In mid-August, I walked into a Fulton County, Georgia, health department site giving COVID-19 vaccines near my house. I told them it was my first vaccine, gave them my driver’s license, and received my third Pfizer COVID-19 vaccine. Fifteen minutes later, I left the facility with documentation of the vaccine. Other than some mild sore arm and myalgias which started 30 hours after the injection and resolved in about eight hours, I had no other reaction to the booster. I joined over one million other Americans (according to news reports) who have gotten a third injection not approved by the Centers for Disease Control and Prevention (CDC). So, why did I do it?
Presently, the booster is only recommended for immunocompromised patients. I don’t fit into any of the CDC’s criteria for a booster. I am almost 69 years old and have hypertension. As many of you did, I got my first vaccine last December and the second one, mid-January; therefore, it had been around seven months since I had been immunized. At least from the CDC data, I should still have good protection from severe infection and hospitalization. What disturbed me was the data coming from Israel. More than 5.4 million Israelis, or 78% of the population, approved to receive the vaccine there have been immunized. Yet, daily COVID-19 cases have dramatically increased over the last month. In Israel, the Pfizer vaccine has been used almost exclusively. Since Israel has a single payer system and an extensive testing and tracking system, their ability to follow disease activity in the country is excellent. In May, they published data from January through early April showing that the vaccine was 95% effective in preventing infection and 97.5% against severe infection. In examining data from early June to early July, the percentage in preventing COVID-19 infection dropped to 64%. But what was very disturbing is some of the most recent data looking at June 20 to July 17 which suggested that the effectiveness dropped to 39%. The good news is that protection from serious disease was still at 91.4%. There is some criticism of these latest data as the overall numbers of people in the data were small, but nevertheless it is concerning.
So, is the protection from the COVID-19 vaccines decreasing over time and having less effect on the Delta variant? It appears that this may be happening. In late July, Pfizer released data suggesting that the efficacy of the vaccine wanes after six months, with a drop from 96% to 84%. The good news was that protection for severe infection was 97%. As of now, this paper has not been peer reviewed. I did not feel that I was depriving anyone who wants a COVID-19 vaccine from getting one. We hear about vaccine expiring in the U.S., as it is not being used. Should I have waited for more data and clearance from the Food and Drug Administration and CDC? If I waited, the booster may not take effect until after the Delta variant swept the U.S. For all of these reasons, I believed I did the right thing for me — to skirt around the system to get a booster.
The World Health Organization has been adamant that boosters should not be given in wealthier countries until other countries are able to vaccinate their population. But some are starting to administer boosters, nevertheless. Israel is now giving boosters to everyone over the age of 50 years. France is giving it to the immunocompromised. Germany will be offering boosters this month to older people, nursing home residents, and the immunocompromised. It is clear that the CDC is looking into boosters for other groups in the U.S., including health care workers and nursing home residents who received the vaccines first. We know the U.S. government is stockpiling vaccine for further use.
Should you get a booster? What if my patients ask for a booster? I agree that the data is not completely clear at this time. You have to evaluate your personal situation and medical status and the age and medical status of your patients to weigh the pros and cons of a booster. At least until the CDC opens boosters for all Americans.