Following the FDA’s authorization and the CDC’s recommendation that all children ages 12-17 should receive COVID-19 booster shots, Paul Offit, MD, director of the Center for Vaccine Education at Children’s Hospital of Philadelphia, reflected on the US vaccine strategy We do. Offit, who serves on the FDA’s Vaccines and Related Biological Products Advisory Committee, also investigates some missteps in communicating with the public during the pandemic.
Following is a transcript of his remarks:
Recently, what we did is that we recommended a booster dose for children between the ages of 12 and 15. What percentage of children in that age group are fully vaccinated? about 50%. This means that 50% have not been vaccinated. Does it really make sense to focus on protecting those who are already protected from serious illness? Or should we really dedicate our resources to protecting those who are downright vulnerable?
If you work in a hospital, as I do, and you see kids who are 12 to 15 years old come to your hospital, they’re not there because they didn’t get the third dose, they’re there because They haven’t received any doses. I mean, it is really, at least at the hospital level, a disease for the illiterate, and that should be our focus. I think to some degree we’ve given up on that, and this constant talk about promotion is in many ways a detour.
The question is, what do we want from this vaccine? If we want to prevent serious disease with this vaccine, then the current two-dose vaccine strategy for mRNA vaccines, or the two-dose strategy for J&J [Johnson & Johnson] The vaccine provides protection against serious disease up to the present day for all age groups. So if that’s the goal, we’ve reached it. If, on the other hand, the goal is to try and prevent even a mild illness, which will fade over time, you can argue for a booster dose, realizing that the booster dose will give you more than what you need. The protection dose against mild illness will probably last about 3 to 4 months.
I think there are many misconceptions regarding these vaccines. For example, a year ago, when in December, we used to consider the FDA Vaccine Advisory Committee, Pfizer and Moderna Vaccines. What you saw was 95% efficacy against mild disease. It was remarkably high. The reason it was so high was that they were studying for 3 months. In other words, most of the participants in those studies had recently received their second dose. The neutralizing antibodies were therefore higher and therefore the effectiveness against mild disease was greater. There was no way that was going to last. The neutralizing antibody had to come down and therefore the defense against mild illness had to be reduced.
The second miscommunication, I think, occurred on July 4th of last year when thousands of men gathered together for a holiday in Provincetown, Massachusetts. About 80% of them were fully vaccinated. Still, 346 of those men developed COVID; 346 fully vaccinated men developed COVID. Of those 346, four went to the hospital, with a hospitalization rate of 1.2%. That’s great. This is a vaccine that is working well. Another 342 had mild illness or no symptomatic infection. Those transitions were called breakthrough transitions, and that [term] It should never have been stipulated that we should be using it.
The word “success” means failure. This is not failure. What you want from these vaccines is that you want protection against serious disease. For vaccines such as the influenza vaccine or rotavirus vaccine, or the pertussis or whooping cough vaccine, you get excellent protection against moderate to severe disease, but not very good protection against asymptomatic or mild symptomatic effects. That would be true for this vaccine as well, and I think we’ve inadvertently cursed this vaccine by holding it up to a bar that’s nearly impossible to reach.
What makes Omicron difficult is that, although everyone talks about how it is more contagious, it is technically not actually more contagious. The infectivity index for Delta was between 5 and 9. So the infectiousness index means that, if it is a contagious index of 5, for example, it would mean that if I had an infection and went about my normal day and came into contact with everyone who was susceptible. I will infect five more people.
The infectivity index for Omicron is probably somewhere between 3 and 5. There is no evidence that it is more contagious. The problem with Omicron is that it is somewhat immunosuppressive. So even if you have been vaccinated, you can still get a mild infection. For example, if you look at Delta and Omicron in the home of unvaccinated people, it’s actually fairly evenly spread. However, if you see Delta and Omicron in a household where people are vaccinated or even vaccinated and raised, you are more likely to get mild illness with Omicron than with Delta. happens more. And that’s the problem with Omicron. Even people who are vaccinated can get mild illness. And that’s why you see such a huge increase in cases, but you don’t see a proportionately huge increase in hospitalizations and deaths.