What the potential deployment of the Covid-19 booster could look like

Last month, U.S. health officials announced plans to offer booster doses of the Covid-19 vaccine starting the week of September 20, subject to approval by the U.S. Food and Drug Administration and United States Centers for Disease Control and Prevention.

Those conversations begin this week, including a key meeting of FDA vaccine advisers on Friday, but the decision is not a slam dunk, experts said.

Still, those responsible for administering boosters can’t wait for the details to be finalized.

“We don’t want to be caught off guard,” Lori Tremmel Freeman, executive director of the National Association of County and City Health Officials, told CNN Wednesday.

She said local health departments are now planning to be ready after the FDA’s review of Pfizer’s data – especially since they are already “really overwhelmed” right now with the response to the outbreaks of cases. of Covid-19, working to get the unvaccinated vaccinated, and prepare for the flu season.

The last thing local health officials need right now is more chaos or confusion, but many of their recall questions still haven’t been answered: “What’s the interval for the recalls?” Is it less than eight months at this point? the age limit? Will there be priority groupings? “Freeman said.” We don’t want to appear uncoordinated on boosters. ”

What must happen before the boosters take up arms?

The FDA’s Vaccines and Related Biologics Advisory Committee will meet this Friday to discuss whether data on Pfizer / BioNTech’s Covid-19 vaccine supports the idea of ​​giving people a booster dose. 16 years of age and over approximately six months after completing their second dose. And there will be other steps before boosters are allowed to go into the arms of the general public.
“It’s important to note that the role of the FDA is really to say, can we use this – can we use this product or can we use this booster. used or not, “Dr Anna Durbin, director of the Center for Immunization Research at the Johns Hopkins Bloomberg School of Public Health, said Wednesday in a virtual briefing.

“So even if the FDA approves the use of the boosters saying they’re safe and doing what they’re supposed to do, the CDC will still have to review and approve the use of the boosters to say that they are actually needed, and for whom they are needed and they may recommend it for different populations – the elderly, for example, or people in nursing homes, we don’t know, “he said. she declared.

U.S. health officials have maintained they want to stay ahead of the virus – but not get ahead of U.S. health agencies.

“No one is going to get any recalls until the FDA declares that they are approved, until the CDC advisory committee makes a recommendation. What we want to do is be ready as soon as that. will happen, “White House Chief of Staff Ron Klain told CNN. Dana Bash on “State of the Union” earlier this month.

“We will wait one hundred percent for FDA approval, we will wait for CDC approval.”

Klain said that even if boosters for both injections didn’t receive full approval until September 20, the administration would still be ready to distribute them by then.

What might the distribution of the extra doses look like?

The recall rollout plan won’t quite resemble previous vaccination efforts, where pharmacies traveled to nursing homes to vaccinate residents and stadiums held up long lines of people waiting for vaccines at vaccination sites. massive.

“There is still a lot of emphasis on pharmacies to continue to play an important role in delivering vaccines, and over 70% of doses are currently given to pharmacies,” NACCHO’s Freeman said, but added. that in some states, some pharmacies and hospitals may not participate in recall programs because they will not have the staffed capacity to do so, among other reasons.

Biden administration booster rollout on September 20 could be reduced to Pfizer Covid-19 vaccine alone at first

In these cases, the boosters could be administered at other sites, such as specific doctor’s offices or vaccination clinics.

“It could be different from state to state,” Freeman said, but she stressed that there were “no limitations” or constraints on the vaccine supply.

On the contrary, “we have heard from the local health services, without any confirmed information reaching them, they are starting to assess who in the field will have the capacity to make reminders, who will remain as a vaccine supplier and who will withdraws – so we have a better understanding of how the community will be served and by whom, ”Freeman said. “There is just a lot of confusion about it.”

How many people might be eligible for the boosters?

It is not known what parameters the US recall program will have, if it launches at all.

The Biden administration previously said U.S. residents would be eligible for a third dose of the Covid-19 vaccine eight months after receiving their second dose.

In that case, up to 5.2 million people could be eligible to receive a booster, or a third dose, of a Covid-19 vaccine during the week of September 20, if the booster program then begins.

CDC data shows that about 3.4 million U.S. residents were fully immunized on January 20, which would make them eligible for a booster eight months later, on September 20. Up to 5.2 million people could be eligible for their recall by the end of the week.

The initial rollout of the booster is on track to include Pfizer / BioNTech doses – pending FDA clearance – but it could take a few more weeks to move forward with Moderna’s vaccine boosts.

More than half, 56%, of the doses given as of Jan. 20 were Pfizer / BioNTech doses, according to CDC data. In December, the FDA cleared the Pfizer / BioNTech vaccine for emergency use about a week before the Moderna vaccine.

Public health officials and medical experts from the US Department of Health and Human Services noted in a joint statement in August that the rollout of the booster could be staged by default since the initial rollout of the first doses was staged.

For example, if booster shots are recommended for people six to eight months after receiving their second dose, health workers and the elderly will likely be the first group eligible to receive booster shots if a deployment takes place next week. .

If anyone got their second dose in January, it was eight months ago. March was six months ago.

“At that point, people who were fully immunized at the start of the immunization rollout, including many health care providers, nursing home residents and other elderly people, will likely be eligible for a reminder, ”the statement read. “We would also begin to make efforts to deliver booster shots directly to residents of long-term care facilities at that time, given the vaccine distribution to this population early in vaccine deployment and the continued increased risk. that COVID-19 makes them run. “

The FDA and CDC have previously approved authorization of third doses for people who are immunocompromised. More than 1.9 million people have already received an additional dose since mid-August, according to the CDC.

CNN’s Virginia Langmaid and Deidre McPhillips contributed to this report.

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