COVID Booster Q&A


The FDA and CDC recently authorized Covid vaccine boosters. The following is an attempt to clarify who is eligible for boosters and explain how you can get your dose in Calvert County. The goals and rationale of the CDC are followed, but there are a few differences between CDC guidance and our local protocol. These differences simplify the process and improve access to booster doses against a disease that took the lives of 5 Calvert residents last week. Since the beginning of the pandemic, 84 of the 86 Calvert residents who have died from Covid were unvaccinated. We cannot emphasize strongly enough how important it is for every eligible person to get vaccinated against this disease. More recent studies have shown a gradual decline in protection from the original vaccination series. Booster doses have improved protection back to the original levels of nearly 95%. Those eligible for booster doses should consider taking advantage of the additional protection for themselves and vulnerable people close to them. In order to receive a Covid booster through the Calvert Health Department, individuals must meet the following criteria: 1) The initial vaccinations received were either Pfizer or Moderna. *For those who received Johnson & Johnson (J&J), please see below. 2) At least 4 months have passed since receiving your second vaccine dose 3) All members of the general public age 50 or older are eligible for booster doses 4) Anyone 16 and older who works in a prioritized job classification is eligible, including Nursing home and assisted living staff Healthcare workers First responders People who work or live in congregate residential facilities such as ARC housing, the Domestic Violence Shelter, Substance Use Treatment facilities, or the County Detention Center Public transit and school bus drivers Teachers/classroom staff and daycare staff. Boosters are especially recommended for those who work with children unable to wear face coverings due to developmental reasons. *People under 50 years-old who qualify as a result of their job will need to bring your work ID or a note from your employer to show that your job qualifies you for a booster dose. Those in the groups below must have a note from their personal physician or nurse practitioner recommending a booster dose. This includes: 1) J&J recipients. Please understand that supplies of J&J vaccines are very limited. You should talk to your healthcare provider about the possibility of receiving a Pfizer or Moderna booster if Johnson & Johnson vaccines are not available. 2) People under age 50 with chronic health conditions that place them at high-risk of Covid complications. 3) People under age 50 who live with severely immunocompromised household members. To emphasize: The Health Department will not give boosters to those who had their second dose (or single dose of J&J) less than 4 months ago. Vaccine boosters can be obtained through many primary care providers and pharmacies. You can also schedule an appointment to be vaccinated by Calvert County Health Department nurses using the following link. Once you click on the link, scroll down the page to find the date and brand of vaccine that is best for you: https://www.calvertcountycovid19.com/vaccination If you choose to get your booster through the Health Department, you must bring proof of your previous vaccinations. You can bring your CDC Vaccination Card or download a record of your vaccinations to your smartphone or home computer via the secure Maryland database: https://md.myir.net/rorl?next=/ The following will hopefully address questions you may have about booster doses: Please explain why booster doses are important and why the Health Department is offering them to everyone 50 and older who received their second dose at least 4 months ago. Since the delta variant appeared in Southern Maryland in mid-July, an increasing number of breakthrough infections, and in some cases, hospitalizations, have occurred. Although fully vaccinated people (2 doses of Pfizer or Moderna or 1 dose of Johnson & Johnson) remain 10-times less likely to become severely ill from Covid than those who remain unvaccinated, over 20 fully vaccinated Calvert residents have required hospitalization since early August. The best available studies are currently from Israel. The data show that a booster dose eliminates almost all breakthrough hospitalizations with 7-10 days of inoculation. (https://www.nejm.org/doi/pdf/10.1056/NEJMoa2114255?articleTools=true) Boosters also dramatically reduce milder infections that can result in long-term health problems or lead to spread within households. The science behind Covid boosters is complex. The recent explanation posted on our Covid-19 website provides a detailed explanation about the reasoning behind boosters and the protection they offer. You can find the post at: https://www.calvertcountycovid19.com/post/booster-vaccinations-in-calvert The CDC guidance recommends that people 50-64 should have underlying health conditions to qualify for a booster. Why does the local protocol allow everyone in this age group to get a booster? The CDC’s definition of high-risk health conditions includes well over 80% of people in this age range. It is unnecessarily confusing to put limitations on access when so many people qualify for vaccination. For example, everyone who is overweight or obese (BMI >25), everyone with high blood pressure or diabetes, every current or former smoker, everyone who is African American, Hispanic, or Native American, everyone with cancer, and everyone with dozens of other chronic health conditions qualify for boosters. For anyone interested, the CDC’s list of qualifying conditions can be found here, but again, anyone 50 or older is eligible for a booster through our Health Department: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html The FDA and CDC guidance for boosters is limited to those who previously received Pfizer vaccines. Why does the local protocol allow those vaccinated with Moderna to receive a booster? Pfizer submitted its booster data several weeks ago, and Moderna is still finalizing its study. The FDA is only allowed to act on medications and vaccines after the manufacturer submits their final study data. As a result, they cannot formally approve Moderna boosters at this time. Since the clinical trials for Pfizer and Moderna began in July 2020 and the Emergency Use Authorizations were approved by the FDA in December, over 200,000,000 Americans have received these vaccines. Study after study have shown the effectiveness and safety of these two vaccines mirror each other. There is every reason to expect the effectiveness and safety of Moderna boosters will be comparable to Pfizer.

Given the significant increase in breakthrough infection since the arrival of the delta variant, including an average of 4 hospitalizations each week among our vaccinated county residents, delay in access to boosters leaves Moderna recipients at unnecessary risk. Most people did not have a choice of which vaccine brand they would receive, and no one could have foreseen that getting Moderna would later leave them at increased risk of breakthrough infections due to federal regulatory restrictions. Healthcare providers have a professional duty to protect. Denying people access to booster protection under these circumstances could arguably be seen as unethical.

This decision, as with other components of our local booster protocol, was part of a consensus agreement among physicians representing all of the primary care practices in Calvert. Anyone who received Moderna and wants to wait for FDA/CDC guidance has that option. But for those who want to move ahead with a booster, the cumulative evidence of the last 14 months supports this decision. Why do people under 50 need a note from their personal healthcare provider in order to receive a booster? The CDC Advisory panel was clear that people under 50 who have already received the standard Covid vaccination series are at considerably lower risk of severe illness than those over 50. However, there are people with specific health problems that are at substantial risk. The CDC panel recommended that such people should have a conversation with their personal healthcare provider to see if a booster is in their best interest. Our local physicians also determined that this is the best course of action. In addition to discussing booster doses, such conversations with your healthcare provider give you an opportunity to optimize control of your underlying health conditions so you’re less susceptible harms from other infections, including influenza.

If your doctor or nurse practitioner provides Covid vaccinations, you should be able to get your booster there. If not, you only need a brief note from your provider stating that she/he recommends you receive a booster, and the Health Department will provide the vaccination. What if I am not at personal risk of severe illness, but someone in my household is at very high-risk? If you live with a person who is severely immunocompromised, for example someone currently receiving chemotherapy, it is very important that you don’t inadvertently pick up the virus. Even when a severely immunocompromised person is vaccinated, their protection is unpredictable and their potential for severe illness if they do become infected is much greater than for the average person. Once a person brings Covid into a household, the delta variant spreads very quickly. If it’s been at least 4 months since you completed your vaccination series, a booster will further decrease the potential that you will end up catching even a mild case of the virus. The Israeli studies show that a booster makes someone 11-times less likely to become infected if it’s been 5 or more months since their initial vaccination. Will I need to get a booster every 6 months? That is unlikely, but a definitive answer cannot be given. Many established vaccines require a booster close to 6 months after the first dose is administered. Examples include vaccines to prevent hepatitis, HPV, and polio. In general, once the 6-month booster is given, much longer lasting protection is provided than the protection obtained from the very early dose(s). The potential for future boosters is more likely to be the result new variants emerging than as a result of the current booster wearing off over the next 6-12 months. Can I get a flu vaccine at the same time as my Covid vaccine? Yes. You can safely receive a flu vaccine at the same time as either an initial Covid vaccination or a booster. For those who wish to separate the two vaccinations, that is not a problem. It’s mostly a matter of personal preference. Influenza vaccines are optimally administered in September or October.

If Covid continues to mutate in ways that periodically reduce vaccine effectiveness, it’s possible that a combined Influenza-Covid vaccine could be produced each year. For the moment, flu vaccines remain a separate inoculation from Covid.

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