It’s time to update COVID-19 vaccines
OzSAGE position statement
21 September 2023
It’s time to update COVID Vaccines in Australia
Our boosters are outdated, and “hybrid immunity” is ineffective
The emergence of new variants of SARS-CoV-2 has led to booster vaccines becoming outdated. The boosters currently available in Australia are matched to the BA.1 and BA.4/5 variants which have come and gone over a year ago. This means that the currently available boosters do not offer good protection against newer variants such as BA.2.86 (Pirola).
Although some have suggested that “hybrid immunity” (acquired via a combination of vaccination and infection) is enough to provide ongoing protection, this is not the case.
Immunity from infection wanes over a period of months, and it comes at the cost of risking long COVID and severe acute COVID-19.
It doesn’t make sense to risk getting infected to gain some transient immunity against the very same infection, which is the situation that most adults in Australia now face without access to a further booster vaccine.
Monovalent boosters would be more effective
In May 2023, the World Health Organisation (WHO) recommended developing monovalent (providing immunity to one strain only) boosters against XBB and related variants. The WHO also recommended moving away from vaccines that contain the original strain of SARS-CoV-2.
The current bivalent (two strains) vaccines available in Australia contain vaccines against the original strain plus the old BA.1 or BA.4/5 strains. Giving a vaccine for only one strain results in better immunity than two strains together. Immunity is even better when the vaccine matches the circulating strain.
On the 11th of September 2023, the U.S. Food and Drug Administration approved the use of XBB COVID-19 vaccines that better protect against current circulating variants. The updated vaccines contain components that address the XBB.1.5 variant and are a better match for emerging variants such as EG.5 and BA.2.86.
Australia should adopt a more liberal and transparent vaccine policy, like the USA
The USA has more liberal vaccination parameters for their populace than those current in Australia, allowing this new booster for any adult, as well as for children 6 months and older. The US vaccine committee has public, transparent meetings and provides all the data supporting their recommendations, which is best practice in the view of OzSAGE.
Bivalent Omicron-based mRNA COVID-19 vaccines containing the original strain are no longer the preferred vaccination for all doses and should be replaced with monovalent vaccines targeted at the more recent variants of the virus, as per the WHO recommendation.
Long COVID prevention should be considered in booster vaccine policy
The benefits of vaccination including boosters to all age groups, including children is proven. Hospitalisation and death rates alone should no longer be the sole indicator for determining the need for booster vaccinations. Complications of COVID-19 include long COVID, which is an ever-growing burden on our health system and economy and can affect previously fit and healthy young people.
In 2023, we should be looking at prevention of long COVID as an additional benefit, with research showing that vaccines reduce long COVID. One Australian study estimated that 4.7% of Australians have had or currently have long COVID, which is already impacting individuals, society and the economy.
Ensuring that Australians have access to updated vaccines will significantly reduce the ongoing impact of COVID-19, including hospitalisation, death, and long COVID. While there are relatively lower rates of severe illness in younger people compared with older age groups, rates of infection are higher in younger people so that burden of disease may still be significant, and long COVID risk remains high in younger people. All people can benefit from booster vaccination.
The risk of long COVID and other complications of COVID-19 increases with reinfection, which means people not able to get a further booster may face an ever-increasing risk of long COVID.
Recent Australian research shows that the risk of long COVID decreases with each booster a person receives. People who have received 4 vaccine doses have less risk than people who have received 3 doses, while those who have received 3 doses are at reduced risk compared to the cohort who have received 0 – 2 vaccine doses.
Restricting vaccination boosters is a missed opportunity to protect Australians, and overwhelmingly affects young and working adults and children, which may have substantial economic effects on our society.
Recommendations
1. We urge the government to review the evidence provided by the US vaccine committee and at least provide people the choice of receiving a further booster.
2. We ask that the Australian government make prompt provision of a variety of XBB-targeted vaccines to Australians, and to broaden the booster recommendations to include all adults, and to urgently consider primary vaccination of children under 5 years (who still remain unable to get any vaccine dose at all, unlike many countries – e.g., USA, Canada, Singapore and so on).
3. Encourage uptake of the above via effective public health campaigns.
4. Other mitigation measures are also necessary to protect the population, as we have outlined in previous advice. Governments should not rely on vaccination alone to control this disease, especially with such a restrictive booster policy in place.