How effective is the booster vaccine against Omicron?

The effectiveness of the booster is a question that needs answering for a number of reasons. Firstly, is it worth taking on a personal level? If the risk/benefit analysis contains a low vaccine efficacy then in young, healthy individuals the answer to this is inevitably no.  Even if the answer is yes, are your antibody levels still high? Should you have the booster early anyway – Pfizer’s own recommendations are to have it 6 months after the second dose, no mention of having it earlier. However, in the UK we are being advised to have the booster 2/3 months after the second dose.  Have any trials been undertaken to show this is necessary or safe?

Secondly, on a societal level, should we move heaven and earth to ensure everyone has one, no matter the consequences?  This also ties in with how mild omicron is - initial findings from South Africa are looking promising, but that is still an unknown.

Currently, in the UK, Omicron mania is rising as exponentially as the variant itself.  On Sunday, the Prime minister (Boris Johnson) announced to the nation that every adult will be offered a booster by the end of the year.  In order to do this, GPs have been told to stop face to face appointments, the army have been drafted in and people have been queueing round the corner to get injected (we are British and it is Christmas, however, so this may have happened anyway!)

These announcements are inevitably going to disrupt lives and cause deaths.  Patients no longer getting the care they require will have a massive knock on effect but no risk/benefit analysis has been produced yet again.  Let alone any financial implications on procuring and administrating so many injections.

So, are the negative impacts of concentrating on boosters for an entire month or more worth it?  We must know the answer, otherwise it’s a big gamble to take.

Is it effective against preventing death? There’s no way of knowing that yet.  On Sunday, when the announcement was made, zero people had died from Omicron.  It has recently been announced that one person has sadly died, but no further details as to their vaccination status, co-morbidities or whether they died with or from Omicron have been released.

Does it protect against serious disease? Again, no way of knowing that yet.  As of yesterday (when I began writing this), there were 10 people in hospital with Omicron despite ministers falsely reporting 20 times that number in the media.

So, symptomatic infection, there must be a lot of data showing us how well it prevents that?  That must be the reason the health service is grinding to a halt to allow boosters to happen?

The first answer comes from Pfizer which recently announced an initial laboratory study showing that sera from two dosed individuals showed a 25 fold reduction in neutralisation titres against Omicron compared to the wild type.  Luckily, a third dose increases antibody titres by 25-fold.  However, they go on to say that two doses may still offer protection against severe disease due to the majority of vaccine induced T cells not being affected by mutations.  They then go on to state that protection is improved with a third dose, so as many people as possible should be boosted – but they would say that.  Moderna, also were worried that their vaccine would be less effective but again that is good for business.

This was just an initial lab study so real world data would be more interesting. 

The basis on which the accelerated booster regime was approved were data provided by the UKHSA.  This report, from 10 December, looks at vaccine effectiveness against symptomatic disease and made headlines by proclaiming that two jabs offer no protection but the booster brings the efficacy back up to 75%.  All of this was based on only 548 cases, of which only 31 were in the boosted group.  Furthermore, 13 of these cases were after an Astrazenca booster, which isn’t being used anymore, so the whole decision is based on 18 cases, which in my opinion is a far too small subset to base an entire health system destruction policy on.   

Looking at the Omicron cases as a percentage of all cases (Delta & Omicron) we find that in the unvaccinated group it represents 1.16 percent of cases whilst in the boosted group it represents 1.39 percent.  Now these numbers are based on very small numbers, so don’t really show anything, but is this really the confirmation needed to mess up the health system during its busiest period?

The reasons stated are that if we don’t act quickly the doubling time of Omicron means huge numbers infected quickly and without boosters that means a lot of hospitalisations.  However, looking at UKHSA’s own modelling (doubling every 1.9 days), every single person in this country will be infected with Omicron by Christmas Day.  Even if everyone was boosted today, then it wouldn’t make much difference as the booster takes a few weeks to offer adequate protection.

So, in short, we don’t have enough substantial evidence to show the efficacy of the booster vaccine against Omicron yet (although officially it’s 75%).  Certainly not enough to justify closing down the rest of the health system.  Why prioritise an 18 year old getting a booster jab, after they’ve only just had their second dose 2/3 months ago, at the expense of someone’s care who is seriously ill? It makes no sense.  Especially, when the modelling suggests everyone will have Omicron before most of the boosters are even administered.

Another addition to the ‘makes no sense’ pile.  Overreaction? Wanting to seem like the Politicians are doing something? Pandering to public panic? Trying to deflect from last year’s Christmas parties (there have been a lot of newspaper leaks about politicians having Christmas parties last year when they had banned them for us mere mortals)? Or something more sinister? Sajid Javid (the Health Secretary) announced that when everyone has been offered the booster, COVID passes will be changed so that only 3 doses will count as vaccinated.  Are they speeding up the booster programme in order to facilitate this change quickly and with fewer people in the two dose category to make a fuss?  Hopefully, my last suggestion is just a cynical one but in these crazy times, who knows. 

As with all my posts, I am looking for other explanations and alternative views, so if you think something I’ve said is inaccurate, call me out!