Should you get another COVID booster? Guidelines are changing

The World Health Organization (WHO) on Tuesday said it no longer “routinely recommends” additional COVID-19 vaccine boosters for medium or low-risk people, but one Canadian doctor is warning the “advice isn’t probably the best.”

The updated roadmap from WHO outlines three priority-use groups for COVID-19 vaccination: high, medium and low, and is designed to prioritize vaccines for those at greater risk of the disease.

The WHO recommended additional booster doses for high-priority groups such as older people, immunocompromised people of all ages, front-line health workers and pregnant people. But for those who fall under the low and medium-risk group, WHO did not recommend additional COVID-19 boosters, citing “low public health returns.”

The WHO’s updated guidance comes just weeks after Canada’s National Advisory Committee on Immunization (NACI) last updated its guidelines on boosters.

“Society is caught between wanting this whole thing to be over and still reconciling that it’s still a threatening problem out there,” Dr. Kashif Pirzada, a Toronto emergency room doctor, told Global News.

“We see plenty of people with just two vaccines who get a fairly brutal illness…the most severe your illness, the more chances you’ll have long-term lingering symptoms. So I think they didn’t really factor that in is that it’s still out there,” he said.

Despite the persistent presence of the highly contagious Omicron variant in Canada, COVID-19 is not expected to surge in the coming months as hospitalizations and deaths remain stable, federal health officials said earlier this month.

2:36 COVID-19 apathy: vaccination rates slowing three years into pandemic

On March 10, Canada’s chief public health officer, Dr. Theresa Tam, said that COVID-19 activity has reached a “relatively steady state,” in the country and “we may not see any major waves in the coming months as we prepare for a potential fall and winter surge.”

Because the country is seeing a decrease in deaths relating to COVID-19 infection, Dr. Susy Hota, medical director of infection prevention and control at the University Health Network, said she agrees with WHO’s recommendations.

“I think from a global perspective it makes a lot of sense and probably also makes sense from a Canadian perspective,” she said.

“We know that especially in Canada, younger people have a higher level of hybrid immunity. So having had vaccine doses, but then also prior infections…may offer better protection overall,” she said.

Canada — and the rest of the world — seems to be shifting into a new way of dealing with the disease, she added, which is transitioning into something “more sustainable” for the long term, such as focusing on high-risk individuals.

In terms of where Canada stands on vaccine boosters, Pirzada said there has been little messaging out there, other than a spring shot for high-risk individuals.

NACI’s latest guidance on COVID-19 vaccines on March 3 recommended that people facing a high risk of serious illness should get another COVID-19 booster in the spring.

The committee advises all Canadians five years old and up should get immunized against COVID-19 with a full primary series of vaccines. For most people, a primary series is two doses of a COVID-19 vaccine, at a recommended interval of eight weeks apart.

NACI states that “children 6 months to under 5 years of age may be immunized with a primary series of an authorized mRNA vaccine.”

NACI further recommends a booster dose six months after the last dose of a primary course for everyone aged five years old and up.

Because the most recent NACI guideline is only for high-risk individuals, Pirzada worries, like the WHO, NACI is not taking into account long-term COVID-19 symptoms, which can happen in healthy young people too.

“And the farther out you are from your boosters or from your vaccines, the more chances of having a much more severe course of illness,” he said.

His advice for Canadians is to get a booster if you are six to 12 months out of your vaccine, especially if you’re going to travel or be around large crowds.

If you don’t fall under the high-risk category and want to get boosted, Pirzada said “to make a case” to a physician or pharmacist saying, you’re worried about COVID-19 infection and want a booster.

“Boosters will protect you for three months from infection. That’s pretty good…protection for three months. If you are at high-risk settings in that time where you want to really have fun, that’s not a bad idea,” he added.

Hota believes that low-risk individuals, mainly those who feel nervous about travelling without a booster, should modify their behaviour “if they are concerned.”

The goal of vaccines, she said, is to reduce the risk of severe illness, and if an individual has a very low risk of getting severely sick from COVID-19 (because of hybrid immunity), “it’s probably not going to be offering you that much more protection.”

4:41 Health Matters: Bivalent vaccines and pregnancy

She stressed that vaccines will have the greatest impact on those at the highest risk.

According to Health Canada, a booster dose of a BA.4/5 bivalent mRNA COVID-19 vaccine “provides increased protection against both symptomatic disease and hospitalization, compared to those who did not receive a bivalent booster dose but received at least two previous doses of original monovalent vaccines in the past.”

— with files from Reuters