Yet no other infectious disease expert in any branch of the U.S. government has Fauci’s influence. And while other scientific leaders support boosters, many scientists believe Fauci and his colleagues at the NIAID — some of the world’s leaders in immunology and vaccinology, men and women in daily contact with their foreign peers and their research findings — are leading the charge.
Fauci was hard-pressed to give exact dates for when his thinking turned on the need for boosters. The past 18 months are a blur, he said. But “there’s very little doubt that the boosters will be beneficial. The Israelis already have that data in spades. They boost, they get an increase by tenfold in the protection against infection and severe disease.”
In July, Israel, which started vaccinating its population early and used only the Pfizer-BioNTech vaccine, began reporting severe breakthrough cases in previously vaccinated elderly people. Israel’s Ministry of Health announced boosters July 29. Fauci noted that Israel and — to a lesser extent — the U.K. were about a month and a half ahead of the U.S. at every stage of dealing with covid.
And once Israel had boosted its population, the Israeli scientists showed their NIH counterparts, hospitalizations of previously vaccinated people, which had been rising, dropped dramatically. Emerging evidence suggests boosters make people far less likely to transmit the virus to others, an important added benefit.
To be sure, members of the White House covid response team — including Fauci and former FDA Commissioner David Kessler — had begun preparing a timeline for boosters months earlier. Kessler, speaking to Congress in May, said that it was unclear then whether the boosters would be needed but that the U.S. had the money to purchase them and ensure they were free.
Fauci explained that “practically speaking, the earliest we could do it would be the third week in September. Hence the date of the week of September the 20th was chosen.” The hope was that would give regulators enough time. The FDA’s advisory board meeting Friday is set to be followed next week by a gathering of the CDC’s immunization advisory committee, which offers recommendations for vaccine use that can lead to legal mandates.
Tuesday, Dr. Sharon Alroy-Preis, Israel’s head of public health services, told a Hebrew-language webinar that her country’s booster launch came at a critical time. She provided supporting data that Israeli scientists are bringing to the FDA meeting Friday.
Some U.S. scientists have discussed limiting the boosters mostly to those over 60, Alroy-Preis noted, but “if you don’t keep it under control, it’s like a pot on the flame. If you don’t start lowering the flames of the pandemic, you can’t control it.”
Real-Time Science
Scientists tracking the coronavirus are swimming in data. Hundreds of covid studies are published or released onto pre-publication servers every day. Scientists also share their findings on group email lists and in Zoom meetings every week — and on Twitter and in news interviews.
Kessler, chief science officer of the White House covid response team, said the case for boosters is “rooted in NIH science” but includes data from Israel, the Mayo Clinic, the pharmaceutical companies and elsewhere.
As Fauci put it: “Every 15 minutes, a pre-print server comes out with something I don’t know.”
The SAVE group, active since February, was organized by NIH officials who in normal times track influenza epidemics. The 60 to 70 scientists are mostly from U.S. agencies such as the NIH, CDC, FDA and Biomedical Advanced Research and Development Authority, but also from other countries, including Israel and the Netherlands.
“This is very much the basic scientists who are in the weeds trying to figure things out,” said Dr. Daniel Douek, chief of the human immunology section within NIAID. Douek said the larger SAVE group meets every Friday but several subgroups meet several times a week, focusing on different aspects of the virus, such as early detection of viral variants and testing suspicious variants for their ability to evade vaccine-induced immunity and sicken vaccinated mice and monkeys.
The sharing of data and information is free-flowing, Douek said. SAVE is “an amazing thing.”
Dr. Robert Seder, an NIH senior investigator, was in a group testing the booster theory long before America’s “Summer of Delta.” The researchers injected rhesus macaque monkeys with the Moderna vaccine for the “express purpose of looking at the immune responses over a long period of time.”
“Are they durable? And would you need to boost?” Seder said.
Matthew Frieman, a participant and associate professor of microbiology at the University of Maryland School of Medicine, said the data makes it clear that the time for boosters is approaching. Biden’s booster announcement “may have gotten ahead of the game, but the trajectory is pointing toward the need for boosters,” Frieman said. “The level of antibody you need to protect against delta is higher because it replicates faster.”
While SAVE is an elite group, it’s not the only forum for discussing late-breaking data, said Natalie Dean, a biostatistician at the Rollins School of Public Health at Emory University. “We all saw the same data out of Israel,” she said. Dean, like many other scientists, found that data unconvincing.
Monday, an international group of scientists led by Dr. Philip Krause, deputy chief of the FDA’s vaccine regulation office, and including his boss, Dr. Marion Gruber, published an essay in The Lancet that questioned the need for widespread booster shots at this time.
Krause and Gruber had announced their retirements from the FDA on Aug. 30 — at least partly in response to the booster announcement, according to four scientists who know them. Gruber, who will remain at the agency until later this fall, is listed as a participant in Friday’s meeting.
