New Vaccine Boosters: Playing Catch Up With The Virus

In a somber sea of mourners standing side by side in Westminster Abbey, two men stood out. The Chinese delegation, led by Vice President Wang Qishan, was the only one wearing masks among more than 2,000 guests at Queen Elizabeth's funeral service in London on September 15. 

For all of the other guests, COVID-19 seemed a thing of the past. 

United States President Joe Biden, seated in row number 14, had declared the pandemic over shortly before arriving in London, while at the same time admitting that the virus was still causing problems. On the same day, 516 people died from the disease in the United States. 

Japan Readies the Omicron BA.1 Booster 

Meanwhile, Japan's seventh coronavirus wave has passed its peak, with infection numbers falling steadily. There were about 62,000 daily cases on average during the week of September 15, and around 125 COVID-19 deaths per day. 

Soon thereafter on September 20, Japan rolled out its booster vaccination campaign with the newly available vaccine. This one is specifically adapted to the Omicron subtype of the coronavirus.

“We must fully anticipate the next spike of infections,” Health Minister Katsunobu Kato said on Sunday September 18. People aged 60 and older, as well as medical workers who have yet to receive their fourth shots, will first receive the booster tailored to the BA.1 subvariant. 

The new vaccines made by pharmaceutical companies Pfizer and Moderna targeting that subvariant were approved by the Japanese Ministry of Health only days earlier in the week of September 15. Eligibility for the Omicron booster is supposed to be expanded in October to those aged twelve and above who have been vaccinated at least two times. 

A Newer Subvariant Vaccine, But What Are We Targeting?

Another vaccine more specifically tailored to the Omicron BA.5 subvariant is expected to get approval by the Japanese authorities in the coming weeks and will be rolled out shortly thereafter. 

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Pfizer filed a request for its BA.5 vaccine on September 13. At present, BA.5 is the dominant virus variant in Japan and globally, while the BA.1 lineage has become practically extinct. 

This has led to some confusion on whether using the BA.1 adapted vaccine is still a good idea or not. 

Japan’s Health Ministry has urged people to get the new vaccine, stating that the BA.1 vaccine would also be effective against BA.5. 

In anticipation of the “eighth wave” of the novel coronavirus epidemic this winter Japan hopes to administer the improved vaccines at a pace of over one million shots per day. “We'll accelerate vaccinations,” health minister Katsunobu Kato told journalists. 

Giving one million shots per day might be slightly optimistic. While the percentage of elderly people who have received a third shot is over 90%, the overall rate of third-round vaccinations stands at only 65%. 

However, globally, Japan comes second in terms of booster doses (third or fourth shot), with 90.4 administered doses per 100 inhabitants. In comparison, the USA ranks 73^rd with 32.9 booster doses per 100 residents.

Protection Against Infection Less Likely

While the new Omicron vaccines are certainly a step forward in the fight against the virus, more needs to be learned about their efficiency. Data suggests the shots will protect their recipients from death and severe illness. There is less certainty about the degree of protection from infection that the new Omicron shots will bring. 

Eric Topol, physician and editor-in-chief of the medical information site Medscape has not displayed much optimism: “Based on the evolution of the virus through Omicron and its subvariants, it appears unlikely the new vaccine will have a major or important impact on reducing infection or transmission,” he recently wrote.  

Is Playing Catch Up the Best Option?

There are also two recent studies that call into question the present vaccination strategy of playing catch up with the mutating virus. 

Researchers who are studying the evolution of the virus are raising concerns about the ability of our immune system to mount sufficient levels of neutralizing antibodies against the Omicron virus subtype. 

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“Looking like with the latest turn of direction the virus has managed to escape our immune system efficiently yet again”, writes Ulrich Elling on twitter. “One thing appears certain: SARS-CoV-2 is still able to outrace us again and again”. 

Elling links the problem to the way our immune system works.  “A bit like the guy with a hammer: every problem looks like a nail (…) Once we have an antibody repertoire, we try to tackle similar viruses with the old repertoire.” 

Even a new booster shot cannot erase the old immune response. And with the virus mutating even further away from the original Wuhan virus, our immune system is drawing a blank – or bringing a hammer to a gunfight.

Playing Tricks With Hope 

Moreover, there are already new Omicron offshots appearing that could outperform the now dominant BA.5 variants and play tricks with existing antibodies against the virus. “Now is the time to stop chasing SARS-CoV-2 and start mounting an aggressive get- ahead strategy”, concludes Topol. 

“Enough of the booster after booster shot-centric approach; it has been formidable, lifesaving, sickness-avoiding and helpful as a bootstrap, temporizing measure. Now we need to press on with innovation for more durable, palatable, and effective solutions.” 

Some scientists are pinning their hopes on nasal vaccines, a nose spray that could help block the virus where it enters the body – in the thin mucous membranes that line nose, mouth and lungs. There are about 100 research teams at present trying to explore this avenue. 

India and China have recently approved two such vaccines – one is administered as nasal drops, the other is inhaled through nose and mouth as an aerosolized mist. It is still unclear how successful these vaccines will be. But stopping the transmission of the virus would be finally ending the pandemic for good. 

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Author: Agnes Tandler

Since the start of the pandemic in 2020, Agnes Tandler has been based in Japan, where her reporting covers COVID-19 for a daily healthcare newsletter in Germany. Find her other essays and reports for JAPAN Forward here. 

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