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Is it time for a second booster?

Is it time for a second booster?

The Atlantic includes an article: "How to Time Your Second Booster—The effects of the first one may be fading. When will it be time for seniors to re-up?” 

Imagine if older Americans had been forced to weather the past three months without the option of a booster shot. Having an additional vaccine dose during the Omicron surge cut seniors’ risks of hospitalization and death by more than 70 percent. 

But the extra shots still didn’t come close to eliminating risk: Boosted adults ages 65 and older were still hospitalized at nearly twice the rate—and dying at 16 times the rate—of unboosted 18-to-49-year-olds, despite the fact that far fewer seniors were testing positive for the coronavirus.

Given these persistent risks, the possibility of waning immunity, and the apparent onset of a new wave of cases across Europe, even boosted Americans over 65 might be feeling a little nervous. 

Pfizer asked the FDA to authorize a fourth shot for older people, and not much is stopping seniors who want to re-boost from doing so already. 

Whether they ought to is a different matter: Given that COVID rates in the United States are pretty low right now, and that we don’t have a ton of information yet about the value (or potential downsides) of the extra shot, most seniors should probably wait.

As humans age, our immune systems tend to get weaker in the same way that our bones and joints and memories do. 

That’s why older Americans are more vulnerable to bad outcomes from COVID, and it’s also why they were among the first to be eligible for COVID-vaccine boosters in the fall. Back then, the CDC’s primary motivation for allowing more shots hinged on waning immunity: After several months, the vaccines weren’t doing as good a job at keeping people, and especially older people, from getting sick.

Now, on top of the vaccines’ diminished effectiveness against Omicron, something similar might be happening again. 

In the United Kingdom, the effectiveness of a third Pfizer dose at preventing symptomatic COVID was shown to fall from 67 to 46 percent within a few months after vaccination. 

A study published in The Lancet in late February found that blood samples taken from a small group of elderly people showed a steep decline in neutralizing activity against Omicron over the span of three and a half months following a first booster shot. 

All of these trends are very preliminary, as are the data on whether adding one more dose actually helps. 

A yet-to-be-peer-reviewed study of healthy medical workers in Israel who had received a second booster showed an eightfold increase in antibodies against Omicron two weeks after the shot. 

Among Israelis 60 and older, who have been eligible for a second booster since early January, those who received it were one-quarter as likely as the singly boosted to be hospitalized with severe COVID at the peak of the country’s Omicron surge. But no one can say how long that improved protection will last.

The question of durability might matter more now than it did in the fall. In September, experts were fairly confident that a winter wave was coming; even if the boost lasted only, say, five months, the fresh antibodies of a senior jabbed in October would likely last through the worst of the surge. Today, Omicron is in retreat in the United States (at least for now), and we’re eight-ish months away from the next possible winter surge, and four-ish months from a summer surge that would match the ones in 2020 and 2021. 

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