Analysis: Co-morbidity clause removed for 60-plus to get COVID-19 booster shots. Will it draw more people to vax centres?

The government, on March 14, announced that the condition of comorbidities for the 60-plus population for COVID-19 booster doses will now be removed. With this, the entire population of the 60-plus age group in the country will now become eligible for booster doses, officially called precaution doses.

Comorbidity refers to the simultaneous presence of two or more diseases or medical conditions in a patient.

The announcement, however, is unlikely to lead to a dramatic rise in those seeking precaution doses.

The other condition – completion of 9 months from the administration of the second dose -- stays. So far, about 2.01 crore booster doses have been administered in India.

Beginning January 10 this year, precaution doses were administered for healthcare and frontline workers, and for those above 60 years of age with underlying diseases. The latter, however, was not required to produce a medical certificate confirming co-morbidity, at the time of taking booster shots.

The new announcement, to be applicable from March 16, makes it clear that those senior citizens who do not have any pre-existing diseases qualify for precaution doses.

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Sources from the healthcare industry said that the latest move is likely to emphasise on the need for boosters for the most vulnerable age group—people above 60 years-- whose population is estimated at nearly 7.75 crore in India.

Greater interest in booster shots expected?

Dr Harsh Mahajan, President, NATHEALTH, a body representing India’s healthcare industry, said that while the new announcement may not lead to a sharp rise in those above 60 years of age coming for vaccination, the move may stress the benefits of a booster dose, even though most qualifying for the additional shot may have already taken it.

“It will also build greater understanding around the fact that even though the number of new COVID-19 cases in the community in India is very low, we cannot afford to let our guard down,” he said.

The BA.2 variant of Omicron is causing a huge number of infections in some parts of the world. Since this variant may even infect those who have been infected with the previous variants and has a robust vaccine escape capability, we need to be cautious for the next few months, he said.

Dr Rajeev Jayadevan, a public health expert from Kerala, highlighted that the new announcement may make the message on booster shot easier in people’s minds.

Why elderly should not ignore recommendation on booster doses

Dr Jayadevan says that if all risk factors for severe COVID-19 are listed in the order of rank, age is the strongest.

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In other words, being older by itself is the most consistent risk factor for severe disease outcomes with COVID-19, much more so than each individual disease condition. “Hence, people over 60, who have an exponentially greater risk of severe outcomes --100-1,000 fold, compared to a 25-year-old—qualify for the precaution dose the most.”

He, however, also pointed out that hybrid immunity already exists in many people, which may mean that COVID-19 infection occurred after two doses of vaccination.

Such people may not immediately need a precautionary dose, Dr Jayadevan suggested, and they may be prioritised behind others who have not had a natural infection after vaccination.

Now, there is also evidence that the two-dose vaccination provides excellent long-term protection against severe diseases, even though protection against infection wanes after a few months and that additional benefits achieved by a 3rd dose over 2 doses is minimal, perhaps noteworthy only in those over 65.

Dr Sonam Solanki, consultant pulmonologist at Masina Hospital in Mumbai, pointed out that even if booster doses may only help marginally, the elderly should take it, considering that they continue to be susceptible to severe COVID-19.

Dr Bishnu Panigrahi, group head, medical strategy and operations, Fortis Healthcare, echoed similar views.

“Since immunity from the vaccine wanes after some time, the booster will enhance immunity and protect the 60-plus age group,” he said.