Tropicana Forum Medical Minutes: 4th vaccine dose.

 

Paul Goldfinger, MD    Editor Tropicana Forum  3/10/22

 

You may have noticed that there is not much talk lately about a 4th dose of vaccine  (a second booster.)  I asked a CVS pharmacist in Fla whether he would give a 4th dose to people over 70.   He said that he has not been authorized by the FDA to do so unless they are immunologic ally compromised.

He said that the 4th dose will not protect against infection and only can be expected to prevent getting very sick or dying. “What’s wrong with that?”  I asked.

“Nothing,” he said.  So you can see that there is some uncertainty currently swirling around this topic.

There have been some studies of 4th jabs, and they found that the immune response is not very impressive in terms of protecting against infection in the face of declining immunity from the first 3 shots.

And, it is true so far, that the most you can hope for with a fourth shot is that it will keep you from getting very sick–hospitalized or death.

A scientist from the FDA, in a NY Times interview said that the data  is too premature to make policy:

The Times report said,  “Waiting is exactly what the Food and Drug Administration has decided to do before it recommends an extra booster shot to anyone. ‘We simply don’t have enough data to know that it’s a good thing to do,’ Dr. Peter Marks of the FDA  told The New York Times on Thursday.”

“But several countries are already moving forward with a fourth dose. On Tuesday, Sweden began to offer an extra jab to people over age 80 and those living in nursing homes. Chile now offers a fourth dose to anyone over age 55 who had their third dose more than five months ago. And Israel has authorized fourth shots to adults over age 60 and any adult with underlying health conditions.

“So getting a fourth dose is probably important only for those vulnerable populations who need this extra protection,” says Regev-Yochay, of Sheba Medical Center. “In general, I would recommend they receive any protection they can.”

CNN report:     “If or when the FDA authorizes a fourth dose for the public, the next step would be for the US Centers for Disease Control and Prevention to review the data before making a recommendation for use, as the agency has done for other coronavirus vaccine recommendations.”

“The CDC has no recommendation of fourth doses of coronavirus vaccine for the general public, but the agency  updated its guidelines in October to note that certain people who are moderately or severely immunocompromised may receive a fourth dose of the Moderna or Pfizer/BioNTech vaccines.

NY Times:      “We’re starting to see now diminishing returns on the number of additional doses,” said John Wherry, director of the Institute for immunology at the University of Pennsylvania. Although people over 65 or at high risk of illness may benefit from a fourth vaccine dose, it may be unnecessary for most people, he added.”