As vaccine makers seek approval for a fourth dose of their Covid vaccines in America, existing vaccination delays and a lack of federal funding could slow the next rollout of boosters across the country, experts say.
“We’re way behind the eight-ball,” said Eric Topol, founder and director of the Scripps Research Translational Institute. The launch of the first round of boosters approved in the US last fall “just fell off the cliff,” with many Americans still not realizing they are eligible or that the booster is endorsed.
With a potential second booster on the horizon for vulnerable groups, the Biden administration is still struggling to spur US public interest in additional firing — and funding for Congress to fund Covid initiatives.
“We’re pretty much out of money for pandemic spending, which is scary because we don’t know what’s coming around the corner,” said Katrine Wallace, an epidemiologist at the University of Illinois Chicago.
Pfizer-BioNtech asked the US Food and Drug Administration (FDA) on March 15 for another round of booster shots for people ages 65 and older, while Moderna went a step further and on March 17 offered another booster shots for people ages 18 and older the FDA asked for “flexibility” in considering who would benefit from additional shots, including at-risk younger people, the company said.
The doses in question would be the original formulation of the vaccines. Omicron-specific vaccines are still in the experimental phase, but scientists believe updating the vaccines as the virus evolves could expand the immune response to future variants.
A $15 billion funding package for tests, treatments, vaccines and more was unexpectedly removed from a Congressional spending bill on March 9th.
Health officials discussed the urgent need for Covid funding at a meeting Wednesday with Democratic senators, Politico reports, but the plan could face opposition: Republicans who didn’t attend the meeting say the $22.5 billion -The White House’s request must be accompanied by equal cuts in government spending elsewhere.
There is ample funding to give fourth doses of the vaccines to immunocompromised people who already qualify for the vaccinations and people over 65 if the vaccine is approved for them in the coming weeks, the coronavirus response coordinator said , Jeff Zients, at a White House briefing on Wednesday.
But broader booster campaigns would not be funded under the current budget gaps, and first- and second-shot campaigns could also be affected in the longer term.
The collapse in funding may also affect future research into updated vaccines and treatments. “We may see a new variant that escaped all of these, and we need a new vaccine,” Wallace said. Without the funding to manufacture and then distribute the updated vaccines, “that’s going to be a problem.”
According to a US Centers for Disease Control and Prevention (CDC) study released Friday, three doses were on average 94% effective against requiring mechanical ventilation or dying during the omicron surge.
That kind of effectiveness is “a miracle,” Topol said. “It’s incredible, but it’s never been conveyed to the public – it’s amazing to me.”
“If we had chemo that would do that for cancer — increase the odds of survival that much — everyone with cancer would want to get it,” Wallace said.
Yet only about 29% of the US population has been augmented. Less than half (44%) of all Americans who received their first vaccinations continued the series, although that number is higher for those over 65 (67%).
“There was a big push to get people fully vaccinated, which was the two doses, but not as big a push for the booster,” Wallace said. “A lot of people just don’t understand that the booster is now available to everyone.”
When boosters were first introduced, they were limited to certain demographics, including elderly and immunocompromised Americans, and healthcare workers, before opening up to all adults and eventually children 12 and older.
“There was mass confusion, and that’s why the reception is so bad,” Topol said.
Some populations — including older Americans and health workers — received their first booster shots last fall, raising concerns about waning effectiveness among those most at risk of contracting the virus or becoming very ill.
The effectiveness of the third dose in preventing hospitalization drops to 78% four months after the booster, according to another recent CDC report.
In a recent study from Israel, a fourth dose of mRNA increased antibody levels and provided slightly better protection against infection.
Members of the FDA’s Independent Advisory Committee will meet on April 6 to discuss further regulatory approvals for boosters, particularly with regard to new and emerging variants.
No vote is planned for the advisors’ meeting, which will focus on a framework for boosters rather than specific regulatory submissions.
The CDC recommends that anyone age 12 and older who has received two doses of an mRNA vaccine or one dose of the Johnson & Johnson vaccine should also receive a booster shot two or five months later, depending on the vaccine.
Those with compromised immune systems — including cancer patients, organ transplant recipients, people living with HIV, and those who regularly take immunosuppressive drugs like corticosteroids — may be eligible for as little as a fourth dose because they may not have a strong or sustained response to the first three shots . About 2.7% of Americans, or about 9 million people, are immunocompromised.
Officials must also step up efforts to vaccinate those who are not fully vaccinated, which makes up about a third of the US population. “We’ve got to kind of try to get our footing in this group because it’s big,” Wallace said.
And vaccinating the rest of the world is key to halting the waves of the virus and the emergence of new variants around the world.
Those three groups — the immunocompromised, those over 65 and the unvaccinated — should be given priority before others get the fourth dose, Wallace said.
The US is likely to see another wave of Covid and it may take weeks for vaccines to take full effect, making vaccination campaigns now urgent, experts said.
“It’s good that there is a lull in circulating viruses — that’s wonderful,” Topol said. “This is the time to guard for the next wave of which there will be one or two or more – but that has not been conveyed.
“People have been lulled into a zone of complacency, which is unfortunate,” Topol said. “It’s understandable after all the tiredness and everyone’s so sick of it, but it’s not what’s on the cards and we have to prepare, defend and protect people.”