Questions Surround Rollout of COVID-19 Booster Shots for General Population

The FDA recently authorized COVID-19 vaccine booster shots for immunocompromised individuals, who comprise about 3% of the US population.

The surging Delta variant and news of breakthrough infections have sparked considerable interest in COVID-19 booster shots. The FDA recently authorized third shots for immunocompromised individuals, who comprise about 3% of the US population.

Questions about when booster shots will be recommended for the general population are sure to intensify in the coming weeks, and the only answer pharmacists can give is: “Not yet.”

Israel has already begun offering booster shots to all fully vaccinated individuals 60 years of age and over, citing rising infections and signs that the vaccines’ efficacy is dwindling over time. Moderna announced last week that people who had 2 doses of its vaccine will begin needing boosters by the fall.

A recent non-peer reviewed study at New York University suggested that the 1 dose of the Johnson & Johnson (J&J) vaccine may not offer enough protection against the Delta variant. San Francisco recently announced it will offer booster shots to people who received a J&J vaccine and who have consulted with a physician.

But the CDC does not currently recommend boosters for most fully vaccinated individuals. This guidance applies to people who received both doses of either the Pfizer-BioNTech or Moderna vaccine or the single-dose J&J vaccine.

Although boosters are not yet indicated, it is likely that the CDC will recommend them in the not-so-distant future, given the fact that we are still battling the virus and there is now a surplus of supply in the United States. The rising cases of infection from the Delta variant may not allow time for studies to confirm the benefit of the third dose and the decision to implement booster shots might be rushed on this basis.

But for now, when someone requests a COVID-19 vaccine, we as pharmacists must determine whether the vaccination is appropriate for the individual—as we do whenever we vaccinate for the flu, shingles, pneumonia, etc. This includes asking patients whether they have had a COVID-19 shot already.

Although this information may be available in state and city databases, there have been data entry omissions, particularly for patients vaccinated in temporary pop-up clinics. You should follow good screening practices and question customers about whether they have been vaccinated before.

If patients have already been vaccinated but want a booster, you can educate them about the current guidance or you can also refer them to their physician. San Francisco has put the onus on physicians to decide whether a booster shot is appropriate, given their patients’ individual situation.

In addition to not knowing when booster shots will be recommended for the general population, we also do not know how they will be rolled out. We do not have the significant shortage of supply that we had in the first round, but this round is likely to be implemented in systematic phases that put front-line workers and the elderly next in line after the immunocompromised.

Another question that needs to be answered is whether individuals should receive the same brand of vaccine that they received the first time. Rather than mixing, say, Moderna and Pfizer, it is likely that staying with the same series will be recommended.

There have not been any studies to determine whether there are any benefits to changing between the series unless someone was suspected to be allergic to any of the components of vaccine after administration. Guidance on this matter will likely be announced when the boosters are recommended.

As more workplaces require that their employees be vaccinated, there may be increased demand for first-round COVID-19 vaccinations while booster shots are rolled out, putting heavy demand on pharmacies. Fortunately, pharmacies gained valuable experience from going through the first mad rush.

We know what to expect in terms of the level of manpower needed, including extra technicians and especially clerical staff to check customers in and out and process their paperwork. Pharmacists will benefit from having gone through this prior experience when boosters are finally approved and rolled out.

About the Author

Ferkhanda Najib, PharmD is a pharmacy manager for Community Care Rx, a full-service, long-term-care pharmacy with offices in Hempstead, N.Y. and Totowa, N.J.