5 key considerations for the expanded booster shot rollout

By Pamela Divack, consultant 

FDA's expanded authorization for booster doses of Pfizer and BioNtech and Moderna's Covid-19 vaccine significantly increases the number of Americans eligible for a booster shot. While some states—especially those concerned about waning immunity (like Colorado, California, and Vermont)—have already expanded booster shot eligibility to all adults who want one, this authorization is an important milestone in our pandemic response.

As a next step, CDC must officially recommend the shots before they could be widely administered. However, there are five things all health care leaders must keep in mind today:

1. Ensure a swift booster rollout, but don't forget about getting unvaccinated adults and kids their first shots.

Despite the positive booster news and authorizations, our best tool to fight the virus is still getting as many people vaccinated as possible. However, recent CDC data has shown that more fully vaccinated people are getting their booster shots of Covid-19 vaccines than unvaccinated people getting their first shots. Efforts to roll out boosters should not detract from trying to improve vaccine uptake overall.

2. Proactive and consistent communication is (still) critical for vaccine uptake—including boosters.

People may have questions about why it's important to boost immunity and whether there are potential side effects, as well as hesitance to take off work or dedicate time to getting the additional shot. Additionally, reaching originally hesitant and hard-to-reach populations and convincing them to take a booster may be a challenge—especially with effective Covid-19 treatments on the horizon, which may discourage some people from getting vaccinated. Successful booster rollout will require proactive outreach efforts from all parts of the health care industry.

3. National data collection will be essential to understanding boosters' impact on immunity.

The United States has relied mainly on data from other countries—primarily Israel and the UK—for its Covid-19 booster strategy and understanding of vaccine effectiveness over time. However, FDA advisors and regulators are not always convinced by international data, citing that it does not apply to the United States which has different population characteristics, definitions of breakthrough cases, and health care system infrastructure. With boosters rolling out more broadly—and mixing and matching becoming more prevalent—national data collection will be essential to informing future questions and decisions such as: whether we will need yearly boosters, which vaccine regimens are most effective in certain subpopulations (e.g., high-risk, immunocompromised), optimal timing of vaccination, effectiveness against different variants, and more.

4. True success in booster rollout revolves around strong equity efforts.

We've said this before and will say it again: equity must be embedded into every aspect of the battle against Covid-19. Providers, pharmacies, and clinics must not lose sight of lessons learned during the initial phase of rollout—such as offering boosters at convenient hours, so people don't need to take off work or bringing the shots directly into the community.

5. It may be time for regulators and health care leaders to consider the definition of 'fully vaccinated'.

The widespread availability of boosters raises a myriad of questions including: Does the term "fully vaccinated" now also include receiving an eligible booster shot? Will individuals who have had a diagnosed Covid-19 infection also be required under mandates to receive the booster? These are just some of the many questions that should be expected in the coming weeks and months. However, some countries and states are already thinking ahead. Prime Minister Boris Johnson recently announced that the U.K. will adjust the definition to include booster shots; New Mexico is actively discussing changing the definition of fully vaccinated.