Third dose Covid booster shots: No final decision yet

By Yumiko Perera

In the wake of another surge in daily Covid-19 infections and related deaths in the country, authorities are considering administering a third dose of a Covid-19 vaccine as booster shots to healthcare workers, following a request by the Government Medical Officers’ Association (GMOA), The Sunday Morning learnt.

While reports suggest that it is likely that healthcare workers may receive booster shots five months after the administration of the second jab, according to the Ministry of Health, the provision of the third dose of a Covid-19 vaccine is currently being evaluated by experts, and a decision is yet to be finalised in this regard.

Speaking with The Sunday Morning, Medical Research Institute (MRI) Department of Immunology Head and consultant immunologist Dr. Rajiva de Silva opined that a third dose would not be necessary, factoring in that the present objective of the country is to reduce the mortality rate owing to the sudden surge in infections.

Replying to The Sunday Morning’s query as to whether a third dose booster shot is being considered for healthcare workers, Dr. de Silva noted that the Advisory Committee on Communicable Diseases (ACCD) has not discussed anything in this regard as of yet.

“While the ACCD has not been informed about a booster dose, I believe for the time being, the only people who should be considered for a booster shot – or a third dose of the Covid-19 vaccine, for that matter – are those who have ongoing malignancies, particularly those with blood cancer, etc., as even if you look at data from other countries that have begun to administer the third dose, especially Israel, there is very limited evidence in this regard. We also need to realise that fully vaccinating people has significantly brought down the mortality rate as well as the number of patients that require intensive care,” he said.

“There is a lot of noise in this regard, and another argument for a booster is the belief that it would help curb the spread from person to person, but there simply isn’t enough data to come to any concrete conclusions. When you don’t have many vaccines, the focus should be on saving lives, which is why I believe immunising those who have not received even a single dose of the vaccine should be prioritised for the time being, as vaccine equity should be ensured for all,” Dr. de Silva noted in conclusion.

Speaking with The Sunday Morning previously, Deputy Director of Public Health Services (DDPHS) and Disaster Preparedness and Response Division Head Dr. Hemantha Herath noted that the possibility of a booster shot is continuously being reviewed.

Meanwhile, sharing his views on the possible third dose, or booster shot, a medical expert who wished to remain anonymous told The Sunday Morning that those with underlying health conditions should ideally be given priority if the Government planned on rolling out third doses of Covid-19 jabs.

“At this point, if the Government decides to inoculate healthcare workers with a third dose of the vaccine, we would be depriving a sect of vulnerable people, who may need the immunisation even more. 

“Furthermore, there is also a chance that it may bring about unnecessary friction amongst people. That being said, several countries have started administering the third dose and have recommended it to be rolled out, but that has been done after making sure that their two-dose vaccine coverage reached at least 80-90% of the population, and also after some time since the vaccines were rolled out in the first place,” he noted. 

Noting that the countries that have recommended a third dose of a Covid-19 vaccine have already underlined the priority groups that would be inoculated, the medical expert further reiterated that the identified priority groups mainly consist of immunocompromised people who are receiving immunosuppressive treatment for cancer and people with HIV with low CD4 counts or detectable HIV viral load, The Sunday Morning learnt. 

Furthermore, he further elaborated that when vaccine production companies recommend a third dose or a booster shot, there may be a conflict of interest, and the commercial aspect must also be taken into account.

Explaining what is expected of the immunisation process, the medical expert further elaborated: “When it comes to Covid-19 vaccines, the first dose does both priming and boosting. So, even if you take the first dose, there would be a significant amount of protection, and when you take the second dose, which is a booster, the protection is increased.

“Once a booster dose is given, going by the data available as of now, neutralising antibodies would last in the immune system for nearly five or six months, and then they slowly decline; in the scientific sense, it is referred to as the waning of immunity. 

“Moreover, when you consider any viral disease, what gives us protection is not the neutralising antibodies; rather, it is cell-mediated immunity. Even if the impact of the vaccine concentration is reduced eventually, our bodies still have immunological memory, which means if one contracts the virus, their immunological memory would reduce the severity of the disease.  

“This is precisely what we are expecting through mass immunisation. Likewise, when you slowly increase the proportion of the population of those who have immunity, the SARS-CoV-2 would eventually turn into something like the common cold, which is what is expected of the vaccine,” he noted. 

Moreover, World Health Organisation (WHO) Director General Dr. Tedros Adhanom 

Ghebreyesus, earlier this week, called upon countries to delay giving out booster shots of the Covid-19 vaccine until nations with low vaccination rates can inoculate more of their population, The Sunday Morning learnt.

While some countries, including the US, have already announced their intention to offer booster shots in the upcoming weeks, Israel earlier became the first country to distribute a third dose of Covid-19 vaccines, offering the extra jab to anyone over 60 years of age.

Speaking to The Sunday Morning in that regard, Minister of Health Keheliya Rambukwella stated: “The World Health Organisation has not yet given a clear reading on the third dose of a Covid-19 vaccine as a booster shot. Having said that, this is something that we may have to consider as time goes on.”

Moreover, it is learnt that the Covid-19 Task Force is discussing the matter.

Meanwhile, President Gotabaya Rajapaksa has called for health experts’ recommendations on whether the next priority should be a third booster dose for those aged 60 and above or whether the country should proceed with vaccinating those aged 30 and below.

Several attempts by The Sunday Morning to get in touch with DGHS Dr. Asela Gunawardena; State Minister of Production, Supply, and Regulation of Pharmaceuticals Prof. Channa Jayasumana; and Army Commander and National Operation Centre for Prevention of Covid-19 Outbreak (NOCPCO) Head Gen. Shavendra Silva proved futile.