Janet Lang had two doses of coronavirus vaccine, but she still double-masks every time she leaves her house. 

That’s because Lang, 73, takes oral chemotherapy to control a rare blood cancer. Although the drugs have helped to keep the cancer at bay, they also suppress her immune system, leaving her with the constant worry that although she’s fully immunized, it’s not enough to protect her against COVID-19.   

“I’m feeling quite fragile,” Lang told CBC News in an interview near her home in Waterloo, Ont. 

A booster shot, she said, would help ease her fears, especially when it comes to the delta variant, she said. 

“I’d like to see it put on the agenda [in Canada],” Lang said.  

Booster shots will be one of the next big decisions for Canadian officials, with the rise of the more transmissible delta variant, a lack of clarity over when boosters might be needed, and calls from the World Health Organization to get the planet vaccinated before rich countries worry about third doses.

In general, booster shots are used to increase the body’s antibody response to a virus after the immune system has been “primed” by the initial vaccination (for example, tetanus shots). Additional vaccine doses can also help the body fight off different variants of a virus (like the yearly flu shot). 

Vaccine manufacturers, including Pfizer and Moderna, are working on developing and testing the safety and efficacy of booster shots against Sars-CoV-2 — the virus that causes COVID-19 — and potential new variants. 

At this point, Canadian experts say, the existing COVID-19 vaccine schedule is offering excellent protection, including against the delta variant. But it’s not yet known, they say, how long that protection lasts in various populations — and therefore when or whether a booster shot will be needed. 

Still, Lang may get her wish in the coming months if Canada follows the lead of the U.K.’s Joint Committee on Vaccination and Immunisation (JCVI), which is already issuing guidance on potentially starting a booster shot campaign in about two months.  

“The JCVI’s interim advice is that, should a booster programme be required, a third COVID-19 vaccine dose should be offered to the most vulnerable first, starting from September 2021 to maximise individual protection and safeguard the NHS [National Health Service] ahead of winter,” said Prof. Wei Shen Lim, COVID-19 chair for JCVI, in a news release.

The British committee recommends that those who are immunosuppressed, living in long-term care or retirement homes, people aged 70 years and older, and front-line health workers should be the first to get a third dose of COVID vaccine, or booster shot. 

The U.K.’s targeted approach to booster shots is “spot on,”  said Dr. Allison McGeer, an infectious disease specialist at Mount Sinai Hospital in Toronto. 

“People who live in long-term care facilities, people who are immunocompromised, do generate lower antibody levels and they decline faster over time,” McGeer said. 

“There are likely to be some of those people who will not be well-protected come October or November and who might be better protected if they get an extra dose of vaccine.”

WATCH | COVID-19 vaccine booster being considered for the most vulnerable

As more Canadians get vaccinated against COVID-19, now the discussion is turning toward a possible third dose. A booster shot, not necessarily for everyone, could potentially help control the spread of variants of concern, including delta. 2:01

Dr. André Veillette, an immunologist at the Montreal Clinical Research Institute and member of Canada’s COVID-19 vaccine task force, said that although vaccines are doing an excellent job at controlling COVID-19 in Canada right now, he thinks it would be wise to offer booster shots to vulnerable populations in the fall. 

“[In] light of the fact that we’re probably going to get in Canada more and more of this delta variant, I think it’s reasonable to start thinking that we’re going to need also a booster or a third dose,” Veillette said. 

Both McGeer and Veillette agree that booster shots should go to people in long-term care, those who are elderly and people with suppressed immune systems first. 

WHO chief slams booster shots

But some experts, including the World Health Organization, say that policymakers need to look at the broader picture when they’re considering whether to offer booster shots — including the fact that many people in the world have not yet been able to get even their first dose of a COVID vaccine.  

“Some countries with high vaccination coverage are now planning to roll out booster shots in the coming months,” said Dr. Tedros Adhanom Ghebreyesus, WHO’s director general, in a news briefing on Wednesday.

“Vaccine nationalism, where a handful of nations have taken the lion’s share, is morally indefensible and an ineffective public health strategy against a respiratory virus that is mutating quickly and becoming increasingly effective at moving from human-to-human,” he said. 

Some Canadian physicians, including Dr. Caroline Quach-Thanh, pediatric infectious disease specialist and medical microbiologist at Chu Ste. Justine in Montreal, share that concern — and argue that one of the best ways to protect vulnerable people against COVID-19 is to vaccinate as many people as possible to build herd immunity. 

“If you give those [third] doses here, it means that you’re not giving them elsewhere, you know, worldwide. And at this point in time, what is absolutely needed is for the entire planet to be vaccinated, because if we want to stop the emergence of all those variants of concern that we’re seeing like day in, day out, we absolutely need to have everyone vaccinated,” Quach-Thanh said. 

Both Veillette and McGeer, however, said that by the fall, everyone who wants to be vaccinated in Canada will likely have received their doses, and there should be plenty of supply to allow for boosters, especially if it’s limited solely to those who are elderly and those who are immunocompromised.  

NACI watching to see if boosters needed

Canada’s National Advisory Committee on Immunization (NACI) is watching the scientific data develop as they consider whether booster shots will be needed — or when, said Anna Maddison, spokesperson for the Public Health Agency of Canada, in a statement emailed to CBC News. 

“Based on previous evidence, booster vaccines may be required when immunity decreases below levels of protection and if there is an increase in breakthrough disease,” Maddison said. 

“Booster vaccines may also be required if the evolution of the virus, due to variants of concern, is no longer efficiently recognized by the natural immune system or the vaccine.”

Even if all the data on boosters isn’t in yet, Canada should be ready to use them as a proactive measure, Veillette said. 

“I think the science may not be there [yet] to prove that elders need a third dose, but at the same time, do we need to go through what we went through before? Meaning, you know, outbreaks in elders’ homes and then people getting very sick, people dying?” 

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