The panel advising Israel’s Ministry of Health about the Wuhan coronavirus (COVID-19) pandemic will be discussing the possibility of giving yet another booster vaccine shot for immunocompromised patients.

Several studies have shown that certain categories of patients with weakened immune systems were much less likely to develop antibodies after two doses compared to the general population.

A study by the Rabin Medical Center-Beilinson Campus in Petah Tikva and the Clalit Health Services showed that among lung transplant patients, 33 percent developed antibodies after the booster compared to 18 percent after the first two shots.

For heart transplant patients, the rates were 58 percent after the third shot compared to 31 percent after the second. For liver transplant recipients, 71 percent developed antibodies after the third shot compared to 47 percent after the second.

The advisory panel will discuss the option of a fourth shot later this week.

Real-world COVID vaccine experiment continues

Cyrille Cohen, head of the immunology lab at Bar-Ilan University, said that this move makes sense.

“We know that three shots are needed by people with a functional immune system. Immunosuppressed patients got their third vaccine already almost six months ago, so it is not a bad idea to offer them another booster, since they are at high risk,” he said.

He also said that it is hard to know if it is going to help unless the procedure is carried out. “It is very complex to answer the question without actually carrying out the procedure. We saw how with the third vaccine many were skeptical as Israel started to administer it, and now most of the world agrees that it is needed.”

Cohen is essentially saying that the real-world COVID vaccine experiment should continue.

Is the fourth shot safe?

One thing that should be considered is whether or not a fourth shot would be safe. 

According to Cohen, most of the side effects associated with the Pfizer vaccine are connected to an overreaction of the immune system, so he believes that additional shots should not be an issue for patients whose immune systems do not react strongly enough.

But Cohen cautioned that not all immunosuppressed patients can be considered the same way. For instance, he noted the difference between transplant recipients whose immune systems were weakened on purpose, and cancer patients whose immune systems can be weakened as a side effect of treatment.

In July, Israel’s Health Ministry started to administer booster shots to specific categories of patients; cancer patients suffering from solid tumors did not qualify. Those that did qualify were people with rheumatological or autoimmune diseases being treated with specific drugs, those with hematologic malignancies, and recipients of heart, lung, kidney or liver transplants.

However, despite the government-sanctioned rollout of COVID vaccine boosters and Cohen’s positive outlook, there are not enough credible studies to vouch for the safety of boosters in healthy individuals, much less the immunocompromised.

Israel making preparations

The country has been making preparations since September to ensure that it has a sufficient supply of the COVID-19 vaccines in case a fourth round is necessary. Health Ministry Director-General Nachman Ash said: “We don’t know when it will happen. I hope very much that it won’t be within six months, like this time, and that the third dose will last for longer.”

Israel has already inoculated most of its population, with the third dose already being administered since August. Health officials also said that the effects of the initial COVID-19 shots begin to weaken five months after inoculation, making the boosters “necessary.”

As the U.S., the U.K. and the rest of Europe began administering their booster shots, the World Health Organization pleaded for a moratorium on third shots, asking governments to wait until the end of the year so that poorer countries get better access to the vaccines.

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