Editorial: Clarity needed on use of boosters

Until this point, the urgency around getting a COVID-19 booster vaccine has not been a top note in the messaging sent by public health officials, at either the federal or state levels. The basic takeaway has been that anyone who is over 65 and six months past their shots, or is immuno-compromised, or who feels at risk due to some employment or living condition, should go and get their booster.

To some extent, it’s been left to individuals to assess their own vulnerability and need for a booster. That laissez-faire approach is likely to shift into high gear, especially with the approach of the holidays.

Both Moderna and Pfizer-BioNTech have appled for emergency use authorization for their booster vaccines to be accessible by all adults. The Food and Drug Administration is poised to authorize them this week, and final approval could come soon thereafter from the Centers for Disease Control and Prevention.

Once that happens, more clarity about the need for these shots will be imperative. And the more the scientists learn about the pandemic, the more urgency is warranted.

A recent Department of Veterans Affairs study showed efficacy waning significantly after six months, dropping to just 58%, 43% and 13% for Moderna, Pfizer-BioNTech and J&J vaccines, respectively.

That sounds far more alarming than declining immunity had been described at first. Hawaii needs to tamp down its infection rates to levels that will be manageable for the longer term, and keeping its vaccinated population from becoming continuing vectors of the virus will be key.

The state Department of Health (DOH) correctly continues to place the top priority on giving first shots to Hawaii’s unvaccinated population — including, importantly, the newest eligible group, children ages 5 to 11. That will do the most to safeguard the community, said DOH spokesman Brooks Baehr.

But he added that boosting the existing immunity also is seen as important. The state vaccine inventory is sufficiently robust to allow for officials to urge broad distribution of booster shots with confidence, Baehr said, which is exactly what they should do.

Already several states — California, Colorado, New Mexico, Arkansas and West Virginia — have jumped ahead of the federal agencies and have opened booster eligibility to all adults.

The rationale on the national level is plain. More adults 65 and older are ending up in emergency rooms, according to the CDC, fallout from the weakened immune response.

Third doses of the two-dose Moderna and Pfizer shots have been given for months already, primarily to people with health conditions preventing a sufficient initial immune response. Boosters are third shots needed after a successful response declined over time.

The effect of a booster is to remind the body’s immune system about the virus, to ward off an infection, although a newly infected vaccinated patient likely will avoid a serious progression in the disease. That’s because the shot stimulates development of the immune system’s T-cells — a more durable element of protection.

Keeping up an optimal shield is important, though, because the delta variant has made COVID-19 so much more transmissible. Any infection, including “breakthrough” infections of the vaccinated population, can spread to someone who still may be vulnerable.

The state has given about 139,000 third doses so far. That’s good, but Hawaii should expect a more aggressive rollout, assuming booster approval for all adults comes soon.

Everyone is eager for holiday reunions with family and friends, starting with Thanksgiving next week. It’s time to celebrate — but wiser to do so with armor that is closer to peak performance.