Has Israel become the over-inoculation nation for COVID?
Should people be forced to get a COVID-19 booster just for the privilege of entering Israel?
The Health Ministry is requiring a third shot for everyone entering the country through Ben-Gurion Airport more than six months after they were vaccinated, regardless of with which vaccine they were inoculated, or they are forced to be isolated a minimum of seven days.
The policy presents particular difficulties for those who were not vaccinated with Pfizer and for whom a booster might not be advisable or available.
People who received two shots of Moderna, for example, are being unofficially told to get a Pfizer vaccine booster, which in the US is only approved for people 65 years and older, or who are at high risk of getting coronavirus or developing severe disease.
Moreover, on Tuesday at the Jerusalem Post Annual Conference, Dr. Sharon Alroy-Preis, head of Public Health in the Health Ministry, said that Palestinians who were vaccinated with two shots of Moderna six month ago had lost their Green Passes. They can still enter Israel to go to work, but they cannot visit any establishments that require a Green Pass unless they take an antigen test.
The situation raises medical and ethical questions, since it is still unclear if, or certainly when, a booster shot should be required for people who received Moderna.
A key US Food and Drug Administration panel was set to hold a meeting late Thursday to discuss and vote on the use of Moderna’s COVID-19 booster shots. Depending on the results of that meeting, the FDA could make a final decision within days as to whether the booster should be used. Then, the Centers for Disease Control and Prevention would make specific recommendations on who should get the shots.
While at press time, a recommendation had still not been reached, it is unlikely the FDA will vote in favor of a mass Moderna booster campaign.
In Israel, the country has seen what Alroy-Preis described in other interviews as a “break in the epidemic curve” thanks to its booster campaign, which now includes around 50% of the eligible population. However, Israelis have almost exclusively taken the Pfizer vaccine.
Moderna, like Pfizer, is a novel mRNA vaccine. Their basic technology is the same. Therefore, it can be assumed that the Moderna vaccine’s effectiveness will also wane.
However, the vaccines are not identical.
Moderna is two shots of 100 micrograms while Pfizer is only 30. In addition, the two Pfizer doses are administered three weeks apart compared to Moderna’s four.
Some studies also show that longer gaps between administering these vaccines make them last longer and that more neutralizing antibodies are developed.
NEARLY ALL research has shown that Moderna’s effectiveness wanes slower than Pfizer’s.
While one study found that after six months Pfizer was only 42% effective in protecting against COVID infection after six months, Moderna was more than 70% effective. Moreover, a CDC report published last month found that while Pfizer had become less than 80% effective at preventing hospitalization after four months, Moderna was still more than 90% effective.
Of course, any waning is not good because it increases the chance of infection. A person who has coronavirus is contagious and could spread the virus to someone unvaccinated, including a child or an immunocompromised individual, who could then develop serious disease.
Though some studies have shown that vaccinated individuals in general are less likely to shed the virus, others have contradicted this premise.
Additionally, there is likely no danger in getting a booster shot. The FDA approved Pfizer’s booster only for a limited population but not because it was unsafe, rather because they did not yet have enough data they said to deem it necessary in the US at the present time.
Preliminary reports by FDA scientists released earlier this week said that the Moderna booster shot did not seem to increase protective antibodies substantially.
In some countries, a third shot of Moderna is already being encouraged, according to Prof. Cyrille Cohen, the head of the Immunotherapy Lab at Bar-Ilan University. In France he said for example, a person 65 or older and people who work in healthcare or who live with someone who is immunosuppressed can get either a Pfizer or a Moderna booster six months after taking one shot of the Johnson & Johnson vaccine or two shots of any other vaccine.
A recent study by the National
Institutes of Health showed that people who took the Johnson & Johnson vaccine developed four times more antibodies if they took a second shot of J&J, 35 times if they got a shot of Pfizer and 76 times more if they took a dose of Moderna.
Not being dangerous and being valuable or necessary are two different things.
Even though a third shot would likely not cause harm, if getting one does not improve protection in some cases, then doing so is superfluously medicating and also wasting precious resources.
While an advisory group to the World Health Organization said earlier this week that people with weaker immune systems should receive an additional shot of approved COVID19 vaccines, the organization continues to discourage mass booster campaigns. WHO said that the focus should be on poorer countries with low vaccination rates to better help stop the pandemic.
Some 80% of the 5.5 billion COVID vaccine doses that have been administered worldwide have been given in high and upper-middle income countries, WHO has said.
“Another thing to consider is that it makes sense to wait to take the booster until it is needed to prolong the protective effect of the vaccine,” Cohen said.
Israel was correct to pioneer the Pfizer booster.
Someone has to be first and Israel was the first to vaccinate, the first to research and to have solid data to show that the Pfizer vaccine waned and people were at risk. Given the severity of the pandemic and the benefit of the booster shot observed lately in Israel, it seems the country made the right decision not to wait for the FDA when its own scientists felt confident.
However, Israel has not been researching Moderna and should likely wait for more data, and until it has it, should make a separate policy for people entering Israel who received it.
Vaccinating intelligently is the key to stopping the pandemic. Israel should be praised for being bold, but the country should be cautious to not push for over-inoculation.