(Sylvia Owusu-Ansah, an emergency department physician at UPMC Children’s Hospital of Pittsburgh, receives Pfizer’s COVID-19 vaccine, Mon., 12/14/20)
By Michael Ollove
Now that the Biden administration has determined that Americans vaccinated against COVID-19 should get booster shots, state health officials say they can avoid a repeat of the chaos that accompanied the first months of vaccinations.
The primary reason for that optimism? “Now supply is stable,” said Michele Roberts, an acting assistant health secretary in the Washington State Department of Health. “There’s more than enough vaccines, and the feds say supplies will continue to be good.”
Still, the expected launch of boosters Sept. 20 will further burden an already strained public health system that has been battling the pandemic for more than 18 months and is still struggling to persuade nearly 40% of the eligible population to get even a first COVID-19 shot.
“There is a sense of utter exhaustion among public health workers and health workers,” Roberts said. When the Biden administration announced the booster plan, she continued, “There was a level of ‘Ugh, we’re doing this again?’”
Meanwhile, some people already may be jumping the line. ABC News reported earlier this month on an internal document at the federal Centers for Disease Control and Prevention document that said an estimated 1.1 million people already had gotten a third shot weeks before the Biden administration announced plans for a booster. And many others will likely fail to get their boosters because of inattention, indifference or misinformation.
White House health officials said they issued the booster recommendation in reaction to studies showing waning protection against SARS-CoV-2, the virus that causes COVID-19, over time. That and the dominance of the delta variant prompted the booster decision, they said.
But some infectious disease doctors say the administration’s decision is premature. Other critics, including the World Health Organization, argue that first doses of vaccines should be disseminated to other countries before nations with large vaccine supplies move on to booster shots.
Some state and local public health officials complain that the White House’s Sept. 20 launch date doesn’t give them sufficient time to prepare. But at least one governor, Republican Larry Hogan of Maryland, said boosters should begin immediately, especially at nursing homes. (Hogan, a cancer survivor, got a third shot this month, as recommended for people with weakened immune systems.)
In its initial announcement, the Biden administration said vaccinated Americans should get a booster shot eight months after their second shots. But at a virtual meeting with public health officials last week, White House officials said nursing home patients could be given third doses even sooner than that, according to Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, who participated in the discussion.
Last week, The Wall Street Journal reported that federal regulators are likely to approve boosters for everyone at six months rather than eight.
The plan to expand access to booster shots next month remains contingent upon authorization from the U.S. Food and Drug Administration and a review by the CDC, which is likely to offer additional clinical guidance.
Initially, approval will likely be limited to people who received the Pfizer or Moderna COVID-19 vaccines.
The White House said it expects to recommend a booster of the Johnson & Johnson vaccine after reviewing more data in the next weeks. The J&J vaccine requires a single shot, and was not available in the United States until March, three months after the Pfizer and Moderna vaccines were released.
Will Mass Sites Return?
Most states and localities closed mass vaccination sites months ago, and appear to be taking a wait-and-see attitude about whether the facilities again will be necessary. “I think it’s relatively unlikely,” said Dr. Cliff Mitchell, director of environmental health in Maryland’s health department, who has helped direct the state’s pandemic response.
Mitchell doesn’t think the mass clinics will be needed because the vaccines are now available to far more providers. At the beginning of the vaccination effort, physicians largely were cut out of the process and it took two to three months before pharmacies were heavily involved (though early on, the federal government did tap them to give shots at nursing homes).
The landscape has changed completely. Health clinics and private physicians now can order vaccines and are limited by only their capacity to store the drugs at the required cool temperatures. The CDC reports that as of early August, more than 41,000 retail pharmacies had administered 108 million COVID-19 jabs around the country.
Mitchell doesn’t foresee a repeat of last spring, when many Americans were frantically searching public health and hospital websites for appointments.
“It’s completely different between now and before because we have a system in Maryland and elsewhere that gives physicians and pharmacies the ability to receive vaccines directly,” he said. “Thanks to all the work done in the states, there’s a system in place for COVID vaccines that looks much more like the system people use to get their influenza vaccinations or any other vaccines.”
Roberts said that the infrastructure around COVID-19, which states built on the fly after vaccines first became available in December, has improved dramatically. “We have done a lot of quality improvements, and made adjustments,” she said. “The vaccine locator tool is much better. Call centers are much more robust.”
The booster rollout could be more predictable because the eligibility for boosters will echo that for the initial vaccinations.
Mitchell, the Maryland health official, said the predetermined order of the boosters should remove a lot of the anxieties that occurred when the vaccines were first launched. “The real difference here is that people’s expectations are vastly different than they were then,” he said.
In Maryland, for example, the first to receive shots were health care providers; nursing home residents and staff; law enforcement, firefighters, EMS, and other first responders; and correctional staff. Next in line were Marylanders over 75 and residents of assisted living, independent living, behavioral health and developmentally disabled group homes; those of other congregate facilities; teachers; and child care workers. Then came people over 65 and then those over 60. All others followed.
Some people who got their initial vaccines through their health care providers or pharmacies may receive reminders for their boosters. States track who got COVID-19 vaccinations, including the dates shots were administered. Some states, such as Washington, collected contact information when residents were first vaccinated and sent out reminders for their second doses, said Shelby Anderson, a spokesperson for the health department.
But states don’t have vaccine information for people inoculated at federal facilities, including the temporary Federal Emergency Management Agency tents that popped up around the country but now are long gone.
America’s fragmented system of medical record-keeping will likely result in many tardy booster shots, said Jennifer Bard, a professor in the University of Cincinnati’s colleges of law and medicine. Relying on the vaccination cards people received with their COVID-19 vaccines, rather than a centralized system, reflects poor planning, she added. Although states keep that data, it is not always accessible to patients or providers.
“With those scraps of paper, every day is another day they can be lost or damaged,” she said.
Public education campaigns are another tool states can use to promote boosters. Roberts said the Washington health department plans to post information on its website and meet with community groups that helped vaccinate people. She emphasized that those efforts will supplement the department’s top priority: vaccinating people who haven’t had any shots.
Mitchell said Maryland’s public campaign will in part aim to assure people that the protection afforded by their initial vaccines is not going to suddenly disappear.
“It’s really important to understand that it’s not going to be the case that at seven months and 31 days you are going to have immunity and the next day you are going to have no immunity,” he said. “The data suggests that there may be some decrease in immunity, but it’s important to stress that will happen gradually. This is not a switch that goes off in your body.” He said people could possibly wait up to two weeks after their due date to get a booster shot.
James Blumenstock, senior vice president for pandemic response with the Association of State and Territorial Health Officials, said clinicians are eager for more information about the boosters.
“If someone goes into their primary care doctor to get a flu shot and says, ‘Can I get my third shot while I’m here?’ and they’re at seven months and one week, should or shouldn’t the doctor administer the shot three weeks short of that eight-month window?” he said.
“It’s a work in progress.”
Michael Ollove is a reporter for Stateline, an initiative of the Pew Charitable Trusts, where this story first appeared.
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