Debate: Should COVID-19 vaccine mandates include a booster shot? | Pro/Con

As COVID-19 cases have surged in our area, several local colleges have updated their vaccine mandates to include a booster shot. But not all.

The CDC now recommends that everyone age 18 and up receive a booster shot six months after completing their first round of vaccinations.

That’s been enough for colleges such as Penn, Drexel, Haverford, and Moore to now require booster shots for students and staff.

A spokesperson for Rutgers, however, has said the college wants to “encourage everyone to take advantage of booster shots” but does not require them.

We asked two local experts where they fall on this debate: Should vaccine mandates include a booster shot?

By Paul A. Offit

The Food and Drug Administration has authorized coronavirus vaccine boosters for people ages 16 and older. I am a member of the expert committee that advises the FDA on vaccines, and, as is true for several people on our committee, I disagree with widespread boosting for all.

I don’t believe that most people need a booster to be protected against COVID-19, even the omicron variant. The main goal of vaccination is to prevent serious illness and death. And for that, two doses of the original mRNA vaccines (by Pfizer and Moderna) are often sufficient. Recent research, such as a study out of North Carolina, has found that the Pfizer and Moderna vaccines are “remarkably effective and durable in reducing the risks of hospitalization and death.”

In my opinion, boosters should be reserved for people who work on the front lines, are older than 65, have problems with their immune systems, live with someone who is elderly or in poor health, or live or work in long-term care facilities.

What’s more, expanding eligibility and mandates to boosters could actually hurt our overall efforts to protect the public from COVID-19.

Let me explain.

The Pfizer and Moderna COVID-19 vaccines already faced hurdles by requiring two shots instead of a “one and done.” Indeed, some data suggest millions of Americans have skipped their second shot. Now, with booster mandates, we’re telling everyone to get a third shot — and that runs the risk of sending a bad message about the effectiveness of vaccines. Some may think: If the shots work, why do I keep having to get more of them? What’s the point in getting vaccinated at all? In this way, pushing boosters may actually prolong the pandemic by discouraging people who were on the fence about vaccines from ever getting a single shot.

“Some may think: If the shots work, why do I keep having to get more of them? What’s the point in getting vaccinated at all?”

The advantage of a booster dose is that it provides better protection against mild disease. But for how long? One recent study showed that this kind of protection is short-lived, lasting only a few months.

We don’t have unlimited resources and energy, so all this effort we’re putting into booster campaigns and mandates is better spent trying to vaccinate the more than 40% of Pennsylvanians who still haven’t gotten their first two doses. When I rotate through the COVID ward at Children’s Hospital of Philadelphia, the vast majority of children over 5 who I see are not vaccinated, and neither are their families. Many of the people are reachable; they are not a “lost cause.” And these are the people who are falling seriously ill and dying. These people are at the heart of our ongoing COVID-19 crisis.

By pushing booster dosing, we are focusing on further protecting those who are already protected instead of protecting the unprotected.

» READ MORE: Colleges weigh mandating booster shots as COVID-19 cases surge

Yes, omicron is a very different variant from the strains of COVID-19 we’ve seen so far, but my opinion about boosters hasn’t changed. If anything, given that two doses of an mRNA-containing vaccine are very likely to protect against serious illness, I’m even more convinced that we should hold off on pushing boosters when such an unusual variant is circulating. For people who have two shots and are not at immediate risk from COVID-19, there may be benefits to waiting for a booster that’s more tailored to a variant that is completely resistant to protection against serious illness afforded by the vaccine.

In the meantime, let’s focus on getting those first two doses into as many people as possible. Then we can talk about a third.

Paul A. Offit is a professor of pediatrics at Children’s Hospital of Philadelphia, a member of the FDA’s Vaccine Advisory Committee, and the author of “You Bet Your Life: From Blood Transfusions to Mass Vaccinations — The Long, Risky History of Medical Innovations” (Basic Books, September 2021).

By Michael J. Stephen

When considering whether COVID-19 vaccine mandates should include boosters, the key question is: Do the benefits of the booster to the common good justify the burden of another immunization?

For me, the answer is an unequivocal yes.

So far, more than 800,000 Americans have died from COVID-19, and more than 50 million have been infected, some of whom have been left infirm. As a doctor who has worked in the ICU during the pandemic, I have witnessed this devastation firsthand. It is in our best interest to do everything we can to mitigate this pandemic.

Vaccines have proven to be extraordinarily effective at preventing severe disease and death. The CDC has estimated that if infected, unvaccinated people are more than 10 times likelier to die than those who have received the vaccine.

Mandates have been part of the vaccine effort, and they work. As an example, after Tyson Foods instituted a vaccine mandate for its workforce, vaccination rates jumped from less than 50% to more than 90%. Similar examples abound.

Mandates are also not new. In 1905, the Supreme Court upheld a Massachusetts mandate for smallpox vaccination, stating that public safety can supersede personal liberties. The Supreme Court weighed in again in 1922, upholding a Texas law that a student may be barred from school for not being appropriately vaccinated.

The country is growing weary of the unvaccinated holding our economy, our hospitals, our health-care workers, and our schools hostage with their false logic. This is as it should be, as vaccine mandates are legal and save lives; they are our strongest weapon to normalize our schools and economy.

Adding a requirement for a booster makes sense now. Just as the virus mutates constantly, most recently with the arrival of the omicron variant, so must our vaccine mandates evolve — backed up by appropriate scientific evidence. And the latest scientific evidence suggests adding boosters will make a difference.

“Just as the virus mutates constantly, most recently with the arrival of the omicron variant, so must our vaccine mandates evolve — backed up by appropriate scientific evidence. And the latest scientific evidence suggests adding boosters will make a difference.”

Recently, Moderna published data showing that its standard 50-microgram booster dose increased antibodies 37-fold. Further evidence comes from a small Israeli study that recently showed two doses of the Pfizer vaccine provided little protection against omicron, the now dominant strain, while the addition of a booster shot increased effectiveness hundredfold. Pfizer has presented similar data from a different study, showing that three shots were significantly better than two at neutralizing omicron.

» READ MORE: Philly is averaging record-high COVID-19 cases, but officials hope this wave will have fewer hospitalizations

Vaccine mandates are not absolute. There are safeguards for appropriate medical and religious exemptions. Also, if you do not want to adhere to the mandate, nobody will show up at your house and force you to take the shot. You can simply resign from your job and find another that does not have a vaccine mandate.

But please first consider the risk you are taking. I know firsthand the effectiveness of COVID-19 vaccines, including the booster. I was infected with COVID-19 in May 2020, before any vaccines existed, and I ended up in the hospital with pneumonia and blood clots. It took me four months to recover. Then, on Dec. 21 this year, after exposure to a colleague who later tested positive, I developed a fever and sore throat; one day later, I tested positive. This time, with two vaccines and the booster in me, I was better in four days and able to write this piece.

It is time to have faith in our science and our government. With the arrival of omicron, full vaccination must now include a booster. Booster shots should be mandated for the common good so that we can reclaim our country and our lives from this devastating plague.

Michael J. Stephen is an associate professor of medicine at Thomas Jefferson University and head of the Adult Cystic Fibrosis Center. You can read more about him at drmichaelstephen.com.