The U.S. Food and Drug Administration has expanded its emergency use of Pfizer-BioNTech and Moderna’s COVID-19 vaccines to authorize a booster shot for certain immunocompromised patients including those with HIV, cancer, organ transplants, and those taking immunosuppressant drug.
This group amounts to close to 3 percent of the U.S. population and is a step in the right direction based on a growing body of evidence that at least some of the immune protection garnered from these vaccines begin to wane after six months.
The FDA authorized a COVID-19 booster shot for certain immunocompromised patients after evidence indicated a weak immune response following the initial two-dose series.
This move is a big step in the right direction especially given the increasing number of vaccine breakthrough infections from the delta variant, unfortunately it doesn’t go far enough.
As a practicing internist I will likely have discretion in interpreting the new FDA rules to apply to my patients, but as with Israel, I would like to have the option to be able to provide boosters for all my patients over 50, as well as those who are obese, have diabetes, heart and lung disease, and are semi-immunocompromised from chronic illness.
Israel on Friday lowered to 50 from 60 the minimum age of eligibility for a COVID-19 vaccine booster shot and will also offer them to health workers, hoping to stem a surge in Delta variant infections.
And what about health care workers? Those of us on the front lines, seeing patients every day, are at higher risk of COVID breakthrough infections as well as unwittingly spreading COVID in part because we were among the first who were vaccinated last winter, and therefore among the first whose vaccines are likely becoming less effective. Israel is now offering boosters to health care workers as well.
I think we should follow Israel’s example and offer boosters to these groups as soon as possible. We should target all with chronic illness, health care and front line workers including teachers, police, firefighters.
There is no science yet to confirm that if you wait too long to boost a fading immunity from the COVID vaccine you will have to start all over with a vaccine series, but this is true with many of our regular vaccines including hepatitis, shingles, and HPV.
So now is the time.
And what about the Johnson and Johnson shot? Studies of a two shot regimen (similar to the Oxford/Astra Zeneca vaccine) are ongoing, but not yet complete.
Here again, I believe that an additional shot will prove quite useful in cementing a durable immunity against a wildly changing terrain, with more easily transmissible variants emerging (delta, etc.) which are at least somewhat resistant to the vaccine.
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Across the country, many patients who feel they are at risk are probably going to pharmacies and receiving a third shot by simply not acknowledging that they had a previous one.
There is no uniformity from state to state in terms of these records. I certainly do not recommend this, and no doctor should.
What I can do, as I wait for all the data to roll in and for an MRNA booster to become widely accessible, is to check what is known as a spike antibody protein on all my patients who have received the vaccine.
This test is quite variable from lab to lab and it is NOT a direct indicator of immunity, since it includes many antibodies that are not neutralizing the virus, but recent studies on neutralizing antibody itself against the SARS COV 2 virus have shown that it is a good indicator of overall immunity against this virus.
So I and many others use the spike antibody test as an informal guide – if your value is low it is an indicator that your immunity may not be sufficient, if it is high, it is reassuring.
Of course even if your number is low, I still don’t have a formal way to remedy that with a quick booster.
I join other doctors and patients across the country hoping this reality changes soon.