California OKs COVID vaccine boosters for all adults

  • by Liz Highleyman, BAR Contributor
  • Wednesday November 17, 2021
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California is now allowing COVID booster vaccines for all adults. Photo: iStock
California is now allowing COVID booster vaccines for all adults. Photo: iStock

The availability of COVID-19 vaccine boosters is rapidly expanding as officials rush to get ahead of another surge in the pandemic. California was the first state to allow boosters for all adults six months after their last shot, and the federal Food and Drug Administration and the Centers for Disease Control and Prevention are expected to follow suit by the end of the week.

[Updated, 11/19/21: The FDA authorized and the CDC now recommends boosters for all adults.

"We are taking an expansive approach to COVID-19 boosters, realizing that people are at risk of getting COVID or spreading it as we enter the busy holiday season," said San Francisco Director of Health Dr. Grant Colfax, a gay man. "We are already seeing an uptick in cases, and that could mean hospitalization for some vulnerable people, even if they are fully vaccinated. We have been stressing that boosters are essential for higher risk individuals, but now it's become apparent that we need many more people to receive a booster dose so that we can protect ourselves, our families and friends, and our community."

San Francisco has managed to keep COVID cases and hospitalizations relatively low compared to other cities, but both are beginning to rise. As of November 17, San Francisco was back in the CDC's orange tier, indicating "substantial" transmission, after briefly falling into the yellow, or "moderate," tier.

Conversely, San Francisco's vaccination rate is higher than that of most other cities. Currently 76% of the city's population is considered fully vaccinated. The CDC recommended vaccines for children ages 5 to 11 on November 2, and nearly a third have received their first dose. More than 100,000 residents have already received a booster, according to the San Francisco Department of Public Health, but this is only a small fraction of those who received an initial dose. "Booster uptake has been abysmal," Dr. Peter Chin-Hong of UCSF told the San Francisco Chronicle.

While the Pfizer-BioNTech and Moderna vaccines continue to provide strong protection against hospitalization and death, a growing number of people — especially those over 65 and those with other health conditions — are experiencing breakthrough infections, which in some cases can be severe. Studies have shown that antibody levels begin to wane a few months after vaccination. Memory B-cells and T-cells provide longer-lasting protection against serious illness, but they take longer to kick in, giving the highly transmissible Delta coronavirus variant a chance to establish infection.

Experts say it is not yet clear whether a third vaccine dose will lead to more durable immunity or whether additional boosters will be needed on a regular basis going forward. Many have emphasized that unvaccinated people getting their first shots will do more to curb transmission and hospitalization than vaccinated people getting boosters.

Official authorization

On August 12, the FDA authorized an additional dose of the Pfizer and Moderna vaccines for immunocompromised people, including people with advanced or untreated HIV. In September and October, the FDA and CDC went further, recommending Pfizer and Moderna boosters after six months for people 65 and older, younger adults with underlying health conditions, and those at high risk for exposure due to their work or living situation. The agencies also said all adults who received the single-shot Johnson & Johnson vaccine could get an additional dose two months after the first one.

At that time, the FDA and CDC decided not to make Pfizer and Moderna boosters available to all adults. But as COVID cases rise and the holidays approach, some states are taking matters into their own hands. In addition to California, Arkansas, Colorado, New Mexico, West Virginia, and New York City have also expanded booster eligibility to all adults.

On November 9, the California Department of Public Health issued a letter to providers stating that people seeking boosters should not be refused as long as it has been at least six months since their last shot. Similarly, SFDPH stated in a news release, "No one should be turned away if they feel they are at risk of COVID-19 and would like to get a booster in advance of the holiday season."

The vaccines are free, and people can choose any brand of booster; they do not need to get another dose of the vaccine they originally received. Likewise, they do not have to get a booster from the same provider.

San Francisco health officials are not planning to re-establish mass vaccination sites to administer boosters. Instead, they will be provided by physicians, clinics, retail pharmacies, and community-based organizations.

Some vaccine websites have been slow to reflect the expanded eligibility. As of Wednesday, California's and Walgreens' website were still asking if customers meet the CDC's eligibility criteria, but Kaiser is now allowing anyone to make a booster appointment online.

Pfizer asked the FDA last week to authorize boosters for all adults ages 18 and older. The request did not include 16- and 17-year-olds, even though they can receive the initial two-dose series. Moderna is expected to do the same soon.

The CDC is scheduled to meet Friday, November 19, to discuss expanding its booster recommendation. The FDA typically authorizes vaccines before the CDC can recommend them, which suggests the agency may take action November 18.

Updated, 11/19/21: This article has been updated to state that the FDA now authorizes and the CDC recommends COVID boosters for all adults.

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