A Brigham and Women’s doctor is ‘skeptical’ about rolling out booster shots



Coronavirus

“Offering boosters to healthy Americans is all but guaranteed to exacerbate vaccine inequity.”

David L. Ryan / The Boston Globe

Federal officials announced this week that starting in mid-September, COVID-19 booster shots will be offered to all Americans to bolster protection eight months after individuals have gotten their second shot of either the Pfizer or Modena vaccine.

The plan is being rolled out with health officials citing concerns that the vaccines’ effectiveness wanes over time, even as the highly contagious delta variant continues to surge.

But some doctors are expressing concern about the approach being taken for the extra shots. 

Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital, wrote Wednesday he is “skeptical” of the effort.

The doctor said he remains a “staunch supporter” of vaccination, since the inoculations are keeping people of all ages out of the hospital and prevent many from dying from COVID-19. 

But at this point, he said he believes the potential upsides and downsides of a third dose for the broader population, rather than just those who are immunocompromised, both seem “uncertain.” 

“While some data show that vaccines may be offering slightly less protection in preventing hospitalization and death as a result of waning immunity and the Delta variant, the vaccines have been holding up remarkably well,” Faust wrote in a piece on “Inside Medicine.” “Nothing I’ve seen suggests that a boost for the general population will drastically decrease rates of severe disease, hospitalization, and death — at least not yet. Those are the outcomes that matter in terms of ending this global emergency.”

Faust argued that data is still needed to prove that a third dose is correlated with large changes  preventing serious outcomes. 

“You may be asking, what’s the harm of boosting?” the doctor wrote. “Why not decrease mild and moderate illness and spread, if we have the resources to do so? If there were no potential harms, then yes, this would simply be a question of logistics and policy. But there are two categories of potential harm to consider that I fear have not been: individual and societal harms.”

At the individual level, Faust said more data is needed on what potential side effects could be seen with a third dose for young, healthy adults, and he questioned what could happen if a worse variant arrives later in the year and prompts the need for a fourth dose.

The policy, he argued, is being rolled out before having all the “safety data” needed. 

“The societal harms must also be considered,” he said. “While the talking points are that we can ‘do everything,’ the reality is that rolling out boosters will make it harder to get more people their first doses, both in the United States and abroad. Offering boosters to healthy Americans is all but guaranteed to exacerbate vaccine inequity.”

Faust said he is also concerned that telling people who are fully vaccinated that they need a third dose will undermine confidence for those who haven’t gotten a single shot.

“If the government or researchers produce data demonstrating that a third dose enhances protection from serious disease and critical illness — or impressively limits breakthrough infections from being contagious to others at higher risk including those not yet eligible to be vaccinated — then yes, I’ll line up for one,” he said. “But so far, I just have not seen data that leads me to that conclusion.”

Read his full post on Inside Medicine.