Israel cannot vaccine boost its way out of the COVID-19 pandemic - analysis

WHO Director-General Dr. Tedros Adhanom has been fighting what he considers “blanket booster programs” that are “likely to prolong the pandemic, rather than ending it” for several months.

A health worker is seen preparing to administer the a third COVID-19 booster shot (illustrative). (photo credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)
A health worker is seen preparing to administer the a third COVID-19 booster shot (illustrative).

Israel made headlines this week when it became the first country to recommend the launch of a fourth shot program against COVID-19.

However, the move has experts, and even the World Health Organization, wondering if it pays to be first when it comes with a strategy that might have a limited capacity to slow the pandemic.

WHO Director-General Dr. Tedros Adhanom has for several months been fighting what he considers “blanket booster programs” that are “likely to prolong the pandemic, rather than ending it.”

He called for better use of traditional measures to keep the pandemic under control.

“No country can boost its way out of the pandemic,” Tedros stressed on Wednesday. “And boosters cannot be seen as a ticket to go ahead with planned celebrations without the need for other precautions.”

An elderly Israeli is seen receiving the third COVID-19 booster shot at a Clalit clinic in Jerusalem, on August 1, 2021. (credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)An elderly Israeli is seen receiving the third COVID-19 booster shot at a Clalit clinic in Jerusalem, on August 1, 2021. (credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)

Yet sometimes it seems in Israel that vaccines are seen as magic shots to cure the country’s COVID economy.

The country saw its reproduction rate hit over 1.3 on Thursday and daily cases at their highest point since August, seemingly backing up the Omicron fears of the Pandemic Response Team and the COVID-19 Vaccination Advisory Board, who earlier this week recommended Israel administer a fourth shot to those most at risk.

Prime Minister Naftali Bennett has made his main objective in dealing with COVID clear: Keep the economy open, whatever it takes.

Although he does not sit on the Health Ministry’s committees, it was the prime minister who nudged the country’s health officials to trump the US Food and Drug Administration in the fall and administer a third Pfizer vaccine. Shortly after the decision was made, he wrote an opinion piece for The Economist in which he bragged about his role.

“Fighting a pandemic is like fighting a war, where the strategic decisions must not be made by the experts, the generals, but by the elected government, taking into account a broader picture,” Bennett wrote.

He said the coronavirus pandemic impacts nearly all areas of people’s lives, from the economy to education, from supply chains to mental health and therefore needs to be looked at from a holistic perspective. And whereas public health experts “tend to be conservative and risk-averse,” COVID-19 requires “quick decisions” and “decisive action.

“Sometimes, not making risky decisions can be more damaging than taking a calculated risk,” the prime minister wrote.

ONLY FOUR months later, with Omicron no longer on a jet plane en route to Ben-Gurion Airport but likely in our synagogues and schools, the country’s vaccine committee has once again made an unexpected ruling to recommend giving a fourth vaccination.

It had met on the subject only 10 days prior and ruled in the opposite way.

“I am not sure on what data this decision was made,” Prof. Cyrille Cohen, head of the Immunology Lab at Bar-Ilan University said, noting that none of the vaccine data has changed since December 13, although more is starting to be understood about Omicron.

While it is becoming clear to scientists that the third shot of the Pfizer vaccine wanes between four and six months after inoculation, just like the second dose did, it is still unclear by how much. There is also no data on what benefits a fourth dose would provide.

“A decision was made to give a fourth dose when we do not know how effective it will be,” Cohen said. “We do not even know the efficacy of the third dose against Omicron.

“I am not saying the committee’s decision was wrong, I am just saying I don’t see enough scientific evidence to support or disprove it,” Cohen said.

For the past few weeks, Sheba Medical Center at Tel Hashomer had been pressing the Health Ministry to allow its lab to kick off a fourth shot trial to get answers to some of these questions, but the trial was never approved. Instead, as Sheba’s spokesperson said in a WhatsApp message to press on Thursday, “A fourth vaccine has now become a national and not an experimental research project.”

He said Sheba would start vaccinating personnel on Sunday within the realm of the government’s parameters, although by Thursday evening, Health Ministry Director-General Nachman Ash had not yet given his formal approval nor the exact protocol for administering the jabs.

The Pfizer vaccine was never intended to ward off infection, but to prevent severe disease and death. And it appears that the third shot does a decent job of that already. It also is starting to appear that the Omicron variant causes less serious disease in general than its Delta predecessor.

A study released Wednesday by London’s Imperial College showed that individuals with the Omicron variant of COVID-19 had a 40% lower chance of hospitalization than those who contracted the Delta variant. A South African study released on the same day found that people who caught Omicron between October 1 and November 30 were 80% less likely to be hospitalized than those infected with any other variant during the same period.

To some extent, a fourth shot so soon after the third – and recall that the vaccine committee this week also recommended getting a third shot only three months after the second – is a symptom of the failure of all other preventative COVID measures.

The Green Pass program is not being properly enforced. Many Israelis are lazy about putting on their masks, and the country’s enforcement program falls short.

While masking and social distancing could not stop the entrance of Omicron into Israel, individuals would be less likely to encounter the variant if they respected COVID safety measures.

ISRAEL IS a small country, so the doses that it provides its citizens are not taking a significant number away from the global vaccination effort. And Israel did agree to send more than a million vaccines to Africa through the WHO’s COVAX program. However, Tedros said Wednesday, “Diverting supply to countries that already have high levels of vaccination coverage gives the virus more opportunity to spread and mutate.

“It’s important to remember that the vast majority of hospitalizations and deaths are in unvaccinated people, not un-boosted people,” he said.

More than 125 countries have already issued recommendations on boosters, according to the WHO, which also has said that additional doses may be needed for some at-risk populations.

Multiple studies have shown a decline in vaccine effectiveness, including a more significant decline in older adults.

“Additional doses of a vaccine may be needed as part of an extended primary series for target populations where the immune response rate following the standard primary series is deemed insufficient,” the WHO explained in a statement. “The objective of an additional dose in the primary series is to enhance the immune response to establish a sufficient level of effectiveness against disease. In particular, immunocompromised individuals often fail to mount a protective immune response after a standard primary series, but older adults may also respond poorly to a standard primary series with some vaccines.”

At the same time, WHO has called for a moratorium on booster vaccination for healthy adults until the end of 2021 and to divert those vaccines to lower income countries whose most at-risk populations have not been vaccinated.

“While many countries are far from reaching the 40% coverage target by the end of 2021, other countries have vaccinated well beyond this threshold, already reaching children and implementing extensive booster vaccination programs,” the WHO website said. “Globally, about 20% of COVID-19 vaccine doses, daily, are used for booster or additional dose vaccination.”

Tedros said that a sufficient quantity of vaccines were administered in 2021 to have reached the coverage target by September if vaccines had been distributed more equitably.

Cohen said he does not think there is a “particular problem” with administering a fourth shot to Israel’s most at-risk population and that he believes the shot will be safer than the virus. He also said that in the throes of a pandemic, fast action is required.

“You cannot tell the Omicron to wait two or three weeks until we have more data and then decide if we want to boost or not,” he explained. “But I still believe there is much uncertainty around this issue.”