Third booster jab for over 50s in Autumn

[RedToothBrush]

Times reporting today that the current plan going forward is now to give a third jab to the over 50s and clinically vulnerable in the Autumn.

Its thought that case numbers will be so low it wont be necessary to boost the under 50s unless they have clinical need.

The proposal is to do this at the same time as the flu vaccine. (which leaves the question hanging about those under 50 who qualify for the free flu jab due to work).

There are two trials ongoing over how to do this apparently. One is a variant specific booster (similar to how we do flu vaccines) and the other is just a straight booster with the same vaccines we've already got (it doesn't say anything about mix and matching vaccines I note).

This sounds extremely promising and proactive though I confess I'm not entirely sure how I feel about being in my 40s and apparently not needing a booster.

It does sound as if the autumn may be less fraught with concern regarding a new wave than has been suggested up to this point.

You're not the only ones questioning it; several people have given reasonable answers to the question - it's not something that nobody has ever considered.

They are trialling mixing vaccinations to see how the immunity works. It won't just be an assumption that it's OK, but the results from those trials. There may have to be an element of "it's not ideal, but we have these vaccines and no others, so you get the best we can do" if the results show something that isn't necessarily possible with the vaccines available at the time. Orders have to be placed in advance and it's a bit of a strategy move, with some risk involved - how much money should be spent ordering every possible vaccine that could be ordered, to make sure that what turns out to be the best combination after the trials is available to be implemented, for example. They have to make decisions based on a mixture of cost, benefit, risk, practicalities, etc., and none of it is going to be perfect in terms of giving what is the most ideal combination of vaccines at the ideal time to exactly the people that need it. Something might be 'ok' but not 'ideal', and they may still have to choose that, knowing that it's not the best, but that it is the best considering the whole set of circumstances. If that happens, it doesn't mean that they don't know it's not ideal. But time is against us, and there are limited supplies of vaccine, money, vaccinators, clinics, etc.

I don't think they know how many doses you can have of vaccines like AZ - I think research is ongoing. There is a possibility that if you give it too many times, your body will develop immunity to the vector as well, and then not make antibodies to the extra virus information that it contains, but I don't think it's known for sure yet how often you can have it or if there are other things they could tweak about it to prevent that. Research is still underway.

Mixing vaccines is used successfully for hepatitis and studies in mice of mixing AZ and Pfizer vaccines have shown a broader antibody response. Hopefully these findings will be replicated in the human Com-CoV trials.

www.npr.org/sections/health-shots/2021/05/05/993882203/giving-2-doses-of-different-covid-19-vaccine-could-boost-immune-response?t=1620279916220

This is a fab summary about mixing vaccines. They actually think it could give a better immune response & it’s being extensively trialled at the moment. It won’t be a stab in the dark, if they go ahead with mixing it’ll be from significant trials & scientific evidence.

Thank you @HolmeH - I’m on the trial so it’s good to read this!

I’m happy to have it.
I’d like to have Pfizer this time as I had AZ first, I think there could be some benefit in swapping.

All the people I've spoken to re the Autumnal booster that SAGE? Are suggesting, are concerned about
Mixing the vaccines.

As PP said, the over 50’s & flu jab list members are most vulnerable to serious illness. They also had their first vaccines from December onwards, so early on.

Round here over 50s only started last month so not at all early. Flu jab list was still being done in March and not all have been done.

Re the healthy people that are under 50 who got theirs very early because they turned up at vac centres at the end of a day to use up spares, they will lose their immunity sooner rather than later, but won't be eligible for the booster. (Same goes for any queue jumpers, people who deceived their way in for an early vac).

Lots of healthy people who wouldn't be offered the booster were some of the first to be vaccinated, through work.

I'm fairly certain The Times are making most of this up (as usual).

At the moment they don't know what will happen later in the year, so to claim there are plans for boosters for >50's is misleading - that's ONE possibility that they are trying to cater for.

What we actually do will depend on many factors - the prevalence of new variants and the longevity of immunity. I'm fairly sure they won't boost the 65's, it MAY be necessary to give them a top up but far more useful if it gives them better protection against new strains.

For the

@penni00

Re the healthy people that are under 50 who got theirs very early because they turned up at vac centres at the end of a day to use up spares, they will lose their immunity sooner rather than later, but won't be eligible for the booster. (Same goes for any queue jumpers, people who deceived their way in for an early vac).

Given that the SIREN study has shown that people infected by covid still have good immunity nearly 12 months on (and counting), the immunity from TWO vaccine doses is likely to last years in the

bookworm1632, was that just the Pfizer?

@penni00

bookworm1632, was that just the Pfizer?

Sorry - what are you referring to?

bookworm. Sorry, ignore me, I misread your post. (I was meanwhile searching on the net for info regarding how long immunity lasts if a person only ever has the first dose of AZ, and my mind I was distracted by that!) Yes, hopefully the two doses will give long immunity, I see your point.

Found the below for those previous posters who were interested:

'I understand why Australia’s government originally prioritised getting the AstraZeneca vaccine. It’s easier to manufacture, store and distribute. It made sense in the early stages of the pandemic. And it’s still an effective vaccine that people, here and abroad, should be receiving as soon as possible — any immunity is better than none and you will certainly be protected from severe COVID-19.

But as time goes on, using the AstraZeneca shot isn’t the best long-term strategy.

One reason for this is what immunologists call “vector immunity”. The AstraZeneca and Johnson & Johnson vaccines use a viral vector, which is an inactivated (cannot replicate) form of a common type of virus called an “adenovirus”. They use this adenovirus as a delivery vehicle to get DNA into our cells to give them the instructions to develop immunity against the coronavirus. However, you can’t be repeatedly immunised with this type of vaccine because you’ll likely develop immunity to the adenovirus vector (the delivery vehicle) itself. When that happens your immune system interferes with the delivery vehicle getting into your cells and the effectiveness of these vaccines would erode over time.'

I think eventually everyone will move on to the MRNA vaccines, the MRNA vaccines can be tweaked so much more quickly than the adenovirus vaccines too, the speed of which is important for future variants. (I have read that MRNAs can be tweaked in 6 weeks, but adenovirus vaccines more like 6 months).

@penni00

Found the below for those previous posters who were interested:

'I understand why Australia’s government originally prioritised getting the AstraZeneca vaccine. It’s easier to manufacture, store and distribute. It made sense in the early stages of the pandemic. And it’s still an effective vaccine that people, here and abroad, should be receiving as soon as possible — any immunity is better than none and you will certainly be protected from severe COVID-19.

But as time goes on, using the AstraZeneca shot isn’t the best long-term strategy.

One reason for this is what immunologists call “vector immunity”. The AstraZeneca and Johnson & Johnson vaccines use a viral vector, which is an inactivated (cannot replicate) form of a common type of virus called an “adenovirus”. They use this adenovirus as a delivery vehicle to get DNA into our cells to give them the instructions to develop immunity against the coronavirus. However, you can’t be repeatedly immunised with this type of vaccine because you’ll likely develop immunity to the adenovirus vector (the delivery vehicle) itself. When that happens your immune system interferes with the delivery vehicle getting into your cells and the effectiveness of these vaccines would erode over time.'

I think eventually everyone will move on to the MRNA vaccines, the MRNA vaccines can be tweaked so much more quickly than the adenovirus vaccines too, the speed of which is important for future variants. (I have read that MRNAs can be tweaked in 6 weeks, but adenovirus vaccines more like 6 months).

That actually wouldn't make sense.

If the concern is merely about immunity to the delivery system creating issues for boosters, then there'd be nothing to stop you using the AZ for first and second doses and THEN switching to mRNA jabs.

I'm fairly sure that the Oz approach is largely because against some variants, the AZ vaccine seems to be less effective at protecting against symptomatic disease and is thus likely to have a lower impact on infectiousness. That could make herd immunity impossible and as a result mean that if the virus got into Australia it would still spread quite efficiently through the vaccinated population.

Note - the use of "could" and "likely" above - none of this is known.

So my guess is they are looking at Israel and thinking, we'll copy you...

It's funny but a few years back, the AZ vaccine would have been a miracle of modern technology. But now mRNA, as a much bigger miracle is stealing all the limelight.

I think that using AZ for first and second doses, and then switching to MRNA for boosters is what the gov is hoping to happen here in the UK. Hence they have bought enough Pfizer booster vaccines for everyone. I believe, providing the mix and match trials are proving positive (plus there will be the outcome data of the likes of France and Germany who are already mixing AZ with MRNA for certain age groups, that the gov will offer the booster in the form of MRNA to all in due course.

bookworm
Interestingly the SputnikV adenovirus vac uses a different adenovirus even for the second dose. This below from bmj:

'Gamaleya researchers used common cold viruses in their vaccine prototype. Notably, they opted for two different adenovirus vectors (rAd26 and rAd5) delivered separately in a first and second dose, 21 days apart.1 Using the same adenovirus for the two doses could lead to the body developing an immune response against the vector and destroying it when the second dose is administered. Two different vectors reduces the chance of this.'

Does this mean that the second dose of AZ may, I emphasise may, not do an awful lot in some people?

@penni00

bookworm Interestingly the SputnikV adenovirus vac uses a different adenovirus even for the second dose. This below from bmj:

'Gamaleya researchers used common cold viruses in their vaccine prototype. Notably, they opted for two different adenovirus vectors (rAd26 and rAd5) delivered separately in a first and second dose, 21 days apart.1 Using the same adenovirus for the two doses could lead to the body developing an immune response against the vector and destroying it when the second dose is administered. Two different vectors reduces the chance of this.'

Does this mean that the second dose of AZ may, I emphasise may, not do an awful lot in some people?

It's certainly an interesting possibility - but before anyone starts worrying about it, should add that a single dose gives excellent protection - the second adds a bit, and may result in the immunity lasting longer, but this is as yet unproven.

Should also add, that Oxford team chose a monkey virus precisely for this reason - as nobody would have developed previous immunity to it, while Sputnik uses two common cold viruses.....

Ah yes, that makes good sense using the monkey virus. I am interested particularly in the benefits of two doses of AZ as opposed to one dose, as since the first dose of AZ seven weeks ago I have had persistent side effects. Therefore, I may have to decline the second dose. I certainly do not want to risk further damage if a second AZ dose is not going to do anything particularly significant regarding immunity. I would like to think that my first dose may last until a future mRNA booster is available. I do not even know whether you can miss a second dose of AZ and then go on to have a mRNA booster. I do not even know whether a booster (when it is aimed at the same variant) is a full dose or a partial dose. So many unknowns!!! However, there must be a number of people that are unable/unwilling to have a second AZ dose who, like me, are wondering what their next step would be......

I'd like to know what my alternative is s I've had Gp confirmed side effects for several weeks now.

I'm not sure that there is an alternative as they aren't licensed to be mixed.

Hmmm, so that would mean anyone having a serious adverse reaction to a first dose, will have to go unprotected from covid (once first dose immunity worn off), until mixing is licensed?

What is mixing is never licensed - would that mean years of being unprotected from covid?

Plus I really cannot see those who have had AZ will stay on it in the long term, because I do not think that AZ adenovirus vaccine will be able to be tweaked quickly enough to keep up with the changing variants. If it takes 6 months to tweak an adenovirus vaccIne (unlike the 6 weeks to tweak a mRNA), the AZ will not keep up.
I hope and pray that the mixing of vaccines becomes licensed.
Mind you, other countries have been mixing them unlicensed....