Let's focus on reaching the unvaccinated at home and abroad as we await more data on Omicron

by Amesh Adalja, MD December 2, 2021

In the wake of the discovery of the Omicron variant of COVID-19, the CDC modified its guidance on booster vaccines. [MedPage Today]

The agency now says that all adults should get a booster vaccine dose if at least 6 months have passed since their initial mRNA vaccine series (or 2 months for Johnson & Johnson recipients). For some time, there have been differing opinions over the benefit of universal boosting, especially for healthy younger individuals. Now it is important to consider whether Omicron changes the calculus.

A booster dose has clearly been demonstrated to be beneficial for certain populations. However, the net benefit of rushing to boost the average healthy person is less clear, especially in the context of the potential need for an Omicron-specific vaccine in the near-term and considering the global fight against COVID-19, which depends on first and second doses.

Studies have established, unsurprisingly, that a booster dose increases antibody levels and is, at least temporarily, likely to stave off a breakthrough infection. But with a destined-to-be endemic coronavirus, a breakthrough infection (symptomatic or asymptomatic), especially with our current vaccines, is likely for most people. For those at heightened risk for severe COVID-19, preventing a breakthrough infection from becoming severe is very important. Anyone over 65 or who has underlying conditions should be boosted as soon as possible. But for most people who are not at high-risk for severe COVID-19, any breakthrough infection will be unlikely to cause severe illness, hospitalization, or death. Therefore, for the young, healthy population, the value of boosting with the vaccine currently available to transiently prevent what would likely be non-severe illness is, to me, of marginal value. The likelihood of non-severe COVID-19 in young, healthy people is almost certain to be as true for Omicron as it has been for Delta, and we will learn more in the coming days and weeks.

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