COVID-19 vaccine boosters are coming, but pandemic experts remain focused on unvaccinated

With the federal government poised to announce who can get the COVID-19 vaccine booster later this week, local and national health officials worry that it will divert the focus away from the larger threat: the unvaccinated.

“First and foremost we have to get the unvaccinated vaccinated to extent that we are able to get people to take the vaccine,” said Sonoma County Health Officer Dr. Sundari Mase.

She added that it’s unclear at this point what the federal Food and Drug Administration or the Centers for Disease Control and Prevention will decide on third doses.

What is known, she said, is that third doses do help those who are immunocompromised, more than 50% of whom fail to achieve immunity after their second dose.

Observational studies, she added, have shown some waning immunity in the general population, though COVID-19 vaccines are still more effective than others, like the flu vaccine.

Mase said whatever the federal agencies decide on in terms of eligibility, there’s not likely to be the same level of “urgency” surrounding COVID-19 booster shots as was seen during the initial vaccination effort last winter.

“They may say elderly first, they might do that, I don’t know,” Mase said. “This wouldn’t be an urgent, urgent thing like the initial two doses were.”

Mase’s comments are in line with a leading group of U.S. and international scientists who appeared to put the brakes on the idea that everyone needs to get a booster as soon as they are eligible.

The group, which includes FDA scientists Dr. Philip Krause and Dr. Marion Gruber, published their review of current vaccine research in the journal The Lancet and said there is little concrete evidence that supports giving boosters to the general population.

They said vaccine resources should be focused on those who are not yet vaccinated.

“The limited supply of these vaccines will save the most lives if made available to people who are at appreciable risk of serious disease and have not yet received any vaccine,” the review states. “Even if some gain can ultimately be obtained from boosting, it will not outweigh the benefits of providing initial protection to the unvaccinated.”

Dr. John Swartzberg, a UC Berkeley infectious disease expert, said the arguments in The Lancet were “sound.” Swartzberg cautioned that existing research on waning immunity in those who have been vaccinated is “observational” and not the results of randomized control studies, the gold standard for such research.

Swartzberg said that while extremely rare, there could be serious side effects from a third dose that may not be needed for most people. “They go on to say that if the data isn't as sound as we'd like, then from a public health standpoint — when you’re talking about using a lot of resources to accomplish this … is it safe and it is the best use of the resources in terms of safety,” he said.

On Aug. 18, President Joe Biden announced that he expected coronavirus booster shots to be available nationwide starting on Sept. 20. The announcement set off a wave of expectations, with many wondering when their turn would come up.

The FDA is scheduled to hold a virtual meeting of an advisory committee to discuss in general third doses of COVID-19 vaccines, and specifically to consider the use of the Pfizer-BioNTech vaccine for a booster shot in people 16 and older.

In Sonoma County, 326,623 residents 12 and holder have been fully vaccinated. That’s 75% of the vaccine-eligible population.

Mase said she expects primary health care providers to lead the charge around the administration of booster shots. The county, she said, will continue to focus its efforts around vaccinating the unvaccinated. That includes doing pop-up vaccination clinics where needed.

Swartzberg said Monday he believes it’s unlikely the FDA would greenlight boosters for everyone, as suggested by the president less than a month ago.

“I don’t think there’s going to be enough solid science to support giving a third jab to everyone a week from today,” he said. “But I wouldn’t be surprised if certain groups are selected.”

Dr. Jason Cunningham, the CEO of the West County Health Centers, said his organization’s clinics are getting multiple calls daily from patients asking when they can get a boosters. He said at this point, third doses have only been approved by the FDA for those who have compromised immune systems. These are not boosters, he said.

“It’s a very hot topic for most people, particularly those who were first vaccinated, who are 65, 75,” Cunningham said, adding that older patients are seeing stories in the media that suggest one’s protection again hospitalization and severe illness wanes over time.

“At this point we are saying that we are waiting for guidance from the federal government and that it has to be FDA approved,” Cunningham said. “Right now there’s nothing that’s FDA approved for a booster.”

Mase said local residents who have been vaccinated should try to be patient and wait to see what the FDA and CDC recommends later this week.

“Lets keep our focus on getting people vaccinated who are unvaccinated,” she said. “For those who recently got their vaccine, they’re not going to be up for boosters for at least six months, probably more like eight months. You’ve got pretty good immunity, just with the first two shots or the one shot of J&J. So don’t worry too much. It’s not an urgency to get the booster.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.