Opinions stand apart on COVID-19 boosters

Various agencies, Hogan have different advice for vaccinated

Who needs a COVID-19 booster shot? Like a choose-your-own-ending book, there is more than one way to read the advice.

Federal regulators say older adults and those with underlying health conditions or at risk from their hospital or similar job should get a booster if they initially got the two-dose Pfizer vaccine more than six months ago.

Maryland’s health officials add anyone who got the two-dose Moderna vaccine, though federal regulators won’t decide on that until next week.

Then there is Maryland Gov. Larry Hogan, who got out in front of all the federal guidance last month in recommending boosters to older adults and tweeted Tuesday that anyone six months out ought to consider another shot:

“Marylanders who received their second Pfizer dose at least six months ago should strongly consider getting a booster shot,” he wrote in Twitter.

Hogan, who has been pushing for the increased use of boosters for a couple of months, issued a news release Tuesday that reiterated that six-month recommendation and reported that 119,899 booster doses have been given, out of more than 8 million shots total in the state.

Mike Ricci, a spokesman for Hogan, said the governor’s statement makes sense when you consider who was vaccinated six months ago.

“If you received your second shot six months ago or more, that means you received your first shot in early March or so, which would put you in a phase consistent with the guidelines for boosters,” Ricci wrote in an email. “The ‘general population’ wasn’t really eligible for a second shot until the end of April.”

Still confused? Many in the scientific community understand and continue to support boosters for some — but not everyone. One new study published in the medical journal Lancet concluded that the Pfizer vaccine’s effectiveness at preventing COVID19 infection dropped to 47% from 88% six months after the second dose. And a top U.S. Food and Drug Administration official said such new data suggested boosters might be needed for everyone 18 and older, though the agency still needs to go through its formal process before making that recommendation.

So, the general takeaway is yes, the vaccine’s protections wane over time and possibly because of the more contagious delta variant. But they still largely protect the public from the worst of the virus, preventing hospitalizations and deaths in most people who are fully vaccinated but become infected anyway.

The data is clear that older, more vulnerable people are good candidates for boosters and younger, healthier people who don’t work in a hospital or the like can largely hold off.

“There are the vaccine-hesitant and the vaccine enthusiasts, and the enthusiasts think if two shots are good, three are better,” said Dr. Kawsar Talaat, a vaccine researcher and associate professor in the department of international health at the Johns Hopkins Bloomberg School of Public Health.

“That’s just not proven,” she said. “I’m 50 and healthy. I got my last vaccine dose 11 months ago in a trial and I’m not getting a booster now.”

Talaat said data is strong that those who are immunocompromised need a third dose (not called a booster because they didn’t likely respond well to initial doses). Older adults’ immune systems are less able to “remember” how to fend off the virus, so they too would benefit from a booster.

After that, she said, “the scientific data isn’t there yet.”

The rationale for including health care workers in the guidance is “a bit different,” said Dr. Kathleen Neuzil, director of the University of Maryland School of Medicine’s Center for Vaccine Development and Global Health.

Giving boosters ensures a healthy workforce at a time when workers already are overburdened and in short supply, she said.

She and Talaat agreed the more data will inform more decisions going forward.

An advisory panel to the U.S. Food and Drug Administration is scheduled to meet next week to consider data related to boosters for the Moderna and the Johnson & Johnson vaccines, and the scientists say the experts are likely to recommend the same path as they did recently for Pfizer about those older, sicker people and at-risk workers.

The FDA will meet shortly after the advisory panel and determine what to authorize. The U.S. Centers for Disease Control and Prevention and its advisory panel then will weigh in on specific guidance for providers about who should get a booster and when.

This may help with messaging, as for now Neuzil notes only Pfizer has authorization for any boosters, though the guidance is “being interpreted more broadly.”

Dr. Jinlene Chan, deputy Maryland health secretary for public health services, said state health officials wanted to send clear and specific messages to providers and to the public about who should get a booster.

That includes older adults six months from their last dose who have gotten Pfizer or Moderna, those living in long-term congregate settings, and those with underlying medical conditions or a job-related increase in risk, including health care workers, teachers, workers in those congregate settings.

“It can be a very confusing landscape,” she said. “Should I get a booster or not. It’s looking at the risk of getting infected or having a complication.”

But who ultimately should decide on a booster? Chan said people should “self attest” to providers that they are eligible. And providers should “reduce barriers.”

In a webinar Tuesday hosted by the COVID-19 Vaccine Education and Equity Project, officials from the FDA and CDC said they understood the guidance takes some explaining, but they urged the public to understand that scientists are still learning about the virus.

They base decisions on available data, collected from around the world, said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research.

“It’s become increasingly clear over time the vaccines we have against COVID-19 have lost some effectiveness,” he said. “You might hear some debate about how much effectiveness is lost.”

He said the bottom line is immunity does wane and that for many such as those older adults and immunocompromised, the data “leads us to the idea of the booster.”

But he and the other scientists agreed with Chan from the state health department, who said, the most important shot in ending the pandemic isn’t No. 2 or No. 3.

It’s the one that goes into the unvaccinated people with the highest potential to fill hospitals and morgues.

It’s, Chan said, “the first shot.”