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WASHINGTON — The Biden administration announced on Wednesday that Americans who are already vaccinated against the coronavirus will need booster shots in order to “extend and enhance the protection the vaccines are giving us,” as Surgeon General Vivek Murthy put it during a White House pandemic response team briefing.
“The time to lay out a plan for COVID-19 boosters is now,” Murthy said. “Recent data makes clear that protection against mild and moderate disease has decreased over time.”
Booster shots will begin on Sept. 20, Murthy said, although he described approval of the Food and Drug Administration as “pending.” People will become eligible for booster shots eight months after having received their second dose of the coronavirus vaccine, meaning that older and more vulnerable people, who were the first to receive their vaccinations last winter and spring, will also be the first to receive their booster shots come fall.
The shots will be free, White House pandemic response coordinator Jeff Zients said, and recipients will not be asked for immigration status or insurance information. He said boosters would be as easy to obtain as the vaccines have been.
So far, third doses will be made available only to recipients of vaccines manufactured by Moderna and Pfizer, which use a technology called messenger RNA, or mRNA. The single-dose Johnson & Johnson vaccine used an older technology, called an adenovirus vector. Murthy said that recipients of the Johnson & Johnson vaccine should also expect to become eligible in the near future.
The announcement comes as the Delta variant continues to sweep across the nation, causing infection rates to rise and hospitals to fill. Coronavirus vaccines are highly effective in preventing serious and critical illness. But, as Murthy said during Wednesday’s briefing, they show a “pattern of decline” in efficacy over time.
That pattern of decline was most pronounced in the data from Israel, where the economy fully reopened and new daily cases plummeted to zero this spring, after more than 70 percent of adults were double-jabbed faster than anywhere else. Yet starting in July, Delta sent cases skyrocketing again, and they’re now higher (with more than 8,000 reported Tuesday) than at any point since February — even higher, relative to population size, than in the United States.
After studying the numbers — including the fact that residents over the age of 50, whose vaccination rates are relatively high, now account for 90 percent of Israel’s new cases — Israeli officials concluded that (in combination with Delta’s increased transmissibility) waning immunity from early vaccination with two doses of the Pfizer vaccine spaced three weeks apart was making it easier for the virus to spread.
According to the Health Ministry, protection against severe illness among those over the age of 65 who received a second shot in January had fallen as low as 55 percent, and the Pfizer vaccine’s effectiveness in stopping new infections in everyone who was fully vaccinated that long ago had also dropped sharply.
In response, Israel recently became the first nation in the world to begin offering a third dose of the Pfizer vaccine to people over 50 (as well as health workers, prisoners and prison staff, and other high-risk groups). So far, more than a million Israelis have received a booster, and third-dose recipients appear to be 2.5 times more protected from infection than those who received only the first two doses, according to Health Ministry figures.
“We have initial information about the influence of the third dose [in preventing] infection,” the Health Ministry’s director-general, Nachman Ash, said Sunday, giving “an initial estimate” that boosters would reduce the number of new cases by 50 percent.
Experts are still debating how much vaccine protection has waned, but other studies are starting to corroborate Israel’s findings. A Mayo Clinic study that tracked infections through mid-July, for instance, found that effectiveness declined especially sharply for the Pfizer vaccine, from 76 percent to 42 percent. The drop was markedly less steep for Moderna, from 86 percent to 76 percent. Some scientists have suggested that a longer interval between initial doses — Moderna recommends four weeks between shots, and the U.K. concluded that eight weeks is optimal — may provide a stronger, more durable shield.
It’s important to note, however, that the sharpest decline in protection appears to be from infection rather than illness, meaning that a vaccinated person simply tested positive. An earlier study, of a Delta-fueled outbreak in Provincetown, Mass., found that among hundreds of vaccinated people who tested positive for the coronavirus in early July, only seven were hospitalized — and none died.
“Vaccine effectiveness against severe disease, hospitalization and death remains relatively high,” Centers for Disease Control and Prevention Director Rochelle Walensky said during Wednesday’s briefing, describing three recent studies, including the one conducted by the Mayo Clinic, that led her and other top officials to conclude that boosters were necessary.
“The data consistently demonstrate a reduction of vaccine effectiveness against infection over time,” she said, although she repeated that there is clear evidence of “stable and highly effective protection” for the vaccinated against severe and critical illness.
But with only about half of the nation vaccinated, and the Delta variant showing a much greater ability to spread than earlier variants of the coronavirus, the danger is that vaccinated people could spread the virus to their unvaccinated counterparts — even if they do not become ill themselves. Walensky and others have called the recent surge a “pandemic of the unvaccinated,” since they are far more vulnerable to serious cases of COVID-19 than people who are not vaccinated.
A fourth study introduced by Walensky showed that the Delta variant had a greater ability to evade vaccines, regardless of how much time had elapsed since vaccination. That study showed the effectiveness of vaccines dropping from 92 percent to 64 percent.
“These data suggest full vaccination in the context of the Delta may be correlated with less protection” than against earlier variants, Walensky explained. Booster shots are presumably intended to bolster those gaps, as well as whatever gaps emerge over time.
“Higher levels of antibody are associated with higher levels of efficacy of the vaccine,” Dr. Anthony Fauci, President Biden’s top medical adviser, said during Wednesday’s briefing. He added that booster shots showed a “remarkable increase” in the antibodies a person’s immune system produced against the coronavirus after receiving a third vaccine shot. He said those encouraging results held for both the Moderna and Pfizer vaccines — and, crucially, against the Delta variant.
Now the Biden administration enters a grueling new stage of the vaccination effort, which began under former President Donald Trump. Biden had hoped for a “summer of freedom” from the coronavirus. The Delta variant has scuttled those plans and now has administration officials scrambling to add a new layer to the already complex vaccination effort.
“We are prepared for boosters,” Zients said, “and we will hit the ground running.”
With additional reporting by Andrew Romano.
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