Pause booster shots. Don’t pause first shots.

Seven vaccination stations at a senior residence in Jerusalem on December 25, 2020. (courtesy)

Israel has astounded the world by vaccinating against the coronavirus at the fastest rate on the planet: more than 10 times the rate per capita in the United States.  But according to Health Minister Yuli Edelstein, Israel may pause this progress.

The rationale is not crazy – it is to follow the protocol used in the vaccine studies and reserve doses to give as booster shots several weeks after the first shot.  But as I and others have pointed out (here, here, and here), that may not be the best approach.  It is clear from Figure 3 of the Pfizer paper and Figure 2 and Table 15 of the Moderna FDA submission that the major protection begins well before the second shot.  It is highly likely that the good done by a first shot is far greater than the good done by the booster.

Instead of delaying first shots to the population, we should pause the boosters for a few months until we have enough supply of vaccine.

This is not some abstract decision.  Last week my 91-year-old mother got her first shot at the senior residence where she lives in Jerusalem.  It was impressive to watch the efficient process by which hundreds got their shots at 7 vaccination stations set up in the dining room. Within days she and all the other residents are likely to have 90% protection from the virus.

Two weeks from now, I won’t protest if she is given a booster that gets her to 95% protection.  But is that the best way to reduce her risk?  Or is it better to give next doses to the clerks at the grocery store where she shops so they are less likely to expose her to the virus?  And wouldn’t it be more ethical to use the next doses for younger people with diabetes who are at high risk from the virus and still waiting for a first dose?

There are a few people who should get boosters as soon as possible.  Obvious examples are those working with patients infected with coronavirus, and those with the most critical responsibilities in public life.  But these are only a small segment of the population and MK Edelstein is not pausing first doses because of them.

It is important to understand why we give boosters after several weeks.  We do so because that was what was done in the clinical trials.  But the clinical trials were not structured to answer the question of what to do if there is scarcity.  As New York Times columnist Ross Douthat observed, we should follow the science, but we shouldn’t necessarily follow the science bureaucracy.  The bureaucracy is built on regulations that assume there is no scarcity.  When there is scarcity, we should modify the regulations to do the best we can with a limited number of doses.

The United Kingdom has adopted the approach of pausing boosters in order to get a first shot to more people.  Canada is assessing whether to do the same.  Israel should too.  Israel  should exhibit the same world-leading prowess that it demonstrated by its high vaccination rates by pausing boosters until there is enough vaccine to give first shots widely and defeat the epidemic.

About the Author
Michael Segal is a neurologist and neuroscientist in the United States.
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