If we are to do boosters, once the immunocompromised have been 3rd dosed we should seriously consider vaccinating certain high transmission groups (network nodes) - benefits of focussed & timely transmission reduction might outweigh alternative options.
Anyone know of any published modelling for this?
(I recognise importance of total take up over probably anything else).
Of course, how to (or whether its possible to properly) identify, and then efficiently vaccinate, those high transmission groups remains key:

I guess my point is just that, if VE against severe disease unlikely to have waned significantly thelancet.com/journals/lance… (for now), but immunity against infection/transmission does/has,
the 10s of millions of vaccine doses we are (likely) to give to 'boost' immunity *may* provide greater overall PH benefit if given tactically in an attempt to suppress the winter wave, rather than just by age group in descending order.
Of course, very many variables here, and certainly I acknowledge that even without any potential waning VE in older people is lower , and so possibly is best to, if 'boosting', just do so by direct medical risk.
Also ofc much would depend on ability to optimise timing of response against nAb waning
and, as said, actually identifying those high transmission groups.
Another factor ofc is those groups Delta infection/recovery status (likely many in high transmission groups have already had Delta, so third vax of reduced benefit here both in terms of any additional individual protection and network transmission reduction..).
But, for instance, in the initial scale-up of vaccine roll-out many key workers, including younger people, were offered and vaccinated at scale with 'spare' doses.
These are groups with (likely) higher than avg contact rates, so benefits to be had if they have high levels of nAbs through winter, and their vaccine induced immunity against infection/transmission waning as vaccinated earliest
Arguably (recognising this is just my 'logical' thinking rather than systematic modelling) more population benefits to be had from 3rd dosing these groups over, say, a WFH 53 year old..
Not saying this is easy or the right answer, for sure, and difficult for JCVI/ministers to make decisions off a stream of thoughts or even hazy modelling over actual robust evidence and more certain and direct medical benefits,
but I do think if we are to give tens of millions of boosters, it is certainly worth serious consideration of what we want to, or can, achieve with these doses.
I've always been a believer that a more adaptive and tactical response can achieve considerably greater PH benefit:
bmj.com/content/374/bm…
- and the potential benefits of suppressing a winter COVID wave through effective and adaptive vaccination would be significant…
Much of this again comes down to what is within JCVI remit:

If they are not really able to consider potential for wider Public Health benefits of vaccination, are the decisions being made the most optimal from a Public Health perspective..?
Yesterday I found myself quite liking a system where JCVI assess direct medical benefits to individuals and then pass to CMOs to take a wider health and social (although still from an individual rather than population benefits vs risks) perspective.
But is such a process tuned to be able to realstically achieve an (IMO highly desirable) adaptive and tactical PH response..?
Ofc would also have to consider if, in younger people, side-effects outweigh/marginalise any benefit against infection/disease whether it is appropriate to boost these groups w/ only uncertain benefits to population..
But again though, all comes back to how we *make* decisions - are we sure current approach is the optimal decision-making *process* (not just decision) for society and the collective Public Health of the UK..?

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Remi Joseph-Salisbury, another of the report’s authors, said:

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🧵
But high vaccine coverage also means governments may/can decide that transmission is now less of a problem, and therefore doesn't need to be suppressed with NPIs to the same extent as pre-vaccination (see Denmark & other gov statements (not just UK))..
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Spread may/will also reach immunocompromised patients, where VOCs may emerge.
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I will say - I imagine measuring secreted Abs in nose/throat (the mucosal immune response potentially relevant in reducing infectiousness of shedded virions) is difficult (largely due to variability within assays).

2/
Therefore, imho the absence of correlation between nAbs and peak viral loads identified here, and following suggestions that vaccination may not lower the infectivity of 'breakthrough' infections, are not certain to be 'true.'

3/
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