Booster shots are coming. Here’s what that means for Virginia.

The White House and federal health officials announced yesterday that COVID-19 boosters will likely become available to U.S. adults by Sept. 20, following a review by the U.S. Food and Drug Administration. 

In Virginia, officials have already begun planning the logistics of the rollout, state vaccine coordinator Dr. Danny Avula said at a news briefing on Thursday. More than 4.7 million Virginians — just over 55 percent of the total population— are currently fully vaccinated. Most will become eligible for their third shots over the next eight months, boosting lagging demand across the state.

Here’s everything we know so far about the next stage of the Virginia’s vaccination campaign.

Why do I need a booster?

The U.S. Centers for Disease Control and Prevention based its recommendation on emerging evidence from several national studies and data from other countries, including Israel, which is grappling with a new surge of infections despite a highly successful vaccination campaign.

There are several main takeaways from the research, Avula said. One is that the protection of available vaccines against infection — or the presence of SARS-CoV-2, the virus that causes COVID-19, in the body — appears to wane over time. Another is that vaccines appear to be somewhat less protective against the Delta variant, a highly infectious form of the virus that now accounts for the vast majority of new cases across the country.

Understanding that immunity appears to wane over time, the federal government is anticipating that third shots will be needed to boost the immune system’s defenses against COVID-19. “Basically, it’s a reminder that the immune system needs to remain vigilant for this,” said Dr. John McCarty, medical director of the Cellular Immunotherapies and Transplant Program at VCU Massey Cancer Center.

Importantly, though, the recommendation shouldn’t be interpreted as a sign that the shots aren’t working. Even with waning immunity and the rise of more aggressive variants, studies show that COVID-19 vaccines are still highly protective against severe disease and death. Most so-called “breakthrough” infections, or cases among the fully vaccinated, are asymptomatic or mild — another clear signal that inoculations are doing their job.

Waning immunity is also a well-known part of vaccine science, McCarty pointed out. The flu vaccine is reformulated and distributed every year to protect against new strains of the virus. As some people get older, they lose their natural resistance to chicken pox, which is why older adults often face recurrent cases of shingles. And some COVID-19 vaccine manufacturers are now developing boosters specifically targeting the delta variant, though they likely won’t become available until at least next year.

“Sometimes, in the middle of the night, the watchman gets a little sleepy,” McCarty said. “This is like a nice little shot of espresso.”

Who will be eligible for a third shot?

Currently, the recommendations only apply to people 18 and older who have already received two doses of the Pfizer or Moderna vaccine. Right now, the CDC doesn’t have enough data to recommend a booster shot for the Johnson & Johnson vaccine, which was authorized for use later into the rollout. 

Avula said federal officials hope to have enough data compiled by Sept. 20 to issue a recommendation on boosters for Johnson & Johnson recipients. Health officials are also still examining if children will need an additional dose.

While healthy adults become eligible for the shots next month, third doses are already available — and recommended — for certain immunocompromised people. Those include many cancer patients, organ and stem cell transplant recipients, and patients with advanced or untreated HIV, or other conditions that can cause immunodeficiency.

The recommendations for immunocompromised patients are also limited to those who received the Pfizer or Moderna vaccines. For those patients, two shots may not have been enough to build up a sufficient immune response against the virus.

When should I get my booster?

For healthy adults, eight months after receiving your second dose of the Pfizer or Moderna vaccine. Since the original rollout was staggered — a function of limited supply — Avula said most boosters will gradually be administered through the end of the year. The biggest rush is expected the week of Dec. 26, when about 320,000 Virginians will become eligible.

Of course, the initial rollout was flush with residents flocking to far-away clinics or scouring Facebook to find appointments before shots became available in their own local health districts. “I do think there will be a rush of people who are ready, they’re waiting, they’ll try to get vaccinated as soon as they’re eligible or maybe even before,” Avula said.

Some local health districts are already reporting similar experiences. “Our pharmacies and community providers are already being overwhelmed with calls from people wanting a third dose,” Dr. Noelle Bissell, director of the New River Valley Health District, wrote Monday in her weekly health update. 

But Avula emphasized there’s much less urgency over booster shots for fully vaccinated Virginians, who are still well-protected against serious disease — especially if they follow indoor masking and social distancing recommendations from the CDC. The state is currently operating on an honor system when it comes to administering third doses to immunocompromised individuals, who aren’t required to provide proof. But it’s likely at least some providers won’t be willing to provide early booster shots to patients they know aren’t eligible. 

Where will I get my third shot? Can I mix and match?

State officials are still mapping out plans for administering booster shots once they become widely available next month. But Virginia is in a far different place than it was for much of the winter, when supply was scarce and shots were rarely available outside hospitals or local health departments.

“The pharmacy footprint is just massive,” Avula said. “And when you look at the distribution of vaccines overall in the state, pharmacies have done the most.” Over the last few months, more and more physicians and other private providers have also begun offering the shots, and Avula said it’s likely boosters will be available through those settings.

State officials are still coordinating with local health districts to monitor their capacity and determine whether they’ll need to hire contract workers to help boost availability. But at least right now, Avula said he’s not worried about vaccine supply. Virginia currently has more than a million doses on hand, spread among different providers, and has the ability to pull down another 2.5 million shots from the federal government.

“Looking at the runway over the next few months, that’s more than enough to meet that demand,” he said.

As for mixing and matching, the CDC currently recommends that patients are given the same vaccine they received for their first two doses. But if that brand isn’t available, Avula said there’s wiggle room to receive another mRNA vaccine — a booster of Pfizer after two Moderna shots, for example. 

There aren’t currently recommendations for using Johnson & Johnson as a booster after an mRNA vaccine. Avula said there’s also no recommendations for patients immunized in other countries with vaccines that haven’t been authorized by the FDA. 

Will booster shots reduce the transmissibility of the Delta variant?

Booster shots are being recommended for individual protection, but right now, health officials aren’t sure whether a third dose might help prevent the transmission of the virus. That’s been a major focus amid recent studies indicating that vaccinated individuals can carry the same viral load of the Delta variant as those who are unvaccinated. Health officials still believe vaccinated people are overall less likely to transmit the virus because they are less likely to contract it. 

At Wednesday’s White House press briefing, chief medical adviser Dr. Anthony Fauci said it was “entirely conceivable” that boosting the immune system’s response through a third dose could lower the viral load in vaccinated patients. 

“I certainly hope that’s the case,” he said. “If it is, you could really get multiple benefits from doing this. You could get benefits for severity of disease and then ultimately for infection and transmission.”

The most important tool in fighting the spread of COVID-19, though, remains immunizing as many people as possible with their primary vaccine series. Right now, nearly 34 percent of adult Virginians still haven’t received their initial shots. That leaves them far, far more likely to catch and spread the virus. 

High numbers of unvaccinated people also mean the disease can continue to spread and evolve, potentially developing into even more dangerous variants.

“We won’t have that concern if basically there’s no place for the virus to go,” McCarty said. “This is like an arms race. We’ve got our virus on one hand and we’ve got our tools on the other hand. We are trying to get ahead of the curve.”