Too many, too soon?

With a slight bump in cases due to BA.2, the question is – do we need a fourth dose?

Pfizer and Moderna, the two big mRNA vaccine developers have been pushing through media and various press releases their application with the US Food and Drug Administration for that ‘fourth dose’. The evidence they present is based on “data from the Center for Disease Control and Prevention that found the effectiveness of both company’s vaccines against hospitalization dropped from 91% two months after a booster shot to 78% after four months”. This sweeping statement is reckless and the evidence for a fourth shot is based on “how well the Moderna vaccine has protected against the omicron variant in the United States and Israel”.

Let’s dissect the statement provided as justification for another dose.

The United States and Israel are two different countries – and are not the only nations that implement mRNA as the sole vaccines for their citizens. Singapore, a country of 5M people uses mRNA vaccines in over 90% of its population. If you look at the number of COVID19 cases in these countries, the US, a country of 334M people has recorded more than 81M COVID19 cases since the start of the pandemic. In short, it has at least 250,000 cases per million population OR 1 in every 4 Americans have had COVID19. Israel, a country of less than 10M people and the first to roll out the mRNA vaccines and boosters and pediatric vaccination now has more than 3.75M total COVID19 cases. This gives them a per capita of 400,000 cases per million population or 2 in every 5 Israelis has had COVID19. Singapore will exceed the 1M number of COVID19 cases tomorrow. This puts the country at 170,000 cases per million population (or around 1 in every 5-6 people having had COVID19). The data clearly shows that the mRNA vaccine are NOT transmission blocking agents. It works at reducing the risk of more severe infections, but will definitely change how mild or asymptomatic infections develop among those who get sick from SARS-CoV-2.

Deaths are a different endpoint. The US has also the highest number of deaths in the world with close to 1M dying from COVID19 since the start of the pandemic. Deaths are a lagging indicator and therefore underreported everywhere. The US has almost 3000 deaths per million population or 1.3% case fatality rate. Israel on the other hand has had just more than 10,000 deaths or 1117 deaths per million population or 0.3% case fatality rate. Singapore has almost 11,000 deaths or 201 deaths per million or 0.18% case fatality rate. This shows that other factors are highly dependent on outcomes of this pandemic. Why some countries have lesser fatality rate compared to others are likely due to factors not due to vaccine protection alone.

The study of the CDC Prevention and Control was a very broad snapshot. Very broad is an understatement. It failed to factor in hospitalization by age, presence of underlying conditions and basically other intangible factors like mask wearing, distancing and other minimum health standard measures.

If a second booster after two full doses is short-lived, what assures the developers of the vaccine that additional doses will provide longer protection? Which begs the answer to the question – how many booster shots should one get? At the rate the recommendations are coming from the “pharmaceutical companies”, it looks like a quarterly jab. If this is true, then the bottomline is that the mRNA vaccines are short-lived and providing a homologous vaccine may not be the way to go in preventing COVID19 infections (even from mild infections). There are ‘mix and match’ studies (heterologous vaccination) that demonstrate a more sustained immunologic response against mild infections. The other observation is that while protection MAY be waning against mild infections, without more data and better randomized controlled trials, is protection waning against severe disease? If the answer to the latter question is NO, then why would you push people into getting more shots. Again.

The uptick in cases in the past week is driven by countries who are going through BA.2 wave. But governments and people are tired of lockdowns and this pandemic has affected global economies and the way people interact with others.

There are no long term studies for ALL the COVID19 vaccines. We know they work at preventing more severe disease. We know they do not block transmission. We know that there are adverse effects in a very minority of the population. We know that it doesn’t work at lower doses in a select age group for now.

The drug companies and regulators forget that the pillars of a drug being approved for human use and recommendation lies in three key words: quality, safety and efficacy. One cannot help but think that there are those that simply take advantage of the pandemic situation.

Before making further recommendations and giving the nod to Moderna on the fourth dose for all, the data presented must show definite advantage in the long run on those key issues. Do we really need another shot soon?

4 thoughts on “Too many, too soon?

  1. HL March 19, 2022 / 4:24 pm

    Exactly!!!!

    Like

  2. lordmychef March 19, 2022 / 5:13 pm

    Thank you, Doc Benjie for this very enlightening piece.
    This is the reason why i never accept every news on covid not until i have read your analysis.
    You are a gift, a grace from God. He must be so happy with you, Doc.
    God bless you more!

    Like

  3. Tata Rivera March 19, 2022 / 7:04 pm

    Agree doc … now is the time to be more discerning and not jump the gun to soon especially on vaccination.

    Like

  4. rvmoran March 21, 2022 / 6:47 pm

    You might be interested to read this article from the NY Times a couple of months ago about boosters.

    Like

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