A growing number of countries are rolling out plans for a fourth dose of coronavirus vaccine amid surges of the omicron variant despite pushback from some experts who remain unconvinced about the necessity of an additional booster shot anytime soon.

Israel is leading the way, currently administering an additional booster to anyone over 60, health workers and immunocompromised people.

Israeli Prime Minister Naftali Bennett cited preliminary data that a fourth dose of Pfizer’s COVID-19 vaccine boosts antibodies fivefold a week after the shot is administered.

He said that such an antibody boost likely means a “significant increase” in protection against hospitalization and severe disease.

But the European Union’s drug regulator has expressed doubts about the need for a fourth dose, saying there’s no data to support the approach. And the head of the World Health Organization continues to advocate against widespread booster shot programs, saying “no country can boost its way out of the pandemic.”

Still, that hasn’t stopped Hungary, Chile and Denmark from making plans for additional doses for certain populations as well.

And some immunocompromised Americans can get a fourth shot starting this week, under updated vaccine timeline recommendations from the Centers for Disease Control and Prevention.

For people with compromised immune systems, a third dose of coronavirus vaccine was not considered a “booster shot” but rather a part of their primary series of shots. The CDC endorsed a third dose of either Pfizer or Moderna vaccines for moderately or severely immunocompromised people in August. In October, the agency said that the group may get a fourth dose at least six months after getting their third shot. But the CDC recently shortened that recommended timeline to five months, meaning that those who got a third shot in August could be eligible for a fourth shot this week.

Given that third shots were first offered to immunocompromised people before being expanded into more groups and, eventually, the general adult population, the fourth shot development puts pressure on federal officials to address what the general population can expect moving forward.

Leading infectious disease expert Anthony Fauci said it’s “conceivable” that a second booster could be needed.

“But right now we are hoping that we will get a greater degree of durability of protection from that booster shot,” he said.

Rochelle Walensky, the head of the Centers for Disease Control and Prevention, said that the Biden administration is monitoring the data coming out of Israel.

“We will be following our own data carefully as well, to see how these boosters are working in terms of waning effectiveness – not just for infection but, importantly, for severe disease,” she said.

The Rise of Variant-Specific Shots

For the general population, another shot is inevitable and could come soon, says Robert Murphy, the executive director of the Havey Institute for Global Health at Northwestern University Feinberg School of Medicine.

“I think it’s a matter of time before it gets approved for everyone,” Murphy says. “But we will be gathering information in the interim to determine when that time is for Americans, and I think it’s going to start actually pretty soon.”

The real question, he says, is whether it will be another dose of the same coronavirus vaccine or a variant-specific shot.

The rapid rise of the omicron variant prompted vaccine makers to pivot and explore variant-specific shots. Both Pfizer and Moderna are working on such shots.

Pfizer CEO Albert Bourla told CNBC that their omicron vaccine would be ready in March. The company is already manufacturing doses of the shot, which will also target other variants that are circulating.

But the shot needs to be studied and go through the regulatory approval process, so it’s unclear when it could make its way to the American people.

“The hope is that we will achieve something that will have way, way better protection particularly against infections, because the protection against the hospitalizations and the severe disease – it is reasonable right now, with the current vaccines as long as you are having let’s say the third dose,” Bourla said.

The Moderna CEO said their omicron shot could come in the fall.

While omicron has lessened the protection vaccines offer against symptomatic infection, booster shots are holding up well against severe disease, according to health officials. Fauci has said that an omicron-specific shot is not needed as of now.

Still, Murphy notes that he doesn’t believe the coronavirus will go away, so vaccine makers will have to continue to adapt to different variants as they arise.

How Many People Would Take a Fourth Dose?

Vaccination trends in the U.S. do not bode well for the uptake of a fourth coronavirus shot. Just 37% of the fully vaccinated people in the U.S. have gotten a booster dose, according to CDC data.

“We’re having trouble giving people the third dose, and we have plenty of vaccine,” Murphy says.

But some are already eager to move on to a fourth shot, including one Republican governor.

West Virginia Gov. Jim Justice, who is currently sick with the coronavirus, last week wrote to federal officials to request permission to give out a fourth vaccine dose to certain at-risk members of the state’s population who are at least three months out from their first booster dose. He proposed the shot first be offered to people ages 50 and older and essential workers.

“Just like West Virginia has led the nation time and again throughout this pandemic, Israel has led the world. And, right now, Israel is offering a fourth dose to an even bigger population – people who are four months out from their Pfizer or Moderna booster shots,” Justice said. “What we want to do is walk hand-in-hand with Israel.”

He indicated that even if the CDC says no to his request, he might move forward with the plan anyway.

“If the CDC comes back and says no we can’t do this now, and then there’s enough governors that go together, we’ll sure go with them. And then we may get across the finish line that way,” Justice said.

Nearly 55% of West Virginia’s population is fully vaccinated – slightly less than the national rate of nearly 63%.

Surveys show that the omicron surge could push more people to get booster doses.

Half of vaccinated adults who had not yet received a booster dose said the omicron variant makes them more likely to get a booster dose, according to a Kaiser Family Foundation survey published last month.

But how the CDC rolls out another dose will also play an important role in uptake.

CDC’s initial booster plan for who was eligible to get the shot prompted much confusion, which is proving to be lasting. As of a December survey, 23% of adults said they were unsure about the CDC’s recommendation or incorrectly said the CDC has not recommended booster shots for all adults.

Murphy says some patients have told him they want to wait for an omicron-specific vaccine. But he advises that people shouldn’t wait for a specific vaccine, especially with cases and hospitalizations reaching records in the U.S.

“I don’t think they realize how long that’s going to be,” Murphy says. “Hopefully you stay alive until that happens.”

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