Jerusalem, Israel. C: Pixabay under CC licence

Is Israel already prepping… a fourth booster vaccine shot?

We won’t make you wait until the end of the article to get the answer to the question posed in the headline. The answer is yes, with a huge, stonking great “but” attached: The proposed (and not yet approved) fourth jab is to be used only on a very limited and targeted basis, and not for the general population. For more detail, we turn to those relative experts on Israeli public affairs, the Jerusalem Post:

The panel advising the Health Ministry on the corona pandemic will discuss the possibility of giving a fourth vaccine to immunocompromised patients, The Jerusalem Post confirmed on Sunday.

In previous months, several studies showed that certain categories of patients with a weakened immune system, such as transplant recipients, were much less likely to develop antibodies after two doses than the general population.

While research showed that the booster generally improved the situation, this was not true for all immunosuppressed individuals.

According to Prof. Cyrille Cohen, head of the immunology lab at Bar-Ilan University, the move makes sense.

“We know that three shots are needed by people with a functional immune system,” Cohen said. “Immunosuppressed patients got their third vaccine already almost six months ago, so it is not a bad idea to offer them another booster, since they are at high risk.”

According to the scientist, it is hard to know if it is going to help.

“It is very complex to answer the question without actually carrying out the procedure,” he said. “We saw how with the third vaccine many were skeptical as Israel started to administer it, and now most of the world agrees that it is needed.”

There are several things to say here:

First, to be clear, this is not a population-wide fourth booster dose. It is specifically targeted at people with weak immune systems whose immune systems may not have been strong enough to be stimulated into producing covid-19 antibodies by the first three shots.

Second, this is entirely experimental. There has been a lot of talk, since the development of these vaccines, of them being “experimental”. Much of that talk has been hyperbole. But in this instance, as the bits highlighted (by me) in bold above demonstrate, this move is 100% experimental. When doctors are saying “we do not know what will happen until we do it”, then you are describing an experiment.

Third, it is an experiment with significant future potential consequences. If, for example, they find that a fourth booster shot does, in fact, generate antibodies in the immunosuppressed, expect its use to become widespread global practice in short order, for that segment of the population. And expect the argument for fourth boosters for the general population to become more mainstream globally, sometime next summer.

Fourth, as of right now, much of the online commentary around this move by the Israelis is thoroughly misleading. They are not, as some think, proposing a fourth booster because the third one has not worked for the general population. This is being discussed for immunosuppressed people only, not the healthy vaccinateds.

It may, of course, later transpire that the third booster shot offers protection that wanes, and that a fourth booster shot is proposed for everybody. It might even be reasonable to tell people to expect that to happen. But it is definitively, and absolutely, not what is happening right now. Much online commentary and reporting that you might read on this is just plain wrong.

To get to the point of a fourth booster vaccine for the general population, we will probably first need to see widespread evidence that the third booster vaccine provides immunity which wanes sharply over time. There are reasons to suspect that will happen (on the basis that it happened with the first two doses) but also reasons to suspect that it will not happen anywhere nearly as fast (on the basis that Pfizer’s public research finds that jab three boosts antibodies to well above the level they were at from two doses).

The bottom line is this: A fourth booster may well happen, in time, and it would be foolish to rule it out. But this is not it, or at least not anything like what it is being presented as in some quarters of the internet.

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