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Health officials readying for third doses, boosters

Despite an upcoming convergence of COVID-19 vaccinations for booster and third doses,  shots to children under 12 and the continued, yet at times frustrating efforts to reach the unvaccinated, state health officials say they’re ready to handle all of it.

Pending Food and Drug Administration approval, the Centers for Disease Control and Prevention has authorized a booster shot for everyone who has been fully vaccinated with two doses of the Pfizer BioNTech or Moderna vaccines beginning Sept. 20. Health officials said the booster would be necessary eight months after receiving the second dose due to waning immunity over time, particularly with the Delta and other more potent variants spread.

Potential third doses or boosters for those who received the one-shot Johnson & Johnson vaccine are still being studied.

Currently, those who are immunocompromised can receive a third dose of the Pfizer or Moderna vaccines.

State Health Commissioner Dr. Norman Oliver, in an interview Friday, said the third dose for the immunocompromised, such as those with cancer, HIV or who have had transplant surgery — around 135,000 in Virginia — is already taking place.

“We’ve seen that the first two doses hasn’t given them enough antibodies to protect them from the disease,” Oliver said.

Dr. Danny Avula, in a briefing Thursday, said there is no difference between the first and second dose of the Pfizer or Moderna vaccines and their third or booster doses, though those vaccine manufacturers are working to develop a different vaccine that would be more effective to COVID-19 variants. Avula also advised that those getting boosters or third shots get the same vaccine they have already received, though it is acceptable to get a different vaccine if that is the only choice they have from their provider. However, Avula said did not have clarity on whether those who have come to the United States and have received a different vaccine than ones it has approved could safely get a third dose or booster of the Pfizer or Moderna vaccines.

Across Virginia, 62.8% have received at least one dose of a COVID-19 vaccine, and 55.6% have been fully vaccinated as of Aug. 20. However, in Western Tidewater, those percentages are much lower, especially among people who are younger than 55.

Just 49.6% of people in Suffolk have received at least one dose, and just 43% have been fully vaccinated. But less than 40% of those ages 12 to 15 and 25 to 34 have received at least one dose. And among those ages 12 to 54, the percentage of people fully vaccinated is no higher than 42.1%, and is just 32.6% among those 25 to 34 and 27.4% of those 12 to 15.

In Southampton County, less than 40% are fully vaccinated, and about 30% of people ages 12 to 34 have been vaccinated, including 16.2% of those ages 12 to 15. Isle of Wight and Surry counties have seen the highest vaccination rates in Western Tidewater, but have still been behind overall state percentages. In Isle of Wight, 49.2% of all people have been fully vaccinated, and 47.5% in Surry have been fully vaccinated. Franklin has seen 43% of its population fully vaccinated.

Oliver said there are “vanishingly small” numbers of people who have serious side effects from the vaccines, with hundreds of millions of people worldwide having been vaccinated. More than 98% of all positive COVID-19 cases are among those who have not been fully vaccinated. And, more than 97% of those hospitalized for COVID-19 and more than 98% of all COVID-19-related deaths around the state have come from those who have not been fully vaccinated.

“I don’t want to lose the importance of the fact that people getting that first dose is actually way more important in the long run to progressing beyond this pandemic,” Avula said, “that we really need people who have not been vaccinated to get there. Some of that is going to happen … because Delta is real and it is causing more infection, and as we see cases surge, that’s driving vaccination.”

Avula said full FDA approval of the vaccines, which could come for Pfizer’s as soon as next month, will move people off the fence to get vaccinated. He acknowledged that there will be some who see boosters or third doses as evidence that vaccines don’t work or don’t work enough.

“I am sure there will be a segment of the population … where the inclusion of, now, a booster dose starts to, I don’t know, lessen confidence in the effectiveness of this,” Avula said. “And I think that’s where we just have to keep going back to what is happening in real life, which is that we’re seeing cases skyrocket, we’re seeing hospitalizations increase and the vast majority of that is happening in unvaccinated people.”

Oliver said it is important for people to get vaccinated in order to curb the spread of Delta or potentially more potent variants.

“We obviously want to increase that number (of people vaccinated), particularly with the Delta variant being more infectious,” Oliver said. “The more we get vaccinated, the less likely it is that the virus will continue to spread. I think that people who are still hesitant, who are still sitting on the fence concerned about safety of the vaccine, concerned about its effectiveness, the most we can do is continue to drive home the fact that it is safe.”

Oliver said different people, however, will have to become the messengers to convince others to get vaccinated.

“I think that the trusted individuals in those communities in rural Virginia,” Oliver said, “and Black and Brown communities across the state where we’ve seen some hesitancy around getting vaccinated, if we have the pastors that they trust, the pharmacists they’ve been going to see for the last 20 years as people who are the ambassadors and champions of this vaccine, I think that will help.”

In a statement from the Virginia Department of Health, it plans to spend more time on messaging to younger residents about getting vaccinated.

“Currently, we are launching a campaign to educate the adult GenZ generation to improve vaccine uptake for that age group,” it said.

Gen Z is considered to be people ages 25 and younger.

Avula, though, expects a rush of people to get their booster shot once they become eligible.

“We’ve got a pretty long runway before we get to the high volume of booster doses,” Avula said. “So I don’t anticipate that being in conflict until probably December. And my hope is that by December, we’ve reached the vast majority of our holdouts for first doses, but we’ll need to keep an eye on it.”

Avula also expects that employer-mandated vaccinations will also drive up vaccination percentages. But for those getting a booster dose, Avula said it isn’t urgent for that to take place exactly eight months after that second dose.

“We reiterate the guidance, and really, it goes back to reassuring the public at large that your immunity doesn’t disappear overnight,” Avula said, “that there is no burning emergency for you to go get vaccinated the day you … hit that eight-month mark, but that it is a slow and progressive decline in immunity.”

The state department of health said it is working with local health districts and local community partners, including pharmacies, providers and hospitals “to operationalize our COVID-19 vaccine with the new and upcoming recommendations. We are confident that we’ll be able to provide vaccine per possible anticipated guidelines.”

With some school divisions in the state having started the new year already and others to start just after Labor Day, Oliver said there are things adults can do to help those children under 12 who are not yet eligible to be vaccinated.

“I think that those of us who are eligible, we get vaccinated,” Oliver said. “We’re helping to protect our children. … If we wear our face masks in schools, we are protecting those children.”

Oliver and Avula both expect the Pfizer vaccine to be approved for children ages 5 to 11 in the next several weeks, and they encourage parents to get their children in that age group vaccinated at that time.

Oliver said, however, that he expects school divisions who follow the COVID-19 mitigation strategies put forth by the CDC, VDH and state department of education will be able to stay safe and open for in-person learning.

Said Avula: “In the face of a much more contagious Delta variant, we really need staff and students to wear masks at all times indoors.”