Saturday, June 15, 2024

4 reasons ineligible Americans shouldn’t sneak a COVID booster — yet

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Rochelle Walensky, director of the Centers for Disease Control and Prevention, overruled her own advisory panel on Friday and recommended COVID-19 boosters not only for Americans over 65 and adults with underlying health conditions but also for a much broader group of people: anyone who considers themselves at high risk of exposure and says so the next time they swing by a CVS.

“What we are doing now is self-attestation,” Walensky explained.

Officially, the only healthy Americans under 65 who are supposed to “self-attest” at this point are those who face “increased risk for COVID-19 exposure and transmission because of occupational or institutional setting,” according to the CDC. Think nurses, teachers, incarcerated individuals and people in homeless shelters.

Rochelle Walensky

CDC Director Rochelle Walensky. (Stefani Reynolds/Pool/Getty Images)

In reality, however, 74 percent of fully vaccinated U.S. adults say they would get a booster if they could — and millions are likely to cut the line now that no one is stopping them (even while much of the rest of the world is still struggling to contain the virus without any vaccines at all).

“It should be easy,” one state immunization official told the Washington Post. “There won’t be heavy screening. No one has time or resources for that.”

So does this mean you should sneak an extra dose ASAP, either by pretending you still need your first shot— as more than a million ineligible Americans have already done — or by characterizing yourself as high risk?

Easy is one thing. Worthwhile, or even wise, is another.

The immediate benefit of boosters is that they probably lower even a younger, healthier individual’s chances of testing positive for COVID-19, at least temporarily. But for the vast majority of those people, “waiting your turn” — which President Biden has urged ineligible Americans to do — may make more sense than jumping the gun, from both a personal and a public health perspective.

“This is a ‘walk, don’t run’ situation to go get your boost,” Walensky told the Atlantic earlier this week. Here are four reasons why.

A nurse gives a dose of the Pfizer vaccine to a student

A nurse gives a dose of the Pfizer vaccine to a student in Longwood, Fla. (Paul Hennessy/SOPA Images/LightRocket via Getty Images)

1. The risk of getting really sick is still very low — and it may be getting lower. By now, most people who pay attention to pandemic news are aware of the studies (primarily out of Israel) showing some waning of vaccine effectiveness against infection over time and in the face of the hypercontagious Delta variant (particularly Pfizer’s vaccine). That’s why we’re talking about boosters in the first place.

But across various populations, the COVID shots continue to stave off hospitalization and death to a remarkable degree, especially in younger, healthy individuals. From Feb. 1 to Aug. 6, for instance, vaccine effectiveness against hospitalization among U.S. veterans ages 18 to 64 at five Veterans Affairs Medical Centers was 95 percent — and showed no sign of weakening once Delta became dominant over the summer. A recent U.K. study, meanwhile, found that people who are fully vaccinated appear to have a much lower likelihood of developing long COVID than unvaccinated people, even when they contract the virus (which doesn’t happen nearly as often).

So while younger, healthy people who still aren’t eligible for boosters can certainly experience breakthrough infections, few of those infections turn out to be dangerous.

There may also be fewer of them than before. Over the last two weeks, new U.S. COVID cases have fallen by 33 percent as America’s summer Delta wave subsides; the share of tests coming back positive is down, too. Cases are rising in some Northern states, probably because cooler weather leads to more indoor gathering. Yet most Northern states have higher vaccination rates and more stringent precautions than the lax Southern states that were hit hard over the summer, which could blunt Delta’s continuing impact. 

Avery Shih, 6, with her family

Avery Shih, 6, gets her second Moderna COVID-19 vaccine in Los Angeles as her parents and brother look on. (Sarah Reingewirtz/MediaNews Group/Los Angeles Daily News via Getty Images)

Either way, the trend line is largely positive at the moment — and the lower your chances of encountering the virus, the lower your chances of getting infected.

2. The risk of getting someone else sick is low, too. Beyond individual immunity, the other big argument in favor of boosters for all is that restoring everyone’s protection against infection to pre-Delta levels will starve the virus of the hosts it needs to spread and will hasten the end of the U.S. pandemic.

On paper, this makes some sense; using boosters to block more breakthrough infections should slow transmission, even if such an effect hasn’t been quantified yet. But in real life, booster “bandits” won’t be anywhere near numerous enough to have this sort of population-level impact — especially because they’re also the least likely people to be spreading COVID in the first place.

For one thing, they’re fully vaccinated, and full vaccination continues to prevent most Delta infections. Vaccinated people tend to cluster together as well, which further strengthens their immunity. They’re also more cautious than unvaccinated people, with 68 percent saying they still wear masks in public always or most of the time (compared with just 46 percent of the unvaccinated). Finally, the fully vaccinated people who want boosters so badly that they’re willing to go under the table are, by definition, the most cautious of the bunch.

So, yes, boosting your antibodies ASAP will have some effect. But maybe not all that much.


Syringes at a pop-up clinic in Fullerton, Calif. (Francine Orr/Los Angeles Times via Getty Images)

3. To get more bang for your buck, consider waiting a bit. Timing is an underappreciated element of the booster equation. Even now, older and more vulnerable Americans aren’t supposed to get a third dose until six months after their second — roughly the point at which Israel observed some waning.

Why? Because “if you get all three shots at the same time, or really close to each other, you may not be doing what you set out to do, i.e., train the immune system to remember (how to fight a virus) for many years,” Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco, recently explained. “The immune system generally does better in terms of ‘remembering’ if you wait a few months before the last shot.”

Dr. Marion Pepper, an immunologist at the University of Washington, told the Atlantic that overstimulating the immune system can even have a negative effect (as opposed to just a neutral one) by making your body less adept at fighting off certain infections — something Pepper often observes in her work on malaria. Your immune system “needs some time and space to calm down in between seeing one infection and the next one” so that it can hone its pathogen-detection skills, Pepper said.

Given that younger, healthy Americans weren’t allowed to get their first and second shots until the spring, few of them have reached the six-month threshold at this point — which is all the more reason to resist any “temptations” to bend the rules, according to Dr. Anthony Fauci, the nation’s top infectious disease expert.

“If you allow the immune response to mature over a period of a few months,” he said Friday, “you get much more of a bang out of the shot, as it were, in enhancement of your antibodies.”

Anthony Fauci

Infectious disease expert Dr. Anthony Fauci. (J. Scott Applewhite/Getty Images)

And speaking of antibodies, experts estimate that they tend to peak sometime around three weeks after a boost, preventing nearly all infections and possibly transmission. Timing that short-term protection to coincide with a period of higher exposure and risk — such as Christmas, or Thanksgiving, or whenever cases surged in your area last winter — could be more beneficial than sneaking a booster now, when cases are falling.

4. The more people who fake their way into a booster, the harder it is to understand when the rest of us really need them. That’s because every time someone lies about being unvaccinated or immunocompromised or “high risk” in order to get a bonus shot, the more it skews government data on who’s been vaccinated and how well the vaccines are performing. Without a clear picture of that, it’s hard to know for sure when effectiveness is really waning and when universal boosters should finally roll out.

Regardless, they will almost certainly roll out — and sooner rather than later. Experts and activists have called on the U.S. to focus less on boosting its own population and more on vaccinating the rest of the world, but the White House says it can do both (and unfortunately, unused U.S. doses are more likely to be thrown out than teleported to a vulnerable person elsewhere).

“Near term, we’re probably going to open this up anyway,” Biden said Friday. “We’re looking to the time when we’re going to be able to expand the booster shots basically across the board.”

Still, he added, “it would be better to wait your turn in line.”


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