitment to “encourage flexible working” and will inform any consultation to make this ‘the default unless employers have good reason not to,” said Clarke.

Declared interests

Prof Jonathan Ball: “Receiving funding to develop and trial new generation COVID19 vaccines.”

None others received.

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