Bivalent Covid-19 Vaccines – A Cautionary Tale

Dr. Paul Offit of the Children’s Hospital of Philadelphia wrote a fairly centred piece for the New England Journal of Medicine titled, “Bivalent Covid-19 Vaccines — A Cautionary Tale” published on 11 January 2023.

https://www.nejm.org/doi/10.1056/NEJMp2215780

Of course, he writes the obligatory, “For vaccines against SARS-CoV-2, a mucosal infection with a short incubation period, protection from severe disease is the only reasonable and attainable goal”, and, “Although it was reassuring that early data from southern Africa showed that previous infection or vaccination protected against severe disease caused by omicron, public health officials worried that the BA.1 strain posed a serious threat to the effectiveness of existing Covid-19 vaccines and therapies”, and, “Fortunately, SARS-CoV-2 variants haven’t evolved to resist the protection against severe disease offered by vaccination or previous infection.”

But the rest of the article is quite an interesting read. He writes, “A series of rapid-fire policy decisions followed. On June 29, 2022, the Biden administration agreed to purchase 105 million doses of Pfizer–BioNTech’s bivalent vaccine. One month later, the administration agreed to purchase 66 million doses of Moderna’s bivalent vaccine. On September 1, the CDC recommended bivalent vaccine boosters for everyone 12 years of age or older. On October 12, the CDC extended this recommendation to include everyone 5 years of age or older. At that point, no data from humans, including immunogenicity data, were available for comparing the relative capacities of the monovalent and bivalent vaccines to protect against BA.4 and BA.5.” So there was no data for humans at that time, but yet 5-year-olds were recommended to get it.

He goes on, “On October 24, David Ho and colleagues released the results of a study examining levels of neutralizing antibodies against BA.4 and BA.5 after receipt of a monovalent or bivalent booster dose. They found “no significant difference in neutralization of any SARS-CoV-2 variant, including BA.4 and BA.5, between the two groups.” And just “One day later, Dan Barouch and colleagues released the results of a similar study. They noted no appreciable differences between participants in the monovalent-booster group and those in the bivalent-booster group. Neither research group found the bivalent boosters to elicit superior immune responses.”

But the most pertinent statement, I think, is in the final paragraph. “Although boosting with a bivalent vaccine is likely to have a similar effect as boosting with a monovalent vaccine, booster dosing is probably best reserved for the people most likely to need protection against severe disease — specifically, older adults, people with multiple coexisting conditions that put them at high risk for serious illness, and those who are immunocompromised. In the meantime, I believe we should stop trying to prevent all symptomatic infections in healthy, young people by boosting them with vaccines containing mRNA from strains that might disappear a few months later.”

Hear, hear.

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