People who may face recurrent infection may need booster dose: Dr Padma, Chief, Neurocenter, AIIMS

“I think a booster dose would be required for the people who when face a recurrent infection will go to a severe illness,” claimed Dr Padma Srivastava, Chief of Neurocenter of AIIMS, in an interview with Medically Speaking.

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What is your view on booster shots for the immuno-compromised?

Dr. Padma

Let me answer this in few verticals. First is to understand the immune response after the vaccine. So, once there is a vaccine shot, you have two types of immune protection that is generated in a human body, what is called as a b cell or T cell , the other cellular immune response. So, both of them give you some kind of protection and that’s what we need. There are ways trying to record or measure this kind of a response. You might have heard of anti-bodies. So people do the serum anti-body test after the immunization and say anti-body is very good or anti-bodies are not there, so that gives you some measure of what is the immune response and what is the kind of protection you may have. Although that is not protection, but that is one measurement. Now what we have gained in our knowledge ever the last year of vaccination programs in most of the world and probably more than a year across several other counties across the world. And in our country nearly now 11 months there are some things which have come forward and some things which have been published. Number 1 is that, when someone is immunized, there is a group of people who are immune-compromised like what you have said. People, say are very elderly or someone who is immuno-compromised because of a comorbid situation like a bad controlled diabetes, or someone who has cancer or who are on medication with a very commonly used drug called a steroid, which is a chronic steroid used and there are several other immune suppressants. So, I must say, earlier publication from US and other countries which have said that even after two shots of vaccine, this group of cancer patients, or say who were on chemotherapy did not receive the immune response as measured by anti-bodies. So, they say if the immune response is not good, can we give them a booster dose, in order to augment the protection level. And then came this entire thing of how long  does the protection last after the two doses of vaccines. So, this was seen in two ways, 1. They have generally looked at the anti-body responses even for those who are infected, say with the corona virus infection and looked at the anti-body responses for several months, how it veined or did it persist. The second one was after the vaccination, in that then they had come to this, that on an average maybe 6 months, hence the anti-body response was not so robust. So, this was across several countries and people also started another vertical of, testing of the booster dose. And also you know we have an Indian trial, where the booster dose was given to the people who were immunized with two shots. So, with Pfizer, Moderna at the end of six months they gave these boosters and those results also have come and all of them have said that  yes that booster dose did not lead to any significant adverse actions but it did increase the immune-response, therefore it was good to give. So, altogether what it seems is, that  booster dose may be required in the group of individuals where the anti-body response is not going to be robust, for example, immune-compromised. 2^nd , booster dose maybe given to those individuals in which now we know after 6 months, although we don’t know for sure, maybe some be gone for 12 months, or even longer but overall it seems 6 months. It is kind of a zone where you might need a booster. So, therefore those individuals, if they get an infection, will get more severe infection who are more prone to getting exposed and therefore maybe infected Or other group of individuals, say journalists going down to the mass and get exposed or other individuals who, if they get an infection they might get a severe illness, so maybe they need a booster. Said that, there is another vertical that has come in, which is the ethical vertical because in those situations where in we have a significant population where in even the first dose has not been given or Did not receive the full doses. So, is it  ethical to go with a booster dose for those who have already been vaccinated while there are people waiting for the first dose itself. So, that’s and ethical vertical that has come. Hence, we have the recommendations from the CDC , recommendations. And also the recommendations from the World Health Organization. So, I think we should look at all of them and take in the best course of action which is suitable for our country.

Would you say that once everyone gets their first and the second dose, should the government look at the booster shot for the remaining population?

Dr. Padma

I think there definitely are groups, especially the task force which is looking into the vaccination program at the central level. And, I did see one of the press releases that they are strongly looking at a way forward on this and they will take the best action for the same. Yes, if you ask me, my personal opinion is that yes, I think a booster dose would be required for the people who when face a recurrent infection will go to a severe illness, so yes we need to take care of that and in a lot of countries it is thus targeted but then what has happened in other countries is because there was a long list of medical conditions, they said look it is difficult to go through each and every condition so let’s go with everybody after the age of 18 years. That I don’t think will come to our country right now, we have to vaccinate the maximum number of people in our country before we get to that. But, having said that, in that small group, I must say the percentage of the population varied. If they are exposed and get into severe illness, they must be considered for a booster dose having significantly vaccinated, a significant proportion of our country. But I will not say the booster dose should be given to everybody before everyone gets there two shots of vaccines.

Would you say or recommend, perhaps a booster shot for all adults is something which the government should look at?

Dr. Padma

So, by then I think we will be having an advantageous position because it would have been rolled out in other parts of the world. We have that advantage to see how safe it is and by then we would know that giving these shots to everyone over the age of 18 years as a booster dose is that what is the priority vs vaccinating children. So, you see there are a lot of things we need to weigh and then decide, but till such time, we come to that important line or I should say, lets cross the bridge when it comes to it. Before that I think we should train our guns towards vaccinating everybody and in the meanwhile, also try and protect the vulnerable population who have been received two doses and who are six months hence, so that they would get their booster dose to protect themselves.

Who all do u think should be included in those who should get the first priority to get booster doses?

Dr. Padma

I would say, the ones who get a severe infection once they are exposed  again, so in that group I would put the normal ones, immune suppressed and immune-compromised and that doesn’t have an age bar. Even if it is an 18-year-old who has a bad cancer and Is on chemotherapy should get it. That, plus the elderly population and severe comorbid situations. Next come the healthcare worker and other workers like you, me and others who have a greater chance of getting exposed to an infection. Population who has  a chance of getting severe illness, that would be my number one, next is the groups who are exposed to the likelihood of getting exposure. These two will be in my priority zones.

The scientific data does not back for any booster shot in India, perhaps just stay indoors, just follow the covid protocols and you will not need the booster shots. What will be your response to that argument?

Dr. Padma

I don’t really think that the scientific community is saying so because, we have publication to this regard, as I  even said the task force is also looking at the concern and I do believe that there is some data even from Indian make vaccines, they said after 6 months maybe you would require 1 booster dose to pep up and keep up the immunity. But, fortunately we still speak  that we have not really had a bad 3^rd wave which is a great thing and a great boost in the arm and hope that it never happens. Said that though, in preparation to prevent bad infections from happening to even this small group of people where there is definite immune-compromised situation.  No we have a  lot of literature that has come in saying that they would need a booster shot and I think that part nobody would negate. But again coming back to generalizable kind of per statement we can not give, that everybody should get a booster shot before we vaccinate everybody. That I don’t think is tenable for our country yet.

What would you like to tell the people who are watching the show and are very eagerly waiting for the booster shot because that’s a large number of a population?

Dr.  Padma

So it seems that there still exists vaccine hesitancy, I still come across of patients who say that they have not been vaccinated for whatever reason and then we tell them please don’t do that and get vaccinated. So as we still look at vaccine hesitancy which is now still cutting short our prerogative that everyone must get vaccinated. On the hand, the people who got vaccinated are waiting for the booster dose, so I would still say that I do believe that the booster dose for us has situation. Those individuals should get the booster dose and we should not get into this race. And yes the data is rolling in for the mix and match  that you can mix vaccines and that also has inseminated from the availability of these vaccines. You shouldn’t keep waiting for another vaccine to come in. whatever is available, you take it at that point which is required to be taken.