No need for 4th COVID-19 shot just yet, Long Island health experts say

Medical experts on Long Island said Monday it remained uncertain whether a fourth dose of the COVID-19 vaccine will be necessary any time soon, even as the head of Pfizer said he believes it's needed.

The question of a fourth dose comes as studies show the effectiveness of two vaccine shots followed by a booster wanes over time. The U.S. Centers for Disease Control and Prevention has said the booster’s effectiveness against hospitalization drops from 91% to 78% four months after it is given.

That means someone with a booster is 91% less likely to be hospitalized than an unvaccinated person after two months, and 78% less likely four months later.

During the omicron surge, the CDC found that the booster's effectiveness against emergency room or urgent care visits dropped from 87% to 66% after four months.

Given the decline in effectiveness, a fourth shot is needed, said Pfizer CEO Dr. Albert Bourla Sunday on CBS’s "Face the Nation."

"Right now, the way that we have seen, it is necessary, a fourth booster right now," Bourla said. "The protection that you are getting from the third [shot], it is … actually quite good for hospitalizations and deaths" but, he added, a fourth shot will be necessary because the third's shot's protection against infection wanes over time.

Bourla added that Pfizer is submitting data to the FDA, and waiting for a ruling from that agency on whether a fourth shot will be approved for the general public.

But infectious experts on Long Island said they do not see a need for a fourth shot now, and it is hard to predict whether one will be necessary in the immediate future. They do expect some kind of yearly shot to ward off COVID-19 eventually will become a permanent part of our lives, like the flu shot.

"I don’t think we know for sure yet" whether a fourth shot will be needed soon, said Dr. Bruce Farber, chief of public health and epidemiology for Northwell Health.

Farber said that because infection rates continue to fall, "it would be hard to justify," a booster right now.

"By the same token," he said, "I suspect a fourth dose will be needed and I think it’s unlikely that our rates will remain this low as we move into the fall."

After breaking records during the omicron surge in January, COVID-19 levels have dropped sharply on Long Island and in New York State. The seven-day average for positivity on Long Island was 1.55% on Sunday, down from a record high of nearly 27% in early January.

Long Island registered 138 new daily cases on Sunday, compared to more than 14,000 at the height of the omicron surge. Across the state, 10 people died Sunday from causes linked to the virus, with no fatalities on Long Island.

Given the relatively good COVID-19 indicators, said Dr. Aaron Glatt, chairman of medicine and chief of infectious diseases at Mount Sinai South Nassau hospital in Oceanside, he also believes a fourth shot will not be needed soon, though conditions could change rapidly with the arrival of a new variant.

"I think the answers to that are all still unknown," he said. "I think the possibility that we will need additional shots is there but I don’t think the data" has shown it is needed yet.

"If the incidence of COVID remains very, very low," he added, "it might be appropriate to hold off on giving booster doses until we have better understanding of what that additional dose would be."

Farber noted that Israel has conducted some studies on the effectiveness of a fourth shot. The studied found that people over 60 and health care workers obtained a modest increase in antibodies, Farber said.

He also noted that COVID-19 levels in Israel were high during the studies

"Things look remarkably good in the short order," he said. "But as always these rates need to be followed every week and if the trajectory changes then they need to change."

Both the CDC and the FDA would have to sign off on allowing a fourth shot for the general population. The CDC has approved a fourth shot for those who are immunocompromised.

Many Long Islanders would not yet be eligible for a fourth shot, because they have not received their third shot, which doctors recommend for full protection.

Long Island lags just behind the rest of the state in the number of fully vaccinated individuals who have received at least one booster dose. According to data from the CDC, 43.8% of fully vaccinated Long Islanders have received at least one booster dose, compared to 44.4% of all fully vaccinated New Yorkers.

According to state Health Department data, the number of booster shots administered on Long Island has declined from 27,945 for the seven days ending Jan. 13 to 6,602 for the seven days ending March 13 — a 76.4% drop.

Some doctors have argued that Long Island and the state should focus on getting more people their third shot before worrying about a fourth. But it all remains uncertain, as the virus continues evolving, experts said.

"People have to understand that it is a rapidly changing field always," Glatt said. "We have to be very cautious with predictions."

With Matt Clark

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