Experts urge order with booster shots
Little policing in place to ensure third shots go to intended people
COVID-19 boosters are now available to millions of Americans who fall into certain broad categories and want greater protection from the coronavirus.
While many are relieved boosters are finally here, there’s little policing to ensure third shots go to the intended people. Health experts say some people who don’t meet the requirements are ignoring official guidelines and seeking third shots.
“Right now, it’s been the Wild West. I know people are going out and helping themselves to all kinds of things and basically lying to do so,” said Dr. Camille Kotton, an infectious disease expert at Massachusetts General Hospital and a member of the Advisory Committee on Immunization Practices, a CDC advisory group. “We really want to make sure that things proceed as safely and in the best way possible, so we encourage people to follow the rules.”
The third jabs are only available to recommended groups who got their second dose of the Pfizer-BioNTech vaccine at least six months ago. Those groups are: people 65 years and older; residents in long-term care settings and people 50 to 64 with underlying medical conditions. People 18 to 49 with underlying medical conditions and people 18 to 64 years who are at increased risk for exposure and transmission because of occupational or institutional setting also may receive a booster.
As per CDC guidance, hospitals and pharmacies are relying on patients to “self-attest” their eligibility as defined by the guidelines to help “reduce barriers to access for these select populations.”
When scheduling an appointment with CVS, patients are asked to provide the manufacturer and date of their COVID-19 vaccine, according to a company release. A similar strategy is being used at Walgreens.
“Ultimately, we are focused on removing barriers and improving access to potentially life-saving vaccines,” said Walgreens corporate spokeswoman Rebekah Pajak.
While it may improve access to vaccines, it also leaves room for people to be dishonest. Experts warn these people could be increasing their risk for severe side effects, especially when combining the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines.
“The problems that could potentially arise if you start combining vaccines are that you could see some side effects that we haven’t seen before,” said Mansoor Amiji, university distinguished professor of pharmaceutical sciences at Northeastern University in Boston. “We’ve seen some rare types of side effects and when you combine (the vaccines) you may see some additional ones.”
One such rare side effect linked to the mRNA vaccines and mostly seen in younger adults is myocarditis, or inflammation of the heart muscle. Although there’s no evidence of this so far, experts worry combining vaccines and taking extra doses outside of CDC recommendations could increase risk of developing the extremely rare condition.
Severe side effects after vaccination are normally covered under the National Vaccine Injury Compensation Program, but experts say a vaccine injury resulting from a booster shot taken outside of official recommendations may not be covered.
“It violates the PREP Act. ... They may not have coverage if they were to have a significant side effect from the vaccine,” Kotton said. “People should be aware that it’s not just their decision at CVS but there may be further ramifications.”
Extra doses may not only carry these potential risks, but they also do little good for people already protected by first doses.
“You’re not going to continually improve the vaccine’s efficacy by giving yourself multiple doses because at some point you’re going to reach the maximum immune response,” Amiji said. “Once you’ve reached your threshold, that’s it. You’re not going to get more and more antibody production.”
The mRNA vaccines, like those made by Pfizer-BioNTech and Moderna, direct cells to produce a protein from the virus. The immune system makes antibodies in response that will recognize and fight off the real virus.
Taking multiple vaccines is like reintroducing that same protein to the immune system over and over again, said Dr. Carl Lambert Jr., a family physician and assistant professor of family medicine at Rush Medical Center in Chicago.
“Your immune system is pretty smart. It doesn’t really need five different vaccines,” he said. “It’s probably like, ‘OK, we got it. We know what the virus looks like now.’”
Lambert understands people who are technically eligible to get a booster dose but received either the Moderna or the J&J vaccine may feel frustrated, but said authorization may come soon.
Booster shots of the J&J or Moderna vaccines are not yet approved, but Moderna submitted third dose data for the FDA to review on Sept. 1, according to a company release.J&J released new data last week showing a booster dose of its vaccine given two months after the one-shot vaccine provides 94% protection against moderate-to-severe COVID-19 symptoms.
Lambert urges recipients of these vaccines to follow official recommendations and avoid getting a Pfizer-BioNTech vaccine unless health agencies issue new guidance.
“You don’t have to get all the vaccines,” he said. “It’s not Pokémon, you don’t have to catch them all.”
“Right now, it’s been the Wild West. I know people are going out and helping themselves to all kinds of things and basically lying to do so.” Dr. Camille Kotton, Infectious disease expert at Massachusetts General Hospital