U.S. prepares for COVID booster shots: what it can learn from Israel

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The Biden administration announced last week that it plans to make COVID-19 vaccine booster shots widely available, starting September 20, as infections rise from the delta variant, citing data indicating diminishing protection from the vaccines over time.

U.S. officials are prepared to offer a third shot to Americans who completed their initial two doses of the Pfizer-BioNTech and Moderna vaccines at least eight months ago, the Department of Health and Human Services said in a statement. The announcement came on the same day as an Israeli study that found booster shots significantly decrease transmission among those aged 60 and older.

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Initial booster doses will be given to Americans who received the two-dose vaccines, but U.S. health officials said they anticipate that people who received the single-dose Johnson & Johnson shot will also need boosters.

The U.S. announcement comes less than a month after Israel became the first country to officially launch a booster campaign. Here is what you need to know about Israel’s vaccination drive, and some lessons it can offer the United States.

A COVID booster shot administered in a Jerusalem facility, on Friday.Emil Salman

Why did Israel begin offering COVID booster shots?

Following the successful rollout of Israel’s nationwide vaccination campaign last December, new cases and deaths declined dramatically, raising hopes this summer that the country had finally put the pandemic behind it after several lockdowns.

A study published in The Lancet last May found that the two-shot Pfizer-BioNTech COVID-19 vaccine was 95 percent effective in preventing symptomatic SARS-CoV-2 infections, in line with a study conducted three months earlier by Israeli health maintenance organization Maccabi Healthcare Services.

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However, the protection provided by the vaccines appears to have waned over time and by the beginning of July, cases were again on the rise.

On July 5, the Health Ministry announced that, following an epidemiological analysis, it had concluded that the vaccine’s effectiveness in preventing infection had dropped to 64 percent – a development that was “observed simultaneously with the spread of the delta variant in Israel.”

Despite the decrease in protection against infection, the ministry emphasized that the vaccine was still 93 percent effective in preventing hospitalizations and severe illness.

Vaccine effectiveness is a measure of relative risk between vaccinated and unvaccinated populations. An effectiveness of 64 percent means that vaccinated individuals are 64 percent less likely to become infected, and not that 36 percent of those vaccinated will contract COVID.

Another study released by the ministry a few weeks later found that the vaccine’s effectiveness had further dropped to 39 percent, though it cautioned that this was from a relatively small sample size.

Despite the decreasing effectiveness of the vaccine in preventing infection, it still provides significant protection against severe illness and death even without a booster shot.

As of August 21, the Health Ministry recorded 215.9 severe COVID-19 cases per 100,000 people among the unvaccinated over the age of 60, compared to 21 per 100,000 people among those who had received two doses of the Pfizer vaccine. This makes unvaccinated older people more than 10 times as likely to experience a severe case than their immunized counterparts.

Speaking with CNBC in late July, Pfizer CEO Albert Bourla said that while the vaccine’s protection dropped by about 6 percent every two months following the second dose, he was “very, very confident that a third dose, a booster, will take up the immune response to levels that will be enough to protect against the delta variant.”

New serious COVID cases and deaths in Israel, which had dropped to zero in June, had risen significantly by July 29 when Prime Minister Naftali Bennett announced his world-first booster plan for older Israelis.

The same day Bennett announced that adults over 60 who had received their second vaccine dose at least five months prior would be eligible for a third shot, the Health Ministry reported 2,140 new cases nationwide.

Bennett – who believes that accelerating the country’s vaccination campaign is critical to preventing another national lockdown and “destroying the country’s future” – recently instructed the directors of Israel’s four HMOs to double their vaccination rates.

On August 20, only a week after extending eligibility to those over 50, the government opened up the booster program to anyone over 40, as well as teachers, caretakers for older people and pregnant women. So far, 1.3 million have received a booster shot.

According to the latest Health Ministry figures, 58.6 percent of Israelis aged 60-69 have received their third shot. In the 70-79 age group, this figure stands at 74.6 percent.

The benefits of a COVID booster shot being explained to a Bedouin woman in the southern Israeli city of Rahat last week. HAZEM BADER – AFP

While members of the Health Ministry’s pandemic response team were split on expanding the boosters to younger age groups, one source on the team said earlier this month that “the higher the number of the seriously ill climbs, the less opposition there is.”

Is the booster effective?

A Maccabi Healthcare Services study released last Wednesday found that the booster shot was effective in preventing COVID-19 infection among people 60 and older.

“The third shot is highly effective both against infection and serious illness,” said Anat Ekka Zohar, the head of Maccabi’s Quality, Research and Digital Health Division, urging anyone eligible to get vaccinated.

“The vaccine’s effectiveness is proving itself against the delta variant and is the solution for curbing widespread infection,” she added.

Speaking with the Ynet news site last week, Prof. Ran Balicer, one of Israel’s top coronavirus experts, said that over two days, he had observed a “curb in the number of new cases in the over 60s, who are mostly inoculated with a third dose.”

He added: “We can say that, today, booster shots for 60-year-olds and now even people over 50 are doing their job in the sense that they reduce infection rates.”

According to Health Ministry data, new cases have seen a small decline over recent days – from 8,646 cases on August 16 to 7,815 cases on August 20.

Are there side effects to the booster shot?

In a statement issued earlier this month, the Health Ministry reported that it had recorded “fewer than 50 reports of adverse events potentially related to the third dose,” stating that side effects were “mild” and primarily limited to localized pain at the injection site, fever and nausea.

Around the same time, Israel’s largest health care provider, Clalit, said a survey it had conducted of about 4,500 people found that recipients of the third dose felt similar or fewer side effects than they did after receiving the second shot.

Thirty-one percent reported some side effects, the most common being soreness at the injection site, while about 0.4 percent said they suffered from breathing difficulties and 1 percent said they sought medical treatment due to one or more side effect.

What other countries are offering boosters?

Offering a third dose has proved somewhat controversial. In the United States, some experts have questioned the focus on booster shots when around 30 percent of eligible Americans have yet to get even a first vaccine dose, despite new COVID-19 cases and deaths surging across the country.

The World Health Organization has called on countries to stop administering third shots, arguing that when many poor countries have barely begun with their first doses, such efforts are both morally and epidemiologically unacceptable.

The Health Ministry said that its decision took into account the lives the booster saves – a claim that appears to be borne out by the latest infection statistics.

Britain, France and Germany have all indicated that they plan to proceed with booster campaigns, despite the WHO’s appeal.

French President Emmanuel Macron said France was working on rolling out a third dose to older people and the vulnerable from September. Germany intends to give boosters to immunocompromised patients, the very old and nursing home residents from September, its health ministry said earlier this month.

According to the BBC, UK Health Minister Sajid Javid has not yet set a date for Britain’s booster rollout and is currently waiting for “final advice” from the government’s Joint Committee on Vaccination and Immunization. However, he said it is likely to start next month, beginning with the “most vulnerable.”

The U.S. Food and Drug Administration is aiming to give full approval to Pfizer’s COVID-19 vaccine on Monday, the New York Times reported on Friday. Once it obtains the approval (rather than the current status of being for emergency use), Pfizer-BioNTech is expected to quickly ask the FDA to approve a third dose as a booster shot.

Reuters contributed to this report.