How will we deal with Corona in the future?

On the table is a proposal for an annual vaccination with two doses for small children, the elderly and the immunocompromised.

“Scientists at the Food and Drug Administration are proposing to make Covid-19 immunization a regular, once-yearly vaccination with an adjustment for current SARS-CoV-2 strains, the documents the FDA released Monday say has,” wrote the US pharmaceutical information service Stat.

The FDA Advisory Panel on Vaccines and Related Biological Products meets on Thursday. There, the experts from what is still the most powerful drug authority in the world should give feedback on whether such a strategy for switching from pandemic vaccination to annual screening – preferably in the fall – would make sense in their opinion.

One vaccination per year?

In the future, according to the FDA’s proposal, a Covid-19 vaccination could be appropriate for adults once a year. Two doses of the vaccine could then be given to young children, older adults and people with weakened immune systems. In the near future, small children are likely to be largely without any prior contact with SARS-CoV-2 until they are vaccinated. People over the age of 60 or 65 already show a poorer response to vaccinations, this also applies to people with a weak immune system, for example people with certain previous illnesses or medical therapies that weaken the immune system.

In any case, the procedure with which the vaccine is adapted to the current pathogen strains is also important for annual vaccination. In the case of influenza, the antigen selection is carried out regularly by the WHO for the southern and northern hemispheres of the world, for the north every year during these weeks. A completely new approval of the adapted vaccine by the drug authorities is no longer necessary. The vaccine is adjusted in terms of its antigen content. It is currently considered likely for the USA that in the near future all Covid-19 vaccines will have both a component against the SARS-CoV-2 pathogen originally from Wuhan and against omicron variants.

Study from Israel

Just last weekend, the German virologist Ulrike Protzer explained at the Austrian Vaccination Day in Vienna that unvaccinated people in the USA had a 16-fold higher hospital admission rate than those who were sufficiently immunized with the first vaccine variants. A booster with a new vaccine adapted to BA.4/5 results in a 2.7-fold lower hospitalization rate for a breakthrough infection. The positive effect is also evident in the subsequent virus mutants.

According to FDA experts, an Israeli study that has not yet been subjected to the peer review process (expert opinion) has shown that the new bivalent vaccine (BA.4/5) as a booster in over 65-year-olds leads to a vaccination compared to no vaccination 81 percent lower hospitalization rate and 86 percent lower death rate.

The FDA has not yet taken a position on the issues scheduled for discussion Thursday. “I assume that the authorities are open to advice and that they themselves are not quite sure how to proceed,” said Paul Offit, a member of the expert commission and head of the Vaccine Education Center at the children’s hospital quoted by Philadelphia from the New York Times.

For Eric Rubin, also a member of the convened committee and editor-in-chief of the most respected medical journal in the world (New England Journal of Medicine/Boston), much is still unclear. “I would like to see scientific data on the effect of the vaccination interval (once a year?; NB), at least from observational studies,” he explained. You have to be able to somehow assess on the basis of hard information whether you are heading in the right direction with the planned strategy. After all, it should be clarified whether an annual vaccination against Covid-19 is sufficient for sufficient protection in the future. The recommendations are also crucial for the production of the vaccines.