The last time many of us asked for boosters, we were toddlers trying to sit at the adult table at Jack Astor’s. But in 2021, the word has taken on a whole new meaning as countries like Israel and the United States have begun rolling out booster shots to the COVID-19 vaccines in an effort to combat the highly infectious Delta variant. More and more countries are following suit: France, Germany, and the United Kingdom all recently announced they’ll be administering booster shots beginning next month. *Takes a breath.* That’s a lot to digest. We’ve *just* started to get comfortable with our vaccination numbers, with 65% of Canadians fully vaxxed (waxed and ready for snacks).
So, now we need a booster too? And just what are boosters? When should we plan to get them? We spoke with three experts — Burlington, ON family physician Dr. Jennifer Kwan, infectious disease epidemiologist Ashleigh Tuite from the Dalla Lana School of Public Health in Toronto, and Danielle Cane, a masters candidate in infectious diseases at the London School of Hygiene and Tropical Medicine — to get the authority on boosters: what we need to know, what we can expect, and what still remains unknown.
What are boosters and what exactly do they do?
“We get vaccinated every year for the flu,” Tuite says, “because the flu virus changes over time and we need to update the vaccines to ensure we remain protected.” You can think of boosters as offering a similar sort of protection. Boosters, which contain the same dosage of the vaccine as your first and second doses, ramp up the durability of your original vaccine, according to emerging research.
Because these vaccines are so new, no one is quite sure how long they last and at what level of efficacy, especially as the virus continues to mutate. “We have data suggesting that although the vaccines remain highly effective for preventing severe illness, they're less effective for preventing infection with Delta,” says Tuite. “The thinking is, that by providing a third shot, we may achieve better protection against infection with Delta, which could reduce the size of future pandemic waves.”
Israel’s Health Ministry, which has already begun providing booster shots to people 40 and over, have so far found this third dose significantly lowers the risk of infection and serious illness amongst people 60 and over. Earlier this year, execs from both Pfizer and Moderna spoke about their aim to make a third doses available by autumn, noting that it’s likely we may get these boosters every year. Which, again, is nothing new. In addition to annual flu shots, we receive boosters for everything from tetanus shots to HPV to Hepatitis B vaccinations.
Will Public Health recommend boosters shots to Canadians?
That’s TBD. So far, the National Advisory Committee on Immunization (NACI), the advisory body that provides recommendations on vaccination in Canada, “is currently reviewing relevant studies and will update its recommendations in the coming weeks,” a spokesperson for the Public Health Agency of Canada (PHAC) told Global News on Aug. 17.
Still, some provinces are moving forward with boosters for at-risk populations. In Ontario, for example, third shots are now being offered to long-term care residents and some immunocompromised people (for example, transplant patients or patients with active blood cancers). “In older people and immunocompromised people, a booster shot can act to essentially bring their protection up to a baseline level reached in most people with two shots,” says Tuite.
Other provinces like B.C. and Alberta are still mulling over whether to administer boosters to the elderly and at-risk. Quebec, meanwhile, is offering booster doses for people who had an AstraZeneca and Pfizer/Moderna combo due to certain countries not recognizing individuals with Aztrazeneca dosage as “fully” vaccinated. Saskatchewan is offering the same policy.
If I get a booster, does it matter if it’s Pfizer or Moderna?
In a word, no. The mixing of vaccines has been approved by NACI, so we shouldn’t be concerned about combining them, nor should we prefer one brand over the other. That’s called vaccine shopping and can potentially elongate the pandemic due to misinformation spread on social media. It also puts you and those around you at greater risk because you’re delaying getting vaccinated.
“The luxury of choice in a crisis may be exactly that — a luxury,” Cane says. “Unfortunately, many Canadians were turning their noses up at Moderna, for example, but we now have data that indicates how effective this particular brand is.”
She cites a recent pre-print study (which means it’s still awaiting peer review) from nference, a biomedical research organization in the U.S., that found those who were double-vaccinated with Moderna experienced a two-fold risk reduction against breakthrough infection (infection in a fully vaccinated individual). And researchers at the University of Oxford have found both Pfizer and (drumroll, please) AstraZeneca as effective against the Delta variant (although as mentioned above efficacy fades with time). So really, don’t be precious, and just take whatever brand is offered to you.
Why are we even talking about boosters when many countries can’t get their hands on first doses?
Excellent question! That’s called global vaccine inequity and this week, the World Health Organization (WHO) advised countries that are in advanced stages of their vaccination campaigns to pause administering boosters for two months until other countries have had the opportunity to catch up and receive more doses.
“It is not, in my opinion, ethical to mandate third-booster vaccinations for all Canadians while other countries, such as Uganda, may only have roughly 1% of their population vaccinated partially or fully,” Cane says, adding that it is also unethical to let our surplus vaccine stock defrost or expire when it could very easily go to other regions of the globe.
Canada has a 13 million dosage surplus that it has pledged to donate to developing countries. On August 12, the federal government announced that its unused stock of the Johnson & Johnson vaccine would be added to the vaccine stock already slotted for donation to other countries; however it is unclear if these doses have already been shipped.
Dr. Theresa Tam, Canada’s Chief Public Health Officer said earlier this month that Canada has the capability to both offer third doses to those who want them and send doses to developing countries that who need it. “Canada has — in its range of vaccine options — a lot of capacity,” Tam said. “So, I think we can do both.”
Remember, says Dr. Kwan, stronger and more deadly variants can pop up in regions with low rates of immunization, noting that global vaccine equity doesn’t just benefit other countries, it benefits the entire world.
Remember: The pandemic isn’t done with you just because you’re done with the pandemic
“Vaccines aren't the only tool that we have available to curb transmission,” says Tuite. It’s a good reminder just because you got your double-shot you can forget everything we’ve learned over the past two years. Keep calm and carry on masking, washing your hands, testing when required, participating in contact tracing, maintaining a well-ventilated home and work space, and physically distancing.
And stop touching your face.
COVID-19 has been declared a global pandemic. Go to the Public Health Agency of Canada website for the latest information on symptoms, prevention, and other resources.