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Opinion What happens after omicron? Hard decisions about vaccines.

Health-care workers in D.C. prepare to administer a coronavirus booster shot on Jan. 18. (Sarah L. Voisin/The Washington Post)

Vaccines are the answer to the pandemic, but not a perfect answer. They protect against serious illness and death, but efficacy can wane and new virus variants emerge that are more difficult to combat. A big question hanging over the pandemic and over vaccines is: What happens after omicron?

The uncertainty is on display in Israel, which rolled out the Pfizer-BioNTech vaccine early on. Israeli officials concluded that the first booster — the third shot — had done a good job against the delta variant last year. With the omicron wave, Israel decided to offer a second Pfizer booster, or fourth shot, to people over 60, those with compromised immune systems and health-care workers.

When the campaign launched this month, early signs were promising, with reports of higher antibodies. But on Jan. 17, the lead researcher of a study on the second booster at Sheba Medical Center, Gili Regev-Yochay, announced it wasn’t much better than the first, when confronting omicron. “Despite a significant increase in antibodies after the fourth vaccine, this protection is only partially effective against the omicron strain, which is relatively resistant to the vaccine.” She added, “Maybe there are a few more antibodies but not much more compared to the third dose.” The study is tracking 154 health-care workers at the center who got the booster two weeks before. The second booster did not prevent infection, she reported. No data was released, and the results are preliminary, but the announcement suggests the pandemic won’t be ended by simply repeating booster shots. In the United States, uptake of the first booster is only 42 percent of the fully vaccinated over 18 years old. Would the public accept another? It is simply not feasible to boost the world every five months.

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The mRNA vaccines can be reformulated, and Pfizer’s chief executive, Albert Bourla, said Jan. 10 a new vaccine will be ready in March aimed at omicron as well as the other variants. A switch to an omicron vaccine raises a host of questions. Will the omicron variant still be prevalent when the shot is ready? If a switch is made to a new vaccine, will it take away from production of current vaccines? What shots should be used for people who have previously been vaccinated and those who have not? The decision to switch is high-stakes; another variant could easily emerge, leading to another switch. There’s a real need for a more global process to guide companies about what vaccines to make and when to switch — both the Food and Drug Administration and the World Health Organization seem to have grasped this.

Ultimately, in chasing variants, we are always going to be behind the curve. Along with the immediate battle with omicron, renewed effort must be made to develop next-generation vaccines that will provide broader and longer protection and dampen transmission. Ideally, scientists will develop a universal coronavirus vaccine that encompasses all of these characteristics, capable of protecting against many — or all — known variants. That day cannot come soon enough.

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Members of the Editorial Board and areas of focus: Opinion Editor David Shipley; Deputy Opinion Editor Karen Tumulty; Associate Opinion Editor Stephen Stromberg (national politics and policy, legal affairs, energy, the environment, health care); Lee Hockstader (European affairs, based in Paris); David E. Hoffman (global public health); James Hohmann (domestic policy and electoral politics, including the White House, Congress and governors); Charles Lane (foreign affairs, national security, international economics); Heather Long (economics); Associate Editor Ruth Marcus; and Molly Roberts (technology and society).