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**Update: September 17, 2021: The New York Times reports that an F.D.A. panel has recommended authorizing a Pfizer-BioNTech booster for people 65 and older or at high risk of severe Covid. 

September 16, 2021

The current focus 

Up until now, the pandemic strategy has been to prevent hospitalization and deaths. This is a key first step and the Pfizer, Moderna and Johnson & Johnson vaccines have largely achieved these important goals. 

For myeloma patients, an extra booster shot is critical to improving COVID-19 antibody levels. However, because of the negative impact of active myeloma and/or the ongoing treatments that can suppress the response to COVID-19 vaccination, the anti-COVID-19 antibody levels can still remain low. The unfortunate reality is that myeloma patients can remain at risk even after a booster shot. 

The “booster shot for everyone” controversy 

Right now, the Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) are reviewing whether or not a booster shot is recommended for everyone at six-to-nine months after the original full vaccination with the Pfizer, and potentially, the Moderna vaccines. (The booster strategy for the J&J vaccine remains unclear). The focus is on hospitalizations and deaths. The benefit of the original full vaccinations holds up pretty well in this regard. 

However, the problem is “breakthrough infections” in those who have been fully vaccinated. Infections are often mild and asymptomatic, and these breakthrough infections are usually not a problem for people with a good immune system. With the Delta variant, however, the 1,000 times higher COVID-19 virus levels mean that the virus can spread to others, including what is referred to as “the vulnerable,” such as myeloma patients. 

This is a problem! 

Issues for myeloma patients (and all immune-compromised individuals) 

For myeloma patients, there are two issues:

1.    If COVID-19 antibody levels are still low, even after a booster shot, there can be serious medical concerns.

2.    Since myeloma patients really cannot fight off the Delta variant well, they can have high virus levels and contribute to the ongoing spread in the community, even when asymptomatic. This is almost like an unvaccinated person. 

The new focus required 

To protect myeloma patients and all vulnerable groups, the goal must be to stop community spread of the Delta variant and the emergence of new variants (or mutations of COVID-19 “of concern,” as defined by the World Health Organization).

It is important to note that with recent major increases in COVID-19 infections in children, studies of over 3,000 COVID-19 virus samples at Children’s Hospital in Los Angeles have documented new variants of concern, including a Q3 variant of the Alpha strain and new variants of the Delta strain.  It is critical to stop this sequential evolution of new variants of concern. It will be wonderful when vaccination is available for children of all ages to help prevent surges of infection with Delta or other variants. 

Impact of boosters 

Booster shots for the population at large clearly lead to reduction in the community spread, as shown in a study from Israel. There are serious exposure risks for myeloma patients and other vulnerable groups when surges of infections occur, creating “Red Zones,” and the potential for the emergence of new strains is reduced by boosters. These key facts should be the basis for decision making. 

Bottom line 

The focus for vaccination strategies must be on the reduction in community COVID-19 infections, rather than on just prevention of serious disease and potential death. This is the only way to protect vulnerable groups like myeloma patients, and also prevent the ongoing emergence of dangerous new COVID-19 strains of concern, which are even more infectious and deadly. 

We hope for positive regulatory actions by the FDA and CDC, which can help all of us to stay safer. 

We will get through this together! 

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Image of Dr. Brian G.M. DurieDr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.

 

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