A year after Britain became the first country in the world to approve a coronavirus vaccine, the arrival of the Omicron variant has brought with it a new focus: the booster rollout. And, if comments from Pfizer’s chief executive are any indication, it’s a campaign that may never end.
“Based on everything I have seen so far,” Dr Albert Bourla said yesterday, “I would say that annual vaccinations… are likely to be needed to maintain a very robust and very high level of protection.”
The UK says it has pre-empted this booster-filled next phase, announcing this week that it has bought enough shots for two more per person, with 54 million doses from Pfizer-BioNTech and 60 million from Moderna to “future proof” the vaccination programme. But will we be having them forever? Will everyone need one, or just vulnerable groups? And what would a years-long rollout mean for the health service? Here’s what we know so far…
When will COVID booster jabs be given?
All adults should be invited to book a booster shot before the end of January, with the lag between the second and third doses being halved from six months to three.
How often will booster shots be needed?
Professor Saul Faust, leader of a trial looking at the effectiveness of seven different boosters given after two doses of either the AstraZeneca or Pfizer jabs, says that anyone willing to answer this in certain terms is just “speculating”.
“At this point we don’t know,” Prof. Faust, professor of paediatric immunology and infectious diseases at the University of Southampton, explains.
“No one can know at this stage whether we will need boosters every year.”
He says that levels of immunity seen in people after a third dose was much higher than after the first two, adding that the vaccines elicited a broad T-cell response (a key part of the immune system, alongside antibodies).
“Even though we don’t properly understand its relation to long-term immunity, the T-cell data is showing us that it does seem to be broader against all the variant strains, which gives us hope that a variant strain of the virus might be able to be handled – certainly for hospitalisation and death if not prevention of infection – by the current vaccines,” Prof. Faust says.
Which booster should I get?
Prof. Faust’s study, published in The Lancet, which looked at the AstraZeneca, Pfizer/BioNTech, Moderna, Novavax, Janssen, Valneva and CureVac jabs, found that while all worked well as a third dose, some were more effective than others.
“The RNA (Pfizer and Moderna) were very high, but there were also very effective boosts from Novavax, Janssen and AstraZeneca as well.”
Will the vaccine need tweaking to make it more effective?
The flu jab needs to be reformulated every year because a different strain circulates each season.
It’s an imperfect solution because scientists have to make an educated guess as to which strain is likely to be dominant in advance – some years they miss the mark, meaning vaccine efficacy is as low as 10 per cent.
It’s too early to say whether COVID jabs will have to undergo the same process.
The vaccines we’re using at the moment were all developed to work against the original Wuhan or “wild” variant, and we know from the past year that they’re effective against alpha and delta strains. But whether that means they’ll be effective against all future variants is another question.
Should I wait for an Omicron version of the vaccine?
“No,” says Prof. Faust. “People need to have boosters as quickly as they can.”
Scientists at the UK Health Security Agency are currently looking at samples from Prof Faust’s study to see how well the omicron variant can be neutralised by vaccines, so it might be that our current boosters are good enough. Levels of immunity in young people from the Moderna and Pfizer vaccines “are high,” he adds.
Will a future vaccine replace the need for boosters?
There are several trials underway that are testing vaccines that work against multiple variants – to remove the need to tweak a vaccine every year. But scientists don’t know how long immunity from these “variant-busting” vaccines will last, so an annual top up may still be required.
What will this mean for the NHS?
GPs, pharmacies, hospitals and even the military have been roped into this “Great British vaccination effort,” as the Prime Minister described it. Still, there are concerns about the capacity of the health service to tackle other conditions while deploying a vaccination campaign twice the size of the flu jab rollout, which covers roughly 30m people a year. Reports suggest health secretary Sajid Javid and NHS bosses are in talks with GP representatives about relaxing rules which mean family doctors have to do regular health checks for people with conditions, like diabetes and high blood pressure.
But Dr. Bharat Pankhania, a senior clinical lecturer at the University of Exeter, says that a booster campaign would be “good value for money”, but without proper funding and training it could overwhelm the health system.
“We need to have a forward vision,” he adds. “This thing is not going away, and because it’s not going away we need to invest in our primary care networks and community pharmacists.”
Paul Mainwood, an analyst tracking the UK’s vaccine rollout, added that the cost of the current programme “is negligible compared to the cost of
- a) a new lockdown,
- b) crashing NHS capacity in about two months.”
Who is likely to receive an annual booster?
All over-18s will soon be able to book an appointment due to the Omicron strain, but in future – when we know more about variants and immunity – it may be that only those over the age of 50 will be eligible, as they are with flu.
How long before vaccine fatigue kicks in?
While some have raised concerns that seemingly never-ending vaccinations could hit take-up, Dr. Pankhania says that “in my many years of administering vaccines, I haven’t come across anyone saying they’re fed up after having too many jabs.”
What about global vaccine supplies?
Much of the planet still does not have access to coronavirus vaccines – only three per cent of shots rolled out worldwide have been administered in Africa, for instance. Many experts are concerned that the current scramble will only make things worse.
“The only real way to truly end the threat of the virus here at home is to get first and second doses everywhere as fast as possible,” says Romilly Greenhill, UK Director at The ONE Campaign.
“Unless the Government hears that wake-up call, there is a real danger that relying on booster jabs alone is simply a holding pattern rather than a genuine strategy to end the pandemic.”
Could the booster rollout coincide with the flu jab programme?
It could; studies have shown that having a COVID and flu jab at the same time is safe, and has no impact on their efficacy. But while flu is particularly potent between September and February, the COVID jab can be more easily paced throughout the year, says Dr Pankhania. “That should make it much easier… [as] it’s not as onerous as doing it within three months.”
Source: Anne Gulland – The Telegraph