SALT LAKE CITY — With COVID-19 cases surging in Utah, has the time come for the fully vaccinated to get booster shots?
Pfizer and its partner company in producing one of the three coronavirus vaccines approved for use in the United States, Bio-Tech, announced a new study Thursday showing promising results from administering a third shot, six months after the first two, and expect to submit their findings to federal authorities for authorization.
The Centers for Disease Control and Prevention and the Food and Drug Administration responded in a joint statement, "Americans who have been fully vaccinated do not need a booster shot at this time," but said the issue is being studied and the recommendation could change.
"We are prepared for booster doses if and when the science demonstrates that they are needed," the statement said. Someone is considered fully vaccinated two weeks after their final dose of vaccine — two shots for Pfizer or Moderna, and one for Johnson & Johnson.
Utah health care experts also are saying not yet, although they acknowledge there's increasing interest, especially among those who received the single-dose Johnson & Johnson vaccine, in securing more protection against the highly contagious delta variant of the virus first detected in India now dominant in Utah and the rest of the country.
"This one's a tricky one," said Dr. Michelle Hofmann, deputy director of the Utah Department of Health, calling a question about additional shots raised during a recent virtual news conference to encourage vaccinations "on the cutting-edge of where we may be going."
Some countries are already allowing a different type vaccine to be given as a second dose following one that's similar in makeup to the Johnson & Johnson vaccine. The J&J shot is less effective against the original coronavirus, with about 60% efficacy compared to 95% for Pfizer and Moderna.
All three vaccines largely prevent hospitalization and death in the fully vaccinated, but how much their performance declines against the delta variant is now an issue. Studies have shown both doses of Pfizer — and likely Moderna, which uses the same new technology — are needed, but there's little data on Johnson & Johnson.
The CDC's official policy is that vaccines are not interchangeable, although the National Institutes of Health announced in June a clinical trial was underway to determine the safety and effectiveness of giving booster doses of different COVID-19 vaccines to fully vaccinated adults.
"We do not recommend that currently in the United States," Hofmann said, citing potential safety concerns. "We are starting to hear of individuals with an interest, and wondering about that, but that is not currently a recommendation,"
Still, not everyone is willing to wait. Hofmann was responding to a question posted on Facebook from a woman who said she knows "several people who received the J&J vaccine who have gone and got a second dose of either Moderna or Pfizer. Is this recommended or safe or necessary?"
There are multiple media reports of people who'd gotten the Johnson & Johnson vaccine but then surreptitiously sought out Pfizer shots in the hope the higher efficacy associated with the new type of vaccine will make them less likely to experience a breakthrough case of COVID-19.
A few, including Angela Rasmussen, a virologist at the University of Saskatchewan's Vaccine and Infectious Disease Organization, are experts in the field. Rasmussen, an American working in Canada, tweeted in late June she'd gotten a Pfizer shot "to top off the J&J vaccine I received in April" and felt fine.
"I think I did the right thing to make sure I am as protected as possible from the delta variant and thus am protecting others who only have one shot," she said in her much-viewed Twitter thread, adding "Sometimes public health requires making tough decisions without a complete data set to support it."
Shortly before the July 4th holiday, the region's largest health care provider, Intermountain Healthcare, told vaccinated patients in a blog post it's too soon to roll up their sleeves for another dose because, "So far, the signs are good that we won't need booster shots any time soon."
The post said federal agencies are assessing the risk of additional shots by looking at various factors including whether breakthrough cases in the fully vaccinated are going up, if booster doses or combining different types of vaccines provides more protection, and if the variants are harder to fight.
Just how long it will take to make that determination remains to be seen, said Dr. Tamara Sheffield, medical director of preventive medicine at Intermountain Healthcare. That could come sooner rather than later once more is known about the effectiveness of the Johnson & Johnson vaccine against the delta variant.
"At this point, we don't have anything that tells us we should do it yet. But that could change quickly," Sheffield said. In the meantime, she offered some advice for Utahns who got the Johnson & Johnson vaccine — less than 130,000 compared to almost 1.5 million in the state who received Pfizer or Moderna.
"I tend to be someone who's more cautious," she said. "I would say to anyone who may wonder if they're fully protected to follow careful gathering behaviors. If you're indoors with a group of individuals who may not be vaccinated, then people should mask up."
Han Kim, a professor of public health at Westminster College in Salt Lake City, said data about the Johnson & Johnson vaccine is hard to come by because relatively few people got the single shot, adding "it might not be a bad idea to get a booster."
A decision from the federal government about such shots may come closer to fall, Kim said, when COVID-19 cases could surge even higher as students, especially those under 12 years old who aren't eligible for the vaccine, return to classrooms and people spend more time indoors as temperatures drop.
We should be focused on getting people, in fact, their first shot, much less a third shot.
–Han Kim, professor of public health, Westminster College
Pfizer's announcement about booster shots is raising questions, he said.
"There's a lot of chatter amongst epidemiologists and public health folks that this is completely unnecessary," Kim said, noting the vaccine is expected to remain "pretty effective" for at least a year and shots only started last December and became widely available months later.
"We live in a world where there is a huge amount of injustice in terms of vaccine distribution and we're going to start prioritizing a third shot for Americans, in a country that is still struggling to achieve 70% of the adult population with one shot? A lot of people are saying this is far too premature," he said.
Gov. Spencer Cox said Utah has reached that 70% goal, if vaccine doses administered by federal agencies in the state are counted. But many parts of the state, including Utah County and rural communities, have much lower vaccination rates and less than 45% of the overall population is fully vaccinated.
"We should be focused on getting people, in fact, their first shot, much less a third shot," Kim said. He said not only would delivering a third shot be logistically difficult, it is also being seen by some as "Pfizer taking advantage of this situation, to push for a third dose."