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Getting First Series Remains Focus of COVID Vaccine Effort

Patti Singer

Dr. Angela Branche, co-director of the URMC Vaccine and Treatment Evaluation Unit, during a Zoom news conference Oct. 26, 2021 about COVID vaccine boosters. Image from URMC Zoom news conference.

As more people become eligible for COVID-19 booster shots, vaccine researchers at the University of Rochester Medical Center said getting people, particularly minorities, their first series of shots remains a priority.

“The main push is still to get people vaccine in the first place,” said Dr. Ann Falsey, co-director of the URMC Vaccine and Treatment Evaluation Unit.

Half the population in the city has received at least one dose of vaccine, according to the Roc Health Data website. In Monroe County, about 76% of residents have received at least one dose, according to county data.

In general, census tracts on the east side of the city and east side of the county have higher rates of at least one dose of vaccine than west side or city tracts, according to Roc Health Data.

“I still think in most of the communities of color, the initial vaccination should remain the main focus,” Falsey said. “But folks come in to those vaccine clinics boosters and that’s fine as well.”

Falsey said clinics offer first and second doses and booster doses, so someone could go to a clinic and get any shot in the series, if it is appropriate for them.

On Oct. 21, the federal Centers for Disease Control and Prevention expanded criteria for people to receive a booster:

  • 65 and older;
  • 18 and older living in long-term care settings;
  • 18 and older with underlying medical conditions;
  • 18 and older who live or work in high-risk settings such as education, health care and first responders, manufacturing, transit and grocery stores.

In addition, the CDC recommended that people who received the one-dose Johnson & Johnson vaccine can get a booster if they were vaccinated more than two months ago.

At a news conference Oct. 26, Falsey, Dr. Angela Branche, co-director of the URMC Vaccine and Treatment Evaluation Unit, and Dr. David Dobrzynski, assistant professor in infectious diseases, answered questions about boosters, including the practice of “mixing and matching” – meaning the booster was not from the same manufacturer as the initial series.

Is it necessary to get a booster?

Falsey said that’s subjective right now. She said all of the vaccines still are doing quite well against severe disease. “So is it truly necessary to prevent mild to moderate disease? And I don’t have a good, good answer for that.” She said that people started receiving vaccine last December and over time researchers noticed the effectiveness waning for mild to moderate disease. She said data on whether boosters help against mild to moderate disease comes from observational studies in Israel, where it was noticed that infection rates were higher in people that had not received a booster than those who did. She said Pfizer released a report of a randomized clinical trial of booster versus non booster in people that had received their vaccine in the phase three trial. The report said that out of 5,000 people that got the booster, five got infection. As for people that didn’t get boosted, 106 out of 5,000got an infection.

If you got the one-dose Johnson and Johnson vaccine, should you be more willing to go get a booster shot versus if you got the two-dose Pfizer or Moderna?

Dobrzynski said the recommendation for people who received Johnson & Johnson is to get another dose of that or one of the mRNA vaccines, the Pfizer or Moderna. “I think we can see that the antibody levels rise up to the doses of the other two vaccines pretty closely. So there is this potential extra benefit of getting your antibodies and your protection up to that level.”

What do you say to people who are hesitant to mix and match, especially those who got their initial dose, uh, from Johnson and Johnson?

Dobrzynski said the point of a study in which URMC participated was to make sure it was safe to receive vaccines from different manufacturers or types. “That question thankfully, was answered that these vaccines are safe to mix and match. We really didn’t see any significant or worse side effects with the vaccines in terms of whether you got Johnson & Johnson, Moderna or Pfizer. I think the message is if you don’t feel comfortable with mixing and matching, you don’t have to.” He said the big message is, especially for the Johnson and Johnson vaccine, is getting a second dose of that or a booster from one of the other vaccines is recommended. “It does bring up the antibody and the neutralizing antibody levels to help protect against the current strains, including the delta variant.”

Falsey said initial recommendations were not to mix and match because there was no data on any benefits or dangers. “We try to be data driven when we can. The first step in mix and match was to determine that it was safe and it was well tolerated. … That’s why the recommendations changed as we needed to do the studies to then be comfortable making the recommendation that it was okay. It may turn out someday that one regimen versus another of a product followed by a different product, offered us an advantage. But right now what we know is they all boost and they’re all safe.

Branche said that for your primary series, you should still get two doses of whatever it is that you’re initially given. The conversation about mix and match is about boosters. “I think it’s also worth pointing out that the complexity of potentially boosting the entire United States population and then the world, if that becomes the case over the next several months, it might even be harder than the initial vaccine alone. So having to add this extra layer of complexity on top of the regular vaccine rollout — having to make sure you only boosted what you got initially will be really challenging. And so I think being able to mix and match and be able to show that you can do that safely and effectively really opens up possibilities if and when we find that we have the most people more widely.

Starting Oct. 30, Monroe County vaccine clinics will offer Pfizer, Moderna and Johnson & Johnson boosters, County Executive Adam Bello said Oct. 28 during the weekly COVID-19 media briefing. Appointments are recommended. Pfizer and Moderna boosters can be given to eligible people six months after their second dose.