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America's choose-your-own-adventure vaccine approach could create confusion

The choose-your-own-adventure vibe of the pandemic response is spreading to booster shots, with Americans 50 and older now having the option to get a fourth dose — without explicitly being encouraged to do so.

Why it matters: Many experts say yesterday's FDA authorization makes sense as a precautionary measure, but the policy could create more confusion around the long-term vaccination strategy.

The big picture: Authorizing another shot for those who got their last dose at least four months earlier is an added safeguard when it's still unclear how much three doses protect against severe illness over time. The three-dose approach appears to hold up well in the short term.

  • Israeli data has shown that a fourth dose does offer a stronger level of protection in older people, although it's still unclear just how much a difference it makes. Some experts also questioned whether extending the authorization to healthy people in their 50s is really necessary.
  • "Evidence that we have now from Israel suggests that by getting [a fourth dose], one can reduce the risk of hospitalization and death in this population of older individuals," top FDA vaccine regulator Peter Marks told reporters yesterday. "If it were my relatives, I would be sending them out to do this."

What they're saying: The authorization effectively lets individuals choose whether to shore up their immunity against the virus the same way they can now choose to mask or take other precautions.

  • "Giving people the choice to have an added level of protection is where we should be at this point in the pandemic," said Leana Wen, a professor at George Washington University. "To me, the decision of getting an extra booster dose is not much different from the decision to continue masking or to use rapid tests before getting together with people indoors.”

State of play: The gap between the under-vaccinated and those up to date on their shots keeps growing, although it's assumed that plenty of people in both groups have been infected at this point.

  • Tens of millions of Americans — including two-thirds of children between the ages of 5 and 11 and a third of adolescents — have yet to receive any vaccine doses. Children under 5 aren't even eligible yet for coronavirus vaccines.
  • Only half of Americans eligible for a first booster shot have received one, per the CDC, despite the benefits third shots brought during the Omicron wave.

Between the lines: It's normal for vaccines' effectiveness against mild disease to wane over time, and boosting in order to prevent transmission or infection would require a massive undertaking.

  • But people who get boosted now could very well be eligible for another shot in the fall, especially if a variant-specific vaccine is deemed necessary, Marks said.
  • An FDA advisory committee meets next week to discuss boosters, and will likely delve more into what longer-term strategies look like.

The bottom line: Allowing people to minimize their own level of risk through booster shots may be a temporarily justifiable approach, but it doesn't solve the massive issue of vaccine resistance.

  • Boosting large segments of the population every four months also isn't sustainable. If the boosters' protection against severe disease repeatedly wanes in a sizable portion of Americans — something experts think is unlikely that means we need more durable vaccines.
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