BOSTON – Although much of the COVID-19 discussion last week concerned the meeting of a CDC advisory panel regarding booster shots, concerns remain about people who have not gotten a single dose.
“Getting people vaccinated is the highest priority,” said Dr. Mark Poznansky, director of the Vaccine and Immunotherapy Center at Massachusetts General Hospital and professor of Medicine at Harvard Medical School. “Boosters come next for identified at-risk groups like the elderly and immune compromised.”
According to Poznansky, the booster discussion has to be balanced with getting people vaccinated in the first place. “There’s clearly a space for boosters around those people who were vaccinated six to eight months ago and need their immune response to be boosted in order to be protected from the virus,” he said.
Last Thursday, the CDC advisory panel recommended not only a booster shot for the Moderna and Johnson & Johnson vaccines, but also supported mixing and matching booster shots. The panel had previously recommended a booster shot for the Pfizer vaccine as well.
Speaking with the Jewish Journal before the panel announced its recommendations, Dr. Daniel Kuritzkes, chief of the Division of Infectious Diseases at Brigham and Women’s Hospital, said, “I do think it’s completely safe to mix them. There are data suggesting if you initially have the J&J vaccine, you get a much bigger boost in antibody levels [by] getting either the Moderna or Pfizer vaccine [as a booster]. It didn’t matter so much the other way around – a Moderna or Pfizer booster with J&J is no better than getting a booster with Pfizer or Moderna.”
Poznansky wondered whether, in the future, a COVID-19 booster shot might be administered on an annual basis.
“Ultimately, I think, just with the flu, maybe here the data at this time tells us to get a booster shot of some sort once every year,” he said.
Poznansky and Kuritzkes expressed concern about individuals who have not gotten vaccinated. Currently, nearly 70 percent of Massachusetts residents have been fully vaccinated. Vaccine mandates for employees in the public and private sectors have drawn challenges – including at Kuritzkes’s employer, Brigham & Women’s.
“In the hospital setting, for several years now we’ve required flu vaccinations,” Kuritzkes said. “People have to demonstrate immunity to mumps, measles and rubella or be vaccinated in order to work at a hospital. The concern is very much not new. I think everybody would much prefer that people voluntarily agree to be vaccinated, not needing to impose a mandate.”
“I think that institutions have to be safe, especially health care facilities,” Poznansky said. “Going for maximal vaccination against Covid makes sense.” He added, “I think sort of the practical role of a vaccine mandate in places like hospitals is, you deal with people who are not well, you want your staff to be both protecting themselves from the most serious consequences of COVID-19 and reduce the chances of them getting infected and potentially spreading the infection to patients and each other.”
With flu season approaching, Poznansky recommended spreading out the time in which someone receives a COVID-19 shot and a flu shot: “If you can spread the vaccines out, it’s better from the point of view that side effects from vaccines are inevitable – a painful arm, chills.”
Regarding side effects from the COVID-19 shot, Kuritzkes said, “In general, the vaccines are extremely safe. All have the same kind of common side effects you would expect from any vaccine – sore arm, you may also see different muscle aches and pains, low-grade fever, sometimes chills … It’s typically mild and almost always resolved within a day or two. It’s very rare, a couple of [cases] in a million, you can have a more severe reaction to the Moderna or Pfizer vaccine.”
Another source of concern for doctors is the approach of colder weather that may encourage indoor gatherings.
“I think the concern as people move indoors is that we could see another increase in cases, even here in Massachusetts, with a high rate of vaccination,” Kuritzkes said. “The increase would be driven largely by the continued circulation of the virus among unvaccinated people.”
He noted, “The reason for all the flurry of infections beyond the introduction of delta is that the mask recommendation relaxed. Unvaccinated people took advantage of a recommendation that was not intended to apply for them,” resulting in “indoor gatherings of vaccinated and unvaccinated people together.”
For Poznansky, the new normal could see seasonal mask-wearing.
“You just have to remember that masks are a useful protection against viruses spread through respiratory secretions,” he said. “Therefore, we may be using them again in winter in enclosed spaces indoors, not just because of COVID-19 … wearing a good tight-fitting mask at this time of year can reduce the spread of a whole bunch of infections and make the population healthier.
“The annual spread of flu cases was crushed last winter beyond anything we’ve previously seen. It was not the vaccines alone, it was due to social distancing and mask-wearing. So, as a population, we have to learn – sometimes relearn – lessons that masks and social distancing work.”