The Baker administration said Tuesday that the Centers for Disease Control and Prevention (CDC) has yet to issue guidance on an expected COVID-19 booster shot program for the already vaccinated. Boston-area doctors, however, say they soon expect residents to be able to get an extra shot as additional protection against the potent delta variant.
Media reports out of Washington expect that, in the next several days, the Biden administration will announce such a program that would likely kick off in September. Local officials recommend that, in the meantime, questions be directed to healthcare providers.
A booster shot provides enhanced protection to someone who is already vaccinated.
“What happens is the immune system response to the vaccine slowly decreases over many months,” said Dr. Camille Kotton, an infectious disease specialist at Massachusetts General Hospital. “What we're seeing in Israel is that there’s less vaccine efficacy, there’s more disease, there’s more severe disease. So we know that that’s the time for a booster.”
In Israel, over a million such shots have been administered two weeks into a booster campaign, which reportedly is an effort to reduce the spread of the delta variant months after people got their initial doses.
Kotton thinks the state rollout for booster shots will be a lot more organized than the original launch of vaccine clinics in the winter, which were hampered by long lines, and the occasional broken freezer warranting vaccines unusable.
“Now I am pretty confident that we will be able to meet the meet the needs of the community and that we'll be able to give everyone needs one an additional booster dose,” she said in a Zoom interview.
Dr. Paul Sax, Clinical Director of the Division of Infectious Diseases at Brigham and Women’s Hospital, said discussions about boosters really gained steam as a strategy to control COVID-19 when the delta variant hit, and cases began to rise again, notably in the Provincetown outbreak in July.
“We've been discussing it internally,” he said, noting that the official guidance hasn’t been released from the CDC.
Kotton, who also serves on the CDC’s Advisory Committee on Immunization Practice, has no worries about vaccine availability.
That issue plagued Massachusetts in the late winter as groups like teachers and food service workers sought the shot, but were told to wait their turn in the state’s timeline because of delayed and staggered vaccine shipments from the federal government.
“I know that the government would have explored vaccine availability and supply prior to making a recommendation. They wouldn’t say, ‘OK, go get your eight-month vaccine’ if there’s not likely to be enough vaccine supply,” Kotton said.
The booster, both experts said, will likely be the same as the original shot, with no new ingredients. Pfizer’s vaccine is approved for people over the age of 12, and Moderna for those 18 and up.
There is no information on whether the CDC will recommend people who received the Johnson & Johnson vaccine get a booster, but Kotton said that information is going to be available soon.
“All of us are a bit frustrated that there hasn't been some more guidance on people who got the J&J vaccine,” said Sax, who said there are a substantial number of people in an ongoing vaccine study who got one dose of the J&J vaccine who subsequently have gotten the Pfizer vaccine.
Mixing and matching of vaccine is up in the air. It remains to be seen whether the government will allow or recommend people to mix-and-match vaccines, particularly after media reports that people are doing this on the fly.
“I’m hopeful that they will be allowed and there’s no theoretical reason why it should be harmful,” Sax said in a Zoom interview.
Kotton said that for booster doses, it’s currently unknown whether it’s better to get the same or the opposite MRNA vaccine, and added there’s currently research under way by the National Institutes of Health over what the best approaches to booster vaccines are.
Kotton is anticipating the state using already existing resources, like local pharmacies and vaccine clinics, to get people their booster shot. Kotton said the vaccines work well against the delta variant, although not as well as the initial COVID-19 strains. It’s important for people to protect themselves with a booster when it becomes available, especially as many people around the United States continue to be unvaccinated, she said.
She’s also seeing “extreme interest” from patients in getting extra protection.
“There's absolutely no debate about whether or not to protect yourself now,” she said.
It’s likely that workers in health care settings and nursing homes will be first in line for booster shots, Sax said.
The CDC’s upcoming recommendation is different than last week’s recommendation for an additional dose be given to the 3% of Americans who are immunocompromised, with experts saying this is supposed to be a part of the initial vaccine series for people with compromised immune systems, not a booster.
Sax said the Brigham is currently advising people who are immunocompromised get their third shot at pharmacies.
“CVS, Walgreens, wherever you’re going to get your vaccine, they already have set up that they are doing boosters for people who have weakened immune systems and that that’s a little bit of a preview of what’s going to be coming later on,” he said.
As the delta variant continues to stymie policymakers and medical providers alike, Kotton and Sax said they want to encourage people to get vaccinated no matter what.
“Yes, the vaccines are preventing serious illness from delta and we should definitely go forward with vaccinating as many unvaccinated people as possible to get control of this thing,” he said. Sax said he’s seeing more COVID-19 patients this summer than he was last summer, mostly of unvaccinated people, and milder breakthrough cases.
This coincides with public health data. In the two weeks from July 25 to August 7, the number of cases in Boston doubled from the prior two weeks.
