COVID-19 Booster Shots for Older Americans Might be Needed

Sharon Alroy-Preis, MD, MPH, MBA, the director of Public Health Services in Israel stated on Face the Nation yesterday that they are seeing evidence of the effectiveness of the Pfizer/BioNTech COVID-19 vaccine waning over time. Overall, it is still very effective in preventing hospitalizations and deaths, with the exception of those over 60 who have been fully vaccinated before the end of January 2021. Below is a slide from the Ministry of Health Israel.

Source: Ministry of Health of Israel

It is in Hebrew but here is our translation:

Title: Verified after receiving the vaccine, Among the first vaccinated group
From the 1,848,568 people that received two doses of the vaccine by Jan. 31, 2021:
From 07/02 to 10/07 (From Feb. 7, 2021 to July 10, 2021)
1,152,194 got PCR tested
5,770 got corona since vaccination, of which:

* 495 were hospitalized
* 334 were difficult cases or worse (life threatening)
* 123 died

Most of the infections in Israel are caused by the Delta variant. Overall if there was a breakthrough infection: 8.6% hospitalized and 2% died. However, the test positivity rate appears to be low, about 0.3%, indicating that vaccines afford protection against infection.

As can be seen in the right-hand side of the grey/back graphs in the slide below, severe cases and deaths are reappearing in vaccinated individuals above the age of 60, but still staying at a low level in those individuals under the age of 60.

Source: Ministry of Health of Israel
Slide Translation:
Title: Vaccinated in two doses by 31/01/2021 (Jan. 31, 2021)
Hospitalizations, severe morbidity and mortality
Red separated by age: how many vaccinated people hospitalized
Vertical Axis Red: Number of people hospitalized
Horizontal Axis: Week of Hospitalization
Black/gray: how many life threatening situations (gray) and deaths (black).
Vertical Axis: Number of People with Life threatening illness (Black is dead)
Horizontal Axis: Week of difficult cases or death

The initial deaths and hospitalizations shown in the data in the above slide may be due to immunocompromised individuals who did not respond well to the vaccine. But in the elderly, this pattern is now recurring.

As previously reported by Infection Control Today®, the vaccine efficacy rate in preventing infections was 39% and symptomatic infections, 41%. Efficacy in preventing hospitalizations along with severe COVID-19 (including deaths) is approximately 88% and 91%, respectively.

Needless-to-say we need to have robust data being produced by the Centers for Disease Control and Prevention (CDC). In an interview on CNN last weekend, Leana Wen, MD, an emergency physician and visiting professor of health policy at George Washington University, stated that “we are blind without data. This happened during the Trump administration, and we called out the Trump administration for it. Just because you are not testing does not mean the cases do not exist. It just means you do not know about it.”

The CDC data which Wen and epidemiologists have called for includes:

• We need to start collecting data on breakthrough infections and determine who is most likely to develop these infections.
• We need breakthrough infections by the type of vaccine.
• How often do people with breakthrough infections develop long COVID-19.
• Can asymptomatic patients with breakthrough infections spread the infections to others?

Some data are starting to emerge. On Face the Nation, Alroy-Preis stated the ability to transmit the disease in vaccinated individuals was 50% lower than non-vaccinated individuals. And a small report from Israel studying health care workers with breakthrough infections found 19% still had residual symptoms at greater than 6 weeks after their diagnosis, including symptoms of “prolonged loss of smell, persistent cough, fatigue, weakness, dyspnea, or myalgia.”

The take-home message from the Israel data is that the Pfizer/BioNTech vaccine is highly effective in preventing severe disease in those who have been vaccinated, with the possible exception of those over 60 years of age who were fully vaccinated before the end of January.

Those who are not vaccinated need to become vaccinated and, similar to Israel, those over the age of 60 who were fully vaccinated before January of this year, should be considered for a booster.