Who Should Get a Third Vaccine Shot Now?

A woman holds up a sticker after getting her third "booster" dose of Covid-19 vaccine at a clinic. (Photo by ROBYN BECK/AFP via Getty Images)

By Amie Knowles

August 20, 2021

Experts explain who should immediately get a third booster shot to fight COVID-19, and why it is necessary now.

RICHMOND – Health districts across the commonwealth leapt to action following the Virginia Department of Health’s third COVID-19 vaccine recommendation. 

As of Saturday, Aug. 14, the Prince William Health District started offering third doses of the mRNA vaccines. 

The health district scheduled community vaccine clinics featuring third dose availability through the end of the month, including a Pfizer clinic on Monday, Aug. 30 from 4 to 8 p.m. at at 8300 Sudley Rd in Mananssas. 

The Central Shenandoah Health District also announced the availability of the third dose. The booster will be available at all CSHD COVID-19 vaccine clinics that offer mRNA vaccines.  

“Vaccination remains the most effective way to prevent the spread of COVID-19,” said Dr. Laura Kornegay, CSHD director. “We are looking forward to providing additional doses to those who are immunocompromised at our clinics throughout the district, and continuing to provide opportunities for those who remain unvaccinated to get their shot.”

The FDA estimates that approximately 3% of Americans fall into the category recommended to get a third Pfizer or Moderna vaccine. Likewise, on Aug. 13 the Virginia Department of Health estimated that 3% of immunocompromised Virginians may need the booster based on statewide vaccination numbers.

Who Needs a Third Dose? 

If you’ve heard people use vague terms like “the elderly” or “people with weakened immune systems” when they talk about individuals who could benefit from a third vaccine dose, you’re not alone. That might leave you wondering exactly who needs or qualifies for the third round.

According to the CDC, people whose immune systems are compromised moderately to severely should receive an additional dose of mRNA COVID-19 vaccine after the initial two doses.

The CDC defines several groups of people to whom the third dose applies. They include people receiving active cancer treatment for tumors or cancers of the blood, people who received an organ transplant and take medicine to suppress the immune system, people who received a stem cell transplant within the last two years and take medicine to suppress the immune system, people with a moderate or severe primary immunodeficiency such as DiGeorge syndrome and Wiskott-Aldrich syndrome, people with advanced or untreated HIV infection and people undergoing treatment with high-dose corticosteroids or other drugs that may suppress the immune response.

Those seeking a third dose should wait at least 28 days after their second dose to get the additional round. Currently, the VDH does not require proof of a compromised immune system for people requesting a third vaccine dose. 

Why is the Third Dose Necessary?

Robert Parker, PIO for the Western Region of the VDH, explained that the immunocompromised people who could benefit from the third dose may have lower antibody levels after full COVID-19 vaccination, compared to those with normal immune systems. 

These folks are more likely to have a breakthrough infection, meaning they could contract COVID-19 even after being vaccinated.

Their immune response also puts them at a higher risk of getting severely ill from the coronavirus and having symptoms for a longer period of time than a normal COVID infection. People in the vulnerable population may need hospitalization if they contract COVID.

Close contacts should also monitor their own health since those in the vulnerable population may be at greater risk of having symptoms for a longer period and for shedding – and spreading – COVID for a longer time. 

According to an Aug. 13 VDH press release, the available evidence shows that a third dose provides a modest benefit to improving the immune response to mRNA vaccination. However, the department said that immunocompromised persons might still not have a strong level of protection against COVID-19 after the third dose.

Staying Protected 

For those with compromised immune systems, additional COVID-19 precautions remain important.

Suggested precautions include wearing a mask, maintaining physical distance in public and avoiding crowds and poorly ventilated indoor spaces. 

In May, the FDA issued an emergency use authorization for a COVID treatment option for patients 12 and up. Doctors may suggest monoclonal antibody treatment options for people with significant immunodeficiencies. 

Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses. Sotrovimab is a monoclonal antibody that is specifically directed against the spike protein of SARS-CoV-2 and is designed to block the virus’ attachment and entry into human cells, the FDA said.

Finding the Vaccine

Looking ahead, State Vaccine Coordinator Dr. Danny Avula expected a smooth rollout of the third dose.

“In Virginia, we are monitoring the situation and planning through all of the logistical considerations,” Avula said. “If booster vaccine doses are recommended for the general population, the rollout of those boosters will likely take place over several months, as the expected recommendation is that a booster dose should be given within a defined time frame after your second dose. VDH and local health departments now have experience in planning and carrying out the logistics of a large-scale vaccination effort, and rebooting that for booster doses will not be an issue. The infrastructure for administering the booster doses is already in place.”

On Wednesday, top US health officials announced that Americans should get a booster vaccination eight months after their second dose. Boosters will be available starting Sept. 20, with the first rounds heading to nursing home residents, healthcare workers, emergency workers and other adults who were vaccinated early. The FDA and CDC have not made an official recommendation for booster shots at this time, though that’s expected in the coming weeks.

Virginians seeking the third dose may schedule an appointment online or contact their local health department. 

Amie Knowles reports for The Dogwood. You can reach her at [email protected] 

  • Amie Knowles

    Amie is Dogwood's community editor. She has been in journalism for several years, winning multiple awards from the Virginia Press Association for news and features content. A lifelong Virginia resident, her work has appeared in the Martinsville Bulletin, Danville Register & Bee and NWNC Magazine.

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