ATAGI says third vaccine dose ‘likely’ for certain cohorts

The Australian Technical Advisory Group on Immunisation (ATAGI) has foreshadowed the recommendation of a third COVID-19 vaccine dose for some people, including the ‘severely immunocompromised’.
 
In an announcement published on Thursday, ATAGI has said the advice on a third shot of the COVID-19 vaccine will likely be issued ‘in the next few weeks’.
 
‘ATAGI anticipates that a relatively small cohort of individuals, such as those with severely immunocompromising conditions, are likely to require a third dose as part of their primary course of vaccination to ensure optimal vaccine effectiveness,’ the statement reads.
 
The severely immunocompromised is the only group specifically referenced in the ATAGI announcement, but a third vaccine dose for other high-risk patients is also under consideration, the group says. The statement includes no further details on who those ‘selective cohorts’ might be.
 
The advisory group was careful to distinguish between the third shot as part of a primary course to achieve optimal protection and booster shots for the ‘broader population’. According to the statement, such booster doses are designed to lead to ‘improved immune memory’ and optimise protection in the event that immunity wanes over time.
 
While no decision has been made on issuing booster vaccinations, the ATAGI statement indicates that such a program is also likely to be part of the rollout ahead.
 
‘ATAGI anticipates that additional booster doses for other populations may be required in the future,’ it stated.
 
‘Additional doses are currently being considered but no recommendation has yet been made for the general population at this stage.’
 
The group has said it will monitor data from Australia and overseas on the efficacy and safety of booster shots, and conduct more detailed analysis of the best timing for the subsequent doses.
 
There were no details on the vaccine type to be used for either the third doses or the booster shots. It is unclear whether the third dose will have to be the same vaccine type as the initial program.
 
ATAGI says that newer vaccine types, such as Novavax, as well as variant vaccines, are being considered for boosters. It also indicated that the broader population remains well protected from severe COVID-19 by two vaccine doses.
 
‘This is further supported by the Australian data suggesting that severe COVID-19 following full vaccination is uncommon in the current Delta outbreak,’ it states.
 
Preliminary advice on booster shots and timing is expected to be issued at the end of October, with ATAGI saying the current ‘primary course’ rollout remains the focus.
 
‘First and second dose coverage in yet to be vaccinated adults and adolescents remains a priority, as high primary COVID-19 vaccine coverage is expected to have the largest impact on protection against severe disease both directly [by direct protection] and indirectly [by prevention of transmission],’ the statement reads.
 
Booster shots have been a significant cause for international discussion in recent weeks, with the World Health Organization stating vaccines should be prioritised for the developing world rather than for third doses in predominantly wealthy countries.
 
A recent review published in The Lancet found ‘insufficient evidence’ for booster programs targeting the population as a whole.
 
However, an increasing number of countries are already issuing booster vaccinations. Israel was the first to start, with a third vaccine dose initially offered to over-60s from the end of July and now extended to the wider population.
 
The new ATAGI statement indicates the Therapeutic Goods Administration (TGA) has not yet received any application for the administration of additional vaccine doses. It also notes that current vaccines on order for Australia are expected to be sufficient for first, second and additional doses over the next 2–3 years.
 
The Federal Government in July announced an order for an additional 85 million doses of the Pfizer COVID-19 vaccine to arrive next year and in 2023, while 15 million doses of Moderna’s updated variant candidate have also been earmarked for future booster programs.
 
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ATAGI boosters COVID-19 immunocompromised vaccine rollout