In a seemingly quick reversal after contradicting Pfizer’s request for a fourth shot, Moderna has suddenly asked the Food and Drug Administration (FDA) to approve an emergency request for an additional booster shot of their vaccine. Moderna said the request for the additional shot was “to provide flexibility” to the Centers for Disease Control (CDC) and health care providers to determine the “appropriate use” of another booster shot. In requesting the fourth shot, Moderna outdid Pfizer by stipulating the additional dose should be for everyone, as opposed to Pfizer who recommended it should just be for the vulnerable and elderly.

A Sudden Turnaround

The decision by Moderna comes just a few days after the president of the company, Stephen Hoge, said a fourth shot of their vaccine was warranted “only in certain instances.” Hoge said the addition jab is required only for people who are immune-compromised, older adults, those over 50, or at least 65. The Moderna president said the shot should be “encouraged” just like the flu vaccine. Otherwise, Hoge added, getting a fourth shot was “a matter of choice.” When asked if a fourth shot was necessary, Hoge’s response was, “is it necessary? I think that’s a strong word. I think it will provide a benefit to anyone who gets it.” Moderna said its request is based on recently released data from the United States and Israel following the Omicron variant. Israel approved a fourth shot for the elderly and immune-compromised in December. Moderna wasn’t specific about the data, but a study in Israel showed that vulnerable people over 18 were better protected from the virus after getting the fourth shot. The study also showed Israelis over 60 who got a fourth dose of the vaccine were half as likely to become infected with the virus and four times less likely to become severely ill after getting infected with covid. Currently, Israel administers the Pfizer vaccine.

Better but Limited

However, a study of Israeli healthcare workers who did get a fourth booster shot of Pfizer during Omicron found they were only “marginally more protected against reinfection than their peers who had received three jabs of the vaccine.” A study in the New England Journal of Medicine found the fourth dose was more effective in preventing Covid-19 symptoms after infections. Additionally, younger, healthy Israelis who were given a fourth booster of Moderna found the vaccine less effective at preventing covid infections and were slightly less likely to be infected by Omicron than Israelis who’d received only three doses of the vaccine.

Is a Fourth Dose Necessary?

Even though Pfizer made the announcement seeking emergency authorization and Moderna quickly followed, the question of the necessity of the extra booster remains. At this time the CDC recommends the protocol of two doses of a covid vaccine plus a booster. Even though Moderna and Pfizer cite Israeli studies as their justification for a fourth jab, Israel seems unsure. There is one constant fact. Vaccines have been very profitable for both Pfizer and Moderna.

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