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Get a COVID-19 booster shot now or wait? Many wonder how best to ride out the pandemic's next wave – CBS News

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Gwyneth Paige didn’t want to get vaccinated against COVID-19 at first. With her health issues — hypertension, fibromyalgia, asthma — she wanted to see how other people fared after the shots. Then her mother got colon cancer.

“At that point, I didn’t care if the vaccine killed me,” she said. “To be with my mother throughout her journey, I had to have the vaccination.”

Paige, who is 56 and lives in Detroit, has received three doses. That leaves her one booster short of federal health recommendations.

Like Paige, who said she doesn’t currently plan to get another booster, some Americans seem comfortable with the protection of three shots. But others may wonder what to do: Boost again now with one of the original vaccines, or wait months for promised new formulations tailored to the latest, highly contagious Omicron subvariants, BA.4 and BA.5?

The rapidly mutating virus has created a conundrum for the public and a communications challenge for health officials.

“What we’re seeing now is a little bit of an information void that is not helping people make the right decision,” said Dr. Carlos del Rio, a professor of infectious diseases at the Emory University School of Medicine.

Del Rio said the public isn’t hearing enough about the vaccines’ value in preventing severe disease, even if they don’t stop all infections. Each new COVID variant also forces health officials to tweak their messaging, del Rio said, which can add to public mistrust.

About 70% of Americans age 50 and older who got a first booster shot — and nearly as many of those 65 and older — haven’t received their second COVID booster dose, according to data from the Centers for Disease Control and Prevention. The agency currently recommends two booster shots after a primary vaccine series for adults 50 and older and for younger people with compromised immune systems. Multiple news outlets recently reported that the Biden administration was working on a plan to allow all adults to get second COVID boosters.

Officials are worried about the surge of BA.4 and BA.5, which spread easily and can escape immune protection from vaccination or prior infection. A recent study published in Nature found BA.5 was four times as resistant to mRNA vaccines as earlier Omicron subvariants.


New COVID subvariant responsible for summer surge

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Consistent messaging has been complicated by the different views of leading vaccine scientists. Although physicians like del Rio and Dr. Peter Hotez of Baylor College of Medicine see the value in getting a second booster, Dr. Paul Offit, a member of the FDA’s vaccine advisory committee, is skeptical it’s needed by anyone but seniors and people who are immunocompromised.

“When experts have different views based on the same science, why are we surprised that getting the message right is confusing?” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation and Offit’s colleague on the FDA panel.

Janet Perrin, 70, of Houston hasn’t gotten her second booster for scheduling and convenience reasons and said she’ll look for information about a variant-targeted dose from sources she trusts on social media. “I haven’t found a consistent guiding voice from the CDC,” she said, and the agency’s statements sound like “a political word salad.”

On July 12, the Biden administration released its plan to manage the BA.5 subvariant, which it warned would have the greatest impact in the parts of the country with lower vaccine coverage. The strategy includes making it easier for people to access testing, vaccines and boosters, and COVID antiviral treatments.

During the first White House COVID briefing in nearly three weeks, the message from top federal health officials was clear: Don’t wait for an Omicron-tailored shot. “There are many people who are at high risk right now, and waiting until October, November for their boost — when in fact their risk is in the moment — is not a good plan,” said Dr. Rochelle Walensky, head of the CDC.

With worries about the BA.5 subvariant growing, the FDA on June 30 recommended that drugmakers Pfizer-BioNTech and Moderna get to work producing a new, bivalent vaccine that combines the current version with a formulation that targets the new strains.

The companies both say they can make available for the U.S. millions of doses of the reformulated shots in October. Experts think that deadline could slip by a few months given the unexpected hitches that plague vaccine manufacturing.

“I think that we have all been asking that same question,” said Dr. Kathryn Edwards, scientific director of the Vanderbilt Vaccine Research Program. “What’s the benefit of getting another booster now when what will be coming out in the fall is a bivalent vaccine and you will be getting BA.4/5, which is currently circulating? Although whether it will be circulating in the fall is another question.”

The FDA on July 13 authorized a fourth COVID vaccine, made by Novavax, but only for people who haven’t been vaccinated yet. Many scientists thought the Novavax shot could be an effective booster for people previously vaccinated with mRNA shots from Pfizer-BioNTech and Moderna because its unique design could broaden the immune response to coronaviruses. Unfortunately, few studies have assessed mix-and-match vaccination approaches, said Gellin, of the Rockefeller Foundation.

Edwards and her husband got COVID in January. She received a second booster last month, but only because she thought it might be required for a Canadian business trip. Otherwise, she said, she felt a fourth shot was kind of a waste, though not particularly risky. She told her husband — a healthy septuagenarian — to wait for the BA.4/5 version.

People at very high risk for COVID complications might want to go ahead and get a fourth dose, Edwards said, with the hope that it will temporarily prevent severe disease “while you wait for BA.4/5.”

The Omicron vaccines will contain components that target the original strain of the virus because the first vaccine formulations are known to prevent serious illness and death even in people infected with Omicron.

Those components will also help keep the earlier strains of the virus in check, said Dr. David Brett-Major, an infectious disease specialist at the University of Nebraska Medical Center. That’s important, he said, because too much tailoring of vaccines to fight emerging variants could allow older strains of the coronavirus to resurface.

Brett-Major said messages about the value of the tailored shots will need to come from trusted, local sources — not just top federal health officials.

“Access happens locally,” he said. “If your local systems are not messaging and promoting and enabling access, it’s really problematic.”

Although some Americans are pondering when, or whether, to get their second boosters, many people tuned out the pandemic long ago, putting them at risk during the current wave, experts said.

Dr. Georges Benjamin, executive director of the American Public Health Association, said he doesn’t expect to see the public’s level of interest in the vaccine change much even as new boosters are released and eligibility expands. Parts of the country with high vaccine coverage will remain relatively insulated from new variants that emerge, he said, while regions with low vaccine acceptance could be set for a “rude awakening.”

Even scientists are at a bit of a loss for how to effectively adapt to an ever-changing virus.

“Nothing is simple with COVID, is it? It’s just whack-a-mole,” said Edwards. “This morning I read about a new variant in India. Maybe it’ll be a nothingburger, but — who knows? — maybe something big, and then we’ll wonder, ‘Why did we change the vaccine strain to BA.4/5?'”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Delivering new services ‘complicated,’ Freeland says of planned dental care program

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OTTAWA — The government is working hard to meet its end-of-year deadline to deliver dental-care coverage to kids, the deputy prime minister said Tuesday, but added providing new services is “complicated.”

The Liberals agreed to offer dental coverage to low- and middle-income children by the end of the year as part of their confidence and supply deal with the New Democrats to keep the minority government from toppling before 2025.

Several groups have raised concerns about the very tight deadline, and four sources close to the program say the government is working on a temporary solution to give money directly to qualifying families while it comes up with a permanent program.

“As we experienced, for example, in rolling out child-care agreements across the country, delivering new services to Canadians is complicated,” Freeland said when asked about the stopgap plan at a news conference in Toronto.

“I think Canadians understand that.”

Freeland did not confirm or deny the government’s immediate plans but said the Liberals are committed to the dental-care program, and it’s a commitment she’s “happy to make.”

The government could pursue dental-care deals that resemble the ones it made with provinces to lower the cost of child care, in which it offered provincial governments money to administer their programs under a prescribed set of criteria. However, that route is looking increasingly unlikely.

Federal officials have also canvassed dental-health experts about other approaches. The government could contract out a national program to a private insurance firm or have federal public servants take on the work.

“Kids should not have their teeth get rotten just because their parents don’t have enough money to pay for them to go see a dentist, I think it’s as simple as that,” Freeland said.

The Liberals set aside $5.3 billion over five years to fully implement the program. They hope to start with children under the age of 12 with an annual household income of less than $90,000.

Last week NDP Leader Jagmeet Singh said he was confident the dental-care program would come together by the end of the year, as outlined in the agreement with the Liberals.

Freeland said the government is working “very, very hard” to make good on the promise to the NDP. The Liberals risk the NDP walking away from the supply and confidence agreement entirely if they don’t.

This report by The Canadian Press was first published Aug. 9, 2022.

 

Laura Osman, The Canadian Press

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Top commander defends military’s vaccine requirement, says ‘tweak’ in the works

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OTTAWA — Canada’s top military commander said he will “tweak” the vaccine mandate for the Armed Forces in the next few weeks but defended vaccine requirements as necessary to keep the military ready to respond to any emergency.

“This is an institution that’s unlike any other because we do have to be operationally ready, we are the nation’s insurance policy,” chief of the defence staff Gen. Wayne Eyre told The Canadian Press in an interview.

“We have to go into dangerous locations and close confined quarters, we have to deploy overseas, where there’s potentially an increased threat with the pandemic. We also don’t know the trajectory of this pandemic, where it’s going to go into the future.”

When Eyre ordered all troops vaccinated against COVID-19 last October, he said it was to both protect the force and “demonstrate leadership” as the Liberal government adopted vaccine mandates across the federal public service.

The public service vaccine mandate was suspended in June but the military one persists, a fact that has heightened criticism of the military’s policy.

The Department of National Defence said more than 98 per cent of Canadian troops complied with the order. Defence Minister Anita Anand was briefed in June that 1,137 remained unvaccinated.

Those who refuse vaccination face the risk of forced removal from the military. The department says 241 unvaccinated troops have been ousted with disciplinary measures initiated against hundreds more.

Eyre said he is trying to find the “sweet spot” between the military’s medical, legal, operational and ethical requirements.

“We need to maintain our operational viability going forward,” he said. “So over the course of the next number of weeks, we will tweak the policy, we’ll put out something amended. But we also need to realize that this is a dynamic environment, and things can change, the trajectory of the pandemic can change. So we’ve got to maintain that flexibility as well.”

He added that not only has the military been called upon to assist in communities across Canada that have been hit by the pandemic, but that vaccine requirements still exist in many allied and foreign nations and militaries.

The U.S. military still requires all troops to be vaccinated as do some NATO facilities and bases.

“There are going to be operational requirements where to operate with allies, (vaccination) is going to be essential,” he said. “But as we go forward, the options are being developed looking at those four factors that I talked about and finding the right balance.”

Eyre’s comments appear to contradict a draft copy of a revised vaccine policy obtained by the Ottawa Citizen last month, which suggested vaccine requirements for military personnel would be lifted.

The draft document, which officials say has not been approved by Eyre, said military personnel as well as new recruits would no longer have to attest to their vaccination status.

The document also noted potential legal difficulties ahead to deal with people who were kicked out of the military because of the vaccine mandate, suggesting they could be forced to apply for re-enrolment.

By contrast, other unvaccinated federal public servants were put on leave without pay but allowed to return to their jobs when the mandate was suspended.

The military mandate was unsuccessfully challenged several times in Federal Court, most recently last month.

Phillip Millar, the London, Ont.-based lawyer who appeared before the court to seek an injunction on behalf of unvaccinated service members, said the court ultimately decided it couldn’t rule on the issue until the new policy was released.

Millar, who is also representing James Topp, an army reservist charged with publicly speaking out against federal vaccine mandates while wearing his uniform, said he was disappointed with the decision given the lack of timeline for the new policy.

“The military is deliberately dragging its feet on this new direction because it just wants to kick people out,” Millar alleged, adding: “It’s obviously a political policy, not an operational policy.”

Eyre would not say whether Armed Forces members are still being kicked out, or whether such releases have been suspended pending the results of his review.

The Defence Department says there have been more than 9,500 cases of COVID-19 among military personnel, including 113 active cases as of Aug. 1. It did not say whether there have been any deaths associated with the illness.

This report by The Canadian Press was first published Aug. 9, 2022.

 

Lee Berthiaume, The Canadian Press

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Double mRNA COVID-19 vaccination found to increase SARS-CoV-2 variant recognition – News-Medical.Net

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In a recent study posted to the bioRxiv* preprint server, researchers evaluated the impact of double BNT162b2 messenger ribonucleic acid (mRNA) vaccination in recognition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VoCs).

Study: Double-dose mRNA vaccination to SARS-CoV-2 progressively increases recognition of variants-of-concern by Spike RBD-specific memory B cells. Image Credit: CKA/Shutterstock

Background

Studies have reported that double coronavirus disease 2019 (COVID-19) vaccinations generate high titers of SARS-CoV-2 S-targeted antibodies (Ab), Bmem and T lymphocytes; however, VoCs with SARS-CoV-2 S receptor-binding domain (RBD) mutations can evade humoral immune responses.

Booster doses have been reported to enhance VoC recognition by Abs; however, it is not clear whether VoC recognition is enhanced due to higher Ab titers or due to the increased capacity of Ab binding to S RBDs.

About the study

In the present study, researchers evaluated the benefit of double BNT162b2 vaccinations on SARS-CoV-2 VoC recognition.

Healthy and SARS-CoV-2- naïve persons (n=30) without immunological or hematological diseases were enrolled in the study to assess their peripheral blood B-lymphocyte subsets between February and June 2021.  Samples were obtained before the BNT162b2 vaccination, after three weeks of the first vaccination, and four weeks following the second vaccination.

Serum memory B lymphocytes (Bmem) counts and Ab titers were assessed using recombinant SARS-CoV-2 spike (S) protein RBDs of the Wuhan, Gamma, and Delta strains. Neutralizing Ab (NAb) titers were evaluated using 293T-ACE2 cells and SARS-CoV-2 pseudotyped viral assays. Further, the nature of RBD-targeted Bmem was examined based on the expression of cluster of differentiation (CD) 21, 27, and 71.

Enzyme-linked immunosorbent assays (ELISA) were performed to evaluate variant-specific S RBD antibody titers and the serum dilution needed for preventing 50% SARS-CoV-2 entry (ID50) values were ascertained. Flow cytometry (FC) was performed to evaluate Bmem counts. Immunoglobulin G (IgG) titers against SARS-CoV-2 nucleocapsid (N) protein RBD and S RBD were evaluated before and post the first and second BNT162b2 vaccination.

Results

In total, 28, 30, and 30 samples were obtained pre-vaccination, after three weeks of the first dose and after four weeks of the second dose, respectively. All the participants remained SARS-CoV-2-naïve throughout the study without anti-SARS-CoV-2 N antibodies. Most participants (n=22) induced NAbs after the first vaccination, and the NAb titers after the second vaccination had IC50 values >100.

Double BNT162b2 vaccination generated robust NAb responses among all study participants. Immunoglobulin G+ (IgG+) and IgM+ RBD-targeted Bmem were generated after the first vaccination, and IgG1+ Bmem counts increased after the second vaccination. Most RBD-targeted Bmem showed binding with Delta and/or Gamma VoCs, which increased significantly after the second vaccination.

The RBD-targeted Bmem compartment comprised mainly IgG1+ or IgM+ cells, and contrastingly, the total Bmem compartment comprised more IgG2+ cells and fewer IgG1+ cells compared to the RBD-targeted Bmem compartment.

After the second vaccination dose, RBD-targeted IgG1, 2 and 3-expressing Bmem populations expanded significantly, although the total Bmem lymphocyte compartment was unaltered.

The number of RBD-targeted IgG+ Bmem correlated positively with RBD-targeted serum IgG post first and second vaccinations. While two subsets of IgM+ Bmem lymphocytes (CD27+ IgM+ and CD27+ IgM+ IgD+) proportionally decreased after the second vaccination dose, the absolute cell counts were identical to those observed post the first vaccine dose. Taken together, BNT162b2 vaccinations particularly affected the antigen-targeted Bmem lymphocyte counts, and the production of IgG1-expressing Bmem lymphocytes was boosted after the second BNT162b2 vaccination.

CD27 was expressed by 95% of anti-RBD and IgG-expressing Bmem lymphocytes, the proportion of which did not differ between the initial and subsequent BNT162b2 vaccination. After the first vaccine dose, 15% of anti-RBD Bmem lymphocytes were CD21lo, the proportion of which was marginally but significantly lower (reduced to 10%) after four weeks of the second vaccination.

CD71 was expressed by 10% of anti-RBD Bmem lymphocytes after the first and second vaccination. In the total population of Bmem lymphocytes, the results after the first and second vaccination did not differ significantly, denoting the Bmem compartment stability. After four weeks of vaccination, anti-RBD Bmem lymphocytes exhibited a nature and resting Bmem lymphocyte immunophenotype.

Anti-Wuhan S RBD- IgG titers exhibited partial recognition of the Beta, Gamma and Delta VoCs with more prominent reductions for Gamma and Beta VoCs than for the Delta VoC. The second vaccine BNT162b2 dose significantly enhanced anti-Wuhan RBD antibody binding to Gamma and Beta VoCs; however, the neutralization potency of vaccine-induced NAbs against Gamma and Beta was lesser than for Delta.

Delta RBD and Gamma RBD were recognized by 50% and 70% of RBD-targeted Bmem lymphocytes after the first and second vaccinations, respectively, and the increase in VoC-recognizing Bmem counts was largely due to elevated IgG1+ Bmem counts.

Conclusion

Overall, the study findings showed that the second BNT162b2 vaccination elevated NAb titers and SARS-CoV-2 RBD-targeted Bmem counts and that double BNT162b2 vaccination was especially needed for Delta and Gamma VoC recognition. The findings indicated that the second vaccine dose improved S RBD-targeted Bmem counts and the Bmem affinity to overcome VoC mutations.

*Important notice

bioRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

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