Second bivalent booster receives ATAGI recommendation

Matt Woodley

15/11/2022 5:59:09 PM

The vaccine will become available in December and is recommended for people who have not had their first or second booster doses.

Pfizer bivalent vaccine vial.
The new Pfizer bivalent is expected to provide a greater breadth of protection compared with ancestral vaccines against current and future Omicron sub-variants. (Image: AAP)

Australians will soon be able to access a second variant-specific booster to protect themselves against COVID, with Pfizer’s new bivalent vaccine due to roll out next month.

According to Federal Health and Aged Care Minister Mark Butler, Pfizer has agreed to send 4.7 million doses of the new vaccine to Australia in the coming fortnight, with Therapeutic Goods Administration (TGA) already undertaking batch testing on doses that arrived earlier this week.

Like Moderna’s bivalent vaccine, the Australian Technical Advisory Group on Immunisation (ATAGI) has recommended that the new Pfizer offering be used as third and fourth doses in people aged 18 and older.

‘The inclusion of BA.1 in bivalent vaccines is expected to provide a greater breadth of protection compared with ancestral vaccines against current and future Omicron sub-variants such as BQ.1 and XBB, though there are no published data yet to demonstrate this,’ the ATAGI advice states.

‘A clinical trial among people aged over 55 years has demonstrated that the Pfizer bivalent vaccine induces a modestly higher level of antibody response against BA.1 and BA.4/5 Omicron subvariants compared to the Pfizer COVID-19 original vaccine, when used as a second booster dose. 

‘There are no objective data to translate this directly to clinical protection … [but] modelling suggests that differences in the additional protection against COVID-19 from a bivalent booster over an original booster are relatively small compared to the protection obtained from receiving any booster at all.’

However, even though Australia now has access to millions of bivalent vaccines, the level of demand in the community is unclear.

Minister Butler told reporters approximately 5.5 million eligible Australians are still yet to receive their third dose, while 3.2 million people over 50 have not received a fourth dose, despite it being recommended by ATAGI.

‘We all have to accept that we’re not really shifting the dial much at all,’ he said. 

‘Only 7000 of that 5.5 million got their third dose [last week], so that that number just is not shifting.

‘We are taking advice about how to shift that … the building wave that we’ve been experiencing over the last couple of weeks is the obvious opportunity to reiterate the importance of being up to date with vaccinations.’

In addition to the 4.7 million Pfizer doses, Minister Butler also confirmed that Australia is on track to have received 760,000 doses of Moderna’s bivalent vaccine by the end of the month – about 98,000 of which have already been administered.

It is not clear why ‘contractual agreements’ that prevented the Department of Health and Aged Care (DoH) from providing details on doses and shipments did not apply in this instance.

Aside from providing advice on Pfizer’s bivalent vaccine, ATAGI also gave new recommendations related to the use of its COVID vaccine for children aged six months to four years, and booster doses in general.

The paediatric vaccine is currently restricted to children who are severely immunocompromised or are at increased risk of severe illness from COVID-19, while third boosters (fifth doses overall) for the general population are not recommended at this time.

Instead, Minister Butler indicated that ATAGI will likely make new booster recommendations in early 2023 ahead of the southern hemisphere winter. 

‘[ATAGI] particularly noted ... the recent wave in Singapore,’ he said. 

‘They noted that severe disease and death during that wave … was very rare for people who had had at least two doses of vaccine for COVID. 

‘In … what appears to be a building wave, any reduction in transmission by adding a fifth dose to the system would, in their words, likely be minimal.’

Chief Medical Officer Professor Paul Kelly was also present at the press conference and reiterated the importance of antivirals in tackling the ongoing variant-driven wave that has seen case numbers, hospitalisations and deaths increase in recent weeks.

‘[COVID oral antivirals] are extremely effective for those that are eligible for those treatments,’ he said.

‘For example, a person over 70 – even those that have [had] three or four doses of vaccine – can halve the rate of death by taking the tablets. 

‘It is incredibly important to get those treatments as quick as possible. Within a day of being diagnosed is best, but up to five days would also make a difference in both your chance of severe illness lengthy hospitalisation, or indeed of dying from COVID.’

Professor Kelly also noted that oral antiviral use has increased by 43% in the past week and said Australia is likely nearing ‘the middle’ of the current wave.

‘All of the indicators that we have, whether that be furloughing of staff, ambulance call outs, wastewater testing, aged care staff positivity rate – because they continue to be regularly tested – and all of the other measures [suggest we are near the middle],’ he said.

‘This wave has been going up for the last few weeks. If it ends up being similar to Singapore, and I believe it will, then it should peak soon and drop quickly.’

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Dr Ian   19/11/2022 6:58:09 AM

The BA1 booster is welcome as will the BA4 BA.5 when it arrives but particularly before next winter bivalent vaccines that overtake the variants will be the next arms race as with influenza .
Some research indicated the vaccines adjusted for boosters are better in preventing infection for a few months as have others that the original Wuhan based vaccine booster is equal to the bivalents .
Evidence as regards six months plus protection is not yet formulated but up to now the vulnerable need the antivirals Paxlovid with high protection and Molnupiravir with more modest protection .
The intravenous option Remdesivir given early is being said to be under- utilised and if there are waves of immune evasive variants the Remdesivir option which gives 75% plus protection against deterioration to severe Covid and death is worth advancing far more energetically.