Is it time for a booster?

The delta variant has been a challenge to the nation and the world as cases continue to soar. Based on the current numbers, we are back where we were at in October of 2020. The problem is that we got here much faster than back then. The rate of infection is twice what it was in 2020 and doesn’t seem to be slowing. Vaccinations have helped some states keep their levels down, but the rates are still the same across the nation as the delta variant can infect even some of those vaccinated. So, what is the next step in fighting this pandemic?

Based on recent studies, it seems that immunity from the vaccines and from prior infection does wane over time, but that can vary depending on a number of factors. How long before the body can no longer fight the virus adequately is unknown as it has only been 8 months since the first public vaccines were administered and 5 months since widespread distribution began. Until more data is collected, meaning people previously vaccinated or infected become ill with COVID-19, we do not know when something like a booster is needed.

Both Pfizer and Moderna have said that a booster shot will be needed sometime this fall to help maintain immunity from the coronavirus. The question is when in the fall and what kind of booster? Should a new vaccine be created that targets the new variant or will the existing vaccine be considered adequate to stave off the delta variant? If a new vaccine is required, it will take more time to vet and manufacture and could push the booster out to late 2022. If the existing vaccine is considered adequate, there will still be rising infections, but the severity of their impact will be diminished based on data.

While the FDA has not decided on when or whether a booster shot will be needed for all, much less what type booster shot, it has decided to fast track possible authorization of a booster shot for immunocompromised adults who have not exhibited the same robust response to the vaccines. Some countries are already considering booster shots for the elderly and vulnerable starting next month, despite a request from the WHO to hold off and target vaccines to countries who have not been able to get doses of the vaccines.

Even as cases are rising at twice the rate as before, deaths have been lagging. This is something that was seen in other countries that experienced the rise of the delta variant, particularly the UK. While there has not been any detailed study on this, my guess is that while infections surge at twice the rate, the impact of the virus on the body is not much different than prior variants. That means that infections are outpacing deaths and that a wave of deaths is coming in the next few weeks.

Where this becomes a problem is with hospital capacity. Because the rate of infection and hospitalizations increase at a pace faster than recovery, that will lead to hospitals unable to meet demands beyond what we saw during the holiday surge. If this persists into September, particularly among vaccinated adults, that could drive demands for a booster and accelerate the FDA to address the demands. It would also mean we would just get another shot of what we got earlier in the year.

A lot of unknowns as things are playing out in ways we never expected they would.

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