Watch them peer exchange “COVID-19 Expectations on the Roll-out of Booster Shots” series here.
Increasing uptake of the first line of COVID-19 vaccines is important to potentially reach chronic endemic stage. However, communicating the benefits of vaccination to the general public and the uncertainty associated with scientific research, as well as the rapidly changing eligibility criteria for COVID-19 booster vaccines are ongoing challenges.
In a recent infection® peer exchange moderated by Peter L Salgo, MDpanellists discussed strategies for communicating the benefits of COVID-19 vaccination (first series and booster shots), barriers to increasing uptake of COVID-19 booster shots, and the need to improve global access to COVID-19 vaccination.
COMMUNICATION OF THE BENEFITS OF COVID-19 STOPPING RECOMMENDATIONS TO PATIENTS
Communicating with patients that COVID-19 booster shots are recommended (although not mandatory) and are best for those with compromised immune systems (due to older age or medical condition) who are more likely to lose protection over time, aloud Donald J. Alcendor, PhD. However, he added that the current vaccine’s ability to protect against most of the variants of concern (including the Omicron variant to some extent) shows promise. “In the long term, we will have a virus that will become endemic in our population,” Alcendor said. “The idea of believing we could hunt variants with boosters is a failed attempt. We have to recognize that.”
Salgo added that recommendations are often based on population data and often change over time, which can be difficult for the general public to understand. “It’s not always A plus B equals C; A plus B usually equals C, and within a statistical variability it’s pretty good, but it’s not the same,” Salgo said. “It sounds to me like some of what we’re hearing is [regarding] The chatter about the news is not chatter at all. Quite simply, medicine is as good as it can be and will never be much better.”
Communicating uncertainty and basic concepts about infectious diseases and immunity, including how vaccines work and viral transmission, replication and mutation, to the general public has been an ongoing challenge throughout the COVID-19 pandemic. Angela Rasmussen, PhD, explained. “When a broad public health recommendation is made, if you try to make those recommendations spontaneously [of] a lot of uncertainty, and when there’s a whole huge peanut gallery criticizing every step public health officials take, it becomes very difficult to get it right every time,” Rasmussen said.
Rasmussen added that the politicization and misinformation about public health practices surrounding the COVID-19 pandemic have created another obstacle to public engagement with complex issues. “Most of the people I’ve spoken to just want to be safe and want this pandemic to be over,” she said. “It’s just a really challenging environment to deal with all these different moving parts and try to find the right way through all of this.”
COVID-19 BOOSTER ROAD BLOCKS
The frequent changes in eligibility criteria have made it difficult for everyone – from the general public to those who administer the vaccine – to keep track of who can get a booster, Alcendor said. He added that individuals may show up to immunization events not knowing if they qualify for a boost, and some underserved populations may struggle to find boosters. The lack Interest in booster shots (or first series doses) is also a major concern, and priority should be given to giving the first and second doses of vaccine to unvaccinated individuals, Alcendor said.
Jason C. Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS, adding that there is a relative oversupply of COVID-19 vaccine boosters, with vaccination centers shifting from large sites to small clinics and pharmacy chains. He also said mandates for boosters are less important than those for the first series of vaccines and that the main goal is to deliver the first series to as many people as possible to improve community protection.
Rasmussen said hospitalization rates will likely be lower in immunized populations and individuals will be exposed to the spike antigen of SARS-CoV-2 (whether through vaccination or infection), but immunity to infection can be highly variable and short-lived. “We also expect this virus to become endemic, which means we won’t be getting rid of it any time soon,” Rasmussen said. “In the United States we will eventually move from a perpetual crisis mode to a more ‘normal’ [state]. In other parts of the world this process will take different amounts of time, [which] has to do with vaccination.”
Rasmussen also warned that SARS-CoV-2 is a zoonotic virus that can infect many species, including white-tailed deer, cats and raccoons, and that zooanthroponotic transmission (where the virus passes from human to animal to human) is a key remains concern. In particular, the Omicron variant is evolutionarily distinct from other SARS-CoV-2 variants, as it is believed to have arisen through transmission from another animal species.
“It will be very difficult to predict what new variants we might be dealing with and how they might affect a vaccinated population,” Rasmussen said. “But the good news is that the vaccines have been shown to be very cross-protective against serious illness, hospitalization and death for all the variants we studied. That will be the mark we must always look to. In a year, we will stop living in acute pandemic times and enter the chronic phase of endemics in the United States, Canada and countries that have adequate access to vaccines.”
Rasmussen predicted that within the next 1 to 2 years, the United States is likely to achieve some level of herd immunity through a combination of vaccine and infection-related immunity. “If not vaccinated [individuals] exposed, especially if they are reinfected and exposed to the virus multiple times, they eventually develop memory immune responses,” she said. “That could be somewhere on a protection spectrum.”
COVID-19 BOOSTER AND THE FUTURE
Alcendor said vaccinating as many people as possible and addressing injustices in vaccine distribution and manufacture in developing countries remain important priorities going forward. Just as outbreaks can occur in heavily unvaccinated communities, high vaccination rates within a community can also prevent local outbreaks. Jeff Goad, PharmD, MPHexplained.
Gallagher added that extensive media coverage of new variants has increased awareness of the global impact of COVID-19, which could help increase focus on getting people vaccinated in parts of the world with little access to vaccines , and Rasmussen said global vaccine justice may have altruistic and selfish purposes for high-access areas. “If we don’t want to continue playing Whac-A-Mole with different variations – to constantly respond to a crisis – it’s in our best interests [ensure] unvaccinated [individuals]whether they live in a lower-middle-income country or in a wealthy country like the United States have access to vaccines,” she said. “It is crucial that we do everything we can to get them vaccinated. At the population level, this is our best protection.”