COVID-19 Notes
By Dr. Satish K Gupta*
Third Dose Booster To Health Care Workers: Myths And Facts
India starts to administer 3rd dose booster to its health care workers (HCW), frontline workers and elderly people with co-morbidities from January 10, 2022. Announcement of this offer was made on December 25, 2021 by Prime Minister Narendra Modi. In his address he preferred to refer it as ‘Precautionary Dose’.
Already 1, 59, 632 new Corona cases are registered in the last 24 hours — the third consecutive day when the cases crossed more than a lakh figure, and the daily positivity rate has climbed to 10.21% from 9.28% yesterday. Modi today chaired a high-level meeting in New Delhi to assess the COVID-19 pandemic situation and the emergence of new Covid-19 variant Omicron and its public health implications for the country.
There are many questions in the minds of HCWs
Who started the third dose booster?
With the resurgence of Delta infection as cases started to rise in Israel despite more than 55% population having received full vaccination by two doses. It was thought that immunity has waned over a period of 5 – 7 months leading to hospitalization of some vaccinated individuals and possibly Delta variant has over ridden the immunity induced by vaccine a phenomenon called as Secondary Vaccination Failure.
A few small trials were done in Israel showing that falling titres of Neutralizing Antibodies could be augmented safely with third dose booster of mRNA vaccine from Pfizer/Moderna.
Early timeline of third dose booster in Israel: Israeli Ministry of Health announced a campaign to administer a third dose of the BNT162b2 mRNA COVID-19 vaccine (Pfizer–BioNTech). The campaign began with immunocompromised patients on July 13, 2021, and was expanded several times to include people aged over 60 years (on July 30, 2021), 50 years (on August 12, 2021), 40 years (on August 19, 2021), 30 years (on August 24, 2021), and eventually the entire population over the age of 12 years on August 30, 2021.
Please Note: The third dose was only given to people who had received the second dose at least 5 months ago. And it consisted of same vaccine as used in primary series.
Is the third dose approved by FDA?
Yes. On August 12, 2021, the US Food and Drug Administration amended the authorisations for both mRNA COVID-19 vaccines (Pfizer–BioNTech’s BNT162b2 and Moderna’s mRNA-1273) to allow for the use of an additional dose* in immunocompromised patients.
On September 22, 2021, the authorisation was extended to include individuals aged 65 years or older, and younger individuals with increased medical or occupational risk.
CDC Approved the Third Dose booster on 23 September, 2021 and the very next day, US President Joe Biden announced to offer it to Americans in phased manner.
The other countries: Apart form USA other countries the UK,Germany, and France Spain also started campaigns to provide an additional dose* for elderly and vulnerable populations, such as immunocompromised patients, who have been shown to mount a lesser immune response to the vaccine. Later these countries also extended the programme to younger and healthy individuals.
But did the third dose booster really work?
Yes, observational studies done in Israel to see the effect of the third dose booster proved the point.
Results of these observational study read:
1. “..findings suggest that a third dose of the BNT162b2 mRNA vaccine is effective in protecting individuals against severe COVID-19-related outcomes, compared with receiving only two doses at least 5 months ago.
Please note the word ‘Severe’ in the above sentence. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02249-2/fulltext).
Another observational study published NEJM in October 2021 showed similar results in decreasing hospital admissions and severe cases. (https://www.nejm.org/doi/full/10.1056/NEJMoa2114255)
Hence, it can be accepted that third dose booster can prevent occurrence of Severe Disease after 5 months of primary vaccination*
But none of the study could prove the effectivity of the third dose in preventing infection after more than two weeks.
Vaccine after vaccine, dose after dose…
Note: Israel has begun to offer a fourth COVID-19 vaccine shot for over 60s, some at-risk groups and medical personnel from 26th December 2021, in line with a recommendation from a panel of health experts.
Israel seems to be dealing with virus as it deals with Palestine. Does it really make sense? Was third dose booster needed in India in October 2021?
With the onset of third dose vaccination in other countries HCW in India started pitching for the need of third dose booster despite decreasing number of new cases in country. But the Government didn’t budge. Rightly so!
Is the third dose booster needed in India now?
Covid Cases (because of Omicron) started rising in Last week of December in India. Hence third booster could be a rightful consideration.
Initial trends in India so far have shown that even primary series of two doses of vaccination is fairly effective in preventing the severe disease and hospitalisation.
In current scenario despite rising cases mainly unvaccinated people are turning serious needing oxygen and hospitalisation. And it is noteworthy that India has not yet started on third dose booster campaign.
So one may confidently admit that even primary series of vaccination stands effective in preventing serious complication of infection.
Peak case load of 25000 cases a day had created havoc during second wave leading to acute shortage of beds and oxygen. But as of January 8, 2022 despite 20181 new cases, 89% beds in Delhi hospitals are vacant. Though these could be initial trends but reports of mild disease from other quarters of the world is reassuring.
What WHO has to say on third dose booster?
WHO does not recommend third dose booster. It rather advises diversion of surplus vaccine doses to needy nations for mass coverage.
Why India offers third dose booster?
Health care workers are most important resource in fight against Pandemic. Mounting pressure of demand of third dose booster and it’s mass usage in West coupled fear of large number of HCW getting infected and sick probably prompted policy makers to allow the same as abundance of caution. Hence India preferred to call it the precautionary dose.
Will it be safe to take the third dose booster?
Yes, there is huge data on safety of third dose booster from mRNA vaccines and some data from Covishield too. Covaxin being a killed vaccine should not cause any trouble.
Was India late in announcing third dose to HCW?
Reports of large number of HCW getting infected with arrival of third wave are disappointing. It has mounted undue pressure on the system. Further the Booster dose likely to take another week to 10days for the effect to come. Things could have been better if action was taken few weeks earlier.
Also read: Treating COVID-19: How to treat suspected case of Omicron?
*Dr. Satish K Gupta is an MD in Medicines, a Visiting Senior Consultant Physician and Internist at Max Super Speciality Hospital, and a Clinical Assistant Professor at GS Medical College, Chaudhary Charan Singh University, Meerut. He is the author of Journey of COVID in India: A Doctor’s Perspective.
