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In light of the more aggressive strain of the coronavirus and rising cases, public health officials announced plans to give COVID-19 booster shots to all Americans to rev up their defenses against the disease.
The plan, as described by top U.S. health authorities, calls for an extra shot after people get their second dose of the Pfizer or Moderna mRNA vaccines. The boosters could begin later this month.
Here’s what we know so far about the plan and how Virginia is preparing.
Why are we suddenly talking about three shots instead of two?
In the ongoing review of COVID-19 vaccine data, three trends have emerged: Vaccine effectiveness decreases over time; its ability to prevent serious illness and death remains strong; and the vaccine is a little less effective against the new dominant strain of coronavirus, known as the delta variant. Because of those findings, the federal government is planning for Americans to receive booster shots to increase their protection against the virus.
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How do we know all this?
The CDC released several studies. One looked at infections in residents of nearly 15,000 nursing homes. It found the effectiveness of the Pfizer and Moderna vaccines against infection among fully vaccinated residents fell from about 74% between March and early May to 53% in June and July, when the delta variant was circulating.
Another involved 21 hospitals. It found that the vaccine’s effectiveness in preventing hospitalizations was stable — 86% at two to 12 weeks after the second dose and 84% at 13 to 24 weeks after.
And one more conducted in New York found that protection against hospitalizations stayed at about 95% over the three months examined. But vaccine performance against new infections declined from about 92% in early May to about 80% in late July.
The CDC also released Mayo Clinic patient data from Minnesota that showed in July, when the delta variant was prevalent, Moderna’s vaccine was 76% effective against infection and Pfizer’s was 42%.
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When will the boosters begin?
The White House announced that Sept. 20 likely would be the day the government would roll out booster vaccines, contingent on the regulatory process. The recommendation, if approved, will be for people vaccinated with either Pfizer or Moderna to receive a third dose eight months after they took their second. Federal officials said before any booster program starts, the Food and Drug Administration and a CDC advisory panel would need to evaluate the safety and impact of an extra dose.
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What does this mean for people who got the Johnson & Johnson single-dose vaccine?
Right now there’s not enough data for federal regulators to make a recommendation on a booster for J&J vaccine recipients, but the White House plans to have more on that on Sept. 20.
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Are there going to be enough vaccines to go around?
Unlike what happened between December 2020 and March, this will be a different scenario. The federal government has assured state leaders that vaccine supplies will not be strained by the new directive. As people become eligible, hitting their eight-month mark from their last coronavirus shot, there should be enough vaccine for them to access a third shot.
But it’s unclear how much of the supply is stockpiled and how much will have to come off the assembly line as the boosters are administered. Virginia has about 3.5 million doses available, an amount Dr. Danny Avula, state vaccine coordinator, said is more than enough to meet the demand.
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How is Virginia getting ready for this?
State public health officials said they have looked at the data and who would be eligible, week by week. The first two to three weeks after Sept. 20 would be spent primarily delivering boosters to health workers and long-term care facility residents and staff. The highest number of Virginians would become eligible in the week of Dec. 26, topping out at 320,000 recipients. For comparison, there were weeks during the initial vaccination rollout in which the state administered more than 500,000 doses.
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Can Virginia hit those high numbers without mass vaccination clinics?
State public health officials say they’ve analyzed the numbers and believe they could. At peak, they could give about 520,000 doses through a combination of pharmacies, primary care providers, health departments and hospitals. The state health department also has recruited about 2,700 doctors’ offices to become vaccination sites that weren’t involved in the initial vaccination period.
But staff are discussing distribution with local health officials now to determine if any additional contractors will be needed to get the job done.
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Can we afford to wait eight months?
The urgency for a booster is different from the need for first and second vaccine doses, when people had no protection against the virus. Immunity through vaccination doesn’t disappear overnight but slowly wanes over time.
That means if an individual, for whatever reason, receives a booster eight months and three weeks after the second dose instead of at eight months on the dot, that will be OK. Virginians will still have a high degree of protection against the worst consequences of COVID-19.
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If this doesn’t start until Sept. 20, why are some people already getting third shots?
Remember that the CDC also recently endorsed third doses for people who are immunocompromised, including those who are undergoing chemotherapy treatment for cancer, organ recipients and people with autoimmune disorders. The agency has advised these individuals to get a third dose as part of their primary vaccination series, at least four weeks after their second dose. That is a separate recommendation from the one regarding booster shots.
The difference is that public health officials believe people who are immunocompromised generally don’t mount a strong enough resistance to COVID-19 with the two-shot Pfizer and Moderna series in the first place. The booster recommendation, on the other hand, is meant to rev up a person’s immunity after it has naturally declined over time.
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How are people proving whether they’re immunocompromised?
Individuals are being trusted at their word. There is no documentation required, per the CDC’s guidance. The agency wants to create as few barriers as possible to the process. To see who the CDC considers “moderately to severely immunocompromised,” go to shorturl.at/pwBL2.
People who are not immuno-deficient should wait. As Avula, state vaccine coordinator, said: “There is no burning emergency for you to go get vaccinated the day you hit that eight-month mark.”
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How important is it to get the booster?
It’s important for keeping vaccinated Virginians from getting so-called “breakthrough infections.” If vaccinated people continue to catch and spread the virus, particularly to those who are unvaccinated, it will perpetuate the pandemic.
But, relatively speaking, it is not as critical as an unvaccinated person’s need to get a first dose.
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How will I know if it’s my turn for a booster?
State officials are looking at the feasibility of alerting vaccinated residents when they’ve hit the eight-month mark past their second doses. Private sector providers are also looking into such measures. It’s likely that residents will receive a variety of reminders, but the responsibility will fall on them to find and schedule a booster shot.
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Will the booster shots be part of the state employee vaccination mandate?
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The jury is still out on that. The CDC told state representatives the agency considers being “fully vaccinated” as someone who has received the primary two-dose series of Pfizer or Moderna or the single dose of J&J. But the White House has said the federal government likely will consider the booster as a requirement of full-vaccination status. Regardless, it’s fair to assume there won’t be any changes to the definition before Sept. 20.
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What’s in the booster shot?
It’s exactly the same drug as was in the first and second doses of either Pfizer or Moderna vaccines. Though some vaccines, like those for seasonal flu, change every year to adjust to different strains of the virus, this booster is no different from previous COVID-19 shots. But manufacturers are developing new formulations of the vaccine that incorporate the delta variant and others. Those likely won’t be ready before next year, Avula has said.
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Does it matter whether the booster is made by the same manufacturer as your first and second doses?
The CDC will probably advise Moderna people to stick with Moderna and Pfizer people to stick with Pfizer, but if a vaccine provider only has the other one, officials will probably say it’s fine to “cross-dose.”
For more information on COVID-19 vaccines, visit www.vdh.virginia.gov/covid-19-faq/vaccination.
Elisha Sauers, 757-839-4754, elisha.sauers@pilotonline.com