When Covid-19 vaccines first became available in Hawaii, Kailua resident Catrina Nesper sat by her computer and repeatedly clicked refresh until an available appointment opened up.

In September, when booster shots rolled out, the 57-year-old child care worker jumped at the chance again to get a third shot in part because she spends a lot of time with her grandchildren, ages 2 and 4, who aren’t eligible to be vaccinated.

“I like to have as many layers of protection for them as I can,” she said.

Nesper, who was eligible for the booster shot because of her profession, is among a select group of Hawaii residents officially permitted to get Covid booster shots under state and federal guidelines.

Federal regulators, meanwhile, are expected this week to approve booster shots of the Pfizer Covid vaccine for everyone aged 18 and up who got vaccinated at least six months ago, and are considering a similar approval for Moderna, according to The New York Times.

Highly Recommended

Anthony Fauci, White House chief medical adviser, said booster shots are important to protect against a possible winter surge, ABC News reported.

“I happen to believe as an immunologist and infectious disease person, that a third shot boost for an mRNA is likely — should be part of the actual standard regimen, where a booster isn’t a luxury; a booster isn’t an add on; and a booster is part of what the original regimen should be — so that when we look back on this, we’re going to see that boosters are essential for an optimal vaccine regimen,” Fauci was quoted as saying in an interview aired at the 2021 STAT Summit on Tuesday.

With the anticipated expansion of eligibility, experts say booster shots would help strengthen protection against infection as Covid continues to surge in many states as well as in Europe. The caseload has largely leveled out in Hawaii, but state officials still expect more outbreaks to occur as restrictions lessen, social gatherings increase and immunity wanes over time.

As of Wednesday, more than 72% of Hawaii’s entire population was fully vaccinated against Covid. That’s 85% of people aged 12 and up living in the state or 77% of people aged 5 and up.

Five to 11 year olds recently became eligible for the vaccine and while 11% of that age group has initiated the vaccine, not enough time has passed for them to be fully vaccinated. Boosters shots are not yet approved for anyone below the age of 17.

State data indicates 100% of people aged 50 and up have either initiated or completed their vaccine shots.

The state’s relatively high vaccination rate provides protection against the infectious virus, but researchers say that immunity could wane as months pass.

University of Hawaii virologist Sandra Chang says that booster shots are important for elderly and immunocompromised people because studies show that protection gained from vaccination tends to decrease after six months and they were among the first to get shots under the initial rollout. It’s also important for health care workers to get boosters to preserve the health care workforce, she said.

A Personal Decision

For everyone else, immunity is expected to wane over time, but people should still be protected against getting severely sick or dying from Covid. It’s still unclear whether boosters will be a one-time thing or become more frequently required. That may depend on how the vaccine reacts to new variants, Chang said.

Booster shots haven’t been approved long enough in Hawaii to know whether people who have received them have contracted breakthrough Covid cases. The state’s most recent analysis of breakthrough cases included data up to Sept. 30, and boosters were approved on Sept. 24.

One concern about expanding boosters in the U.S. is the fact that residents in so many other countries still lack access to the vaccine.

Chang said that’s a real issue, but it shouldn’t stop Hawaii residents from getting a booster.

“In reality, the vaccine that you have in your state, in your hospital today cannot be sent to other countries,” she said.

Thomas Lee, an epidemiologist at the University of Hawaii, said boosters can reduce the chances of getting infected from Covid but that the important goal is to get shots into arms of people who have so far refused them.

The Pfizer and Moderna vaccines require two doses administered within two to three weeks, depending on age.

Even without boosters, “vaccines are still highly effective with the two doses against hospitalization, severe infection and death,” he said. “The booster discussion is one that is ‘nice to have.’”

People who don’t have health problems and aren’t elderly should make personal decisions about whether to get booster shots, Lee said.

“It comes down to the individual’s situation, their risk tolerance, for themselves and for their family,” he said. 

Less than 10% of Hawaii residents have gotten a Covid booster shot thus far.

Easy To Get

So far, Hawaii has kept its official eligibility for the Pfizer and Moderna boosters to people who got their shots more than six months ago and are age 65 and up, have health issues or face a job or living situation that puts them at risk, in accordance with current federal recommendations.

Everyone who received the Johnson & Johnson vaccine — which requires just one shot — more than two months ago is already eligible for a booster shot.

“We have plenty of doses and a good supply of vaccines. You can get a booster shot at hundreds of locations across the state,” Hawaii Health Department director Libby Char said, describing the existing eligibility framework as “quite inclusive.”

Brooks Baehr, spokesman for the Health Department, said he got his booster shot at Safeway. There, he had to attest that he met the requirements, including being in an at-risk occupation.

He said the state isn’t recommending boosters to all adults but that if you are 18 and up and want a booster, you can get one.

“We have a sufficient supply,” he said. “We are not encouraging people from going outside the guidelines, but we are certainly not going to stop anyone who feels like they need it.”

Several states are going further than Hawaii in explicitly telling vaccine providers not to turn away any adults. The Washington Post reported that on Nov. 9, California became the first state to make booster shots available to all adults. Colorado, New Mexico, Arkansas, West Virginia and New York City followed.

The New York Times has reported that Kansas, Kentucky, Maine and Vermont expanded access for booster shots to all adults too.

Gov. David Ige doesn’t have any plans to officially expand access to booster shots but is tracking what the Centers for Disease Control and Prevention recommends, spokeswoman Jodi Leong said.

People traveling into Hawaii must have proof of vaccination or a negative Covid test to bypass an otherwise mandatory quarantine, but they aren’t required to have booster shots; Leong said the governor will base any decisions about requiring booster shots on CDC guidance.

In Hawaii, more than 138,000 third shots of the Covid vaccines have been administered. Not all of those are booster shots though, Baehr said. Third vaccine shots are sometimes recommended as part of the normal process for people who are immunocompromised.

Gary Chun, a retired journalist, got his booster shot recently in part to protect his 94-year-old mother whom he visits frequently.

The 66-year-old remembers getting the polio vaccine when he was six or seven years old in public school, when the vaccine was placed in a sugar cube so that he and other children would take it. He’s mystified by modern-day opposition to the shot.

“You’re doing this for the social good, not only for yourself but for other people,” he said.