WHO rejects recalls. It’s not the blow it may seem for Israel, friend of the jab
Headlines around the world this week have made hearts skip a beat here in Israel: The World Health Organization has warned against the repeated use of boosters.
It felt like a negation of the mainstream wisdom of the Vaccination Nation. After all, this is the country that stood up to Delta by introducing third universal hits before anyone else.
And for our newly quadruple-vaccinated half-million elderly and at-risk people, it was easy to feel the news was a blow, shaking a new sense of security. Israel’s fourth dose campaign, the world’s first large-scale operation, was launched in hopes of minimizing Omicron’s damage.
People wondered if, in retrospect, the reinforcement we stood for was the best way to protect ourselves. The WHO insisted that “a vaccination strategy based on repeated booster doses of the original vaccine composition is unlikely to be appropriate or sustainable”.
What really drives the WHO position is less about our health outcomes and more about “the need for equitable access to vaccines between countries to achieve global public health goals” and concerns about the “demand for vaccines”.
We are in a global pandemic. The demand for vaccines exceeds the supply. This means that people in some parts of the world are running out of vaccines for the initial inoculation – as vaccines of the same type are used by some countries to boost citizens who already have some protection.
According to the WHO, using the supply to try to keep some countries boosted while others are so far behind is not “appropriate or sustainable”. It’s a global analysis as you’d expect from the World Health Organization (which has opposed boosters on grounds of vaccine equity since they were first administered).
“The WHO is concerned global health; that’s what they’re supposed to do, but that doesn’t mean they have anything specific to say about the state of Israeli immunity,” said Ben University immunologist Professor Tomer Hertz. Gourion, to The Times of Israel.
If you’re Israeli and you’re thinking about your health and the health of those around you, the boosters seem to deliver the goods.
Research published in the medical journal The Lancet in October found that among Israelis, the third dose of vaccine was 92% effective in preventing serious illness compared to those who received only two injections. When officials today criticize recalls, they’re largely talking about doses beyond number three.
Indeed, the very strong protection of triple vaccination as opposed to double vaccination has created an increasingly popular view among physicians that the third injection should not be seen as a booster at all, but rather as part of of the initial vaccination schedule.
Stanley Plotkin, inventor of the rubella vaccine and widely regarded as the world’s top vaccinologist, recently urged the US Advisory Committee on Immunization Practices to drop the term booster for third injections, arguing that it is clearly essential to generate the initial immune response. When he speaks, the doctors notice him.
But what about the 4th shot?
As for the fourth shots, Hertz and others are embarking on large-scale studies that will take months, but very preliminary early data looks optimistic.
A week after receiving dose number four, recipients had almost five times as many COVID-19 antibodies in their blood, according to early research from Sheba Medical Center. New data, giving insight into antibody levels a few weeks later, is expected from Sheba within the next few days, and unless antibody levels have dropped drastically, will be interpreted as suggesting that the fourth doses seem add to protection.
Studies have shown that vaccines are less effective against Omicron and may be even weaker against later variants, but lead epidemiologist Professor Michael Edelstein of Bar-Ilan University’s Azrieli School of Medicine says that administered at the rate adopted by Israel, they do their job well. This is particularly the case when judged by the key variable of deterioration to severe disease, as opposed to infection when it does not seriously harm people.
Edelstein told The Times of Israel: “The effectiveness of three doses in keeping people out of the hospital is pretty good, around 90%, so most people don’t need extra doses right now. as long as it is maintained. The exception is for very vulnerable people who need extra protection in times of high transmission like now.
A weakened immune response?
Some doctors have raised the possibility that repeated boosters may reduce the immune response to the vaccine.
Marco Cavaleri, head of vaccine strategy for the European Medicines Agency, said in a press briefing this week: “One of the concerns here is that if we have a strategy in which we give reminders, say every four months or so we’re going to end up potentially having a problem with the immune response and the immune response may end up not being as good as we’d like so we have to be careful not to overload the immune system with repeated immunizations.
Hertz said statements such as Cavaleri’s only signal the possibility that continued reminders do not add protection and suggest no sense of danger.
“I wouldn’t say we’re concerned about harming individuals or reducing their immune response,” he commented. “The worst I expect is that it wouldn’t really increase protection.”
“The only real herd immunity is global,” reads the title of an April analysis article in The Times of Israel. Ronen Ben-Ami, head of the infectious diseases unit at Sourasky Medical Center in Tel Aviv, commented in the article: “We talk a lot about herd immunity and the idea that if a percentage of the population is vaccinated, it becomes protected.
“But since all countries reside in the world and the world is not immune, herd immunity can only last for a certain period of time,” he continued. “The lesson of 2020, learned well in Israel, is that the world is connected, and in a sense the herd is not a country, the herd is the world.”
Now, nine months later, Ben-Ami’s boss, Professor Ronni Gamzu, is one of Israel’s most prominent doctors to translate that belief into a practical recommendation: Israel should donate vaccines.
Gamzu, CEO of Sourasky Medical Center and former coronavirus czar, said at a recent press briefing: “If I were the director general of the Ministry of Health, I would dedicate part of our vaccines [and] some of our resources and capabilities to third world countries. I believe it is mandatory for any country in the western world.
Internationally, some personalities have gone further. Former British Prime Minister Gordon Brown said last month that the failure to deliver vaccines to poorer countries is a “stain on our global soul”.
Edelstein commented, “For Israel and other heavily vaccinated countries, it’s not just a matter of altruism, it’s also in our own interest to get the world vaccinated. Because if you look at the waves, whether it’s Delta or Omicron, it started in Israel because someone came from another country where there wasn’t a lot of vaccine and brought it back.
There are, of course, responses to complaints against so-called vaccine nationalism, such as the suggestion that vaccines alone will not solve the problem because developing countries also lack the infrastructure to administer them – but none of between them changes the fact that the inequality of vaccines poses a real challenge.
So while the WHO’s latest comments shouldn’t worry Israelis about local politics, they highlight deep concerns about the international situation. Or in other words, instead of a local Israeli headache, we have a global migraine.