A Message from Dr. Rick Larew

Wanted: A COVID-19 Booster Vaccine!

I have received several recent inquiries regarding the possibility of a COVID-19 vaccine booster. People are asking: Can I get a booster? Should I get a booster? Who was just approved for another dose? I share the latest information below.

First, some background to help put this in context. Operation Warp Speed led to the development of two novel mRNA vaccines (Pfizer and Moderna), one adenovirus vaccine (Johnson and Johnson) and others not available in the USA at this time. The mRNA vaccines produced remarkable results with protection against COVID in the 94-95% range. The J&J vaccine was in the 70% range, which is similar to what we see for annual flu shots. Over time, it was expected that the protective benefits of the vaccine would decrease as they do for all vaccines. Indeed, a Mayo clinic study shows that in July 2021 Moderna protection had decreased to 76% and Pfizer had dropped to 42%. However, both remained highly effective at protecting against severe illness that can result in hospitalizations, placement in Intensive Care Units or death.

Those who are immunocompromised – including people being actively treated for cancers or who have received an organ transplant and are taking medicine to suppress their immune system – do not get the same robust response to the vaccine. After receiving their series of Pfizer or Moderna vaccines, they are protected in the range of 59% compared to the 94-95% range for the population at large. Studies have shown that a third dose can increase the number of antibodies and offer additional protection against the COVID virus.

On August 13th, the CDC accepted the FDA’s recommendation to offer a third dose of the vaccine to these subgroups of people, under Emergency Use Authorization (EUA) – the same authorization currently used for the initial series of Moderna and Pfizer vaccines. Please note that this is a very narrow and carefully defined group of people, estimated to represent less than 3% of the population. This does not include those with chronic medical conditions who might be considered ‘immunocompromised,’ such as diabetics; nor does it include those taking immunosuppressive drugs for chronic medical conditions such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease, to name a few.

This seems like a reasonable thing to do for the immunocompromised. The obvious question is: what about another dose, a ‘booster’ for everyone else who wants one? Of course, not everyone wants one because quite a few people didn’t want the first one. Overall, the first-dose daily total population vaccination numbers (7-day rolling average) peaked on 4/11/21, with 2 million people getting their 1st dose per day. The nadir was 7/7/21, when just 218,000 people daily were getting their first dose; on 8/11/21 it was up to 447,000.

So why not offer a booster to anyone who wants one? I cannot come up with a single argument against it. There would not appear to be safety issues because it will be offered to people who are not in robust health. All indications point to the need to give additional protection to people as we try to come to terms with the delta variant. The initial COVID-19 vaccine series are currently available in the US to anyone who wants it.

Unfortunately, I do not believe that I can offer them at my office until approved by the FDA, CDC, Iowa Health Department, and Johnson County Health Department. It’s not entirely clear why it appears to be taking longer to approve a booster shot than it did to approve the original vaccine. Perhaps the FDA and CDC are trying to determine the optimal interval of time between the original vaccine and the booster dose; or if the booster must be the same as the original vaccine.

Here’s where we are today: we have the Moderna vaccine in our office, and the appropriate freezer for storing it, provided to us with a contract to follow the rules for dispensing and administering the vaccine. If I were to start my own program of administering the vaccine booster without the appropriate consent and approval, the Johnson County Health Department might simply show up and take it away. Even if that didn’t happen, you can be sure that Larew Internal Medicine would not be provided with any supply of booster vaccines in the future. I am certain booster vaccines will ultimately be approved, and I want to be able to offer these to patients when that happens. So we will wait, and hope that we can all get our booster doses sooner rather than later.

What is clear is that the vaccine has been a game changer. I’ve believed this would be true since the pandemic began, and it has been borne out by our experience. Masks and hand sanitizer help in the day-to-day battles to decrease the numbers of new COVID infections. I do not want to diminish their importance. But the vaccines help us win the war. Now we need some reinforcements.

Stay tuned… we will keep you informed with the latest information on booster vaccines as soon as it’s available.

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