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Demand for an additional dose – or booster – of coronavirus vaccine is increasing, as the highly contagious delta variant even causes occasional infections in those vaccinated. In San Francisco, people who had received the single-injection Johnson & Johnson vaccine lined up at San Francisco General Hospital on Wednesday to receive a dose of mRNA vaccine, in what appears to be a one-of-a-kind program in the country.
No official federal guidelines have been issued on boosters. Older people, people with weakened immune systems or who have received the J&J vaccine are particularly keen to learn more. But the boosters are also controversial, because for every additional injection an American receives, the global supply of life-saving vaccines decreases. And 42% of Americans haven’t even received a single dose, leading some experts to think the priority should be getting them vaccinated first.
Here’s what we know about the latest developments:
What is San Francisco doing? San Francisco allows people who have received the Johnson & Johnson vaccine to request an mRNA injection from Pfizer or Moderna at clinics run by the city. It is believed to be the first US court to allow an “extra hit,” as city officials call it. San Francisco health officials stress that they do not recommend that everyone who has received J&J be vaccinated with mRNA, and that this option should be limited to recipients of J&J who have had a discussion with their doctor. doctor.
What is the United States doing? The federal government has not recommended additional vaccines for people who have already been vaccinated. Dr Anthony Fauci has indicated in recent days that this may change soon for some vulnerable Americans, saying a recommendation is “likely” to come for those with immunosuppression. Officials did not say if this would be for people who got Pfizer or Moderna, or J&J. Pfizer is expected to seek FDA clearance for a third dose this month. If the FDA grants full approval for the vaccine, which it is expected to do in September, doctors could prescribe a third dose for patients they believe need it.
Are there other Bay Area counties or vendors that offer additional shots for J&J recipients? Not at this time, because the CDC and the FDA do not recommend it. But some counties are watching the unfolding of San Francisco policy and recognize that the decision to get an additional injection is best left to individual providers and their patients. Additional shots at this point are considered non-compliant.
Solano County said it is monitoring what San Francisco is doing and, if the state sees fit, may implement a similar policy. San Mateo County said some vendors might do this on a case-by-case basis: “We know there are vaccine suppliers who can use their clinical judgment to consider off-label uses for patients in case-by-case situations. cases and we differ in their judgment in such cases.
What is the rest of the world doing? Israel last week became the first country to allow booster shots – a third dose of Pfizer – to people over 60. Germany followed suit this week, saying that from September it will allow a Pfizer recall for certain high-risk people, such as those who are older, live in nursing homes, or have weakened immune systems. . Germany will also offer boosters to people vaccinated with the AstraZeneca or J&J vaccine, which studies have shown are not as protective as mRNA vaccines.
The World Health Organization, however, said booster injections should be stopped until the end of September so that at least 10% of the population in each country can get vaccinated.
“Even though hundreds of millions of people are still waiting for their first dose, some rich countries are moving towards booster doses,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said on Wednesday.
Are boosters safe? Yes. There is not yet much data to quantify the exact benefit of the immune response from giving additional injections to vaccinated people, since clinical trials have tested for a two-dose (Pfizer and Moderna) or one-dose (J&J) regimen. ). But getting an extra dose shouldn’t hurt you, experts say. This is based on a lot of evidence from earlier widely used vaccines and what is known about how the immune system responds to vaccines.
Are boosters needed? There is a growing consensus that boosters will likely help the most vulnerable who have been vaccinated – those with weakened immune systems – to build additional protection against COVID, especially now that the highly contagious delta variant is spreading so quickly.
But it’s not clear exactly how beneficial they would be, and whether everyone will need them.
Studies show that antibody levels, which are one but not the only marker of immune response, decrease six months after vaccination; this is normal and does not necessarily mean that someone is no longer protected after six months. And studies of memory T cells and B cells – markers of the longer-term immune response – suggest that vaccines work well in the long term.
Who should be considered for a recall first? Experts say it is reasonable for people with the most weakened immune systems – such as solid organ transplant recipients, people with leukemia or on dialysis, and people undergoing chemotherapy – to receive first reminders. People who are immunocompromised may not have a sufficiently effective response to vaccines because the disease or drugs have weakened their immune system. However, it’s not clear that this group would respond better to a third stroke than the first two, said UC Berkeley infectious disease expert Dr John Swartzberg.
“The immunocompromised group, which is such a logical group, we don’t have strong data that they’ll respond better to a third stroke than the first two,” he said. “It may give people in this group false hope.”
Some also think it’s reasonable for recipients of J&J to consider boosters as well, as studies show this single-dose regimen is not as protective as the Pfizer and Moderna vaccines. This is what Germany will do for those who obtained the J&J and AstraZeneca pictures.
It is also reasonable that the first recipients of the vaccine – those who received it at the start of the deployment, in December or January – will start receiving boosters to learn more about the benefits of additional injections. These would be people who got Pfizer or Moderna, since those two vaccines were cleared in December and J&J was only cleared the last week of February.
“Those who received the original injections or both injections in January and December of last year, or who are immunocompromised – these are the subgroups to target now for a booster and learn from it,” said Stephen Shortell from UC Berkeley’s School of Public Health. “Give it to them, see what the reaction is, follow them over time.”
Some experts note that age on its own may not be the best measure of who needs a booster. A healthy 65-year-old, for example, may not need an additional injection, while a 25-year-old with multiple co-morbidities might.
Is it ethical to give boosters? Some experts say boosters are morally questionable in the context of global public health, even though they may benefit some people. This is especially true because all vaccines are very effective in preventing the most serious illnesses, hospitalizations and death. Thus, those who have been vaccinated are mostly already protected against the worst consequences, while those who are not vaccinated remain extremely vulnerable. The pandemic can only end after nearly everyone, not just people in certain regions or countries, is vaccinated.
“A good argument could be made for selective people in our society to get a recall,” Swartzberg said. “The 2.7% of the population who are immunocompromised, you can argue for that group. You could make an argument for healthcare workers and others at very high risk. But you can also make an argument against these. An argument against that: people who get vaccinated don’t die … So the big question is how can you give it a third shot here when most of the world doesn’t even have it? And it’s in our long-term interests to vaccinate the world.
Chronicle editors Erin Allday, Nanette Asimov, and Aidin Vaziri contributed to this report.
Catherine Ho is a writer for the San Francisco Chronicle. Email: [email protected] Twitter: @Cat_Ho
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