COVID boosters: Who should get them and when?

Pandemic fatigue should not deter anyone, especially the elderly, experts say.

Millions of vaccinated Ohioans — including hundreds of thousands of vulnerable elderly residents — are eligible for a COVID-19 booster shot but have not gotten one.

Public health and medical experts say boosters are a powerful tool to cut down on hospitalization, death and transmission, especially among the at-risk and elderly.

A recent study from the AARP found Ohio was one of the worst states for booster shots in nursing homes — where 44% of residents are boosted — during the same period the state was No. 1 for nursing home resident deaths per capita.

Dr. Glen Solomon, the chair of the internal medicine and neurology department at the Wright State University Boonshoft School of Medicine, said people should absolutely get boosted.

“People are just tired of the pandemic, and pandemic fatigue has just made people less enthusiastic about going and making the effort to get their booster dose,” he said. “And that’s a huge mistake with omicron, because two doses of an mRNA vaccine is really not effective against omicron. But if you throw in that third dose, we’re talking about 95% vaccine efficacy against severe disease. So with this widely spreading omicron, the booster really makes a difference and it works very quickly.”

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Janine Manuel of Huber Heights spoke to a reporter Wednesday as she waited the required 15 minutes after getting her booster shot at Bethesda Temple in Dayton. She said she had been eligible for the booster since November.

“I just kept procrastinating and putting it off,” she said. “But with the new variant out, I decided it was time for me to go ahead and be safe.”

This story is part of a Dayton Daily News series on how the community can transition from a pandemic to a world where the virus is endemic (coronavirus is always with us and surges are milder, similar to the flu). Key to that is encouraging booster shots, even when case numbers have declined, according to public health experts who say eventually the majority of Americans may only need a shot every few years.

Here’s what the experts and evidence say about our current need for coronavirus booster shots, and what our booster regimen future may look like.

How many Ohioans have not gotten their booster?

Over 3.3 million Ohioans have gotten their booster shot, putting Ohio among the most boosted states by percentage of fully vaccinated residents who have received a booster. However, about 2.5 million Ohioans or more are eligible for a booster shot but have not gotten one.

This is according to a Dayton Daily News analysis of Ohio Department of Health data, which found that about 57% of Ohioans who completed their initial vaccination series by five months ago have received an additional dose of some kind (most likely a booster).

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Credit: JIM NOELKER

Credit: JIM NOELKER

Residents discuss why they put off getting the shot

Christina Marshall and her sister Teresa Marshall both stopped by Bethesda Temple on Wednesday for their booster shots.

Christina Marshall said she has been eligible for the booster for a while and kept trying to make time for it. It became more urgent when her stepsister died recently of COVID.

“I’m trying to protect myself and my family at all costs,” she said, adding that she doesn’t want to risk spreading COVID to anyone.

Christina Marshall said people she knows were encouraged to get the vaccine because of incentives like gift cards, and she believes more people would get first shots and boosters if they gave them something to thank them for helping protect the community.

“Make it seem like it’s a party,” she said.

Robert Mills said he originally had to get vaccinated because he worked at Kettering Health. He retired in October and had been meaning to get the booster, but hadn’t gotten around to it until one of his health care providers recommended the clinic.

“Good timing,” he said.

Credit: JIM NOELKER

Credit: JIM NOELKER

What do booster shots do for us, and why are they important?

Coronavirus booster shots decrease your chances of contracting symptomatic illness or transmitting the virus. The temporary boost lasts three to five months, based on data available, explained Zach Jenkins, a clinical pharmacist with Premier Health and a professor of pharmacy practice at Cedarville University.

“In general, booster shots trick your body into thinking a pathogen is present in the body,” Jenkins said. “This results in a ramp up of a person’s immune response. In the case of mRNA vaccines, you will see an increase in the level of circulating neutralizing antibodies (among other immune effects).”

People with less robust immune systems will see the greatest return on protection against severe disease with boosters, Jenkins said. This is because their immune system may not have generated a strong response to the virus with previous shots or infections.

In late January, the UK Health Security Agency released data showing boosters significantly increase older people’s protection against death from omicron. The data showed that around six months after a second dose of any coronavirus vaccine, protection against death from omicron was about 60% in those older than 50. Protection increased to around 95% two weeks after receiving a booster.

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Not enough elderly Ohioans are boosted

Age is by far the biggest risk factor when it comes to suffering severe illness or dying from COVID-19. Compared with someone in their 20s, a person older than 65 is at least 65 times more likely to die from COVID, according to the U.S. Centers for Disease Control and Prevention.

But hundreds of thousands of vaccinated elderly Ohioans have not gotten their booster shot. State data indicates that 71% of Ohioans 60 years and older who have completed their primary vaccine series have gotten an additional dose (likely a booster). That leaves nearly 700,000 vulnerable Ohioans without the extra protection from a booster.

And the latest available data from AARP indicates that some of the most vulnerable elderly in Ohio have not received a booster. About 44% of Ohioans in nursing homes had been vaccinated and boosted as of the four weeks ending Dec. 19. Ohio was the No. 1 state for nursing home resident deaths per capita during the same period. In that month, about six Ohio nursing home residents out of 1,000 died.

Chip Wilkins, long-term care ombudsman for the Dayton area, said the biggest issue is that nursing homes need to do a better job reminding residents and families boosters are available.

“I wish they made a weekly announcement to all residents and/or their legal representative that boosters are available, and that all the residents have to do is ask,” he said. “I know they have booster clinic days at some facilities, but there is not much advance notice or marketing about booster availability or booster clinic days.”

There are an estimated 70,000 Ohio nursing home residents. Wilkins said a sustained marketing of boosters to older residents might remind people how important and urgent they are for them.

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Do people who had COVID-19 need a booster shot?

In 2022 alone, driven by the highly contagious omicron variant, over half a million Ohioans had COVID-19 cases reported to ODH. Do the many people who were recently infected need a booster shot or do they have what some call natural immunity?

Solomon pointed out that immunity generated by coronavirus vaccines is more predictable and reliable than immunity produced by infection. One study from September found that up to 36% of COVID-19 cases resulted in the development of zero antibodies.

“We also don’t really know quite how long the immunity one gets from the natural infection lasts, and we have a little bit better idea with the boosters,” he said.

Jenkins took another tack when answering the question.

“The honest answer is that it depends,” said Jenkins. “We have several studies now that have demonstrated that people who have been vaccinated and previously infected with COVID-19 often have very robust (and arguably the best) immunity.”

For many people, the risk of severe disease from COVID-19 is now low enough that the benefit of a booster against severe disease is marginal, Jenkins said.

“However, for at-risk groups, such as the immunocompromised and the elderly, a booster may be a reasonable thing to consider due to their inherent risk of severe disease and death,” he said. “A person may still find it beneficial to receive a booster to temporarily reduce the chances that they may experience symptomatic illness.”

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Will we need another booster shot soon?

Moderna Chief Executive Stephane Bancel said he believes another booster will be needed by the fall.

Israel recently studied the effects of a fourth shot (i.e., a second booster), and found it to be less impactful than a single booster shot for most people.

“I don’t suspect we will see another booster shot soon,” said Jenkins. “We will more likely see something tailored to current and future variants.”

Both Moderna and Pfizer announced last month they had started clinical trials of an omicron-specific coronavirus vaccine. The tailored booster could be ready by August. But early animal studies with small sample sizes found that omicron-tailored boosters do no better than the original formula.

What does the future of COVID boosters look like?

It is widely accepted that COVID-19 will be with us for a long time as an endemic virus. How we manage the seasonal virus with vaccines is yet unclear.

Many scientists believe we will eventually transition to a seasonal vaccine, possibly even combined with the annual flu shot.

U.S. Chief Medical Adviser Anthony Fauci said last week that annual boosters might not be needed like we once thought.

“It will depend on who you are,” Fauci told the Financial Times. “But if you are a normal, healthy, 30-year-old person with no underlying conditions, you might need a booster only every four or five years.”

Jenkins said there are still many unknowns when it comes to length and potency of long-term coronavirus immunity.

Solomon expressed excitement about development of a nasal coronavirus vaccine on the horizon. The vaccine would be designed to stop COVID-19 from getting a foothold in the upper airway. If they are found to be effective and eventually authorized, they could potentially be more effective than the traditional jab at preventing virus spread.

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