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Doctors Divided About Need for COVID-19 Boosters: Poll

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Sept. 13, 2021 -- Current scientific evidence shows that most people do not need booster shots of COVID-19 vaccines, a team of experts said in a new paper.

Research shows that the vaccines remain effective at preventing severe COVID-19, according to the group, which includes two high-level officials in the FDA who recently announced plans to leave the agency. Their opinion was published in the influential journalThe Lancet.

While this group of experts agree that boosters aren’t yet needed, doctors and nurses in the United States are divided about whether they are needed and how the United States should prioritize its supply of vaccines, according to a Medscape/WebMD poll of more than 1,700 doctors and nurses conducted Aug. 25 to Sept. 6. Medscape is WebMD’s sister site for health care professionals.

Does Evidence Support Boosters?

Overall, 71% of 575 U.S. doctors who were polled said they thought the available evidence supports giving boosters to people who have already had two doses of the Moderna or Pfizer COVID-19 vaccines; 12% disagreed, and 17% said they were unsure. Of 1,133 nurses surveyed, 66% said they thought evidence supports boosters, 15% disagreed, and 19% were unsure.

More than three-fourths of the 348 male doctors support boster shots, while 64% of their female colleagues (208 were polled) agreed.

Responses varied by age: 74% of doctors and 70% of nurses 55 and older said they believed the evidence supports boosters. Fewer of their younger colleagues (61% of doctors and 56% of nurses) agreed.

"The evidence is definitely looking like those who are immunocompromised are needing boosters at this time," says Priscilla Hanudel, MD, an emergency medicine doctor in Los Angeles. These include patients older than 70 and those who are immunocompromised or being treated for cancer with chemotherapy.

"It does look like antibodies are going to wane in the general population," she says. "The general population is well protected from severe disease, but in the next few months, it will probably be worthwhile to boost everyone."

Others see it differently.

"I don't see data for [giving boosters] in the general population," says Monica Gandhi, MD, an infectious diseases doctor and professor of medicine at the University of California, San Francisco. More data is needed as to where severe breakthrough cases are occurring, she said.

So far, the CDC reports that more than 14,000 breakthrough infections in vaccinated people have resulted in hospitalization or death. Gandhi says researchers need to examine those results by age, preexisting conditions, and other immunocompromising factors.

Beyond that, "population studies have not shown a decrease in protection against severe disease across multiple countries," she says.

Among consumers, a survey of 506 WebMD readers taken Aug. 26–28 found that 59% of respondents believe the evidence supports giving boosters to fully vaccinated Americans; 20% disagreed, and 21% said they were unsure.

Again, responses varied by age. Two-thirds of respondents aged 45 and older believed the evidence supports boosters, but only 50% of respondents younger than 45 agreed.

To Donate Doses or Save Them?

When asked how the United States should use its store of vaccines, 62% of doctors said the vaccines should be used for boosters, and 29% said they should be donated for use worldwide. The rest were unsure. About half of nurses (52%) said the United States should use its vaccines for boosters, and 36% said they should be donated.

Nurses and doctors older than 55 were significantly more likely than younger colleagues to advocate using vaccine doses as boosters instead of donating them.

This "is more a political question than a medical question," Hanudel says. Although she doesn't consider herself the best expert to answer this question, she said the priority is getting "everyone who is immunocompromised a third dose, and the first one or two doses to the unvaccinated."

Gandhi, on the other hand, says she "believes really strongly in donating these excess doses."

It has been estimated that the United States will have up to a billion extra doses by the end of September, she says, citing research by Duke University. Other wealthy countries also have excess. According to the Duke Global Health Innovation Center, the United Kingdom has paid for enough vaccines for four times its population, and Canada has paid for enough for five times its population.

Donating doses is the fastest way to get the vaccine to countries that need them ― faster than waiting for manufacturing to ramp up, Ghandi says. From a public health perspective, donating doses will help prevent new coronavirus variants from emerging in these low-income, under=vaccinated settings, she says.

Yet, fewer than half ― 46% ― of WebMD readers said the United States should prioritize booster doses for Americans, 30% said the United States should donate them, and the rest were unsure. Respondents 45 and older were significantly more likely than younger readers to say the United States should use available doses as boosters (54% vs 36%).

But What About the Ethics?

When asked whether they think it's ethical for the United States to use its stock of COVID-19 vaccines to give vaccinated Americans booster shots while many around the world have not received any vaccines, 61% of doctors said yes, 26% said no, and 12% were unsure.

Nurses were more likely to say giving out boosters was unethical (36% said so) or that they were unsure (17%). Among doctors based outside the United States, 62% said it was not ethical for the United States to give vaccine boosters.

Female doctors were almost twice as likely as their male counterparts to say it was not ethical to give boosters to Americans (38% compared to 20%). Sixty-nine percent of male doctors said giving boosters was an ethical choice, in contrast to 47% of female physicians.

Gandhi says prioritizing boosters for Americans over donating to other countries isn't the ethical decision and that, from a geopolitical perspective, the optics aren't good. Because protection against severe infection appears to remain strong in fully vaccinated people, "there could be an argument made that we are protecting Americans from cold-like symptoms" by giving a third dose, Gandhi said.

Health care workers and others in vulnerable settings are dying of COVID-19, she said. "The optics of that are terrible," she noted.

In the WebMD survey, 38% of readers said it was ethical to give boosters; 33% said it wasn't, and the rest were unsure. While 54% of male respondents said providing booster shots was ethical, only 35% of women agreed; 37% of women said it was not ethical, compared to 24% of men.

In her Los Angeles emergency department, Hanudel, says they are seeing very few severe breakthrough infections among vaccinated health care workers despite the fact that they are regularly exposed to the virus (the health care workers wear masks). Anecdotally, that points to the strength of two doses of the vaccine without a booster, she says.

She says that more important than providing a third shot for the fully vaccinated "is for the unvaccinated to get those first two doses."

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