Why you need to get a Covid-19 booster vaccine this autumn

Have you got vaccine fatigue? Do you feel overwhelmed by Covid-jab information? Or has mixed messaging on inoculation left you unsure whether to avail of the current dose of existing vaccine or to wait until the bivalent vaccines, which include protection against the latest variants of Omicron, are available?

The situation isn’t helped by an absence of clear messaging from the Government. It’s almost as if the authorities are themselves suffering from a dose of vaccine burnout. Yet there is clearly a need for specific messaging for those of us who are vaccine-fatigued.

Research suggests some people do benefit from a fourth dose of the Delta vaccine, including long-term care residents, older people and other vulnerable groups, but data showing a clear benefit to those under the age of 60 is lacking. And in fairness to the Health Service Executive, it rolled out a sequential programme of fourth-dose vaccination over the summer.

It is noticeable, however, how Covid-19 vaccine uptake has levelled off over time. (About 13.5 per cent of the eligible population in the Republic had received a second booster as of September 10th.) I suspect this is, at least in part, due to “vaccine fatigue”. Vaccine hesitancy is one reason why a small portion of the public is not getting vaccinated, but vaccine fatigue may also compromise people’s original vaccination intentions.

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‘Burden and burnout’

A literature review published in the journal Frontiers in Immunology in March supports this thesis. The researchers looked at 37 studies to find factors that shape people’s vaccine fatigue, which they defined as “inertia or inaction towards vaccine information or instruction due to perceived burden and burnout”. They found there can be several precursors to vaccine fatigue, such as frequency of immunisation demands, vaccine side-effects and misconceptions around the need to vaccinate.

Last Friday, the Department of Health announced the availability of the adapted bivalent vaccine for those currently eligible for a booster - which includes those aged from 50 to 64, and everyone 12 and older with high-risk conditions.

What is science saying about the new bivalent Covid-19 vaccine? It’s certainly not a magic bullet. Many experts say they have yet to be convinced the two-pronged version has any significant advantage over the current booster dose.

An as-yet-unpublished piece of Australian research suggests that updated boosters offer much the same level of protection as an extra dose of the older vaccines does – particularly when it comes to keeping people out of hospital.

The research team estimated that, for every 1,000 people, a booster campaign based on updated vaccines would result in eight fewer hospitalisations, on average, than one based on older vaccines. “If that translates to hospital beds saved and severe cases averted, that might be a sufficient level to warrant the recommendation for a variant-modified booster,” lead author Dr Deborah Cromer says.

Immunisation gaps

The EU has recently extended its arsenal with the approval of two, new updated vaccines – Comirnaty Original/Omicron BA.1 and Spikevax Bivalent Original/Omicron BA.1. The director of the European Centre for Disease Prevention and Control (ECDC), Dr Andrea Ammon, is clear about the value of all vaccines in the fight against the Covid-19 pandemic. “With the newly authorised adapted Covid-19 vaccines, member states will now have a wider range of choices to roll out autumn/winter Covid-19 immunisation campaigns aimed at protecting most vulnerable groups and boost their immunity against most recent emerging variants,” Dr Ammon said.

“As these new vaccines are currently approved for use as booster doses only, the original ones remain essential to increase the vaccination coverage with a primary series among unvaccinated individuals to close the immunisation gaps.”

So it seems that the new bivalent vaccines may offer slightly better cover than current boosters. From a vaccine messaging point of view, this lack of a clear advantage will pose a significant challenge.

But I sense public health messaging in Ireland is already behind the eight-ball as vaccine confidence drops and complacency sets in. And in the absence of the National Public Health Emergency Team, who is going to step up to the mark?

mhouston@irishtimes.com