A basket of syringes containing the Moderna COVID-19 vaccine ready to be used at Richmond Raceway in Richmond, Va., February 2, 2021. (Parker Michels-Boyce/ For the Virginia Mercury)
Over the last week, Dr. Henry Ranger estimates he’s gotten hundreds of calls about COVID-19 booster shots — not only from Williamsburg, where he co-owns a pharmacy with his wife, Dr. Jade Ranger, but from Newport News, Hampton, Richmond and other cities across the state.
“We were the first pharmacy in Williamsburg to get the vaccine, so we’re really known for it at this point,” he said. The problem, for Ranger, is that most adults won’t be eligible for boosters until at least Sept. 20, when federal officials plan to offer them — eight months after a patient’s first vaccine series, they initially announced — following an evaluation by the U.S. Food and Drug Administration.
In the meantime, third vaccine doses are available, and recommended, for some immunocompromised patients — an announcement made just a week before officials outlined their timeline for booster shots. And while federal health agencies aren’t recommending those patients be required to show proof of their condition, Ranger said he’s had to take matters into his own hands.
“You can’t go by the honor system — mask-wearing has shown us that’s completely ineffective,” he said. “It’s tough to take somebody’s word for it. We’ve had plenty of people trying to deem themselves immunocompromised even when they don’t meet those criteria.”
Ranger isn’t alone. Since the federal announcement, providers across Virginia have reported surging requests for third doses, even if patients aren’t eligible. In the New River Health District, for example, pharmacies “have reported their demand more than doubling, much of it for third shots,” district director Dr. Noelle Bissell wrote in an email on Thursday. “We are getting calls to schedule boosters right at eight months in October-November, even though boosters have not even been formally authorized yet.”
Christina Barrille, executive director of the Virginia Pharmacists Association, said many of its members are experiencing the same barrage of requests. Troublingly, some are reporting that their regular customers — healthy adults — are getting third shots at other pharmacies.
“But booster appointments aren’t available yet,” Barrille said. “So when people say they got a ‘booster,’ it’s that they lied and attested they were immunocompromised to get a third dose.” Dishonesty has also been a problem in Bissell’s district, which is still conducting small-scale vaccination events. Some people will request — and receive — their first shot at the events. It’s not until afterwards, when health workers are importing the information into Virginia’s vaccine registry, that they’ll realize it was actually the person’s third shot, or they received an mRNA vaccine after an earlier dose of Johnson & Johnson.
“It’s challenging because we are trying to remove as many barriers to getting vaccinated as possible while using the current guidelines for who can be vaccinated and get the third dose,” Bissell wrote.
The early demand isn’t a surprise for health officials after the frenzy of the state’s initial rollout, when some Virginians drove hundreds of miles for a dose before their own districts expanded vaccine eligibility. Facebook’s “vaccine hunters” groups, which emerged amid the early days of competition, are already populated with posts from members reporting they’ve gotten their booster shots before the official recommendation.
“I do think there will be a rush of people who are ready, they’re waiting, they will try to get vaccinated as soon as they’re eligible or even beforehand,” Dr. Danny Avula, the state’s vaccine coordinator, said at a news briefing last week. But some of the posts include tips on evading the state’s immunization registry, which has become a challenge for providers.
Ranger has also had customers claim they still need a first or second dose and “forgot” to bring their vaccine cards with them. He always double-checks the registry to determine a patient’s vaccination status — something the Virginia Pharmacists Association is urging all its members to do.
But with so many people claiming they’re immunocompromised, he’s asking for verification if he’s not already familiar with a patient and confident they truly meet the criteria.
“Which has been easy,” he said. “Like, we’ve asked them to bring in their prescription bottle showing the drug they take that compromises their immune system.” But even with the requirement, he still fields dozens of calls from customers trying to plead their case for a booster shot before they’re officially available.
“Like, they’re going to Italy in November and want to make sure they have a booster in their system,” Ranger added. “Or their child is getting married in October and they don’t want to wait until eight months out. And we just have to let them know they don’t qualify for it.”
Barrille said there’s still wide confusion over the difference between booster shots and third vaccine doses for the immunocompromised, which seems to be driving much of the urgency. For immunocompromised patients, third shots are recommended immediately based on a growing body of evidence indicating they may not get the same level of protection from the vaccines as healthy adults. For those individuals, three shots may be needed to build up the same immunity that most patients develop after two doses (right now, neither booster shots nor third doses are recommended for any patient who received the one-dose Johnson & Johnson vaccine, though the company is reporting that a second shot appears to boost antibody levels).
In those cases, a third dose is considered part of the initial vaccine series. Booster shots, on the other hand, were recommended after a growing number of studies — both nationally and internationally — suggested that vaccine immunity begins to wane after several months.
The Delta variant has also complicated the landscape. A recent study by the U.S. Centers for Disease Control and Prevention found that the Pfizer and Moderna vaccines — once about 90 percent effective at preventing COVID-19 infections — sank to 66 percent effectiveness once Delta began to account for the majority of cases.
Both vaccines, though, are still highly effective at preventing severe disease, including hospitalization and death. And even with waning immunity, vaccinated individuals don’t completely lose the antibodies that protect them from COVID-19. There’s some evidence that spacing out the shots actually boosts antibody levels, leading the United Kingdom to shift its dosing recommendations.
“I completely understand why there’s confusion,” Barrille said. Some countries and even U.S. cities — such as San Francisco — are already allowing some patients to receive vaccine boosters. Over the last month, there’s also been growing focus on so-called breakthrough infections, even though the vast majority of coronavirus cases among vaccinated individuals are mild or asymptomatic.
But she also emphasized the data on booster shots is still emerging — a main reason why health officials are urging Virginians to hold off on getting their third dose. Some experts don’t believe boosters will be necessary for every patient, especially given the vaccines’ ongoing effectiveness against serious outcomes. And it’s still not clear what the final recommendations will be. The Wall Street Journal reported Wednesday that federal regulators are now considering booster shots six months after the initial series.
“The science is showing you may want to wait so you’ll be on schedule if there’s a next round of boosters,” said Dr. Melissa Viray, deputy director of the Richmond City and Henrico Health Districts. “If you wait for that, then we’ll understand and you ‘ll understand when it’s time for you to get protected again.”
A rush for booster shots also makes it harder for patients who truly need the vaccines right now, Ranger said. Unlike the early days of the rollout, there’s no shortage of vaccines, and both state and federal officials have said there will be more than enough supply to accommodate boosters. But acquiring the doses is still a process for pharmacists.
Ranger can only acquire the Pfizer vaccine in 30-day increments from his local hospital system. For Moderna, he has to request it from his local health department and drive an hour round-trip to pick it up from the central office in Newport News.
While there’s no more rationing, he only has a finite number of doses at the pharmacy at any one time. And right now, he wants to save them for the people who need them — immunocompromised patients and customers who still need to get vaccinated.
“I want to make sure I have it readily available for those people,” Ranger said. “Because if I run out, I have to go through that process — and that’s in hopes they have it ready to give to me.”
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