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If you are immunocompromised due to medical conditions like cancer, or because you are undergoing treatments or drugs that weaken the immune system, you are now eligible to receive a third dose of the COVID-19 vaccine. This extra dose could raise your antibody levels above the threshold needed for protection against COVID-19.
The third COVID-19 vaccine is recommended for people taking drugs that suppress the immune system, such as some rheumatology patients or those who have had a transplant, as well as cancer survivors.
For the general public, it’s different: if you’re healthy and fully vaccinated against COVID-19, you can likely receive a booster – eventually. However, the question is whether you really need that extra dose since the initial COVID-19 series already offers excellent protection.
With intense discussions between health experts and regulatory agencies such as the Food and Drug Administration and the Centers for Disease Control and Prevention, recall recommendations for healthy people are a moving target – starting with a one-day FDA meeting on Friday, September 17th. , to prepare for a non-binding vote on whether or not to approve boosters for people aged 16 and over.
[See: What Are the Symptoms of Coronavirus?]
Who is eligible for a Booster?
On August 13, CDC director Dr. Rochelle Walensky signed off on the recommendation for an additional dose of the COVID-19 vaccine for people with moderately to severely compromised immune systems. The CDC’s Advisory Committee on Immunization Practices (ACIP) recommendation encompasses immunocompromised people who have already received a first series of two doses of an mRNA vaccine – Pfizer or Moderna -.
For the Johnson & Johnson vaccine, the evidence is still being assessed and an additional dose is not yet recommended.
People can be immunocompromised for a variety of reasons, including:
– Active or recent treatment of cancer.
– Solid organ or stem cell transplant.
– Advanced or untreated HIV infection.
– Medicines such as high dose steroids, chemotherapy medicines, tumor necrosis factor (TNF) inhibitors used to treat inflammatory conditions such as rheumatoid arthritis.
– Medical conditions like chronic kidney disease which can weaken the immune system.
Booster vs third dose
A booster injection causes “B cells” – cells of the immune system that make antibodies – to multiply, increase antibody levels, and an even stronger and faster response to future exposures to the virus.
Vaccine experts point out the difference between a third dose of the COVID-19 vaccine and a booster:
– Wakeup call. A healthy person who receives two doses of the mRNA vaccine develops a good antibody response and a high level of immunity against COVID-19, says Dr. Kathleen Neuzil, professor of vaccinology and director of the Center for Vaccine Development and Global Health of the University. from the Maryland School of Medicine. The booster is given to increase the immunity that already exists, if it starts to wear off after a period of a few months or a year.
– Third dose. An immunocompromised person often fails to achieve a baseline protective immune response after those first two doses of the vaccine, says Neuzil. Fortunately, she adds, “After three doses, a lot more of them get there.”
There does not appear to be any major downside to receiving the third dose, with reported side effects similar to the initial COVID-19 vaccine series, so far.
Immunosuppressed – Increased need for protection
In a comparative study from Israel involving nearly 500 participants – about half of whom had cancer and the other half were healthy – people with cancer produced antibodies more slowly than other people after receiving the first dose of Pfizer COVID-19 vaccine. However, antibody levels improved in cancer patients after the second dose of the study, published July 8 in the journal JAMA Oncology.
Now a good response to the third dose is observed in the first studies:
– The administration of a third dose of the Pfizer vaccine “significantly improved the (ability to elicit an immune response) of the vaccine, with no cases of COVID-19 having been reported in any of the patients” for 101 patients with solid organ (kidney, liver, lung, heart or pancreas transplants), in a study published Aug.12 in the New England Journal of Medicine.
– Likewise, a third dose of Moderna vaccine produced an increased COVID-19 antibody response in another study involving 120 solid organ transplant patients. The response rate was 55% among those who received the additional dose, compared to 18% for those who received a placebo injection in the comparison study.
[SEE: What to Say to Friends or Family Members Who Hesitate to Wear a Mask.]
Details of the third dose for mRNA vaccines
Currently, the third dose has only been evaluated for the two available COVID-19 mRNA vaccines.
“A lot of people are asking if the booster will be different from the first two doses, and at this time it isn’t,” says Dr. Lisa Maragakis, senior director of infection control for the Johns Hopkins Health System and associate professor of Medicine at Johns Hopkins Medicine in Baltimore.
“It’s the same vaccine, although the companies are working on versions maybe for future boosters that will target certain variants, things like that,” Maragakis said. “But for now, the boosters are an extra dose of the existing vaccine.”
Ideally, the third COVID vaccine should be the same as the first two, according to ACIP recommendations. So, if you initially received two doses of Pfizer, the third dose would also optimally be Pfizer – or a third dose of Moderna if you initially received two doses of Moderna. However, if this is not feasible, the use of one of the mRNA vaccines is allowed for the third dose.
In terms of timing, the third dose should be given at least 28 days after the initial round of COVID-19 vaccines have ended.
No side effects for cancer patients
“This is a very important statement that the CDC has cleared the third dose, emergency use clearance, in immunocompromised patients,” said Dr. David Cohn, chief medical officer at Ohio State University Comprehensive Cancer Center, professor of gynecology oncology and a practicing gynecologist-oncologist.
“Patients who are initially immunocompromised have a higher risk of contracting COVID because their immune systems are weakened,” says Cohn. “And if they were to contract COVID, they would have a higher rate of serious complications or death, and hospitalizations from COVID. So this is a very important population to target.”
Cancer patients are eager to get the extra protection that an extra dose might give them. “When we offered the vaccination to our cancer patients, they were the first in line when their number was chosen by the state of Ohio, and I’m sure it’s the same in all over the country, ”Cohn said. “They were really excited to be back to some level of normalcy. And when the CDC cleared the third dose for this population, they were literally lined up at our doorstep waiting to be vaccinated again.”
The third doses are going well. “For the record – because we have already vaccinated thousands of people in our cancer hospital – we did not notice any significant difference in the rates of severe reactions, which are extremely rare, or side effects of the third vaccine. “Cohn said. .
The authorization of the additional dose was carried out in several stages. “The process is for the FDA to provide its recommendation,” Cohn says. “ACIP, the CDC’s advisory committee on immunization practices, then supports the recommendation to the CDC – which is actually the approver for emergency use in immunocompromised patients.”
Boosters for the general population?
If you are healthy and fully immunized, it is less clear whether you should receive a booster. Although the Biden administration initially announced plans to start booster shots for the general public by the end of September, some health agencies like the World Health Organization are pushing back and questioning the need for boosters when the COVID-19 protection of the initial series is still strong.
On September 13, a viewpoint article published in The Lancet argued that with a vaccine efficacy of 95% on average, even against the Delta variant in the general population, the evidence to date may not justify the need for a booster for healthy people. The priority should be to use vaccines to provide initial protection to the unvaccinated, which would do the most good by preventing the continued evolution of COVID-19 variants, the authors concluded.
In the most recent update on the CDC website, “Not immediately” is the response to “When can I get a COVID-19 vaccine booster?” “
While the goal is for people to start receiving the booster in the fall, it is subject to FDA clearance and APIC recommendation, following an independent FDA review of the safety and efficacy of mRNA vaccines.
Once approved, individuals would be eligible to receive the COVID-19 booster starting eight months after their second dose of the Pfizer or Moderna vaccine. The same groups who were initially eligible for the initial round of vaccines because of their higher risk – such as healthcare providers, residents of long-term care facilities, and other elderly people – would likely be the first eligible for the recall.
[See: Fear, Courage, Grit: Meet More Than 50 ‘Hospital Heroes’ in Pictures.]
To remain vigilant
If you receive the third dose, continue to be cautious. “The safest advice for people most at risk of contracting COVID or serious illness from COVID is always to get vaccinated and act without being vaccinated,” Cohn said. “That kind of advice has protected a lot of people. Although, if we lived in a society where everyone was vaccinated, I would tell a very different story.”
Although the discussion has shifted to third doses and booster vaccinations, a persistent problem is that some people are not vaccinated at all.
For people who are immunocompromised and who have made the proactive effort up to the third dose, “It is also very important that their caregivers and close contacts are also vaccinated,” Cohn said. “Because that’s probably the biggest risk they’re going to see. If they’re doing everything to control their environment, not going to the grocery store or putting themselves in danger – if their contacts and family members don’t. are not vaccinated, this still puts them at enormous risk of being infected with COVID-19. “
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