San Franciscans with compromised immune systems are now eligible to receive a third dose of the COVID-19 vaccine. Yet most residents shouldn’t expect to be lining up for a booster any time soon.
“With a third dose of an mRNA vaccine, our intent is to prevent severe illness among people who may not have had a complete immune response to the initial two-dose series,” said San Francisco Director of Health, Dr. Grant Colfax. “For now, we ask that only individuals who meet the criteria for immune compromise request a third dose.”
City health officials said they are monitoring guidance from the Centers for Disease Control and Prevention before expanding opportunities for additional vaccine doses to the broader community.
Some have questioned giving additional doses to people who are vaccinated and have low health risks. “It’s like you’re having a feast and across the fence, someone is begging for food,” said Peter Chin-Hong, a professor in the UCSF Health Division of Infectious Diseases. “I just want to make sure everyone is protected against getting really sick and going to the hospital. It’s an impossible task to really prevent all infection.”
In the meantime, San Franciscans who are in cancer treatment, receiving an organ transplant, have advanced or untreated HIV or have other specific health criteria are trickling in slowly to receive a third dose, which is typical for immunocompromised patients receiving other types of vaccines, as well.
“Two patients who are immunocompromised got their third dose here already, and I have three scheduled for this week so far. But this is nothing compared to the volume of demand we had early in the pandemic,” said Zeke Montejano, director of clinic operations at South of Market Health Center, which has injected more than 10,000 vaccines to residents across The City so far this year.
The CDC estimates that only 3% of the population meets the criteria for a third dose. At clinics like South of Market Health Center where Montejano works, patients self-attest if they qualify for the third dose and do not need proof of medical status.
At the Mission Neighborhood Health Center, Chief Medical Officer Jaime Ruiz has seen about a dozen patients come in the past week for a third dose. One patient was on high-dose steroid treatment for asthma, which meets the criteria for a third dose.
But recently, other community members have been calling and asking about a potential booster shot after President Biden announced that extra doses could soon be recommended for all Americans about eight months after their initial dose.
That’s led to confusion in the days since San Francisco announced that third doses would be available beginning Aug. 18.
Ruiz and other medical experts and practitioners are hesitant about giving everyone boosters for a number of reasons. “My concern is that it was hard to convince people to get the two or one-dose series,” said Ruiz. “I’m not sure how they will feel about a third dose.”
Local and national infectious disease experts are also urging those without severe medical conditions to hold off on getting an extra shot while some communities, locally and internationally, remain hesitant to get their first dose.
“I think the U.S. should donate some of its large surplus vaccine supply for global vaccine equity instead, which will decrease worldwide transmission and the emergence of future variants,” said Monica Gandhi, a professor of medicine at UCSF. “It’s not a good moral and ethical look.”
Even in San Francisco, where 72% of residents have received a full dose, health experts who watched disparities play out with the initial vaccine rollout say The City should be using its muscle to get more individuals vaccinated for the first time before recommending a booster.
Unvaccinated people are nearly six times as likely to contract COVID compared to those who are vaccinated, according to state data released Monday.
Beyond supply issues, Gandhi has another concern: Giving vaccinated people a third dose might not help prevent infection as well as some may think. The majority of symptomatic breakthroughs in San Francisco have been delta variants, but the vaccines were designed with the original variant in mind.
“Another problem with giving a third dose is that the antibodies generated from the spike protein made from the original mRNA or DNA (used in the Johnson & Johnson vaccine) won’t be adapted towards the variants,” said Gandhi.
She and other infectious disease experts are hopeful that the surging delta variant will begin to diminish by the end of September when Biden said boosters should be available for all.
“I predict that delta will go down in the Bay Area by the time plans for boosters come up,” said Chin-Hong of UCSF. “For those who are not immunocompromised, you don’t need an extra shot yet. There’s no evidence to support it,” he said, adding that the World Health Organization and CDC do not yet support extra doses for the general population.
Chin-Hong shares many of Gandhi’s concerns around vaccine equity and supply — but also remains optimistic, given that hospitalizations have been very low among the vaccinated.
Meanwhile, doctors in The City’s community health clinics are pushing ahead with efforts to get as many San Francisco residents their initial dose as possible.
“This really takes an effort from everyone,” said Montejano. “It doesn’t seem like we will be at the end of the tunnel any time soon.”