In an interview with CNBC on Dec. 8, 2021, Pfizer CEO Albert Bourla said that he expects sooner rather than later all Americans will have to get a fourth dose of Pfizer/BioNTech’s experimental messenger RNA (mRNA) BNT162b2 biologic for COVID-19 to try to protect against the Omicron variant of the SARS-CoV-2 virus causing mostly mild COVID disease. Although Bourla had originally stated a fourth dose would be needed 12 months after receiving a third dose, now he says that, with the onset Omicron, the fourth dose may have to be moved up by several months.1
“When we see real-world data, will determine if the Omicron is well covered by the third dose and for how long. And the second point, I think we will need a fourth dose. With Omicron we need to wait and see because we have very little information. We may need it faster,” Bourla said.1
Fauci: Definition of “Fully Vaccinated” for COVID Will Change and Annual COVID Shots Not Ruled Out
Bourla’s announcement about the need for a fourth COVID shot to augment the two dose primary series and a third booster shot came on the heels of the acknowledgement by Pfizer that the two dose primary series was not very effective against the Omicron strain due to waning immunity. NIAID director Anthony Fauci, MD backed up the Pfizer CEO’s statement by telling CNN that changing the definition of “fully vaccinated” to include booster shots is a matter of “when, not if.”2
Dr. Fauci stated that the term “fully vaccinated” is only a “technical, almost semantic definition” that describes COVID vaccine mandates related to attending school or being employed in a workplace.”2
“For me, as a public health person, I just say get your third shot—forget about what the definition is. I just want to see people be optimally protected,” Dr. Fauci said.2
In early December, Dr. Fauci told a CNN Town Hall Meeting audience that, as more SARS-Cov-2 variants emerge, there is a possibility that the COVID vaccine will have to be given to people every year. He said, “The honest answer is we don’t know what’s going to be required.”3
Pfizer Focused on Selling More COVID Booster Shots to Defeat “The Enemy”
Currently, Pfizer CEO Bourla indicated he is focusing on delivering as many booster shots as possible in anticipation of a spike in SARS-CoV-2 infections and COVID illnesses this winter because he said, “Ensuring as many people as possible are fully vaccinated with the first two dose series and a booster remains the best course of action to prevent the spread of COVID-19.”4
Using the building of a wall as a metaphor, Bourla explained:
The best way to see it is the virus is the enemy if we want to protect ourselves, should build that wall. The first dose builds a wall but it is not very high. The second dose builds a wall on top of the first that’s really high and now and it was very good for other variants. Now it looks like the Omicron has the ability to jump over this wall. The third dose takes the wall very high and should stop, expect to stop the Omicron.5
On Dec. 8, Pfizer/BioNTech released results of a preliminary laboratory study that the companies said suggests a third booster shot may provide significant protection against the Omicron variant. Reportedly the booster was shown to be 25 times more efficacious in stimulating the production of SARS-CoV-2 antibodies than the initial two doses of the biologic.4
Bourla noted, however, that the lab results were based on a synthetic copy of the virus produced in a lab. He said Pfizer and BioNTech will try to reproduce the same results with an actual SARS-CoV-2 virus before the end of the year to obtain more accurate results.4
CDC Recommends Fourth COVID Shot for Immunocompromised People in U.S.
A fourth COVID shot is already being recommended for some people in the U.S. On Oct. 25, the U.S. Centers for Disease Control and Prevention (CDC) updated its COVID vaccination guidelines, recommending a fourth COVID shot for immunocompromised individuals at least six months after getting the booster. The goal of the fourth dose is reportedly to “combat waning immunity.”6
Several studies this year have shown that the efficacy of all the COVID biologics available in the U.S. declined significantly six months after the last shot. A recent study published in the journal Science researchers from the Public Health Institute, the Veterans Affairs Medical Center and the University of Texas Health Science Center showed the efficacy of the Pfizer/BioNTech’s BNT162b2 dropped from 86.9 percent in March to 43.3 percent in September. During that same period, the efficacy of Moderna/NIAID’s experimental mRNA-1273 dropped from 89.2 percent to 58 percent and Johnson & Johnson/Janssen’s experimental Ad26.COV2.S dropped from 86.4 percent to 13.1 percent.7 8
Dorry Segev, MD, professor surgery at Johns Hopkins University, said:
We know that six months after you reached a good level of protection, your protection has waned, and we need to boost that. That’s for people with normal immune systems and people who are immunocompromised.6
Israel and the U.K. Considering Fourth COVID Shot
Other countries, including Israel and the United Kingdom, are strongly looking at recommending a fourth COVID shot to their populations. On Dec. 7, Israel’s Minister of Health Nitzan Horowitz said, “If we see that the vaccine’s efficacy drops after a certain amount of time, even after the booster, we could recommend a fourth dose, it’s possible.” Other health officials in Israel such as Professor Arnon Afek, MD, deputy director of the Sheba Medical Center in Tel Hashomer believe a fourth COVID shot for Israelis is inevitable. Dr. Afek said:
Whoever thinks that we won’t [have a fourth dose] is simply mistaken. As long as there is still a pandemic in areas like Africa, which have low vaccination rates, there will be more and more variants.9
In the U.K, Health Secretary Saiid Javid earlier this month that the British government has signed contracts with Pfizer and Moderna for delivery of 114 million additional doses of their COVID biologics in 2022 and 2023. According to an article in the Mirror newspaper, “That appears to suggest Brits could be offered a fourth dose, given the supply would be more than enough to do so.” The British government has already begun the process of arranging for immunocompromised people on the island of Jersey (a U.K. protectorate) to receive a fourth COVID shot.10 11
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1 Kimball S. Pfizer CEO says fourth Covid vaccine doses may be needed sooner than expected due to omicron. CNBC Dec. 8, 2021.
2 Hubbard K. Fauci Says It’s a Matter of ‘When, Not if’ the Definition of Fully Vaccinated Will Change. US News & World Report Dec. 8, 2021.
3 Crane E. Fauci won’t rule out annual COVID booster shots in the US: ‘We don’t know.’ New York Post Dec. 2, 2021.
4 Kimball S. Pfizer and BioNTech say booster dose provides high level of protection against omicron variant in initial lab study. CNBC Dec. 8, 2021.
5 News release. CNBC Transcript: Pfizer Chairman and CEO Albert Bourla Speaks with CNBC’s “Squawk Box” Today. CNBC Dec. 8, 2021.
6 Lewis R. Some immunocompromised people can receive a 4th Covid shot, CDC says. CNBC Oct. 27, 2021.
7 Delgado C. COVID-19 Vaccine Protection Wanes After 6 Months, Especially for J&J. Verywell Health Nov. 11, 2021.
8 TVR Staff. Efficacy of Pfizer’s COVID Biologic Estimated at 33 Percent. The Vaccine Reaction Nov. 29, 2021.
9 Spiro A. Fourth COVID shot for all Israelis a possibility, health minister says. The Times of Israel Dec. 7, 2021.
10 Bloom D, Bucah L. Brits could get FOURTH Covid vaccine as UK buys up 114 million doses to 2023. Mirror Dec. 2, 2021.
11 BBC. Jersey’s most vulnerable to be offered fourth Covid jab. Dec. 2, 2021.