As 2nd COVID vaccine booster approved, should Michiganders get it?

Older Michiganders and those with certain health conditions may soon be able to get fourth doses of a COVID-19 vaccine — actually, second boosters — following authorization of the shots Tuesday by the U.S. Food and Drug Administration.

Late in the day Tuesday, the U.S. Centers for Disease Control and Prevention backed the FDA decision. Boosters are “especially important for those 65 and older and those 50 and older with underlying medical conditions that increase their risk for severe disease from COVID-19,” CDC director Rochelle Walensky said in a prepared statement.

But while the initial vaccines in 2020 and first boosters last year were long-awaited, a fourth dose may not be as crucial for healthy people, especially while cases remain relatively low, some experts have said.

“That third shot is critical. This (fourth) one is a little extra, so in some ways, it’s a harder call” to make, said Dr. Arnold Monto, a University of Michigan epidemiologist and long-time researcher of coronaviruses.

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Monto chaired the FDA’s Vaccines and Related Biological Products Advisory Committee as it weighed safety and effectiveness of the three U.S.-authorized COVID vaccines in 2020 and 2021.

The committee was not consulted on the latest question about fourth doses, but will meet April 6 to discuss long-term questions of when boosters should be given and what variants should be included in them, Monto said.

More immediately, those at higher risk for COVID-19’s worst outcomes — people with chronic conditions, or those who work in high-risk jobs — should consider the fourth dose. Likewise, those most concerned about their vulnerability against COVID-19 will find “reassurance” against waning immunity from the first booster they likely received last fall, Monto said.

Additionally, BA.2, a version of the omicron variant, is now circulating in Michigan, a threat to what is now a relatively low case rate, Monto added.

The subvariant appears to be at least 30 percent more transmissible than its predecessor.

But even Monto, at 89 years old, won’t roll up his sleeves just yet.

“I won’t rush out and get it right now, because things are pretty good,” he said, referring to case rates in Michigan that have dropped to lows not seen since last summer. The state reported Monday just 419 cases for each of the past three days, the lowest weekly average since it was at 603 daily cases on July 31.

Rather, Monto will seek a booster in a few weeks, before traveling to Minnesota to visit his son.

“It’s about your own level of risk,” he said.

The FDA made its decision on preliminary data, but said the vaccine is safe and will boost the waning protection of earlier doses. 

The FDA authorized the following:

• A second booster dose of the Pfizer-BioNTech or Moderna vaccine for individuals 50 years or older,
• A second booster dose of the Pfizer vaccine for anyone 12 years and older who is immunocompromised, including those who have undergone solid organ transplantation.
• A second booster dose of the Moderna vaccine for those 18 and older who are immunocompromised, including those who have undergone solid organ transplantation.

The FDA said it based its decision, at least in part, on data from the Ministry of Health of Israel. That data found no safety concerns among about 700,000 adults who received second boosters of the Pfizer-BioNTech vaccine. Separately, there were no safety concerns from another study of 120 adults who received a second Moderna booster.

And the vaccines appeared to be effective in another study, in which 274 healthcare workers at a single center in Israel received a second booster of either the Pfizer or Moderna vaccine. After two weeks, researchers found an increase in neutralizing antibody levels against the coronavirus, including both delta and omicron variants.

Others, too, were weighing in on a fourth dose in anticipation of Tuesday’s announcement.

Because it takes two or three weeks for cases to surge and boosters kick in within days,  “it'd be rational for low-risk folks to wait. I'll probably get it now, but close call,” Dr. Bob Wachter, the chair of medicine at University of California San Francisco who writes about personal risk and COVID, tweeted over the weekend.

Vaccines in Michigan are plentiful right now, so supply isn’t an immediate concern, said Farah Jalloul, state emergency preparedness coordinator with the Michigan Pharmacists Association.

The bigger concern, she said, is that people will wait too long. She likened it to the flu season,  which often takes hold in October: “A lot of people don’t think about their flu vaccine, though, until there’s three inches of snow on the ground.”

Dr. Russell Lampen also advised against trying to time the boosters. 

The “best time to be vaccinated is two weeks before the next surge occurs,” said Lampen, a medical director of infection prevention at Grand Rapids-based Spectrum Health.

Trying to time a vaccine to COVID’s waves is as tricky as trying to nail stock market fluctuations — and more dangerous. 

“I would be reluctant to try to game it,” he said of the vaccine, though he noted that COVID ultimately will settle into more predictable seasonal patterns.