COVID-19 vaccine boosters on the horizon: How to prepare
The U.S. Department of Health and Human Services (HHS) has announced a plan to deliver booster shots for individuals who have been vaccinated with the Pfizer-BioNTech COVID-19 vaccine or the Moderna COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) updated its website on Sept. 1, 2021, with information regarding the anticipated release of boosters.
It is important to understand the difference between a COVID-19 vaccine booster and the currently recommended third dose for immunocompromised individuals. A booster is given to someone who created a normal immune response from the initial series, but that immune response waned over time. Therefore, a booster is given at a specific timeframe based on evidence that shows immunity is fading. This dose is not considered a part of the primary series.
The additional dose for the immunocompromised is being recommended due to evidence that the initial immune response in these individuals was not adequate. The Advisory Committee on Immunization Practices (ACIP) reviewed data that indicated that individuals with moderate to severe immunosuppression do not create an adequate immune response after the initial two-dose series of the Pfizer and Moderna, and as a result, it is recommending a third dose, as part of the primary series, at least 28 days after completion of the first two doses. Currently, the definition of fully vaccinated remains as two weeks after completion of the series (one or two doses). General information from CDC on vaccines is available here.
The Food and Drug Administration (FDA) and ACIP will meet on Sept. 15, 2021, to develop recommendations for COVID-19 vaccine boosters. Pending approval by both entities, it is likely that all individuals who have been vaccinated with the Pfizer or Moderna vaccine will be recommended to receive a booster shot eight months after the second dose. The recommended timeframe will be confirmed by the FDA and ACIP, but HHS is preparing for a timeframe of eight months after receipt of the final dose. Right now, individuals who have received the J&J/Janssen vaccine are not recommended to get a third shot or an additional shot for the immunocompromised. The CDC and FDA are actively reviewing data from the J&J vaccine to see if there is any waning immunity and will be making recommendations once enough data is available.
The National Healthcare Safety Network (NHSN) updated reporting summaries and table of instructions for residents and health care personnel to include the third dose for immunocompromised individuals a few weeks ago. Any third doses should be reported now and as they are administered moving forward. More NHSN reporting process updates are expected as boosters are approved and made available.
The federal government has given each state the latitude to decide how to best deliver vaccine boosters in long-term care facilities, which are expected to be rolled out in the latter part of September. Although the exact timeline is still unclear, IHCA has been working closely with Iowa Department of Public Health (IDPH) and the Iowa Pharmacy Association to advocate for a smooth process. At this point, it has been established that providers will be given the choice to work with one of three choices to administer boosters in their facility. Providers can choose to work with their current long-term care pharmacy, their local public health department or Hy-Vee, which will be making shots available statewide.
IHCA/ICAL suggests providers take the following key steps to start preparing.
- Identify residents (and/or their representatives) who meet the eligibility criteria for being immunocompromised and offer them the third dose or to talk to their physician about receiving a third dose of an mRNA vaccine.
- Review resident and health care personnel vaccination records to determine an eligibility timeline based upon the anticipated eight-month recommendation.
- Talk to your long-term care pharmacy about their level of confidence in delivering the booster shot, once available, to your residents and health care personnel. If your long-term care pharmacy is not confident in their ability to administer boosters, IHCA recommends the Hy-Vee option. More details will be released regarding the Hy-Vee option as they become available.
- Continue to encourage vaccine uptake among residents and staff. Check out AHCA’s #GetVaccinated campaign website for resources.
For questions, contact Brenda Irlbeck, VP, Quality Improvement and Clinical Affairs, at 515-978-2204.