Precautionary COVID Shots for Those Over 18: Experts Weigh In on Booster Doses
"Not enough evidence to support the need for booster doses in healthy adults yet," say experts.
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On 8 April, the Ministry of Health and Family Welfare (MoHFW) announced that a third 'precautionary dose' of the COVID-19 vaccine will be available to all adults over the age of 18 irrespective of comorbidities starting 10 April.
According to a statement released by the Union Health Ministry, all adults over the age of 18 who has received the second dose of the COVID vaccine at least 9 months prior will be eligible to receive a third precautionary dose.
A third dose of SII's Covishield COVID-19 vaccine is, reportedly, likely to cost Rs 600.
While the centre extending its blanket of precautionary doses to include more people is a welcome move to many, some experts hold their reservations about the need for booster doses, or in this case, 'precautionary' doses.
To Boost or Not to Boost: What Does Data Say?
Speaking at a panel discussion during the launch event for Johns Hopkins Gupta-Klinsky India Institute in Delhi, on 7 April, eminent health experts, including Dr Balaram Bhargava, Director General, Indian Council of Medical Research (ICMR), Dr Gagandeep Kang, Virologist and Professor, CMC Vellore, and Dr Naresh Trehan, Managing Director, Medanta shared their views on booster doses, and if India should start boosting all adults.
According to Dr Naresh Trehan, "every six months till this whole thing is on, we need a booster."
On the other hand, Dr Gagandeep Kang is of the opinion that there isn't enough data to conclusively support the need for booster doses in healthy adults.
Elaborating on her statement, Dr Kang went on to say, "I think we don't know enough to be able to recommend boosters to those who are healthy below the age of 60 at this time."
"I think we need to be doing the research to define the immune responses in people who have been vaccinated with the two doses and infected, as well as people who have just received two doses of the vaccine. This is a complicated situation, and we shouldn't be rushing to boost the entire country," she added.
"We do need more data, that is why the NTAGI is discussing it, debating it, before we come to a final conclusion,"added Dr Balaram Bhargava, a day before the announcement.
Since many countries have been offering a third and even a fourth booster dose to their adults for a while now, can data from these countries be extrapolated to India?
"No,"says Dr Kang.
Data from other countries cannot be extrapolated, she explains, because there have been disparities in results of similar vaccines on the same platform (like the two mRNA vaccines), and so completely different vaccines on different platforms are incomparable.
"You can't just randomly pick something that Israel did and say it applies to India, it doesn't,"she adds.
During the panel discussion, Dr Amita Gupta, Director, Division of Infectious Diseases, Johns Hopkins School of Medicine also chimed in saying, "we are learning as we are going, and we just have to do a good job of saying when we know something and when we don't."
Having said that, things are a bit different in the case of India as here, we're not really talking about booster doses yet, instead, what we have is the 'precautionary dose'.
What difference does the terminology make?
Precautionary Dose vs Booster Dose
"I personally feel in medical sciences, there is no such term called the precaution dose. There is a primary dose, a booster dose and even a second booster. But I have never heard of a precaution dose. I want to leave it to the wisdom of those who designed it," Dr Subhash Salunkhe, Public Health Expert and National Task Force Member was quoted as saying by FIT back in Dec 2021 when precautionary doses were approved for to healthcare workers, frontline workers and those over the age of 60 with comorbidities.
At the same time, Dr Rakesh Mishra Director of the CSIR-Centre for Cellular and Molecular Biology, Hyderabad, told FIT, "it is a precautionary shot for those who are at risk. Since, we do not know enough, it cannot be called booster."
Speaking to FIT now, Dr Kang says, "Precautionary doesn't need to be informed by science,"adding that it is essentially left to the individual's discretion and choice.
She adds that precautionary doses can be beneficial for those with comorbidities and people who are immunosuppressant.
Precautionary Doses in India: Only Private Centres?
According to Dr Kang, precautionary doses should be offered to the public at their own discretion, considering a lack of supporting evidence.
"Lots of people who are travelling overseas need to have a booster dose certificate. There are many reasons why I think giving people access to booster doses for come reasons that have nothing to do with their requirement for protection also makes sense," she says.
Interestingly, according to the Union Health Ministry's statement, precautionary doses for adults will only be available in private centres.
Which means a third dose of the vaccine for those under 60 (who are not frontline workers) will not be available free of charge under the Government's vaccine drive as yet.
"The ongoing free vaccination programme through Government Vaccination Centres for first and second dose to the eligible population as well as Precaution Dose to Healthcare Workers, Frontline Workers and 60+ population would continue and would be accelerated," read the Health Ministry's statement.
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