Patients, doctors call for more nuanced approach to boosters

When Katie, a mother of two from Raleigh, got pregnant during the pandemic, her obstetrician-gynecologist strongly urged her to get the COVID-19 vaccine. The physician told her she was one of only a few patients at their practice who had not yet gotten it. After debating for weeks, she decided to get the shot despite her experience witnessing her oldest daughter having an adverse reaction to a different vaccine and her low risk of serious illness from the coronavirus. Now, she regrets her decision and feels she was coerced into getting vaccinated when she was not fully comfortable with it.

Doctors “only speak to us as if it’s the same for everyone,” said Katie, whose last name WORLD agreed not to use because she worries her opinions on the vaccine could cause her to lose her job. “I don’t believe they are providing the best care they could be.”

Public trust in the healthcare system declined during the pandemic. Earlier this year, an Edelman report said 52 percent of respondents in a worldwide survey had less confidence in the healthcare system to respond to major crises after the pandemic than before. In February a Pew Research Center report showed that over the course of the pandemic Americans on both sides of the political aisle lost trust in medicine and science. For people like Katie, providers’ communication about the COVID-19 vaccine contributed to that declining trust.

Dr. Matt Willis, the public health officer in Marin County, Calif., feels that a shift in communication about the vaccine is needed. While emphasizing that he fully supports the COVID-19 vaccine, he said, “It undermines our credibility if it seems like the reflex on our end is always to say drop everything and go get the next vaccine. The science doesn’t agree with that.”

Last week, the U.S. Food and Drug Administration authorized a COVID-19 booster shot from Pfizer for 5- to 11-year-olds. Now families are facing another critical decision that could test their trust in healthcare providers.

Data from the company shows that a third COVID-19 shot, in addition to the two 10-microgram doses that make up the primary vaccination series, increased antibody levels against the omicron variant of the coronavirus in children without producing significant side effects. The effectiveness of the booster dose for preventing illness in that age group is not yet known because not enough children in Pfizer’s study became sick with COVID-19. The company’s study is ongoing, and the FDA has already authorized a booster dose for children ages 12 and up.

Some experts who support vaccines have questioned the necessity of COVID-19 boosters for children ages 5-11. Dr. Phil Krause, a former deputy director of the FDA’s Office of Vaccines Research and Review, told Today he thinks more research is needed into how long immunity from boosters lasts in children.

“Nobody wants to get a vaccine that they don’t need or where the benefit turns out not to be as good or as long as was promised,” he said.

In March the FDA authorized a second booster (a fourth shot) for people ages 50 and up and others with weakened immune systems. A study published in April found that the three doses of the Pfizer-BioNTech vaccine were 85 percent effective at preventing hospital admission due to the omicron variant at less than three months, but effectiveness fell to 55 percent after three months or longer.

Willis, a Harvard-trained physician with a master’s degree in public health who has also worked for the U.S. Centers for Disease Control and Prevention, said public health officials should allow for more personal discretion when communicating about booster shots. They should recognize a continuum of risk and more strongly promote boosters for those who are at highest risk due to old age, a weakened immune system, or chronic conditions, he said: “I just don’t see that same level of urgency for our 5- to 11-year-olds to get a booster.”

Willis added that public health authorities should have communicated from the beginning that the main benefit of the vaccine was reducing death and severe illness.

“We framed it as something that would prevent transmission. When stepping back, that wasn’t really the prize. The prize is saving lives,” he said.

Data from the CDC supports the effectiveness of the vaccine for reducing hospitalizations and saving lives. A report recently released shows that from March 2021 to January 2022, among hospitalized adults, two or three doses of an mRNA COVID-19 vaccine was associated with a 90 percent reduction in risk of mechanical ventilation or death from COVID-19.

In the United States, 70.8 percent of the population ages 5 and older is “fully vaccinated,” meaning they have received all of the required doses for the first series of COVID-19 immunizations, according to the CDC. A U.S. Census Bureau survey in December 2021 found common reasons adults chose not to get the vaccine included concern about side effects, mistrust of the vaccine or the government, feeling like they didn’t need the shot, and wanting to wait for more studies of the vaccine’s safety.

Among fully vaccinated Americans, only about half of those who are eligible for a booster dose have received one. The CDC now recommends that older Americans who are at the highest risk for severe COVID-19 infection get a second booster as soon as possible due to the rise in cases of the BA.2 subvariant of the omicron strain of coronavirus. CDC Director Rochelle Walensky has also acknowledged that there may be a need for additional boosters in the fall when cases are expected to rise because protection from the booster wanes after four months.