Israel May Give 4th Dose of Covid Shot, Despite Experts’ Doubts

JERUSALEM – Israel is considering whether to approve a fourth dose of a Covid-19 vaccine for vulnerable people to contain the rapidly spreading Omicron variant, despite controversy among scientists and a lack of evidence either for or against another booster.

The panel of experts advising the Israeli government on the pandemic recognized this uncertainty, but on Tuesday recommended a fourth dose, concluding that the potential benefits outweigh the risks. Noting signs of diminished immunity a few months after the third shot, he said any delay in additional doses could be too late to protect those most at risk.

But some scientists have warned that the plan may backfire, because too many shots may cause a kind of exhaustion of the immune system, harming the body’s ability to fight the Corona virus. A few members of the government’s advisory committee have raised this concern regarding the elderly, according to a written summary of the discussion obtained by The New York Times.

Prime Minister Naftali Bennett has made clear he supports a fourth chance, and Health Minister Nitzan Horowitz has suggested that a new round of reinforcements may begin by Sunday. But by Thursday evening, the Health Ministry had not taken action on the advice, and a senior ministry official said it was waiting for more data from other countries.

Israel, a small country with a functioning public health system, was a pioneer in launching the first round of Covid vaccines and later in administering booster doses, so its results were closely monitored by the rest of the world. Its aggressive pace has put Israel in a position to assess early on the effectiveness of the shots and how quickly the protection wears off.

“The price would be higher if we didn’t vaccinate,” Dr. Boaz Lev, chair of the advisory committee, said at a news conference late Wednesday. Describing the Omicron’s spread as “a kind of tsunami or hurricane,” he added, “We don’t have a lot of time to make decisions.”

With Omicron sweeping the world at alarming speed, governments are scrambling to figure out how to contain it in the face of significant public pressure against reimposing harsh restrictions on daily life, curbing holiday celebrations and deepening the economic pain caused by two years of the pandemic.

In addition to concerns that a fourth injection in less than a year could actually weaken immunity, some experts said the Israeli government has not yet made the most of other options, such as vaccinating more unvaccinated people or giving a third injection to about a million eligible people. Citizens who have not received one yet.

Besides the generally sparse knowledge about Omicron, the effect of the fourth dose against the new variant is also unknown. But the country’s medical experts point to poor immunity in those 60 or older, who were the first to get the third shot starting in August.

Israeli researchers from the Ministry of Health and several academic institutions presented the data to the advisory group that made the recommendation for the fourth shot on Tuesday. The presentation, obtained by The Times, showed the incidence of delta doubling among the 60-plus age group within four or five months of the third shot.

There was no clear indication of low efficacy against severe disease.

Israel has confirmed a few hundred cases of Omicron, but officials say the new variant is more widespread, and could overtake Delta as the country’s dominant variant within two or three weeks.

Given the fear of a major outbreak of O’Micron’s disease during the winter, when hospitals are already crowded with patients with complications from influenza and other respiratory illnesses, the advisory panel voted overwhelmingly to recommend a fourth dose for people over 60, and those with compromised immune systems. and two health workers, to be given at least four months after their third injection.

The committee has not recommended a fourth shot for the wider audience at this point. But she advised giving the third dose three months after the second, rather than the current five-month wait.

While there is evidence that Omicron, discovered only last month, usually causes milder disease than previous variants, Israeli officials said that by the time they have clearer information, it may be too late to protect those most at risk.

“We can sit on our academic benches and wait for research from the outside, but that’s the kind of privilege we don’t feel like we have,” said Dr. Tal Broch, another member of the advisory committee.

Israel began giving the two-dose Pfizer-BioNTech vaccine last December and vaccinated a large proportion of its population before many rich countries did. In the spring it became the first country in the world to vaccinate most of its population. Mr. Bennett, the prime minister, was proud of his early decision in late July to administer the third shot, and has been credited with successfully containing a delta wave while keeping schools and the economy open.

The emergence of Omicron threatens to reverse these gains and return the country to some kind of lockdown. But Israel has been quick to tighten border controls and ban most foreigners from visiting, and is compiling an ever-growing red list of countries with high infection rates to which Israelis may not travel without special permission, including the United States and Canada.

Mr. Bennett enthusiastically welcomed the committee’s recommendation for a fourth dose this week, saying, “The citizens of Israel were the first in the world to receive a third dose, and we continue to lead with the fourth dose.”

Germany’s Health Minister Karl Lauterbach said Thursday he expects Germans to get another booster shot next year, depending on how long protection from the third shot takes.

But some medical professionals have suggested applying the brakes.

Professor Hagai Levin, an epidemiologist and president of the Israeli Association of Public Health Physicians, said Israel has not yet seen a sharp rise in infections – daily infections are about 1,200 per day, down from 11,000 at the height of the delta wave in August – and there was no evidence that there was A fourth dose is needed to prevent severe Omicron disease.

Professor Levine said in an interview: “I respect the opinion of those who say it is better to be safe than sorry, and there is no problem with being prepared. But before giving a fourth shot, it is better to wait for the flag.”

Professor Dror Miforach, who heads the coronavirus ward at Hadassah Medical Center in Jerusalem, another vocal critic, also urged to wait for more data.

“Just because we gave the third dose doesn’t mean there should be a fourth dose without a scientific basis,” he said. Reducing antibodies over time is normal, he said, and boosting antibodies may have limited benefit.

The government advisory panel said its recommendation for a fourth dose stems from the confluence of Omicron in particular and the additional burden on the health system during the winter, and may not lead so quickly to a fifth.

At first, many Israelis viewed their country’s leadership in vaccinating the public as a privilege and a ticket to a swift return to normal life. But the possibility of getting a fourth vaccine within a year was off a bit.

“Like many people, I am very ambivalent,” said Chili Edery, 59, the owner of a gift shop in Jerusalem. “The last thing I want is to shut down my business, but I have a feeling this time, they don’t know enough.”

It sounded like hysteria, Benny Mochowski, 80, an architect.

“Israel is the laboratory for the coronavirus vaccine,” he said.

Christopher F Schwitz In Hanover, Germany contributed reporting.

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