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Infectious disease experts aren’t all on the same page about COVID booster mandates

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As Western University imposes a booster mandate for all incoming staff and students – an effort, it says, is to lessen the risk of COVID-19 transmission on campus this fall -- not all infectious disease experts are on the same page about the benefits of such mandates.

Dr. Martha Fulford, an infectious disease expert with McMaster University, says she sees the overall medical value of vaccines but doesn’t agree that booster shots should be mandated for public health.

Instead, she told CTV National News, booster shots should be considered at the individual level.

“It has become clear that COVID vaccines are not stopping onward transmission,” she said, referring to the spread of variants such as Omicron and sub-variants.

When it comes to determining the need for booster shots, it would be easy for each person to have an individual risk assessment with their family physician, Fulford said. “But we’re not going to see a public health benefit in terms of a decrease in onward transmission,” she said.

“If you’re going to mandate something, regardless of whether you agree with that person’s individual decision, there has to be a very compelling public health or medical rational for that. It’s just not there anymore for the COVID vaccines and certainly not for boosters.”

While the benefit of booster shots might be more apparent for an older, immuno-compromised individual, she said, the benefits of another vaccine for a younger person, particularly if that person already has two doses or has actually recovered from COVID, is much less clear.

Karina Top, an associate professor of pediatrics and community health and epidemiology at Dalhousie University, says she supports mandate efforts, believing booster shots could maximize protection for incoming students.

“The boosters are effective at preventing severe COVID,” said Top, whose research focuses on vaccine safety. She maintains that COVID vaccines currently available are “effective against those severe outcomes in people who aren’t [protected] against Omicron.”

What the vaccines are not as good at doing, she said, is preventing infection or mild illnesses from COVID omicron variants.

“What we know is that combined exposure to both the vaccine and COVID-19 seems to offer somewhat better protection against severe COVID and broader protection against variants than just getting infected with COVID alone,” she said.

When it comes to the protectiveness of booster shots, Top pointed out that, a couple of months after the booster, “protection against those mild illness does decrease, but effectiveness against severe disease is sustained over several months at least.”

Top said she strongly recommends students returning to school get a third vaccine shot if they have not already, and to consider getting a booster when it becomes available later in fall.

Florentine Strzelczyk, Western’s provost and vice-president, wrote in an email to CTVNews.ca that their decision to impose a booster mandate for incoming students this year was “informed by consultation with our medical experts and the Western community, and mirrors several of North America’s largest universities, including Brown, Columbia, Harvard, and Yale per CDC recommendations.”

Strzelczyk added: “We know our approach won’t make everyone happy, but we’ve also heard from many people, including students, that they’re pleased to see us use all the tools available to us to help keep them safe and to have a consistent in-person experience this year.” 

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