So I read the anti-booster Lancet article against approving boosters is darn weak. I’ll comment on their argument.
Although the idea of further reducing the number of COVID-19 cases by enhancing immunity in vaccinated people is appealing, any decision to do so should be evidence-based and consider the benefits and risks for individuals and society.
Well, duh. Of course decisions should be evidence based and consider benefits and risks.
Most of the observational studies on which this conclusion is based are, however, preliminary and difficult to interpret precisely due to potential confounding and selective reporting.
Also: duh. But the Israeli data is the least subject to selective reporting. Yes. All population studies are potentially confounding.
Even if boosting were eventually shown to decrease the medium-term risk of serious disease, current vaccine supplies could save more lives if used in previously unvaccinated populations than if used as boosters in vaccinated populations.
Perhaps they “could” save more lives “if”. But so what? We don’t live in a board game where the MD’s who write Lancet articles can just magically create vaccine and deploy it into the arms they want. There is very little reason to think that the US, Israel or the UK not getting boosters will magically teleport vaccine supplies into Africa, Asia, South American and so on. There is even less reason to believe letting American’s who want boosters get them will increase the likelyhood a single anti-vax inclined American will not get the vaccine. They already don’t want a vaccine.
Moreover: I’m pretty sure if the Lancet authors know of a way to get the “not-used-for booster” supply vaccine supplies to the developing world they’d add a sentence to tell us how.
Although the benefits of primary COVID-19 vaccination clearly outweigh the risks, there could be risks if boosters are widely introduced too soon, or too frequently, especially with vaccines that can have immune-mediated side-effects (such as myocarditis, which is more common after the second dose of some mRNA vaccines,3 or Guillain-Barre syndrome, which has been associated with adenovirus-vectored COVID-19 vaccines4
).
First: This is just pearl clutching based on “if”. Of course there always “could” be risks. Of course “if” the booster kills everyone, then we shouldn’t get one. If. If.
Second: Of course we should monitor for safety. But I note the Lancet authors point to nothing to suggest the risks of the boosters are higher. Bubkiss. Israel is already deploying. Is there any evidence of these heightened risks? Surely the Lancet authors could point to some if they were aware of any.
Thus, widespread boosting should be undertaken only if there is clear evidence that it is appropriate.
This is back-assward reasoning. Or perhaps I don’t know what they mean by “clear evidence” or “appropriate”. Presumably that is somehow different from “convincing”? Or “reasonable”?
It’s my view if there is reasonably convincing evidence boosting provides a material benefit to those receiving boosters they should be approved for distribution unless, there you find some evidence of material risks that outweigh the benefits. Is that what they mean by “clear” or “appropriate”? We don’t know because they don’t say. They resort to the structure of demagoguery.
I’ll note they present to no such evidence of increased risks due to boosters. (And there have been many given.)
But to go further: I don’t also don’t know how their choice “widespread” word works here. Maybe they only mean they don’t advocate going as far as Israel has? But there’s reason to believe they want to block approval so that even those who want the booster cannot get it even if they like.
I’m ok with governmental authorities giving permission to get the booster, but saying “it’s up to you”. But then, that’s mostly always been my view. I realize the FDA has not liked that view. But that’s been a long term criticism of the FDA.
Although the efficacy of most vaccines against symptomatic disease is somewhat less for the delta variant than for the alpha variant, there is still high vaccine efficacy against both symptomatic and severe disease due to the delta variant.
“Still high” here means as low as 60% against infection with Gamma and 70% for Beta.
Of course I am more worried about “severe” covid compared to “just infected”. But guess what? I also don’t want to be “just infected” if it is possible to avoid. So while the efficacy of the vaccine is high enough for me to be happy I am vaccinated rather than not, it is also low enough for a booster to materially help me if the booster helps.
My standard for wanting a booster is the same it was for the original vaccine: I want it if it gives me a boost of ~20% in protection against infection or severe disease relative to what I currently have.
I consider 20% increase in protection a material benefit to me. But it seems to me the Lancet authors don’t give a hoot whether the booster might materially benefit me.
Current evidence does not, therefore, appear to show a need for boosting in the general population, in which efficacy against severe disease remains high.
This is simply their opinion based on their (rather mysterious) judgement to utterly discount the benefit of not getting sick at all and their (rather mysterious) judgement to decide that 60% is “high” and that for some reason, people can’t want even better than 60% protection.
They then go on with some rigmarole how studies are hard so we don’t really know people “need” boosters. Sure. But they are once again reporting to the “if we don’t know X” then the truth must be “not X” reasoning.
Yes: it might turn out people who get boosters get little more than peace of mind (which turns out to be an illusion.) That is still a benefit, and outweighs any dangers they have shown evidence for. (Reminder: they point to absolutely zero evidence of material harm from boosters. It’s all “if they harm”.)
To date, none of these studies has provided credible evidence of substantially declining protection against severe disease, even when there appear to be declines over time in vaccine efficacy against symptomatic disease.
I see what you are doing here Lancet authors. You are ignoring the “even when” part. Sorry Charlies, but I don’t want symptomatic disease. And like it or not, Charlies, avoiding symptoms is a valid reason to get a vaccine. That’s why people get shingles vaccines.
The authors them go on to pooh-pooh the Israeli evidence that boosters provide material improvement in immunity to those who get them. (And, in my view, whether boosters give material improvement to those who get them is one of two only factors that are relevant. The other is whether we have evidence of material risks– not just hypothetical “ifs”.)
And the Israeli study does point to material benefits.
The quick turn around Israeli study shows an 11.4 fold decrease in relative risk of infection for booster vs. no booster. And that includes a decrease in the relative risk of getting sick at all. (Reminder: Even if the Lancet authors think I should only worry about “severe” illness, I don’t want to get sick at all.)
The decrease in relative risk of being hospitalized was 15.5 fold! That’s material.
The Lancet article authors clutch their pearls suggesting path might not last. Well. No. But that the new found increase in immunity might not last is a mighty odd standard given that the drive for boosters is, in part, because the original immunity might not last! Double Standard, much? (Yep!)
In all: I think the Lancet article amounts to an opinion piece, in which the authors opinion is that, somehow, even 60% efficacy is “enough”, that “symptomatic only” disease doesn’t matter, “worry” about “ifs” related to risks, and utterly discount evidence of material benefit to those who get boosters. They use fuzzy use of language where they can (what do they mean by “widespread” distribution of boosters which they pretty vehemently advise against? Is allowing people to chose to get boosters “widespread” distribution? They don’t say. And they supposedly prioritizing getting boosters to developing countries without making any real case that not providing boosters will actually accomplish that goal. (Oh. And it won’t.)
And don’t know if the FDA should or should not approve boosters. Perhaps risk data exists that I am not aware of. But the Sorry Charlie authors of the Lancet article didn’t bring any forward even though doing so would have boosted their case.
Am I going to drive to Wisconsin to get an unauthorized booster tomorrow? No. I’m still going to wait to hear more from Israel. But right now, based on reading the Lacent article, I’m saying the case against approving boosters looks mighty weak.