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Should you get a fourth COVID vaccine dose now or in the fall? Five experts weigh in


Should you get a fourth COVID vaccine dose now or in the fall? Five experts weigh in

Fourth time’s a charm?

With the news that fourth doses, sometimes called second boosters, of COVID-19 vaccine are open to all adults in Ontario, many are wondering whether it makes sense to roll up their sleeves now, or wait until fall when it’s hoped there will be new vaccines targeting Omicron.

As another wave of COVID, this time driven by the BA.5 variant, hits the province, Ontario’s chief medical officer of health, Dr. Kieran Moore, has recommended the fourth shot to people 18 to 59 with underlying medical conditions, at least five months after their last dose, and three months after an infection.

For other younger and healthy people, his language was careful; he said they may get the vaccine but it’s not a “should,” and it’s “fine” to wait until the fall, when a bivalent vaccine against Omicron will likely be available.

But the evidence on fourth doses is still emerging, as scientists race to keep up with the virus, so the picture is somewhat nuanced, and not all experts agree.

“I’m very much in favour of everyone running out to get their fourth dose as soon as they’re eligible,” said Dawn Bowdish, the Canada Research Chair in aging and immunity and a professor of medicine at McMaster University.

Bowdish said there are two ways of thinking when it comes to mass vaccination campaigns: One is focused on keeping people out of the hospital and intensive care unit. The other, which she subscribes to, wants to minimize the number of infections.

There’s limited evidence so far on fourth doses. One Israeli study found they offered limited protection. But a study published in Science in the fall found that a two-dose series of COVID-19 vaccines from Moderna or Pfizer-BioNTech was less effective after six months. Another, from researchers at U of T published in Nature, suggests that COVID-19 antibodies generated before this year are not effective against Omicron and its subvariants.

Bowdish and her colleagues have studied the impact of third and fourth doses, in a pre-print paper not yet published in a peer-reviewed journal, and found they “made a difference,” she said. The current wave will be challenging, she added, especially considering the health-care system never fully recovered from earlier spikes in infections.

“I think it’s going to be a really bumpy one and the more we can do to mitigate those bumps, the healthier we’ll be as a community,” Bowdish said.

Kelly Grindrod, a pharmacy professor at the University of Waterloo, said she appreciates that Dr. Moore’s advice may be confusing, but it’s actually consistent with what a lot of health-care providers and experts are thinking. “For a lot of us, this was never black and white,” she said. She agrees with Moore that a fourth shot is a good idea for those with underlying medical conditions that put them at risk.

“If you’re a younger, healthier person, especially if you’ve had an infection recently, there likely isn’t a lot of benefit for you here,” she added. But individuals who have never been infected might want to consider the fourth shot. And if you do want to get it, don’t delay, because you wouldn’t want to have to defer getting the fall Omicron vaccine, because you got this one.

“The second booster, if you’re choosing to get it now, will again bump up that immunity against getting infected, and that will last probably for a couple of months, and it also might just top up slightly your protection against getting severe illness, hospitalization and death, but hopefully you’re retaining a lot of that from the first booster you got,” she said.


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One thing experts agree on is that people who have not yet gotten their third shots need to do so as soon as possible, because “we know it really protects against the severe illness, hospitalization and death,” against Omicron, Grindrod added.

Canada’s expert body on vaccines, the National Advisory Committee on Immunization (NACI), published updated recommendations on fourth doses in late June, writing that they “should” be offered to high-risk people, including everyone over 65, and they “may” be offered to people 12 to 64. Provinces, as well as experts, have interpreted this guidance differently. Quebec, P.E.I. and New Brunswick have opened them up to all adults, depending on the timing of their last dose.

Dr. Gerald Evans, chair of the infectious disease department at the Queen’s University School of Medicine, said that while fourth doses are most important for those over 50 — or people with conditions that place them at a higher risk for severe disease — a fourth shot is also necessary for healthy adults who are more than six months out from their third.

“The third dose does provide well-sustained protection for about six months but is likely beginning to drop off after that. With BA.5, which has some evasion of immune protection …that’s really important to try to get that” fourth shot, said Evans.

Evans said getting a second booster likely won’t prevent an individual from accessing a bivalent vaccine in the fall, and that fourth-dose protection should last about two months, if not three.

Tara Moriarty, associate professor at University of Toronto in the faculties of dentistry and medicine, and an infectious disease researcher, said she would recommend people over 50 get their fourth dose. The same applies to people with risk factors such as diabetes, kidney disease, and obesity who “haven’t realized that their protection against infection is quite low right now.” She’s concerned with rising ICU admissions in some other countries dealing with waves driven by BA.5.

But it’s not quite as simple as a “laundry list” of conditions. Some people in high-risk jobs, such as health-care workers or restaurant servers, may want to get a fourth dose. There’s also the risk of long COVID, which can hit young and healthy people, to take into account, she added.

Sabina Vohra-Miller, co-founder of the Toronto-based Vohra Miller Foundation, which aims to make health care equitable and accessible for all, and co-founder of the South Asian Health Network, says she’s been getting a lot of questions about the fourth dose from family and friends, following the provincial announcement.

With Ontario in a seventh COVID wave, “my recommendation would be for everyone to go get their booster now and then wait and see what happens in the fall for the bivalent vaccines,” she said. But she added she would encourage people to speak to their health-care providers if they are unsure.

“There aren’t any good choices, there’s just tough decisions, and these are some of the decisions we have to make during the pandemic, we just have to be nimble.”

With files from Olivia Bowden

May Warren is a Toronto-based breaking news reporter for the Star. Follow her on Twitter: @maywarren11

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