How worried should I be if I don’t have a fourth dose?

Debate is heating up about the timing of the fourth round of COVID-19 vaccinations in Australia. The key question is: should we delay a widespread rollout to all adults as we wait for a vaccine that better targets the Omicron variant, or quickly roll out the vaccines we already have?

So far, only those aged 65 and over, Aboriginal and Torres Strait Islanders aged 50 and over and those with conditions that increase the risk of severe illness are eligible for a fourth “winter” dose.

Dr Magdalena SimonisCredit:Sion Schluter

There are growing calls for eligibility to be expanded to younger adults, as many of the population is set to face more dangerous Omicron sub-variants many months after their last vaccine dose.

On Monday, Victoria’s Chief Health Officer Brett Sutton said two sub-variants with a greater ability to evade the immunity provided by vaccines had become the most dominant strain in Geelong and Melbourne. The BA.4 and BA.5 sub-variants now accounted for about 40 per cent of virus wastewater detections in Victoria, in line with similar patterns in NSW and Queensland, he said.

We put readers’ questions about the fourth dose issue to Dr Magdalena Simonis, an experienced GP and member of the Royal Australian College of General Practitioners’ quality care expert committee, and infectious disease expert Professor Paul Griffin, who has been the principal investigator for seven COVID-19 vaccine clinical trials.

It’s been more than six months since my third dose. How worried should I be about the new variants if I don’t have my fourth dose?

Simonis: That’s a really good question. What we are seeing in the data is that the protection you get from three does still cover you for the severe consequences of the disease and death, to a large extent. At this stage, fourth doses have been rationed to those who are most vulnerable.

I’ve had COVID twice. Do I still need a third or fourth dose, if I’m eligible?

Simonis: If you’re three months after your last episode of COVID-19, the answer is yes. We don’t know what other variants are out there, and what other variants might arrive on our shores.

I’m a type 2 diabetic. Should I get my fourth dose now or wait a few more weeks to see if there are any new developments with the vaccines that could be more effective against Omicron? I’m doing everything I can to avoid COVID, I’m triple vaccinated and have had my flu shot.

Simonis: Get what you can now. If you’re a diabetic requiring medication, you qualify for a fourth, even if you’re under the age of 65. There are many reasons for this, and I’ll list a few. The disease is prevalent in the community; we no longer have any restrictions on travel; many people are not wearing masks in public spaces; and it takes time for new vaccines to hit the market – we could be looking at many months before another arrives.

Professor Paul Griffin.Credit:Justin McManus

Can I pay to get a COVID vaccine if and when I want one? I want to get my fourth dose now, not wait for the government to decide. It has been more than six months since my last COVID vaccination and I don’t know how much longer I can avoid it.

Simonis: My recommendation would be to have a conversation with your GP who will consider your risk factors, level of concern and latest recommendations from the Australian Technical Advisory Group on Immunisation.

I had my third dose in January. I suspect I now have little to no residual protection against catching Omicron. Is this correct?

Griffin: I think we can say with some degree of certainty that protection has waned over time, but it’s not likely to have waned to zero.

Last year it was reported there were “second generation” vaccines being worked on that will be even more effective. Are there were any advances with this?

Griffin: There are lots and there will be second and subsequent generation vaccines. They won’t necessarily be better, but what they might have is some additional desired properties … things like the ability to block transmission better. Some of these may not replace the existing vaccines, but they may be able to be used in a complementary way.

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