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Bracing for a surge in demand for booster shots to protect residents from highly contagious COVID-19 strains, Santa Clara County supervisors voted unanimously Tuesday on a plan to make doses widely available for all people living or working in the county.
The regulatory rules around booster shots are shifting fast, with the Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) approving a third dose, or a booster shot, of the Pfizer-BioNTech and Moderna vaccines in immunocompromised individuals. The narrow group includes cancer patients and organ transplant recipients, who are at particularly high risk of catching COVID-19 and getting severely ill.
The expectation is that booster shots will soon be approved for use by older adults as well as those who have received the Janssen/Johnson & Johnson vaccine, quickly accelerating the demand for vaccines. Santa Clara County Supervisor Joe Simitian said there is a renewed interest and urgency for booster shots, and that people are on high alert. New COVID-19 cases in Santa Clara County have spiked to the highest number since late February, and the delta variant — the vast majority of the new cases — is far more contagious.
“While other countries have started offering COVID-19 boosters, we do not know when the FDA or other healthcare authorities will authorize them,” Simitian wrote to colleagues. “There is, however, growing evidence that the question of booster shots is when, not if.”
The plan, which county health officials will craft over the next month, will allow residents to get a booster shot across all county sites, with a “no wrong door” approach, meaning that residents can get a vaccine at county sites regardless of insurance coverage or health care provider. It also calls for a close partnership with local hospitals, pharmacies and clinics to do their part “at the same level of efficiency” of the current vaccine. Simitian said support for the booster shots also requires strong communication with underserved populations who may be reluctant to come forward for a third shot.
“As we have seen throughout the country, there is too much confusion, distrust, and misinformation. Our residents will have questions, and they deserve answers,” Simitian wrote.
The FDA’s approval of booster shots in immunocompromised people came weeks after similar approvals in the United Kingdom and Israel, and months after France. The CDC found that those who received two shots of the Pfizer and Moderna vaccine were less likely to have an antibody response if they are undergoing cancer treatment or hemodialysis, and were far less likely to build an immunity if they received an organ transplant.
Two days after the FDA cleared the way for booster shots for those who are immunocompromised, which makes up about 2.7% of the nation’s population, both Santa Clara and Los Angeles counties announced that they would provide booster shots in line with the approval. The CDC recommends that people with “moderately to severely compromised immune systems” wait at least 28 days between the second dose of the vaccine and the third dose.
Though the large majority of Santa Clara County residents are fully vaccinated, “breakthrough” cases in which fully vaccinated individuals contract COVID-19 are still a threat to those who are vulnerable. The CDC cited a study that found 40% of those hospitalized with breakthrough cases were immunocompromised, while another study in Israel found similar results at 44%.
In announcing the approval of booster shots, acting FDA Commissioner Janet Woodcock said in a statement that the action is meant to protect those who are particularly at risk of the disease as the country enters “yet another wave” of the pandemic. But she said the agency is not ready to recommend booster shots for the larger population.
“As we’ve previously stated, other individuals who are fully vaccinated are adequately protected and do not need an additional dose of COVID-19 vaccine at this time,” Woodcock said. “The FDA is actively engaged in a science-based, rigorous process with our federal partners to consider whether an additional dose may be needed in the future.”
