Do You Need A Fourth Shot Of Covid Vaccine? Here Is What Experts Say As Cases Rise

COVID-19 Vaccine: With Covid cases exploding in China, the question arises if India should start administering a fourth dose to those who have already taken their precaution dose.

Health Ministry data has shown that the coverage of the precautionary or booster dose has been inadequate

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The resurgence of Covid-19 cases in parts of the world, especially China, has signalled that the pandemic is far from over and booster doses are a necessary precaution moving forward. With Covid cases exploding in the neighbouring country, the question arises if India should start administering a fourth dose to those who have already taken their precaution or booster dose.

Experts told ABP Live that a fourth Covid shot or second precaution dose for doctors and other frontline health workers should be considered while ensuring that the majority population do not delay their first.

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Fourth Covid Dose For Healthcare Workers

Professor Kiran Kondabagil of IIT Bombay, who is working with the Maharashtra government on tracing Covid variants, said a second booster would certainly help in lessening the severity of the disease.

"The data over the last two years clearly shows that the fatality rates are much lower in people taking vaccination. A second booster will certainly help in lessening the severity of disease as well," Prof Kondabagil, chief scientific mentor at HaystackAnalytics, told ABP Live.

Seconding him, Professor Vivekanand Jha, Executive Director, The George Institute for Global Health, said since vaccine-related immunity wanes over time, "those who received their last dose about five-six months back, should receive a further dose".

Health Ministry data has shown that the coverage of the precautionary or booster dose has been inadequate with low case numbers in India making people complacent. So far, about 22.35 crore booster doses have been administered, which is just 27 per cent of the total population eligible for boosters.

Dr Sakshi Singh, Department of Internal Medicine, Amrita Hospital, Faridabad, said there was no need to panic about the second booster dose at this stage and it should only be considered for the vulnerable population.

"The fourth dose can be considered for those patients with comorbidities, vulnerable population and the healthcare workers as they are involved in taking care of suspected cases. Panic has to be avoided and proper selection of cases for fourth doses is needed," Singh told ABP Live.

In fact, the Indian Medical Association (IMA), in a meeting with Union Health Minister Mansukh Mandaviya, urged the government to consider a fourth dose for healthcare workers and frontline workers since the booster drive started nearly a year ago.

India started administering the third vaccine for health workers and senior citizens with comorbidities in January 2021, for adults above 60 years of age in March and for the 18+ population in April.

Studies have shown that the protection given by a third Covid shot starts to wane after a few months. This spurred some countries, including Israel, Germany, the United Kingdom, and the United States, to introduce a fourth coronavirus vaccine dose.

'Next Generation' That Target Multiple Strains Need Of The Hour

With the Omicron sub-variant BF.7 behind the current surge in global cases, most experts said that going forward India would need "next generation vaccines", especially those that can target multiple strains of coronavirus.

"While the present vaccines will help as boosters, going forward we need next generation vaccines. Clinical trials in the US have shown that bivalent vaccines are more effective than single antigen vaccines," said Prof Kondabagil, who teaches biosciences and bio-engineering at IIT-Bombay.

Simply put, a bivalent vaccine is a type of vaccine that protects against a combination of two or more SARS-CoV-2 strains, helping to create a broader immune response and maximise the duration of protection.

Countries like the US and Canada have authorised bivalent mRNA (messenger RNA) vaccines from Moderna and Pfizer as boosters that target Omicron subvariants BA.4 and BA.5, as well as the original strain of the virus.

Dr Sakshi Singh of Amrita Hospital said the availability of bivalent vaccines in India would be definitely helpful in tackling the potential rise in cases. Citing recent studies, she said bivalent vaccines have incremental benefit in elderly population.

"These type of vaccines can definitely expand the spectrum of protection as the recent variants are seen to be evolved from Omicron but it has also been noted that the duration of protection of mRNA vaccines is not very long," Singh said.

However, Professor Jha of The George Institute said people in different parts of the world have developed varying levels of immunity.

"There is no evidence that the new variant can produce more severe disease or increase the risk of organ failure or death in individuals who have received the currently available Covid vaccines in India. Therefore, the government should ensure that everyone eligible should receive the precautionary dose first," he said.

Nasal Covid Vaccines For Mass Immunisation?

As Covid-19 approaches its fourth year, the coronavirus continues to mutate and become more immune-evasive. In the years to come, experts said booster strategies that can enable mass immunisation and have higher acceptance and uptake rates among people would be key. An over-the-counter nasal spray booster can be a game changer.

India recently included iNCOVACC, the world's first intranasal Covid vaccine manufactured by Bharat Biotech, into its vaccination drive.

"Intranasal vaccines are effective and have comparable clinical performance as the injectable ones. In fact, intranasal vaccines are superior because nasal mucosa is often the initial site of coronavirus infection," Prof Kondabagil said.

Dr Singh said easy nasal delivery can enable "mass immunisation" and it can prove to be an important tool for mass vaccination during pandemic or endemic situations.