Bay Area preparing for booster shot rollout

By Lisa M. Krieger

lkrieger@bayareanewsgroup.com

Bay Area hospitals, elder care facilities and pharmacies are preparing to offer COVID-19 booster shots later this month, once federal authorities give full approval. The exact date of the long-anticipated rollout remains uncertain — the Biden administration had originally set the week of Sept. 20 for the launch — but high-risk Americans are likely to be offered the Pfizer shot within the next two weeks. The U.S. Food and Drug Administration will vote on the shots next Friday. The Centers for Disease Control and Prevention has not yet set a date.

The wait shouldn’t cause worry for most of us. While our immunity has waned in recent months, it hasn’t dropped precipitously — and vaccines we’ve received are still highly protective against severe illness and death.

“I told my own parents: ‘It’s not worth making your blood pressure go up,’” said Dr. Jennifer Tong, associate chief medical officer at Santa Clara Valley Medical Center. “There’s no need to wait in line for a day. There’s time. Take a deep breath. We will eventually be able to get to everyone.”

It is not yet known who will be first in line, but experts assume that federal officials will follow the priority list used in the first two doses, with health care workers and high-risk people over the age of 75 going first. Because Pfizer was authorized first, these groups were Pfizer recip-

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ients - and will get Pfizer boosters.

Bay Area hospitals - ranging from Stanford, Santa Clara Valley Medical Center, O'Connor Hospital, St. Louise Regional Hospital and El Camino - say they are prepared to offer a third dose of the COVID-19 vaccine to health care workers as soon as federal authorities give the green light.

Skilled nursing facilities also are ready to quickly begin inoculations of residents and staff, said Los Altos geriatric specialist Dr. Mehrdad Ayati. They are unlikely to distinguish between people who got Pfizer or Moderna; rather, everyone will get Pfizer.

"All the nursing homes are enrolling in booster vaccine programs. The pharmacies have already started to have this conversation," Ayati said.

Independent living communities for elders, such as Cupertino's The Forum at Rancho San Antonio, is working with CVS to set up an on-site clinic tentatively scheduled in the final days of the month.

For the general public, when will your time come? Check your vaccine card. Depending on the timeline set by federal officials it could be six months or eight months from your last shot.

Because the booster rollout will follow the original procedure, it isn't necessary to wait for your priority group to be called, said Tong. Rather, health officials will look to the date on your card to make sure you are eligible.

Counties are adding new vaccination sites, but there are no plans to launch large stadium venues. Distribution is more dispersed, and supplies are more plentiful, than during the initial rollout.

"Right now, every organization like Kaiser, UCSF, Sutter, Dignity - will be vaccinating patients and employees on their own," said Desi Kotis, UCSF Health chief pharmacy executive. "The supply chain is so much more robust than it was." Side effects will likely be similar to those experienced after the second dose, based on studies from Israel, which is about 1.5 months ahead of the U.S. in its vaccination program.

People who got the Moderna vaccine will be asked to wait their turn - but they seem to be better protected, for now, with lower infection rates and higher antibody levels. The level of antibody that's induced with Moderna is about 2.5 times higher than the amount by Pfizer.

Why? We're not sure. It might be the higher dose - the Moderna vaccine has three times the dose of Pfizer. It could be that the longer duration between shots was helpful - initial Moderna shots were four weeks apart, versus three weeks for Pfizer.

But it's likely that immunity will also wane for Moderna recipients, although it is delayed, Dr. Anthony S. Fauci, the nation's top infectious disease doctor, said in an interview last week with Andy Slavitt, President Joe Biden's former senior adviser on COVID-19.

Recipients of the single-dose Johnson & Johnson vaccine, whose studies of second doses have not yet been announced, should consider getting a Pfizer booster, especially if they're over 60, said UCSF infectious disease expert Dr. Peter Chin-Hong. "There are 'mixing and matching' studies, and it was safe and effective." Two doses were supposed to do the trick. Why do we need three?

Our immune systems do a "cost-benefit analysis," according to Shane Crotty of the Vaccine Discovery Division at La Jolla Institute for Immunology. It takes a lot of energy to make antibodies that will last a decade or more. Three doses of a vaccine generate a much longerlasting immune memory than just two doses.

This third shot is going to become part of the official COVID-19 vaccine regimen, such as it is for tetanus and hepatitis B protection, Fauci said.

"It isn't a question of a vaccine regimen that failed," he said. "The proper regimen needs a boost - and we didn't have a chance to determine that early on because it was such an emergency situation. We had to get vaccines out to people." In Israel, studies show that the booster multiplied by tenfold protection against infection and severe disease.

Waning immunity has been a growing concern; the problem isn't just the highly contagious delta variant. A six-month drop in protection against infection - from 90% to 50% - could portend a drop against protection from hospitalization, according to Crotty.

"So there's a 'better safe than sorry' approach - if you get a booster now and reset that clock, you don't run into that trouble," he said.

There's another reason: It's lousy to get sick with a "breakthrough" infection, even if it is less worrisome than an infection in the unvaccinated. You may not be hospitalized with COVID-19, but it's unpleasant to run a fever, get congested and spend time in bed. And you risk transmitting it to others, Crotty said.

Isn't it better to wait for a redesigned vaccine that is specific against delta? No, say experts. There are two reasons. One: With such high levels of the delta variant circulating in the U.S. population, it's dangerous to sit it out until completion of a new vaccine's clinical trials and authorization. Secondly, our existing vaccines get the job done. They create a powerful immune response that successfully fends off delta.

"The data is very, very clear that you need a booster," Fauci said, "and that the boosters really work." Contact Lisa M. Krieger at 408-859-5306.