Booster shots: Will they be the next COVID-19 prevention strategy for colleges?

Institutions are waiting on guidance from the FDA and CDC. What are the likely timetables they are facing?
By: | September 17, 2021
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While immunocompromised individuals already have been approved to get third doses of COVID-19 vaccines – some are receiving them at Princeton University and at other institutions – debate is ongoing about the need for booster shots for the rest of Americans.

The U.S. Food and Drug Administration on Friday voted against full dispersal of boosters at this time but said yes for 65-and-over and those high risk. The Centers for Disease Control, which will look at the FDA recommendations and other data, likely will determine what paths colleges and universities will take through the academic year.

What’s being discussed? Quite a bit that interest leaders who are trying to protect their campuses from the highly transmissible delta variant.

Public health officials are weighing whether boosters are needed for all individuals now, which populations should receive them, when they might be necessary and whether spread, serious illness or deaths might increase if they are not dispensed. Some studies have shown that vaccine antibodies wane after 6-8 months (and maybe after four, according to new data released Friday by the CDC), though most experts agree that hospitalizations among those fully vaccinated have not shown huge spikes even with delta lurking.

During a recent webinar hosted by UCLA’s Fielding School of Public Health, epidemiologist and professor Dr. Anne Rimoin stressed the need to get doses to those who haven’t gotten them. The majority of colleges and universities still do not have vaccine mandates and some are still scrambling to get populations to try to reach goals via incentives. Continuing those messaging strategies are important.

“Getting people vaccinated is of course, priority number one … because they have no protection,” she said.

Duke University infectious disease specialist and associate professor Cameron Wolfe agreed. “When we talk about boosting for individuals in the general community, that is far less important than still reaching those individuals who are not yet vaccinated at all,” he said during a recent Q&A session with reporters. “We need to continue to talk to those individuals about safety data and how robust it is, and about the profound difference in their risk of hospitalization.”

Questions answered on boosters

But boosters are on the radar, Rimoin said. “We all know that as time goes on and if we do really see this issue of waning immunity, we’re going to have to prioritize boosters, as well. We have to be thinking about what our goal is. If our goals are to save lives, that means that we need our elderly and people who may have waning immunity vaccinated. Those people are at the greatest risk of being infected, of being hospitalized, of dying, of having long COVID. They are going to bear the most serious consequences.”

Though that may not immediately include the vast number of students across college campuses, it does include administrators, faculty and staff who might be more compromised as vaccine effectiveness lessens. University of California system leaders have been proactive with their community in saying that once approved “receipt of boosters will be required … in the same way that the initial vaccination is required.”

How many other institutions, especially the 1,000 or more that have adopted vaccine mandates, would do the same for a COVID-19 booster? What would be the benefit to enacting a similar policy?

“[Public health data] is definitely showing that there is a benefit to having a booster – it looks like about after eight months is good timing,” said Dr. Robert Kim-Farley, epidemiology professor at UCLA. “You can really increase these titers (lab tests for immunity], tenfold or more, for protection. At the moment, it does look like that the vaccine does well against the delta variant and once boosted does even better against the variant. Ideally, in the future as we see more variants arise, especially variants that start to outwit our vaccine, we will see changes and formulations of boosters in the future.”

Those who are immunocompromised now can get a third dose if they’ve passed the 28-day threshold from their last shot, and students and faculty are taking advantage on campuses that offer them. Boosters are different. Though dosing is the same, they are for those whose two-dose efficacy (or one if they’ve received Johnson & Johnson) have waned over time – that 6-8 month or longer period being cited around by public health officials.

Duke is one of the many institutions awaiting decisions from the FDA and CDC. Like Princeton, the university has been dispensing third doses to those who need them. Boosters for the rest of the community are another story.

“I think we need to see much more data to understand what the benefits of boosters are for the overarching general population who are lower risk,” Wolfe said. “So if you’re a 35-year-old who has had your two doses of Pfizer vaccine, that really has no risk of severe COVID, that’s different. I think we need to still see a little bit more data to fully understand why they would need to be boosted.”

Wolfe did note “there is a diminished protection that we’re seeing at the moment in individuals who are vaccinated. We haven’t yet seen a substantial move in the proportion of vaccinated people who get sick enough to be in the hospital.”

He said, it may be that when it comes time to open up the pools of those who can boosters, they should done on a rolling basis depending on when second doses were given.

“I think the timing is important because there’s a long history in vaccinology – of sometimes waiting a little bit of extra time – that is appropriate to get the strongest response,” Wolfe said. “I want to be giving a vaccine that’s given for the right reasons. The endpoint has to be prevention of infection and prevention of hospitalization. You don’t need to do that earlier … if the added benefit of that booster shot is diminished. So I don’t think there is a great reason in otherwise healthy individuals who just were vaccinated with Pfizer two months ago, to go back and offer it to them because they have protection. The question is, can we pinpoint more precisely with waning durability of these vaccines over a six-plus-month period and find that sweet spot where boosting that protection counteracts active viral prevalence? How can I get the best juice out of that one dose.”