Recognizing the impact of vaccinated people now getting and spreading Covid-19, the Centers for Disease Control (CDC) is recommending at least some of them get another shot.
According to CDC, "severely immunocompromised" people make up about 3% of the adult population and "have accounted for a large proportion of hospitalized" cases of fully-vaccinated people contracting Covid-19 after vaccination.
CDC adds that these people are "more likely to transmit the virus to household contacts."
So far, CDC has not gone along with vaccine makers' recommendations that all people eligible to get vaccinated receive a booster.
The public health agency has been grappling with growing public recognition and alarm that fully-vaccinated patients are often proving not to be fully-protected against Covid-19.
CDC is also dealing with a self-created crisis in public confidence. Public health officials have gotten caught distributing conflicting guidance and, at times, even disinformation.
Originally, officials boasted of a 90% or greater effectiveness with the Pfizer and Moderna RNA Covid-19 vaccines in preventing symptomatic Covid-19 cases, "exceeding expectations."
Many people were told that Covid-19 vaccines would prevent them from getting infected with and/or spreading Covid-19. When that proved false, some public health officials falsely claimed, or implied, that at least the vaccines were 100%, or nearly 100%, effective at preventing hospitalization and death from Covid-19.
In April, CDC Director Rochelle Walensky falsely claimed that "vaccinated people don't transmit Covid-19."
But within a matter of months, Covid-19 vaccine effectiveness has proven to be significantly diminished, fully-vaccinated patients have been hospitalized in significant numbers, and CDC has had to acknowledge the reality that fully vaccinated people are likely spreading Covid-19 no differently from the unvaccinated who have not yet had Covid-19.
In one Massachusetts analysis by CDC, the agency acknowledged that many fully vaccinated people were getting and spreading Covid-19, and that four out of five people hospitalized with the virus were fully-vaccinated. CDC also explicitly admitted that "viral load" in vaccinated and unvaccinated patients was "about the same." (Scientists say high viral loads can mean the person is more infectious.)
In Israel, which predominantly uses the Pfizer vaccine, health officials say vaccine effectiveness in preventing Covid-19 has fallen to 39%. That's well below the 70% minimum rate some scientists have suggested is necessary to quell an outbreak.
As these facts have emerged, the public health narratives have dramatically shifted. The current emphasis is to shift away from the vaccine concerns and publicize statistical analyses to try to convince people that it's still better to get vaccinated than not.
For some, that may be the case-- at least in the short term. But experts say risk vs. benefit of Covid-19 and the Covid-19 vaccines are individual calculations. Added to that is increasing awareness of Covid-19 vaccine adverse events such as blood clots, heart inflammation in young people, and Guillain Barre Syndrome autoimmune paralysis.
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Further public skepticism has been stoked by the confounding lack of acknowledgment on the part of so many health officials of the immunity benefits enjoyed by those who have recovered from Covid-19, or had an asymptomatic case (with no symptoms). With well over 120 million Americans in this category (by CDC estimates), multiple peer-reviewed, published studies and analyses indicate a significant proportion of the U.S. population likely has natural, long lasting immunity that outperforms the current vaccines, and that those people would not benefit from vaccination.
Despite that, those millions of people are rarely acknowledged or factored into the idea of vaccine mandates, or calculations as to how safe a community supposedly is. Those calculations are typically, inexplicably, based solely on vaccination rates and restrictions such as mask mandates.
To the extent many public health officials have acknowledged the natural immunity part of the equation at all, it has often been in a one-sided attempt to "debunk" the studies, and urge those who have had Covid-19 to get vaccinated, anyway.
In December 2020, CDC immunization advisory scientists and top officials repeatedly stated, falsely, that vaccine studies showed there was a benefit to people who have already had Covid-19 getting vaccinated. The studies actually showed no benefit.
In less than eight months' time, many public health officials have switched from claiming the vaccines are highly effective at preventing Covid-19 and spread of Covid-19, to claiming they are 100% effective at preventing hospitalization and death, to claiming they are highly effective at preventing hospitalization and death.
Read CDC's information below:
NOTICE: CDC now recommends that people whose immune systems are compromised moderately to severely should receive an additional dose of mRNA COVID-19 vaccine after the initial 2 doses. Widespread vaccination is a critical tool to help stop the pandemic. Read CDC’s statement.
What You Need to Know
- People who are moderately to severely immunocompromised are especially vulnerable to COVID-19 because they are more at risk of serious, prolonged illness.
- People who have compromised immune systems may benefit from an additional dose to make sure they have enough protection against COVID-19.
- CDC recommends people who are moderately to severely immunocompromised should receive an additional dose of mRNA COVID-19 vaccine after the initial 2 doses.
CDC recommends that people with moderately to severely compromised immune systems receive an additional dose of mRNA COVID-19 vaccine at least 28 days after a second dose of Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine.
CDC does not recommend additional doses or booster shots for any other population at this time.
Data on Decreased Immune Response Among Immunocompromised People
People who are moderately to severely immunocompromised make up about 3% of the adult population and are especially vulnerable to COVID-19 because they are more at risk of serious, prolonged illness.
Studies indicate some immunocompromised people don’t always build the same level of immunity after vaccination the way non-immunocompromised people do, and may benefit from an additional dose to ensure adequate protection against COVID-19. In small studies pdf icon[2 MB, 36 Pages], fully vaccinated immunocompromised people have accounted for a large proportion of hospitalized “breakthrough cases,” and that suggests immunocompromised people are more likely to transmit the virus to household contacts.
Who Needs an Additional COVID-19 Vaccine?
Currently, CDC is recommending that moderately to severely immunocompromised people receive an additional dose. This includes people who have:
- Been receiving active cancer treatment for tumors or cancers of the blood
- Received an organ transplant and are taking medicine to suppress the immune system
- Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
- Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Advanced or untreated HIV infection
- Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response
People should talk to their healthcare provider about their medical condition, and whether getting an additional dose is appropriate for them.
Find a COVID-19 Vaccine
Find a COVID-19 Vaccine: Search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233 to find locations near you.
- Check your local pharmacy’s website to see if vaccination walk-ins or appointments are available.
- Contact your state or local health department for more information
Frequently Asked Questions
How long after getting my initial COVID-19 vaccines can I get an additional dose?
Can you mix and match the vaccines?
For people who received either Pfizer-BioNTech or Moderna’s COVID-19 vaccine series, a third dose of the same mRNA vaccine should be used. A person should not receive more than three mRNA vaccine doses. If the mRNA vaccine product given for the first two doses is not available or is unknown, either mRNA COVID-19 vaccine product may be administered.
What should immunocompromised people who received the J&J/Janssen vaccine do?
The FDA’s recent EUA amendment only applies to mRNA COVID-19 vaccines, as does CDC’s recommendation.
Emerging data have demonstrated that immunocompromised people who have low or no protection following two doses of mRNA COVID-19 vaccines may have an improved response after an additional dose of the same vaccine. There is not enough data at this time to determine whether immunocompromised people who received the Johnson & Johnson’s Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.
What are the benefits of people receiving an additional vaccine dose?
What are the risks of vaccinating individuals with an additional dose?
There is limited information about the risks of receiving an additional dose of vaccine, and the safety, efficacy, and benefit of additional doses of COVID-19 vaccine in immunocompromised people continues to be evaluated. So far, reactions reported after the third mRNA dose were similar to that of the two-dose series: fatigue and pain at injection site were the most commonly reported side effects, and overall, most symptoms were mild to moderate.
However, as with the two-dose series, serious side effects are rare, but may occur.