U.S. Pharmacies and States Face Challenges Amid Expanded Booster Rollout

Tens of millions of Americans have the green light to seek out the extra shots.,

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U.S. pharmacies and states face new challenges as an expanded booster rollout begins.

Gov. Philip D. Murphy of New Jersey, left, touring a coronavirus vaccination site earlier this month in Newark.Credit…Justin Lane/EPA, via Shutterstock

Oct. 22, 2021Updated 4:18 p.m. ET

Now that federal regulators have cleared booster shots of all three coronavirus vaccines in use in the United States, state health authorities and pharmacies have begun rolling out plans to get even more shots in arms.

Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, recommended Moderna and Johnson & Johnson boosters on Thursday for tens of millions of Americans, a move that came nearly a month after many Pfizer-BioNTech recipients were cleared for boosters of that company’s vaccine.

The C.D.C. also gave a green light to a “mix-and-match” strategy so people who are eligible for boosters can decide to get a dose of a different type than the one they first received.

And as states, pharmacies and doctors began on Friday trying to get these shots into arms, they faced a variety of complex issues — they will have to help people understand whether they are eligible and answer questions about which booster to get.

According to the C.D.C., certain groups of people who received their second dose of an mRNA vaccine six or more months ago are now eligible for a booster. Those who qualify are people 65 and older, and those 18 and older who live in long-term care, or have underlying medical conditions, or work or live in settings placing them at high risk of infection.

For those who received the single-shot Johnson & Johnson vaccine, anyone 18 and older who was vaccinated two or more months ago is eligible. The Moderna booster, whether people originally got that company’s vaccine or either of the other two, will be a half-dose shot.

Limited evidence strongly suggests that booster doses of one of the two mRNA vaccines — Moderna or Pfizer-BioNTech — more effectively raise antibody levels than a booster dose of the Johnson & Johnson vaccine.

“Now with 10 months of vaccine experience, some may have an express preference for one booster type over another,” Dr. Walensky said on Friday, referring to the mix-and-match option, adding that it was “perfectly fine” for people to choose a booster of the same vaccine that they received initially.

Other challenges medical providers will contend with include reaching marginalized groups, such as homeless people and migrant workers, who may have received the Johnson & Johnson vaccine when it was only meant as a single-dose option, and making sure that people receive the correct dose of a Moderna booster.

More than 120 million Americans will become eligible for a booster in the coming months, Jeffrey D. Zients, the White House coronavirus response coordinator, said at a news conference on Friday, adding that boosters are available at more than 80,000 locations across the country, including at least 40,000 local pharmacies. CVS and Walgreens said they expanded their booster offerings on Friday, and were able to provide “mix-and-match” doses.

But judging by their experiences so far with Pfizer boosters, health officials said they were not too concerned about an overwhelming rush or demand outpacing supply.

“There’s been people who’ve been interested in getting boosters, but it’s been nothing like the kind of demand that we saw at the beginning of the year for the primary series,” said Dr. Marcus Plescia, who represents state health agencies as the chief medical officer for the Association of State and Territorial Health Officials.

State health officials have been arguing for weeks that patients should be able to receive boosters of a different brand than they got initially. That practice can simplify administration, widen availability and offer patients a choice.

But some officials say the approach comes with its own wrinkles.

“The question that health departments get constantly is, ‘If I can get any of them, then which one should I get, which one is better?'” said Adriane Casalotti, a spokeswoman for the National Association of County and City Health Officials. “So on the logistics side, yes, you have a lot more doors where you can get vaccinated, because it doesn’t matter necessarily as much which vaccine they have on hand. But it also can lead to a lot of confusion.”

What to Know About Covid-19 Booster Shots

The F.D.A. has authorized booster shots for millions of recipients of the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines. Pfizer and Moderna recipients who are eligible for a booster include people 65 and older, and younger adults at high risk of severe Covid-19 because of medical conditions or where they work. Eligible Pfizer and Moderna recipients can get a booster at least six months after their second dose. All Johnson & Johnson recipients will be eligible for a second shot at least two months after the first.

Yes. The F.D.A. has updated its authorizations to allow medical providers to boost people with a different vaccine than the one they initially received, a strategy known as “mix and match.” Whether you received Moderna, Johnson & Johnson or Pfizer-BioNTech, you may receive a booster of any other vaccine. Regulators have not recommended any one vaccine over another as a booster. They have also remained silent on whether it is preferable to stick with the same vaccine when possible.

The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.

The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.

Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.

Local health departments have been planning for how to get boosters to homeless people and other hard-to-reach populations, particularly those who might have received the single-dose Johnson & Johnson vaccine and are now eligible for a booster.

“The good thing is, they know who they’ve already reached out to, even if they don’t know how to find those individuals again,” said Ms. Casalotti, who noted that the outreach strategies under discussion include setting up booster sites at food banks and in homeless encampments.

State health departments generally follow the recommendations of the C.D.C., and many were prepared to begin moving ahead with boosters despite the challenges.

“It’s about time,” said Gov. Jared Polis of Colorado in a statement on Thursday, announcing that the state was ready to provide boosters. “I look forward to getting mine tomorrow.”

In Maryland, Gov. Larry Hogan said Friday that boosters and the ability to mix and match were available. The state has been preparing for months, with more than 300 sites available since last month, including large and small pharmacies, hospitals, urgent care centers and mobile vaccination operations, officials said.

In Vermont, Gov. Phil Scott announced that eligible residents could receive the new boosters beginning on Friday.

In Oregon, the state health department has enrolled hundreds of providers to administer boosters, and will train them on giving different amounts of doses, according to Kristen Dillon, a senior adviser to the state’s Covid response and recovery unit.

Officials in New Jersey said they would open several state mass vaccination sites to handle the expected demand, in addition to offering shots at schools, pharmacies and large county sites.

Coral Murphy Marcos and Giulia Heyward contributed reporting.

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