The buzz around booster shots for Covid-19 vaccines has intensified in recent weeks as Pfizer sought approval for a third injection of its vaccination schedule, and Israel, the UK and Germany have gave the green light to additional injections. Federal officials in the United States say booster injections are not yet needed. But some anxious patients still try to get them, either by asking a healthcare professional willing to give them an additional injection or by lying about their previous vaccination.
It is up to hospital systems to develop prescribing policies, vaccination sites to check people’s vaccination records, and insurers to decide whether they will cover vaccines outside of Food and Drug Administration clearance.
The Centers for Disease Control and Prevention is just starting to track data on unauthorized booster injections, Director Rochelle Walensky said on Monday. She said the government can discern the difference between the second and third injection and encourages people to report safety results if they receive reminders, although they are not recommended.
“We have the capacity and are looking at this data right now,” Walensky said. The data is not yet public.
publicityMany vaccination sites, including those at Walgreens and CVS, have explicit policies not to give additional vaccines to people who have been fully vaccinated. But they might not always check to make sure that’s the case.
When patients arrive at vaccination sites, they usually need to complete a consent form asking if they have ever been vaccinated. In an ideal world, vaccinators would check the information on these forms against national vaccine registries to validate that patients are telling the truth.
« For this idea of boosters, it’s going to be hard to control. You just have to rely on local public health departments and local providers to prevent this from happening, ”said Ajay Sethi, associate professor of population health sciences at the University of Wisconsin-Madison.
In reality, some states do not require providers administering vaccines to pre-check, and the mobilization of the Covid-19 vaccination has brought in many new providers who can do the bare minimum, said Rebecca Coyle, executive director. from the American Immunization Registry Association.
Because vaccine supplies have been so plentiful in recent weeks, making sure patients don’t overload vaccines hasn’t necessarily been a priority for providers, Coyle said.
“Examining a person’s history before administration has been the best practice for many years,” Coyle said. “It’s time to have a conversation about ‘Maybe I should do this’ because it hasn’t been on everyone’s mind yet. “
If pharmacists do not check immunization records and a patient receives an unauthorized injection, it could leave providers without payment if insurers deny the claim.
“They have no incentive to say, ‘Hey, come take your third dose,’” said Kurt Proctor, senior vice president of strategic initiatives at the National Community Pharmacists Association.
Kristine Grow, spokesperson for AHIP, the biggest lobby for health insurance, said the group had no indication that anyone is having difficulty getting a third injection when recommended by a doctor.
However, Aetna said based on current CDC guidelines, the insurer does not cover additional injections of Covid-19 for fully vaccinated patients.
Health insurer Anthem is monitoring the situation closely, a spokesperson said, and is awaiting advice on whether additional injections are recommended or needed.
“That said, any claim for the COVID vaccines we receive would be paid for without cost sharing to the member, as has been the case since the vaccine became available,” said Michelle Vanstory, vice president of external communications at ‘Anthem.
The American Medical Association on Friday unveiled a billing code for a Pfizer recall that could help insurers track them, but the code will only be active if the FDA clears the third shot.
If providers catch patients trying to get booster shots, it could be an opportunity for a conversation about current recommendations as opposed to a situation that could escalate.
“People are scared and don’t know what to do,” Coyle said. “There are so many reasons someone would be motivated to look for an extra photo and it’s hard to catch them all, so the logs can be tapped into to ask questions. “
In addition to going to a vaccination site, patients can discuss with their doctor prescribing a third injection outside of FDA clearance. This is what is leading hospital systems to develop policies to determine whether they will allow physicians to prescribe boosters.
The Mount Sinai Health System has said it does not approve of prescribing boosters, and said all providers administering additional doses will be notified and will need to complete additional paperwork to help collect safety data.
“The current surge in the number of people with Covid-19 is directly related to the refusal of people to be vaccinated, and not to the need for more vaccines for those who have already been vaccinated,” said the head of the division of infectious diseases of Mount Sinai, Judith Aberg and George. Baehr, professor of clinical medicine at Mount Sinai Medical School, said in an email.
The Mayo Clinic, University of Washington Medicine and Wellforce Health System are also not providing reminders, spokespersons said. AMA President Gerald Harmon said in an email that the group also supports the position of the FDA and CDC.
Associations of medical specialists who care for immunocompromised patients are also working on referral, as their patients may be good candidates for callbacks in the future. Ted Okon, executive director of the Community Oncology Alliance, said the group’s leadership is monitoring the issue and working on guidelines. The American Society of Transplantation has informed its members that there is not enough evidence to recommend booster shots or advice on when they should be given.
Beyond effectiveness, Deepali Kumar, president-elect of the American Society of Transplantation, said the organization is keenly aware of health equity issues if some patients have more resources to track down injections not. authorized or go to vaccination sites than others.
“It plays a big role, when we’re making recommendations for anything, that we want to make sure all patients have equal access,” Kumar said.