Why I won’t recommend a COVID-19 vaccine booster to most patients

The Biden Administration seems determined — via CDC recommendation and FDA approval — to endorse a COVID-19 vaccine booster dose after eight months because of concerns about the vaccine’s possible waning efficacy.

While the COVID-19 vaccine seems to wane against preventing asymptomatic or mild breakthrough infections, its efficacy against preventing severe disease, hospitalization and death is still stellar by all reports.

In my opinion, the vaccine manufacturers are being disingenuous about the need for boosters. Why? The mRNA vaccines were touted to be more effective, at 94%, than the J&J vaccine at 75% initially. It is important to remember though that the mRNA vaccines were released before the UK or South Africa variant emerged and were not tested against them. The J&J vaccine was tested against those variants, which was a significant factor in causing its lower efficacy when compared to the mRNA options.

In all likelihood, if the Pfizer and Moderna mRNA vaccines were initially tested against the UK and South Africa variants, their efficacy would have been in the same ballpark as the J&J vaccine. We were told that the J&J vaccine, though “less effective” than the mRNA vaccines, was still a great option because it was excellent at preventing severe illness, keeping people out of the hospital and deaths from COVID19. Severe illness, less hospitalizations and preventing death was the goal stated by the CDC, not preventing asymptomatic or mild illness.

All three vaccines were messaged by the CDC as being almost interchangeable and the “best vaccine” was the one to which you could first gain access.

None of the current vaccines were tested against the delta variant, which is even more contagious than the UK or South African variants. Could it be the real story is not that a booster is needed, but we now know that the true efficacy of the current vaccines preventing asymptomatic or mild delta illness is much lower than 94%, thus allowing more “breakthrough” asymptomatic and mild infections?

It has also been confirmed that the mRNA vaccines are still meeting the goal of preventing severe illness, hospitalization and death from delta-caused COVID-19. If the vaccines are still meeting their CDC goals, what is the reason for a booster?

We can objectively measure a person’s COVID-19-related antibody level, or titer, via a simple blood test available to most physicians. Yet the CDC has made no recommendations to do so.

I routinely check my patients’ antibody titers. The cutoff for immunity to COVID-19 is a titer of 0.8. My patients vaccinated in February and March, ages 55 to 76, have an average antibody titer of greater than 400. That’s more than 400 times the level needed to be immune to COVID19. Even if the vaccine’s efficacy is waning at a reported rate of 6% every 2 months, an initial antibody titer of 400 after a year would be down to about 300.

A value still well above the cutoff of 0.8. Given this reality, why would I recommend a booster at 8 months for my patients?

The CDC recommendation may be that seniors are the priority for vaccination and younger adults go later. Sounds reasonable, except that I have seniors with antibody titers of greater than 2,500 and a 50-year-old with a titer of 6.

Why would I vaccinate my senior ahead of my 50-yearold who is clearly more at risk of breakthrough infection? Also, the booster is expected to increase one’s protection 10-fold. That said, after my 50-year-old gets vaccinated, her titer may be as high as 60; still well above the cutoff, but well below my average senior patient at 400 who I will be required to give a booster.

What is the appropriate titer the CDC wants me to boost my patients to above the standard safe cutoff of 0.8 that already exists? I have a 93-year-old patient who did not meet current guidelines for a booster and her pharmacy gave her the shot anyway. Her titer is now greater than 2,500. Did she really need that booster? Do we continue to allow pharmacies to give boosters at-will without verified medical information?

There are Americans below the age of 60 at greater risk of breakthrough infection, based on their antibody levels, than some seniors. Clearly by the science and the data, boosters should be individualized for at-risk groups based on antibody titers and not age groups at a set time. Vaccinated Americans should know their COVID19 antibody titers so that a reasonable, informed decision can be made with their doctor about if and when they will need a booster.

We are about to waste 200 million doses of vaccine on a population that does not need them. Those are doses of vaccine that would save millions of lives around the world, as well as prevent additional variants that can emerge from developing countries and threaten Americans at some point.

Dr. Cecil Bennett