Do you need a booster shot to be fully vaccinated against COVID-19?

San Francisco doctors and health officials differ on the topic

Nearly 98% of San Francisco city employees are considered fully vaccinated — for now.

Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said at a news conference recently that the definition of “fully vaccinated” may need to be updated as boosters become more widely available.

But whether boosters should be required for everyone to qualify as fully inoculated is still up for debate among San Francisco’s top medical experts.

“Boosters will be a bigger deal than I appreciated based on some newer data,” said Dr. George Rutherford, an infectious disease expert at UCSF. “You have to prepare for the worse. Last winter, it went way up starting in October. November will be a make-or-break month.”

Studies have shown waning efficacy for COVID-19 vaccines after more than six months. Specifically, data from Israel, the United Kingdom and other regions have show that COVID-19 vaccines lost some strength when it comes to virus transmission.

But little evidence shows that the original two-dose vaccine series wears off to a dangerous degree for most individuals, and hospitalizations and severe illness continue to remain low in highly vaccinated regions such as the San Francisco Bay Area.

That’s why other experts like Dr. Monica Gandhi, who heads up the Division of HIV, Infectious Diseases, and Global Medicine at UCSF, reject mainstreaming COVID-19 booster shots. Breakthrough infections are to be expected, she said, and vaccines are working.

“We don’t need to boost everyone,” she said. “The vaccines at a two-dose regimen are holding up against severe disease. If you form B cells, they can last 90 years.”

B cells produce antibodies that recognize an invading virus and signal to other immune cells to attack it. Some B cells are eventually stored as “memory B cells,” which create a blueprint for the body to make more antibodies as they naturally wane and fight the same virus in the future.

Yet most epidemiologists including Rutherford and Gandhi agree that some individuals — anyone over 65, people who are immunocompromised or people who come into close contact with the virus due to their work or institution — should get a booster.

Another point that’s not up for debate: Broadening the definition to include booster shots would throw a curveball at San Francisco’s vaccine requirement for all of its 35,000 workers, including those in the mayor’s office and among police officers, firefighters and other first responders.

“Vaccines are the most effective tool we have available to protect each other from COVID-19 both in the community and in the workplace. At this time, The City is not requiring booster vaccinations for city employees,” said Mawuli Tugbenyoh, chief of policy for the San Francisco Department of Human Resources. “We’re proud that the vaccination rate among city employees is nearly 98%. We will continue to provide information about the safety and effectiveness of vaccines including boosters and will closely monitor the situation.”

Just over 830 out of 35,000 city employees reported that they were not vaccinated by The City’s Nov. 1 deadline to get vaccinated. That includes about 200 San Francisco Municipal Transportation Agency staff (including 100 transit operators), 80 police department staff (including 60 police officers), 15 fire department staff and 20 deputy sheriffs, who face due process deliberations that could lead to termination.

City workers are not required to get a booster shot. The City’s Department of Human Resources is encouraging staff to get a booster if they are eligible, but no formal or even informal recommendation or requirement has been put in place.

Currently, San Francisco city employees are considered fully vaccinated two weeks after they have had a two-dose series of the modern or Pfizer vaccines or a single Johnson & Johnson shot. And the definition of “fully vaccinated” is not likely to change soon, as the U.S. Food and Drug Administration does not yet recommend booster shots for everyone.

Those tasked with heading up labor negotiations are now fielding questions about boosters as confusion bubbles.

“Our membership has been asking about this since the beginning. They’re questioning what comes after the booster shot and when will it be enough,” said Roger Marenco, president of Transport Workers Union Local 250A, which represents 2,200 transit workers in San Francisco.

San Francisco’s health care workers, police and transit operators were among the first groups to get offered the vaccine once doses were available last winter. Many people in these groups are now eligible for booster shots, according to local health guidelines.

As experts continue to discuss efficacy surrounding booster shots, local policymakers are navigating whether waning vaccine efficacy is a concern they should prioritize after the nation’s top public health official hinted that boosters could become essential for everyone.

“Walensky was completely out of line to suggest that” fully-vaccinated could eventually include boosters, said Gandhi. “I wouldn’t mandate boosters. We can mandate a vaccine. But this has now been an almost three-month-long discussion with wide public dissent over boosters. This is not something you want to add to any mandate lightly.”

Last week, COVID booster shots were approved for Moderna vaccines, and mixing and matching vaccines for boosters were also recently given the thumbs up by the country’s top medical experts.

The CDC recommends a booster shot of Pfizer or Moderna’s COVID-19 vaccine at least six months after receiving a second dose for: people 65 and older, people over 18 in long-term care settings or with underlying health conditions, and people between 18 and 64 who are at increased risk for COVID-19 exposure in their occupational setting.

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