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The ‘Communication’[1] on the different ‘Immune Responses’ to ‘Booster Doses’ after different ‘COVID-19 Vaccines’ excites further ‘Unresolved Matters’ concerning ‘COVID-19 Pandemic’ and the ‘Global COVID-19 Pandemic Control’ using ‘COVID-19 Vaccines’ as the ‘Pandemic Interventional Control Strategy’. The ‘Immune Performances’ of ‘Booster Doses’ after previous ‘Full Vaccinations’ using seven different ‘COVID-19 Vaccines’ (Pfizer BioNTech, Oxford AstraZeneca, Moderna, Johnson and Johnson, Curevac, Novavax, Valneva) were evaluated with Meningococcal Conjugate Vaccine as a Control in a recent Report [2]. The Report highlights several ‘Unresolved Issues’ with the ‘COV-BOOST Trial’ [2].
Previous ‘Communications’ [3-19] ventilated several ‘Unresolved Determinants’ concerning ‘COVID-19 Vaccines’ and the ‘Immune Responses’ of which a bothersome recurring few are herewith disposed again: Dosage Strength, Interval between Doses, Antibody Responses, Cellular Immune Responses, Antibody Level-Protection Dyad Conversation, Duration of Protection, Antibodies Determination and Real Implications, Breakthrough Infections with ‘Full Vaccinations’, Robustness of Vaccine Efficacy Trials Designs, Vaccine Efficacy Trials and Population Diversity and Disparities, Programme Dosage Prioritization Controversies, Recommended or Proposed Dosage Regimens with ‘Mixed Vaccine Brands’, Several ‘2nd Dose’ Conversational Issues among several others.
The current ‘Communications’ [1,2] regarding ‘Booster Doses’ again elicit several ‘Conversational Issues’ towards further ‘Unending Search’ for ‘Seemingly Elusive Solutions’. The seven ‘COVID-19 Vaccines’, as recommended for ‘Full Vaccinations’, produce different ‘Immune Responses’ (Antibodies and Cellular Responses’) with ‘Booster Doses’ using different ‘Vaccine Brands’ with the greatest ‘Antibody Response’ from Moderna and the least from ‘Half Dose Valneva’. For ‘T-Cell Response’ after ‘Booster Dose’, there were ‘Significant Responses’, after ‘1st 2 Doses of AsraZeneca, with all the ‘COVID-19 Vaccine Boosters’ except AstraZeneca, Valneva and Half-Dose Valneva. There are ‘Issues’ to be further addressed: Dosage Intervals between the ‘Recommended COVID-19 Vaccine Doses’ and also between the ‘Last Recommended Dose’ and the ‘Booster Dose’ and the ‘Booster COVID-19 Vaccine Brand’. Also, the ‘Dose Strength (Full or Half)’ needs further elucidation re: ‘Increased Desired Population Coverage’ and ‘Immune Response and Population Protection’! What is the ‘Immune Response Duration’ after the ‘Booster Administration’ for each of the ‘Evaluated Study Regimens’? There is also the restriction of the ‘Study Population’ to only those above 30 years! The ‘Population Diversity Issue’ requires further attention: Younger Populations and Children, Minority Groups etc.
The ‘Unresolved Issues’ in the ‘Previous Communications’ intertwined with ‘Issues Requiring Further Attention’ in the ‘Current Communications’ certainly leave us with ‘More Unresolved Evolving Matters in the Works’! In the midst of the ‘Evolving Unresolved Confusion’, some Countries are ‘Rolling Out’ their ‘Recommended Schedules’ for the ‘Booster Regimen’. For instance in Nigeria, Pfizer BioNTech Vaccine is recommended for ‘Booster’ after 2 Doses of AstraZeneca and Moderna is recommended for ‘Booster’ after 2 Doses of Moderna Vaccine. Also, Pfizer BioNTech is recommended for ‘Booster’ after ‘1st 2 Doses of Pfizer BioNTech Vaccine’ while Johnson and Johnson Vaccine is recommended for ‘Booster’ after the ‘Single Dose Johnson and Johnson Vaccine’ (National Primary Healthcare Development Agency; December 2021!). What is the ‘Research Justification’ for this and what is the implication for the population-perceived ‘Vaccine Efficacy’ re: AstraZeneca, Pfizer BioNTech, Moderna and Johnson and Johnson Vaccines as ‘Cases-in-Point’? For a successful ‘Global COVID-19 Pandemic Control’ using the ‘COVID-19 Vaccine Interventional Strategy’, a carefully packaged evidence-based ‘COVID-19 Vaccination Regimen’ should be disposed for ‘Global Compliance’. Indeed, what now constitutes ‘Full Vaccination’? Is ‘Full Vaccination’ defined by ‘Completion’ of the ‘Originally Recommended Vaccine Dosage Schedule’ according to the ‘COVID-19 Vaccine Brand’ or is it now expected to be defined by the ‘Inclusion’ of ‘COVID-19 Vaccine Booster Doses’? This certainly further confounds the ‘Unresolved Evolving Issues’!
Currently, from several parts of the World, ‘Breakthrough Infections’ after ‘Booster Doses’ are being reported particularly with the ‘Rapidly Emerging COVID-19 Variants’: ‘Delta Variant’, ‘Mu Variant’ and lately the ‘Omicron Variant’. From current ‘Best Available Research Evidence (BARE)’, what is the ‘Protection’, beyond documented possible ‘Immunogenicity’, induced by the ‘Various Recommended Boosters Regimens’ against the various emerging ‘SARS-CoV-2 Variants’? We certainly need longer ‘Follow-up Studies’ concerning the ‘COVID-19 Vaccine Booster Doses’ to address these ‘Unresolved Emerging Matters in the Works’. There are also the ‘Issues’ of ‘Equity and Social Justice’ with some Countries encumbered with ‘covid-19 Vaccine Booster Doses’ while the vast majority of the populations in other less privileged Countries are still grappling with receiving even the ‘1st Dose’ of the ‘Country-available COVID-19 Vaccines’. This situation calls to the fore the ‘Inverse Equity Hypothesis’ possibly worsening ‘Global Health Disparities’ and putting the ‘Well-formed Conscience’ of our ‘Common Humanity’ to the ‘Test’.
This brief ‘Communication’ is a ‘Contribution’ to further excite reactions to the emerging ‘COVID-19 Vaccine Booster Conversational Issues’. Equity and Social Justice must be considered ‘Rational Variables’ in ‘Programmatic Interventions’ using ‘COVID-19 Vaccines’ for the ‘Global COVID-19 Pandemic Control’. Indeed, is ‘COVID-19 Vaccine Booster Dose’ required for the definition of ‘Full Vaccination’?
REFERENCES
1. Mahase E. Covid-19: Antibody boost after third dose varies greatly by vaccine, study finds. BMJ 2021; 375:n3011
2. Munro APS, Janani L, Cornelius V et al. Safety and immunogenicity of seven covid-19 vaccines as a third dose (booster) following two doses of ChAdOx1 nCov-19 or BNT162b2 in the UK (COV-BOOST); a blinded, multicenter, randomized controlled, phase 2 trial. December 2021. Lancet. www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02717-3
3. Lisboa Bastos M, Tavaziva G, Abidi SK et al. Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis. BMJ 2020; 370:m2516
4. Premkumar L, Segovia-Chumbez B, Jadi R et al. The receptor binding domain of the viral spike protein is an immunodominant and highly specific target of antibodies in SARS-CoV-2 patients. Sci Immunol 2020; 5:eabc8413
5. Duong YT, Wright CG, Justman J. Antibody testing for coronavirus disease 2019: not ready for prime time. BMJ 2020; 370:m2655
6. Sinha I, Bennett D, Taylor-Robinson DC. Children are being sidelined by Covid-19. BMJ 2020; 369:m2061
7. Fore H. Don’t let children be the hidden victims of COVID-19 pandemic. https://www.unicef.org/press-releases/dont-let-children-be-the-hidden-vi... of 9th April 2020
8. Eregie CO. COVID-19 Pandemic and the peculiar affliction of children: Amplification of a social fault cleavage that must be fixed. https://www.bmj.com/content/369/bmj.m2061/rr-2 of 1st July 2020
9. Altmann D. Finding the best covid-19 vaccine should not be a race: 14th August 2020. https://blogs.bmj.com/bmj/2020/08/14/finding -the-best-covid-19-vaccine-should-not-be-a-race.
10. Torreele E. The rush to create a Covid-19 vaccine may do more harm than good. BMJ 2020; 370:m3209
11. Eregie CO. COVID-19 Pandemic and the Value of Antibodies Testing: Still More Matters in the Works. https://www.bmj.com/content/370/bmj.m2655/rr-1 of 14th August 2020
12. Mahase E. Covid-19: Vaccine brands can be mixed in ‘extremely rare occasions’ says Public Health England. BMJ 2021; 372:n12
13. Coronavirus: BMJ urges NYT to correct vaccine ‘mixing’ article. BBC News 2021 Jan 3. https://www.bbc.co.uk/news/uk-55519042
14. Wu KJ. Britain opens door to mix-and-match vaccinations, worrying experts. New York Times 2021 Jan 1. https://www.nytimes.com/2021/01/01/health/coronavirus-vaccines-britain.html.
15. Eregie CO. COVID-19 Pandemic and vulnerability of science to assault: Imperatives to uphold research governance principles. https://www.bmj.com/content/372/bmj.n12/rr-4 of 22nd January 2021
16. Eregie CO. ‘COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccine Approval Programmatic Haze’: The Evolving ‘2nd Dose Uncertainties’. https://www.bmj.com/content/372/bmj.n18/rr-12 of 24th January 2021
17. Eregie CO. ‘COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccine Approval Programmatic Haze’: The Evolving ‘2nd Dose Uncertainties’. https://www.bmj.com/content/372/bmj.n18/rr-12 of 24th January 2021
18. Eregie CO. ‘COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccines Approval Programmatic Haze’: The evolving ‘2nd Dose Uncertainties’; still more unfolding ‘Matters in the Work’. https://www.bmj.com/content/bmj.n18/rr-13 of 27th January 2021
19. Eregie CO. ‘COVID-19 Pandemic, COVID-19 Vaccines and ‘2nd Dose Uncertainties’: Still unresolved evolving matters’. https://www.bmj.com/content/372/bmj.n162/rr-3 of 8th February 2021
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria and
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer and ICDC-Trained in Code Implementation.
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria.
*No Competing Interests.
Competing interests:
No competing interests
17 December 2021
CHARLES OSAYANDE EREGIE
MEDICAL DOCTOR
Professor of Child Health and Neonatology and Consultant Paediatrician and Neonatologist, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria.
Institute of Child Health, College of Medical Sciences, University of Benin, Benin City, Nigeria
COVID-19 Pandemic, COVID-19 Vaccines and Boosters: More Unresolved Evolving Matters in the Works
Dear Editor
The ‘Communication’[1] on the different ‘Immune Responses’ to ‘Booster Doses’ after different ‘COVID-19 Vaccines’ excites further ‘Unresolved Matters’ concerning ‘COVID-19 Pandemic’ and the ‘Global COVID-19 Pandemic Control’ using ‘COVID-19 Vaccines’ as the ‘Pandemic Interventional Control Strategy’. The ‘Immune Performances’ of ‘Booster Doses’ after previous ‘Full Vaccinations’ using seven different ‘COVID-19 Vaccines’ (Pfizer BioNTech, Oxford AstraZeneca, Moderna, Johnson and Johnson, Curevac, Novavax, Valneva) were evaluated with Meningococcal Conjugate Vaccine as a Control in a recent Report [2]. The Report highlights several ‘Unresolved Issues’ with the ‘COV-BOOST Trial’ [2].
Previous ‘Communications’ [3-19] ventilated several ‘Unresolved Determinants’ concerning ‘COVID-19 Vaccines’ and the ‘Immune Responses’ of which a bothersome recurring few are herewith disposed again: Dosage Strength, Interval between Doses, Antibody Responses, Cellular Immune Responses, Antibody Level-Protection Dyad Conversation, Duration of Protection, Antibodies Determination and Real Implications, Breakthrough Infections with ‘Full Vaccinations’, Robustness of Vaccine Efficacy Trials Designs, Vaccine Efficacy Trials and Population Diversity and Disparities, Programme Dosage Prioritization Controversies, Recommended or Proposed Dosage Regimens with ‘Mixed Vaccine Brands’, Several ‘2nd Dose’ Conversational Issues among several others.
The current ‘Communications’ [1,2] regarding ‘Booster Doses’ again elicit several ‘Conversational Issues’ towards further ‘Unending Search’ for ‘Seemingly Elusive Solutions’. The seven ‘COVID-19 Vaccines’, as recommended for ‘Full Vaccinations’, produce different ‘Immune Responses’ (Antibodies and Cellular Responses’) with ‘Booster Doses’ using different ‘Vaccine Brands’ with the greatest ‘Antibody Response’ from Moderna and the least from ‘Half Dose Valneva’. For ‘T-Cell Response’ after ‘Booster Dose’, there were ‘Significant Responses’, after ‘1st 2 Doses of AsraZeneca, with all the ‘COVID-19 Vaccine Boosters’ except AstraZeneca, Valneva and Half-Dose Valneva. There are ‘Issues’ to be further addressed: Dosage Intervals between the ‘Recommended COVID-19 Vaccine Doses’ and also between the ‘Last Recommended Dose’ and the ‘Booster Dose’ and the ‘Booster COVID-19 Vaccine Brand’. Also, the ‘Dose Strength (Full or Half)’ needs further elucidation re: ‘Increased Desired Population Coverage’ and ‘Immune Response and Population Protection’! What is the ‘Immune Response Duration’ after the ‘Booster Administration’ for each of the ‘Evaluated Study Regimens’? There is also the restriction of the ‘Study Population’ to only those above 30 years! The ‘Population Diversity Issue’ requires further attention: Younger Populations and Children, Minority Groups etc.
The ‘Unresolved Issues’ in the ‘Previous Communications’ intertwined with ‘Issues Requiring Further Attention’ in the ‘Current Communications’ certainly leave us with ‘More Unresolved Evolving Matters in the Works’! In the midst of the ‘Evolving Unresolved Confusion’, some Countries are ‘Rolling Out’ their ‘Recommended Schedules’ for the ‘Booster Regimen’. For instance in Nigeria, Pfizer BioNTech Vaccine is recommended for ‘Booster’ after 2 Doses of AstraZeneca and Moderna is recommended for ‘Booster’ after 2 Doses of Moderna Vaccine. Also, Pfizer BioNTech is recommended for ‘Booster’ after ‘1st 2 Doses of Pfizer BioNTech Vaccine’ while Johnson and Johnson Vaccine is recommended for ‘Booster’ after the ‘Single Dose Johnson and Johnson Vaccine’ (National Primary Healthcare Development Agency; December 2021!). What is the ‘Research Justification’ for this and what is the implication for the population-perceived ‘Vaccine Efficacy’ re: AstraZeneca, Pfizer BioNTech, Moderna and Johnson and Johnson Vaccines as ‘Cases-in-Point’? For a successful ‘Global COVID-19 Pandemic Control’ using the ‘COVID-19 Vaccine Interventional Strategy’, a carefully packaged evidence-based ‘COVID-19 Vaccination Regimen’ should be disposed for ‘Global Compliance’. Indeed, what now constitutes ‘Full Vaccination’? Is ‘Full Vaccination’ defined by ‘Completion’ of the ‘Originally Recommended Vaccine Dosage Schedule’ according to the ‘COVID-19 Vaccine Brand’ or is it now expected to be defined by the ‘Inclusion’ of ‘COVID-19 Vaccine Booster Doses’? This certainly further confounds the ‘Unresolved Evolving Issues’!
Currently, from several parts of the World, ‘Breakthrough Infections’ after ‘Booster Doses’ are being reported particularly with the ‘Rapidly Emerging COVID-19 Variants’: ‘Delta Variant’, ‘Mu Variant’ and lately the ‘Omicron Variant’. From current ‘Best Available Research Evidence (BARE)’, what is the ‘Protection’, beyond documented possible ‘Immunogenicity’, induced by the ‘Various Recommended Boosters Regimens’ against the various emerging ‘SARS-CoV-2 Variants’? We certainly need longer ‘Follow-up Studies’ concerning the ‘COVID-19 Vaccine Booster Doses’ to address these ‘Unresolved Emerging Matters in the Works’. There are also the ‘Issues’ of ‘Equity and Social Justice’ with some Countries encumbered with ‘covid-19 Vaccine Booster Doses’ while the vast majority of the populations in other less privileged Countries are still grappling with receiving even the ‘1st Dose’ of the ‘Country-available COVID-19 Vaccines’. This situation calls to the fore the ‘Inverse Equity Hypothesis’ possibly worsening ‘Global Health Disparities’ and putting the ‘Well-formed Conscience’ of our ‘Common Humanity’ to the ‘Test’.
This brief ‘Communication’ is a ‘Contribution’ to further excite reactions to the emerging ‘COVID-19 Vaccine Booster Conversational Issues’. Equity and Social Justice must be considered ‘Rational Variables’ in ‘Programmatic Interventions’ using ‘COVID-19 Vaccines’ for the ‘Global COVID-19 Pandemic Control’. Indeed, is ‘COVID-19 Vaccine Booster Dose’ required for the definition of ‘Full Vaccination’?
REFERENCES
1. Mahase E. Covid-19: Antibody boost after third dose varies greatly by vaccine, study finds. BMJ 2021; 375:n3011
2. Munro APS, Janani L, Cornelius V et al. Safety and immunogenicity of seven covid-19 vaccines as a third dose (booster) following two doses of ChAdOx1 nCov-19 or BNT162b2 in the UK (COV-BOOST); a blinded, multicenter, randomized controlled, phase 2 trial. December 2021. Lancet. www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02717-3
3. Lisboa Bastos M, Tavaziva G, Abidi SK et al. Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis. BMJ 2020; 370:m2516
4. Premkumar L, Segovia-Chumbez B, Jadi R et al. The receptor binding domain of the viral spike protein is an immunodominant and highly specific target of antibodies in SARS-CoV-2 patients. Sci Immunol 2020; 5:eabc8413
5. Duong YT, Wright CG, Justman J. Antibody testing for coronavirus disease 2019: not ready for prime time. BMJ 2020; 370:m2655
6. Sinha I, Bennett D, Taylor-Robinson DC. Children are being sidelined by Covid-19. BMJ 2020; 369:m2061
7. Fore H. Don’t let children be the hidden victims of COVID-19 pandemic. https://www.unicef.org/press-releases/dont-let-children-be-the-hidden-vi... of 9th April 2020
8. Eregie CO. COVID-19 Pandemic and the peculiar affliction of children: Amplification of a social fault cleavage that must be fixed. https://www.bmj.com/content/369/bmj.m2061/rr-2 of 1st July 2020
9. Altmann D. Finding the best covid-19 vaccine should not be a race: 14th August 2020. https://blogs.bmj.com/bmj/2020/08/14/finding -the-best-covid-19-vaccine-should-not-be-a-race.
10. Torreele E. The rush to create a Covid-19 vaccine may do more harm than good. BMJ 2020; 370:m3209
11. Eregie CO. COVID-19 Pandemic and the Value of Antibodies Testing: Still More Matters in the Works. https://www.bmj.com/content/370/bmj.m2655/rr-1 of 14th August 2020
12. Mahase E. Covid-19: Vaccine brands can be mixed in ‘extremely rare occasions’ says Public Health England. BMJ 2021; 372:n12
13. Coronavirus: BMJ urges NYT to correct vaccine ‘mixing’ article. BBC News 2021 Jan 3. https://www.bbc.co.uk/news/uk-55519042
14. Wu KJ. Britain opens door to mix-and-match vaccinations, worrying experts. New York Times 2021 Jan 1. https://www.nytimes.com/2021/01/01/health/coronavirus-vaccines-britain.html.
15. Eregie CO. COVID-19 Pandemic and vulnerability of science to assault: Imperatives to uphold research governance principles. https://www.bmj.com/content/372/bmj.n12/rr-4 of 22nd January 2021
16. Eregie CO. ‘COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccine Approval Programmatic Haze’: The Evolving ‘2nd Dose Uncertainties’. https://www.bmj.com/content/372/bmj.n18/rr-12 of 24th January 2021
17. Eregie CO. ‘COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccine Approval Programmatic Haze’: The Evolving ‘2nd Dose Uncertainties’. https://www.bmj.com/content/372/bmj.n18/rr-12 of 24th January 2021
18. Eregie CO. ‘COVID-19 Pandemic, beyond the ‘Vaccines Marathon Finish Line’ and ‘Post-Vaccines Approval Programmatic Haze’: The evolving ‘2nd Dose Uncertainties’; still more unfolding ‘Matters in the Work’. https://www.bmj.com/content/bmj.n18/rr-13 of 27th January 2021
19. Eregie CO. ‘COVID-19 Pandemic, COVID-19 Vaccines and ‘2nd Dose Uncertainties’: Still unresolved evolving matters’. https://www.bmj.com/content/372/bmj.n162/rr-3 of 8th February 2021
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria and
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer and ICDC-Trained in Code Implementation.
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria.
*No Competing Interests.
Competing interests: No competing interests