COVID Booster Shots to Roll Out in September in the U.S., Health Officials Say

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A woman wearing purple gloves flicks a needle inserted upside-down into a vial.
Medical assistant Martha Velasquez from the Alameda Health System prepares a dose of a COVID-19 vaccine. (Beth LaBerge/KQED)

U.S. health officials Wednesday announced plans to offer COVID-19 booster shots to all Americans to shore up their protection amid the surging delta variant and signs that the vaccines' effectiveness is falling.

The plan, as outlined by the director of the Centers for Disease Control and Prevention and other top authorities, calls for an extra dose eight months after people get their second shot of the Pfizer or Moderna vaccine. The doses could begin the week of Sept. 20.

"Our plan is to protect the American people, to stay ahead of this virus," CDC Director Dr. Rochelle Walensky said.

People who received the single-dose Johnson & Johnson vaccine will also probably need extra shots, health officials said. But they said they are waiting for more data. The overall plan is subject to a Food and Drug Administration evaluation of the safety and effectiveness of a third dose and a review by a CDC advisory panel.

Officials said it is "very clear" that the vaccines' protection against infection wanes over time, and they noted that Israel has begun seeing a worsening of infections among vaccinated people. They said the U.S. needs to get out ahead of the problem before it takes a more lethal turn here and starts leading to hospitalizations and deaths among the vaccinated.

Dr. Anthony Fauci, the government's foremost expert on COVID-19, said that one of the key lessons of the virus is that it's better to "stay ahead of it than chasing after it."

Dr. Mark Mulligan of NYU Langone Health welcomed the announcement as a "proactive" response to signs that vaccine strength is eroding as the highly contagious delta variant spreads.

"Part of leadership is being able to see around the corner and make hard decisions without having all the data. It seems to me that's what they're doing here," he said.

Why is the U.S. recommending booster shots while other countries wait for vaccines?

Top scientists at the World Health Organization bitterly objected to the U.S. plan, noting that poor countries are not getting enough vaccine for their initial rounds of shots.

"We're planning to hand out extra life jackets to people who already have life jackets, while we're leaving other people to drown without a single life jacket," said Dr. Michael Ryan, the WHO's emergencies chief.

The organization's top scientist, Dr. Soumya Swaminathan, said: "We believe clearly that the data does not indicate that boosters are needed" for everyone. She warned that leaving billions of people in the developing world unvaccinated could foster the emergence of new variants and result in "even more dire situations."

U.S. Surgeon General Vivek Murthy rejected the notion that the U.S. must choose between "America and the world."

"We clearly see our responsibility to both, and we've got to do everything we can to protect people here at home while recognizing that tamping down the epidemic across the world is going to be key," Murthy said.

White House officials noted that the U.S. has donated 115 million doses to 80 countries, more than all other nations combined. They said the U.S. has enough vaccine to dispense boosters to the American people.

What does this mean in California and the Bay Area?

As yet, logistics are unclear — but this announcement of booster shots is a move many in the health community here have been anticipating for a while.

Dr. Tomás J. Aragón, California Department of Public Health director and state public health officer, said that CDPH "has been planning for and is ready to begin administering booster doses in California starting in late September, pending review and approval by our federal partners and the Western States Scientific Safety Review Workgroup."

"I think that this has been something we've been waiting for for some time," Dr. Bela T. Matyas, health officer and deputy director of Solano County Public Health said. "From the very beginning of the vaccination campaign, we were aware the boosters are going to be needed at some point. So at least now we're getting better clarity on the timing."

Matyas also said that the general thinking in the public health community is that the COVID vaccination "will probably become an annual vaccination," much like the flu shot.

As well as still administering first and second doses of the vaccine to residents, Bay Area counties are beginning to roll out third doses of the Pfizer and Moderna vaccines to immunocompromised people who qualify for a booster shot under the CDC's guidelines. Right now, these booster shots are limited to a relatively small group of people with specific conditions. Read more about getting a third dose of the vaccine today if you're immunocompromised.

The Bay Area might expect to see at least the partial return of the kind of mass COVID vaccination sites that were established earlier this year to handle the demand for first and second doses of the vaccine for the general population age 12 and over. The majority of these mass vaccination sites — such as the Oakland Coliseum and San Francisco's Moscone Center — were shuttered as demand waned, but a San Mateo County spokesperson said the county expects to "remobilize some mass vaccination capacity to offer timely, large-scale delivery to supplement what our health care partners expect to deliver."

As for the timing of any booster shot program, even if these vaccinations start Sept. 20,  the rollout for a booster dose could be staggered according to eligibility, rather than being opened up to everyone at the same time. San Francisco Department of Public Health officials said they're anticipating "a phased rollout similar to how the vaccine was initially distributed: prioritizing the most vulnerable, in collaboration with our health care and pharmacy partners."

San Mateo health officials also said they're "closely monitoring the federal deliberation that will lead to broader use of boosters for other populations, likely commencing with health care workers, residents of high-risk congregate care facilities and older adults." Dr. Matyas of Solano County Public Health echoes this as an ideal structure for those initial vaccination tiers, after which "then I believe we have the resources to be able to get out there and boost everybody."

How has the thinking on booster shots evolved?

Israel is already offering booster shots to people over 50 to control its delta surge. And European medical regulators said they are talking with vaccine developers about the idea.

Last week, U.S. health officials recommended boosters for some people with weakened immune systems, such as cancer patients and organ transplant recipients. Offering boosters to all Americans would be a major expansion of what is already the biggest vaccination campaign in U.S. history.

Some experts have expressed concern that calling for boosters would undermine the public health message — and reinforce opposition to the vaccine — by raising more doubts in the minds of people who have been skeptical about the shots' effectiveness.

Experts believe health officials will recommend that the booster be the same brand of vaccine that people received initially.

As for why the vaccines appear to be less effective against stopping infections over time, there are indications that the body's immune response to the shots fades, as it does with other inoculations. But also, the vaccines simply may not protect against the delta variant as well as they do against the original virus. Scientists are still trying to answer the question.


Why are booster shots needed in the U.S.?

The call for booster shots is a stark reminder that nearly 20 months into the outbreak, the U.S. is still unable to contain the virus that has killed 620,000 Americans and disrupted nearly every part of daily life.

Just weeks after President Joe Biden declared the country's "independence" from COVID-19 on July Fourth, emergency rooms in parts of the South and West are overloaded again, and cases are now averaging nearly 140,000 per day, quadrupling in just a month.

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In making its announcement on boosters, the CDC released three studies conducted during the delta surge that suggest that the COVID-19 vaccines remain highly effective at keeping Americans out of the hospital but that their ability to prevent infection is dropping markedly among nursing home residents and others.

One of the studies looked at reported infections in residents of nearly 15,000 nursing homes and other long-term care facilities. It found that the effectiveness of the Pfizer and Moderna vaccines against COVID-19 infection dropped from about 74% in March, April and early May to 53% in June and July.

The researchers said it was not clear how much of the decline is attributable to the delta variant and how much might be due to a more general weakening of immunity that could have occurred against any strain.

The study looked at all COVID-19 infections, with or without symptoms. The researchers said more work is needed to determine whether there was a higher incidence of infections that resulted in severe illness.

Another one of the studies looked at 21 hospitals. It found that the vaccine's effectiveness in preventing the need for COVID-19-associated hospitalization was 86% at two to 12 weeks after the second dose, and 85% at 13 to 24 weeks after.

The third study, conducted in New York state, found that protection against hospitalizations stayed steady at about 95% over the nearly three months examined. But vaccine effectiveness against new laboratory-confirmed infections declined from about 92% in early May to about 80% in late July.

The researchers said they are not certain why the decline occurred, but noted it coincided with the delta variant as well as an easing of social distancing and mask rules. Some scientists had been looking for signs that hospitalizations or deaths are increasing, as a necessary indicator that boosters might be needed.

To some leading scientists, the new studies "would not be sufficient, in and of themselves, to make the case for a booster," said Dr. William Schaffner, an infectious-diseases expert at Vanderbilt University and liaison to an expert advisory panel that helps the CDC form its vaccination recommendations.

This story includes reporting from Mike Stobbe, Matthew Perrone and Jamey Keaten of the Associated Press, and KQED's Carly Severn and Tara Siler.