The threat of a full-blown COVID-19 comeback may have sent health policy administrators into a tizzy, but the government, as of now, is not considering a second COVID-19 booster dose even for those considered most vulnerable to the disease.
As of now, booster dose coverage in India, which is permitted for all aged 18 years and above, stands at just 28 percent of the eligible population group. These shots are provided free of cost to those above 60 years of age but people aged 18-59 years can only get them in private hospitals at predetermined rates.
Government officials conceded that there is an emerging view that in the years to come, COVID-19 vaccines may be useful as annual boosters, as is the case with existing vaccines against influenza, for specific groups of people such as those with respiratory problems or multiple comorbidities.
“However, at this point in time there is not even a consideration of allowing more COVID-19 vaccine (booster) doses for anyone, including those considered the most susceptible to severe disease,” said a senior official in the Union health ministry.
He added that the government stance may change in future if there is a recommendation to this effect by top advisory bodies such as the National Technical Advisory Group on Immunisation (NTAGI), based on scientific evidence.
“It is possible that COVID-19 vaccines may be freely available in the market for those who want to receive it on the advice of their doctors,” said the official. “But that (additional government-mandated booster doses) is definitely not happening in the near future.”
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Several developed countries such as the US have offered multiple COVID-19 booster doses to their citizens since vaccination against the infectious disease first started in late 2020. Some experts, such as epidemiologist Dr Naman Shah, said that it may be reasonable for India, too, to consider follow-up booster shots for those at the highest risk, as other countries have done.
Need for bivalent vaccines
Public health specialists and biologists appear unanimous in their verdict that while follow-up boosters with existing vaccines may not be useful, next-generation shots against the COVID-causing coronavirus could do the trick.
Medical researcher Dr Anurag Agrawal, who is associated with Ashoka University, said that there may not be data to indicate that a second booster shot against COVID-19 is useful even for the elderly.
“In future, with variant-specific boosters, maybe a shot beyond three doses could help but we do not have data to support that additional doses — beyond three shots of adenovirus or killed virus vaccines against the ancestral strain of SARS-CoV-2 (such as Covishield or Covaxin) — will work,” he said. “I don’t see any urgency to take such decisions in the absence of data,” Agrawal added.
Dr Chandrakant Lahariya, an expert in public health and health systems, said that while a second booster may not be needed for any population groups in the near future, the only possible scenario for follow-up boosters would be when new bivalent and multivalent COVID-19 vaccines become available.
Bivalent COVID-19 vaccines include a component of the original virus strain to provide broad protection against SARS-CoV-2 and a component of the Omicron variant to provide better protection against the disease.
Similarly, multivalent vaccines may be capable of offering protection against several strains of SARS-CoV-2.
“As of now, people are regularly getting exposed to circulating SARS-CoV-2 variants and sub-variants, which is serving to boost immunity,” he emphasised.
According to immunologist Dr Dipyaman Ganguly, as immunity to SARS-CoV-2 is failing to prevent infections from happening with new Omicron variants, vulnerable groups, such as elderly people, people on immunosuppressants or B cell depleting therapies with Rituximab, and those with comorbid conditions can be considered for a booster immunisation . "The time gap with the last dose is not expected to influence the protective effect too much," he opined.
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