COVID boosters in PA: What we know about plans to distribute additional shots

COVID-19 booster shots are on the way for certain portions of the population in Pennsylvania, and more are expected to roll out this fall.

The CDC on Thursday recommended older adults and those at high risk from the disease should get a third shot of the vaccine, paving the way for millions of extra doses to be doled out in coming months.

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Pennsylvania Department of Health officials said this week they are ready and able to begin distributing the doses.

What’s a booster?

First, it helps to understand the difference between third, or “additional,” doses, and boosters.

Pennsylvania Physician General Dr. Denise A. Johnson noted during a recent press conference that “third doses” are meant for the immunocompromised, “people who did not mount the full immune response like everyone else would have,” in order to increase their overall immunity.

This includes individuals receiving active treatment for tumors or cancers of the blood, people who are taking immunosuppressants following organ or stem cell transplants, anyone receiving active treatment with high-dose corticosteroids or other drugs that may affect their immune systems, and others.

Boosters, however, are different.

“The booster dose is for those who have initially mounted the appropriate response, but that immune response may be waning over time. I think we've seen it in the over 65 population that, although they mounted a good response in the beginning, that started to wane,” Johnson said.

Both Pfizer-BioNTech and Moderna’s COVID-19 vaccines were previously approved for third doses, and as of  Sept. 24, just over 1.2% of Pennsylvanians who were fully vaccinated with either version were given an additional dose, amounting to 75,146 out of 6,175,591 people.

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When should I get a booster shot?

Pfizer-BioNTech's COVID-19 vaccine is cleared for use as a single booster dose for those age 65 and older, individuals between 18 and 64 at high risk of severe COVID-19 cases, and individuals between 18 and 64 who are frequently exposed to the virus, thus putting them at higher risk for severe cases themselves.

The booster can be taken six months after the completion of the first series of doses, and consists of a single shot of the same vaccine used in those previous doses.

The CDC recommends waiting at least 28 days after completion of your initial two-dose vaccination before seeking the additional dose.

I don't fall in the approved categories. When can I get a booster?

Acting FDA Commissioner Dr. Janet Woodcock did not note if and when boosters would become available for the population at large, however, her commentary did leave the door open on the subject.

“This pandemic is dynamic and evolving, with new data about vaccine safety and effectiveness becoming available every day. As we learn more about the safety and effectiveness of COVID-19 vaccines, including the use of a booster dose, we will continue to evaluate the rapidly changing science and keep the public informed,” Woodcock said.

Director of the FDA’s Center for Biologics Evaluation and Research Dr. Peter Marks made similar remarks, noting that the organization “will continue to analyze data submitted to the FDA pertaining to the use of booster doses of COVID-19 vaccines and we will make further decisions as appropriate based on the data.”

What's the science behind the boosters?

The FDA appears to believe that the Pfizer-BioNTech booster will be especially helpful during the current wave of delta, protecting those who got their original vaccine doses earlier on from breakthrough cases — though breakthroughs remain rare.

On Sept. 1, Moderna announced that it had submitted data concerning their vaccine booster to the FDA, though a decision has yet to be made on the subject.

Chief Executive Officer of Moderna Stéphane Bancel noted that the company’s booster “shows robust antibody responses against the delta variant.” A release from Moderna stated the booster proved effective for all variants of concern.

“We remain committed to staying ahead of the virus and following the evolving epidemiology of SARS-CoV-2,” Bancel said. “We will continue to generate data and transparently share to support governments and regulators as they make evidence-based decisions regarding future vaccination strategies.”

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Johnson & Johnson announced on Sept. 21 that when a secondary shot of their single-dose vaccine was administered two months after the initial dose there was a four-fold increase in antibodies, and a 12-fold increase when the booster was given at six months.

Dr. Mathai Mammen, global head of Janssen Research & Development at Johnson & Johnson, said that the company’s phase 3 studies and real-world evidence concluded a single-dose of the vaccine “provides strong and long-lasting protection against COVID-19-related hospitalizations” and “further confirm protection against COVID-19-related death.”

Mammen added that when patients are given a booster, “the strength of protection against COVID-19 further increases.”

Should I get a COVID booster?

As previously noted, boosters will be limited to only particular groups of people for the time being. Experts advise that those who are unsure of whether or not they may need a booster vaccine should contact their primary care physician.

Over the course of the past few weeks, officials have debated whether or not the booster is even necessary.

President Joe Biden’s administration announced in August that they intended to approve boosters for those age 18 and older by the week of Sept. 20, though a recent report from the Centers for Disease Control and Prevention has shown that Moderna remains about 92% effective in preventing COVID-related hospitalization after nearly four months, while Pfizer-BioNTech drops to about 77% effectiveness. The Johnson & Johnson vaccine, however, dips to an average of 68% effectiveness after just four weeks.

On Sept. 17, an FDA panel voted 16-2 against recommending additional doses of the Pfizer vaccine for those age 16 and older. A follow-up vote authorizing another dose of the vaccine for people 65 and older or at high risk of severe COVID-19 passed unanimously.

While the agency is not bound to honor the advise of the panel, it often does adhere to its advice, as it has this time.

The World Health Organization has called for a moratorium on booster doses until the end of the year, with the exception of the immunocompromised, to maintain adequate vaccine supplies for low-income countries.

On Sept. 24, CDC Director Dr. Rochelle P. Walensky endorsed the CDC Advisory Committee on Immunization Practices’ recommendations regarding Pfizer-BioNTech booster shots for certain people, including those in high-risk occupational and institutional settings.

The CDC's recommendation notes that people age 65 and older, residents of long-term care facilities, and those age 50 to 64 with underlying medical conditions should receive a booster; people age 18 to 49 with underlying medical conditions may receive a booster based on individual analysis; and people age 18 to 64 who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional settings may receive a booster, again based on individual cases. In all cases, boosters should be administered six months after the initial vaccination series is completed.

Walensky noted that the CDC will address recommendations for Moderna and Johnson & Johnson boosters as soon "as soon as those data are available."

"While today’s action was an initial step related to booster shots, it will not distract from our most important focus of primary vaccination in the United States and around the world," Walensky said. "I want to thank ACIP for their thoughtful discussion and scientific deliberation on the current data which informed my recommendation."

An FDA advisory committee also stated that there was not enough data to support boosters for all just yet, though they have not dismissed the idea completely.

How do I get a COVID booster in Pennsylvania?

On Thursday, Department of Health Acting Secretary Alison Beam announced that her agency was signing off on an order to launch a booster initiative as soon as the federal government provided final approval for those shots.

To find a vaccine clinic offering additional doses, visit vaccines.gov.

The order directed providers to provide online scheduling for vaccination appointments along with a phone number where patients could also reach out to schedule an appointment during normal business hours, offer walk-in appointments where possible, and to work alongside Area Agencies on Aging and medical assistance-managed care organizations to help schedule appointments for eligible adults and others who cannot leave their homes.

Beam noted that the orders were not “new concepts,” but rather that they “mirror orders issued previously during the initial rollout of the vaccine.”

“Orders such as this and dedicated vaccine providers helped get us to the point where we are today,” Beam said. “While we cannot begin administering booster shots until we have formal approval for guidance from the CDC, we can assure you that first, we have the vaccine available in Pennsylvania, and second, providers are ready to start administering boosters as soon as we have the CDC guidance.”

Some vaccine providers have already jumped on board to provide boosters, including Geisinger, which announced Sept. 24 that individuals can schedule an appointment through their MyGeisinger patient portal, or by calling 570-284-3657.

Lehigh Valley Health Network will begin offering the booster as of Sept. 27. Patients can set up an appointment by visiting the MyLVHN patient portal, or by calling the network's COVID-19 hotline at 833-584-6283. The hotline is open from 8:30 a.m. to 5:30 p.m. Monday through Friday.

CVS Health stated on Sept. 24 that CVS Pharmacy and MinuteClinic locations, including 317 found in Pennsylvania, would begin providing boosters that very day. Eligible individuals can sign up for an appointment through the CVS website.