‘Boosters won’t work, bivalent vax needed against Omicron’, say health experts

The recent instance of a 29yearold who had returned from New York to Mumbai testing positive for Omicron even after having taken three doses of the vaccine has caused health care experts to raise the question on why three doses of the vaccine did not protect himExperts are of the view that instead of booster doses the vaccine industry should accelerate the lsquobivalentrsquo vaccine containing the Wuhan wild virus and Omicron virus in a single product so that a booster with such lsquobivalentrsquo vaccine produces the desire immunity rapidly thereby preventing the rapid spread of Omicron Dr Wiqar Shaikh Professor of Medicine Grant Medical College and Sir JJ Group of Hospitals said that people were led to believe that the Omicron variant was mild would not need hospitalisation and would not result in deathsDr Santosh Bansode head of the department Emergency Medicine Wockhardt hospitalsHe recalled an article in Sunday MidDay on November 28 2021 in which he had said that Omicron was more transmissible than the Delta variant and evades both antibodies as well as Tcells He had also said that vaccines may not be effective against Omicron Indeed he said Omicron is spreading rapidly around the world and has tilldate resulted in seven deaths in the UK Dr Shaikh added that currently there is a clamour around the world to give booster doses 3rd dose of Covid19 vaccine to control the spread of OmicronDr Shaikh quoted a press release from the BMC which said that a 29yearold person had returned to Mumbai from New York on November 09 2021 and was found at the airport to have tested positive for Covid19 His sample was sent for genome sequencing and the results were obtained on December 17 2021 which was positive for the Omicron variant What is shocking Dr Shaikh said is that this person had taken three doses of the vaccine Dr Shaikh said that demanding a booster dose to control Omicron is without scientific evidence and that proper trials need to be conducted before demanding or approving booster doses He said that the WHO has not yet endorsed booster doses Dr Shaikh added that the Subject Expert Committee on Covid19 vaccines in India had met on December 10 2021 and concluded that booster doses are not recommended without adequate trialsDr Wiqar ShaikhIn fact a statement from Niti Aaayog Health said that currently what is more important is to first vaccinate everyone in India Dr Shaikh expressed great surprise that the CEO of Pfizer told CNBC last week that a 4th booster dose may be needed He said that when there is no evidence as yet that a 3rd dose would work against Omicron asking for a 4th dose is simply unscientific The person who has tested positive for Omicron despite taking a 3rd booster is a case in point Dr Shaikh said that he is not surprised that all major Covid19 manufacturers Pfizer Moderna AstraZeneca and JampJ are working on an Omicron specific vaccine which should be available by March 2022He added that if current Covid19 vaccines are working against Omicron why work on a new Omicron specific vaccine and if current vaccines are not working then why demand a 3rd and maybe a 4th dose Dr Shaikh pointed out that when Covid19 vaccines were launched last year only one dose was recommended which after a few months was upgraded to two doses and now to a 3rd and may be a 4th dose He suspects that Covid19 vaccines may soon be recommended on an annual basisWhy 3 doses of vaccine give no protection This question has now baffled health care experts As we all know that most vaccines are made majorly targeting spike proteins of Covid virus and in Omicron variant there are many mutations in spike proteins hence I am of the view that theres a high chance that vaccines wonrsquot be able to protect us fully from this variant opined Dr Santosh Bansode Head of the Department Emergency Medicine Wockhardt hospitals Mumbai Central ldquoItrsquos expected that those vaccines will still protect us from getting severe symptoms Some immunity is better than no immunityWe have seen up till now that vaccines are giving us immunity against Covid which will help us get some protection so that we wonrsquot get severe symptoms and overall mortality will be lessrdquo he said ldquoOne fear is that Omicron will infect an unvaccinated or a person with comorbidities and then might cause severe symptoms in such patients and even can cause death Since it is spreading at a faster rate if we dont take much precautions the number of patients will increase and there is a chance that the vulnerable population will be at risk We must also keep in mind that children are not yet vaccinated and in most schools now children are attending physical classes We should follow very strict Covid protective protocols in schoolsrdquo Dr Bansode concludedConfusion over hypothesisDr Ketan Vagholkar Professor of Surgery at DY Patil Medical College said ldquoReports of Omicron positivity in fullyvaccinated travellers with booster doses entering our country are creating unnecessary confusion Vaccines all over the world were prepared after studying the original strain of Covid19 virus in 2020 The vaccination was then started towards the end of 2020 for healthcare workers and subsequently for the general population in 2021 The Delta variant emerged much latter and infected the majority of the population which included both vaccinated as well as nonvaccinated individualsDr Ketan VagholkarThis proved that vaccination was not protective against the delta variant but claimed to reduce only the severity of the disease Omicron is now the next variant which has emerged whose pathogenicity seems to be quite mild Various hypothesis postulating a third jab to be effective against the Omicron variant have been proposed However there is no authentic scientific data to prove this Hence one should not get misled by the hypothesis of multiple jabs being protective Strict Covid appropriate behaviour with completed twodose vaccination is the best way of preventionrdquoExpert viewIs there evidence that Omicron evades immunity and will booster vaccine help Accelerate the lsquobivalentrsquo vaccine ldquoScientific publications and WHO review meetings across the world are taking a deep look at studies that can provide some evidence of Covid variants including Omicron to see if these are evading immunity in fully vaccinated individuals Populations have received multiple vaccine products so farldquoSome 3040 studies recently reviewed were primarily the ones that were based on immunity markers in individuals who had primarily received mRNA vaccines of PfizerModerna Most studies were of experimental design and found that of 247 neutralising antibodies that are normally produced in the body after Covid19 infection andor vaccines 57 approx 20 per cent of neutralising antibodies showed 720 fold reduction in fully vaccinated people having breakthrough infection with Omicron Most of these declined neutralising antibodies were ones that were directed towards nonprominent parts of the virus envelope In simpler words these declined neutralising antibodies may not be of much protection to the individual moreover these are not standardised todate When these individuals were given booster injection 247 neutralising antibodies increased within one monthBut reassuring findings were that cell mediated immunity mainly comprising of CD4 and CD8 cells in human body remained intact in vaccinated individuals despite some decline in neutralising antibodies directed towards nonprominent parts of virus enveloprdquo said Dr Subhash Hira Professor of Global Health University of WashingtonSeattle and member of WHOGeneva Covid review groupsDr Subhash HiraDr Hira added ldquoThe reviewing scientists raised the following points to counter finding of neutralising antibodies as laboratorybased invitro interim findings a The level of neutralising antibodies occurring in humans invivo will be a more reliable parameter b The breakthrough infection seen with omicron among individuals who had received three injections of mRNA vaccine does suggest that a booster dose raising neutralising antibodies in one month did not help to ward off omicron infection Interestingly there is no data yet to show breakthrough Omicron infection among individuals who received Covid19 inactivated Covaxin or vectorbased Covishield vaccines c The cell mediated immunity has remained intact despite the Omicron infection and that is very reassuring d The most important parameter of vaccine efficiency is the lsquoclinical outcomes and deathrsquo in vaccinated individuals No such clinical studies have appeared as yet with any vaccines e While the world is catching up with unvaccinated populations the vaccine companies may wish to prepare and escalate next generation lsquobivalentrsquo vaccines using the Omicron variant f Since the casedoubling time of omicron is 15 to 3 days and is considered too fast any booster dose given now may not produce any neutralising antibodies for the next one month or more In other words a booster may not be the final solution of this pandemic of Covid19 variantsrdquo Dr Hira saidldquoThe UK most of Europe and the USA are having large waves of Omicron as breakthrough infections despite 6075 per cent of the population having received a full dose of two mRNA vaccines and now booster injection to gt05m people each day By comparison the Indian vaccines that contain vectorbased virus or the inactivated whole virus seem to have produced a wider base of immunity protection even against the variants including Omicron It will remain to be seen if India escapes high deaths being feared due to Omicron while the northern countries are anticipating the winter doublewhammy caused by omicronrdquo he concluded