Syringes are prepped with the Moderna COVID-19 vaccine before being administered at Richmond Raceway in Richmond, Va., February 2, 2021. (Parker Michels-Boyce/ For the Virginia Mercury)
After a slew of rapid-fire — and sometimes contradictory — federal recommendations last week, hundreds of thousands of Virginians are now eligible for COVID-19 booster shots.
And while state health officials are still awaiting clarification on some of the criteria, they say the doses are now widely available to anybody who wants one. Unlike the early days of the vaccine rollout, when deliveries were tightly restricted to hospitals and local health departments, shots in Virginia are now widely available through thousands of pharmacies and private providers. Those settings are largely relying on patients to tell the truth about whether they’re eligible.
“When you get there, it’s on the honor system,” Gov. Ralph Northam said at a news briefing on Monday. “The person giving shots is not required to ask you about your vaccination status, so it’s up to you to do the right thing.”
Virginia’s preparations for administering the doses come after a month of often-conflicting messaging at the federal level. Boosters have been a priority for President Joe Biden since August, when he announced the doses would become widely available for all U.S. adults by Sept. 20 following a review by the U.S. Food and Drug Administration.
The FDA initially endorsed a third shot for a broad swath of Americans, including those 65 and older, 18 to 64-year-olds with underlying medical conditions, and 18 to 64-year-olds with “frequent institutional or occupational exposure” to the coronavirus. The following day, though, an advisory committee for the U.S. Centers for Disease Control and Prevention pared down those criteria, removing the recommendation for high-risk workers.
That decision was quickly reversed by CDC Director Rochelle Walensky, who overruled the advisory committee shortly after midnight on Friday morning. According to state and federal health officials, the following categories of people are currently eligible for booster shots, both in Virginia and across the country:
- People 65 years and older
- People 18 years or older living in a long-term care setting
- People between the ages of 18 and 64 with underlying medical conditions that put them at higher risk of severe COVID-19, including diabetes, obesity and heart conditions such as hypertension
- People between the ages of 18 to 64 whose jobs or housing put them at higher risk of contracting COVID-19 (including Virginians living and working in jails and prisons).
It’s important to note that the recommendations only apply to people who received a primary series of the Pfizer vaccine at least six months ago. Pfizer is currently the only authorized booster, and neither the FDA nor CDC has issued any guidance on whether additional doses will eventually be recommended for those who received the Moderna or Johnson & Johnson shots.
What jobs classify as “high-risk” is also unclear. State vaccine coordinator Dr. Danny Avula said the Virginia Department of Health is still waiting on more details from the CDC, which is expected sometime this week. Frontline health workers, employees in congregate settings and teachers will almost certainly be on the list, but it’s unknown which others will be.
“Those 65 and up should absolutely get it,” Avula said. “Fifty to 64 with an underlying condition should get it. Eighteen to 49 with an underlying condition — they should really talk to their provider and decide whether the individual risk versus benefit leans in the direction of getting a booster now.”
The drive for third doses has been met with criticism from some experts given the vaccines’ enduring effectiveness against COVID-19 hospitalizations and deaths. Emerging data has indicated that the protection of vaccines against infection seems to wane over time — a large part of why Biden began to endorse booster shots. But all three available vaccines still provide strong protection against severe disease for many months after the initial series.
At the same time, some younger populations seem to be at slightly higher risk for side effects — namely inflammation of the heart muscle and the lining around the heart — following vaccination. The risk is very small, and all three vaccines are widely trusted as safe and effective by medical professionals. But Avula said providers would able to weigh in on whether the benefit of a third dose outweighs the potential risk for people who are already well-protected against hospitalizations.
“That’s where the data’s unclear,” he said. “For young, healthy people who are already fully vaccinated, the benefit is not super clear right now in the data.”
More long-term data will also give health experts a better sense of the best timing for booster shots. Right now, it’s still not clear when exactly immunity begins to wane and how the shots should be spaced for the best boost in antibody protection. Those questions likely won’t deter some Virginians, though, many of whom have already begun flocking to local pharmacies for third doses.
“A lot of folks already got vaccinated this weekend,” Avula said. Under strict CDC recommendations, he estimated that around 700,000 Virginians are now eligible for the shots. VDH is currently finalizing a contract to set up additional mass vaccination clinics for administering boosters, but it’s still uncertain how much expanded eligibility will spur demand. While just over 71 percent of all Virginia adults are fully vaccinated, the rates are far lower in many communities. Immunizations have been stagnant for months, with a current average of around 12,500 doses administered every day (in early April, the average was over 87,000).
“After all these months, I don’t know what else to say to people who selfishly choose not to get the shot,” Northam said. “So I’ll say this — I had Covid back before the vaccines existed. Believe me, you don’t want to get it.”
A year after his diagnosis, he said, he still can’t smell or taste anything.
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