New Haven Register (New Haven, CT)
‘YOU DON’T WANT TO WASTE THE BOOSTER’
CT experts question timing of fourth COVID-19 vaccine dose
The U.S. Food and Drug Administration is expected to soon approve a fourth COVID vaccine dose for people 50 and older, but Art Caplan said he won’t be the first in line if that authorization happens.
“I don’t think it’s smart to just run out and get that fourth shot,” said Caplan, a Ridgefield resident and founder of the bioethics department at NYU Langone. “I’m not going to go get one yet. I’m going to wait to see if the rates start to rise or if a new variant starts to manifest.”
The authorization could come as early as next week, The New York Times reported, with the Centers for Disease Control and Prevention following shortly thereafter with its own permission.
Ulysses Wu, chief epidemiologist for Hartford HealthCare, said he believes the decision is out of concern for BA.2, the omicron subvariant being blamed for COVID spikes in Europe and Asia. Yale researcher Nathan Grubaugh said last week that BA.2 is about 40 percent more transmissible than omicron.
According to the CDC, BA.2 comprised 55.4 percent of all tested samples as of March 19.
“I think they’re worried about BA.2,” Wu said. “That’s basically what they’re basing their decision on.”
While Wu said immunity from vaccines may be waning, particularly for people who have not received a third dose, the bigger concern for health experts is that immunity may decrease from the fourth dose while COVID is at an ebb in Connecticut.
“You don’t want to waste the booster,” Caplan said.
“Will you be able to get a fifth shot? Will protection from a fourth shot, will that wane rapidly?” Wu asked. “Will a fifth shot be less effective? We don’t know that.”
The best data supporting a fourth dose is out of Israel, where fourth shots were administered in January.
Wu would be eligible to get a fourth dose, should the FDA and CDC authorize it, but he said he will base his own decision — and his advice to his health system — on COVID’s spread throughout the community.
“It depends where we are with the epidemiology,” he said. “I’ll probably have to make a decision for the health system as well. A lot of it involves predicting. If I think that the curve is flattened and the numbers are going to drop, I will probably not, and I will wait.”
However, Wu added: “If I think that the numbers are going to stay up, I will certainly consider it.”
The state reported Monday that 1,014 additional COVID cases had been identified out of 33,065 reported tests for a positivity rate of 3.07 percent through the weekend.
The number of patients in Connecticut hospitals fighting a COVID-19 infection increased by two on Monday for a total of 97.
The FDA’s authorization for fourth vaccine doses would come prior to meetings of both the CDC and FDA’s advisory boards, which Caplan called a political decision.
“I find the whole thing disappointing,” he said. “Part of the push here is because other countries are doing things.”
Caplan said he’s hoping the FDA will not simply authorize the fourth vaccine dose, and instead offer some guidance on who should get the second booster and when they should receive it.
Caplan also questioned if the fourth dose could be considered a booster or the fourth in a series of doses, or even an annual or semiannual vaccine like the flu. The same questions were left unanswered after the third dose was authorized.
“The third shot was clearly necessary to fight a new variant,” Caplan said. “The fourth shot might be necessary to fight a new variant. I don’t think they’re explaining themselves well. All of that is left unanswered. It breeds confusion. I think the FDA has been making a muddle of the whole booster issue.”
Wu said any move toward making COVID vaccines a regular occurrence, like every other commonly used vaccine, would be premature.
“They can’t yet. They don’t know. You can’t establish a routine until you actually know what the routine is,” he said. “They have to do it piecemeal.”