As the US launches a scaled-back booster campaign, there is a lot of confusion.
Like millions of Americans across the country, Nicole from Brandon, Mississippi, is eager to receive her booster vaccine against Covid-19 — but the advice from her state health department has left the 38-year-old confused about whether she is eligible for another jab.
“[They] told me that they were not scheduling boosters, only third shots,” she said, recounting her conversation with a health department employee.
“I’m still not sure what guidelines or rules [they are] using at this time, she added. “It appears to be fluid at the moment.”
Nicole, who used to work at a non-profit for diabetes sufferers, has since booked her next shot at a Walgreens pharmacy rather than the county health facility where she was originally vaccinated.
The difference between a “booster shot” and a “third dose” is meaningless to the average American, but some officials use the latter term to describe an extra shot intended only for those with compromised immune systems. The terminological distinction is but one example of the confusion and chaos overshadowing the scaled-back booster campaign from Joe Biden’s administration.
Weeks of mixed messaging from public health officials, leading scientists and the president himself have left Americans puzzled about whether they are eligible for boosters, while individual states have interpreted national guidelines differently.
The US Centers for Disease Control recommended booster doses of the BioNTech/Pfizer vaccine on Friday for some people who were originally given that particular jab: those aged over 65, adults with medical conditions and workers in jobs with a high-risk of exposure to the virus.
The eligible population comprises 60m Americans who received two doses of the BioNTech/Pfizer jab, according to Biden, 20m of whom he said can immediately receive boosters as they were vaccinated at least six months ago.
However, those who received two jabs made by Moderna or one by Johnson & Johnson — comprising about 83m people — have been shut out of the booster drive because extra doses of these shots have not yet been authorised by regulators.
When Biden announced the booster campaign on August 18, he said every American adult who had received two doses of BioNTech/Pfizer or Moderna would be eligible for a third jab within eight months of the second dose. But now the president, who received his own booster shot this week, is urging people to “wait their turn”.
Some lawmakers are giving people conflicting advice. In West Virginia, governor Jim Justice is encouraging all adults who have been fully vaccinated with the BioNTech/Pfizer jab to receive a booster. “If you’re 18 or above, you will qualify in some way,” he said this week. “I would really highly encourage you to run to the fire again and get that booster shot.”
Maryland’s governor Larry Hogan has similarly urged residents to have their boosters, saying more than 50,000 extra doses had already been administered. “If you received your second Pfizer dose at least six months ago, you should strongly consider getting a booster shot,” he said last week.
Meanwhile, differing recommendations from the CDC, the Food and Drug Administration and the committees of scientists that advise these agencies have left some individuals unsure about whether they qualify.
William Schaffner, infectious diseases professor at Vanderbilt University in Nashville and liaison member of the CDC’s vaccine advisory committee, said the public’s confusion stemmed from the Biden administration’s initial announcement in the summer. “This process just went a bit backwards, starting of course in Washington,” he said.
Long before any regulatory decisions had been made, president Biden touted September 20 as the date from which all Americans would receive booster vaccines. Two top FDA officials quit the agency in part due to the decision to make the announcement before third doses had been authorised.
“This was the cart before the horse,” Schaffner said. “This was a process I would not recommend to anyone.”
The FDA’s advisory panel rejected a widespread booster rollout and instead recommended a third dose only for a smaller group of older and at-risk individuals. The FDA followed that advice authorising boosters for people aged over 65, adults at high risk of severe Covid-19 and those working in jobs where they are frequently exposed to the virus.
But last week the CDC’s vaccine advisory group declined to endorse boosters for people working jobs with high risk of exposure to Covid, including retail and healthcare workers, saying there was insufficient data about the benefits of boosters in light of potential rare heart-related side effects, especially in younger people.
Rochelle Walensky, head of the CDC, then overruled that particular panel to make a final decision on Friday. She said people working in jobs with high risk of Covid exposure “may receive a booster” based on their individual benefit and risk.
“The messaging has seemed clear and consistent regarding some groups — over 65s — but information for some of the less specific groupings, occupation-based or those with medical conditions, has been confusing,” said Marissa Emanuele, a social media manager from New Hampshire. She has severe asthma and is unsure if and when she should have her third jab.
Her confusion stems from the fact that when Biden announced the campaign in August, he and his top health officials said the waiting period should between the second and third jab should be eight months. But the official recommendation for those eligible is now six months.
“I’m not sure if [I] should be trying to get it now, or to wait until we’re eights months out like the administration was initially saying,” said Emanuele, adding: “I’m very pro-[vaccine] and want to do things the right way.”
Only people who originally received the BioNTech/Pfizer jab are eligible for a booster dose as the agencies await further data from Moderna and Johnson & Johnson. However, in another confusing wrinkle, immunocompromised individuals who initially received Moderna are allowed an extra dose of that jab.
Offering boosters based on the vaccine manufacturer was a point of contention among CDC advisers, who last week fretted about excluding some from a third jab. The agency is also awaiting more data on mixing and matching vaccines, while some Americans are already seeking out unofficial extra doses.
Schaffner said he understood why people were keen to receive boosters, regardless of whether the CDC deemed it appropriate: “In one way or another, everybody would’ve been eligible for a booster at some point.”