Healthcare providers plan to incorporate the distribution of an additional dose of COVID-19 vaccine to immunocompromised individuals with their existing vaccination campaigns—and as preparation for future efforts to get extra doses to a larger share of Americans.
Providers such as New York-based Mount Sinai Health System and Maywood, Illinois-based Loyola Medicine are getting ready to start providing extra doses to vaccinated patients, but key questions remain unanswered for hospitals.
The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration have both OK'd additional vaccine for people with suppressed immune systems, including cancer patients, organ transplant recipients, people with untreated or advanced HIV, patients receiving high-dose corticosteroids and anyone with moderate or severe immunodeficiency. The American Medical Association expedited approval of new Current Procedural Terminology codes for a third dose of both the Pfizer-BioNTech and Moderna vaccines, the organization announced Monday.
Evidence has mounted that the standard vaccine dose isn't as effective for people with weakened immune systems, and the Delta variant has triggered a massive surge in cases and hospitalizations, particularly in regions with low vaccination rates.
Public health experts expected for months that an additional vaccine dose would eventually be advised for vulnerable people. The CDC's new policy still arrived suddenly for health systems, who weren't yet ready to get booster shots into eligible arms.
At Mount Sinai, the health system will follow the playbook it uses when vaccinating people the first time, said Dr. Cardinale Smith, associate professor of medicine, hematology and medical oncology at Mount Sinai. Patients are already calling to ask about booster shots, she said. Mount Sinai will reach out to vaccinated, immunocompromised people through patient portals and telephone calls, she said.
"This is a population who is likely to be much better versed on the risks of what having an immunocompromised system is like, and probably more primed and used to being evaluated for vaccines and other methods to decrease their infection complications," Smith said.
Patients are likely to merely have to attest that they meet the CDC's requirements for another dose, Smith said. Hospitals also must ensure that patients get another dose of the same vaccine they previously received. CDC recommends against giving patients a different vaccine except under exceptional circumstances.
While some health systems have planning still to do, providers such as Loyola Medicine are ready to begin offering booster shots within days.
Identifying every eligible patient treated across multiple departments could be a challenge, said Dr. Richard Freeman, regional chief clinical officer at Loyola Medicine. "Just like with the initial vaccine, we didn't have a lot of lead time," Freeman said. "You can't just hit a button and generate a list of people."
Over the next few weeks, Loyola Medicine will expand vaccination capacity to facilitate booster shots for patients who visit their facilities for other types of medical care, Freeman said.
Rolling out booster shots to immunosuppressed patients could help Loyola Medicine learn best practices that would apply to a broad-based campaign to get extra vaccine doses to a larger share of the population if the CDC and the FDA expand their guidance, Freeman said.
"It allows us to take a couple of small groups and start to work through the third dose in most of those folks instead of having a million people at our doorstep tomorrow," Freeman said.
Approximately 7 million U.S. adults are immunocompromised. COVID-19 vaccines are 59%-72% effective for people with suppressed immune systems compared to 90%-94% for the rest of the population, according to evidence presented to the CDC's Advisory Committee on Immunization Practices on Friday. Immunocompromised individuals made up between 40% and 44% of all COVID hospitalizations involving those who are vaccinated. More than 1 million people are estimated to have gotten a third dose on their own.
