Ask a doctor: Who should prioritize COVID boosters?

With children ages 5-11 eligible for COVID-19 vaccines and all adults in Massachusetts eligible for boosters, this holiday season will look much different than last year. But the broadened eligibility also put more demand on pharmacies and other vaccine providers. GBH News reporter Mark Herz spoke with Dr. Jessamyn Blau, the associate senior medical director for primary care at Cambridge Health Alliance, about who should prioritize getting boosters and what other precautions to take before gathering with family and friends. The following transcript has been edited for clarity.

Mark Herz: Now with vaccinations opened up to everyone 18-plus — and we've been hearing about some waning immunity — there's probably quite a bit of demand. I mean, me and my editor were poking around on CVS website and they only go out two weeks with the vaccine. Boy, nothing to be had. How are things looking on your end?

Dr. Jessamyn Blau: Demand is pretty tight right now, and I completely understand — especially people who want their kids vaccinated before the holidays, they want that little bit of extra immunity. Obviously, Thanksgiving is closing in on us, but there's still plenty of time to get a booster before the end-of-the-year holidays, before Christmas.

And I think our experience has been that the first week or two after these announcements is pretty frenetic with people, as you said, on the CVS website and kind of knocking down the doors, which is great. But for people who are willing to just wait a little bit, they might have a little bit of an easier time.

Herz: I assume you are still running some clinics. Who are they for? What kind of capacity do you have?

Blau: So at CHA, we run one major vaccination clinic that's located in Somerville. We actually are one of the few remaining public sites, so we vaccinate our own patients, but we also are open to the public. We have all three vaccines — J&J, Pfizer and Moderna — and obviously Pfizer for children. Supply has been fine. ... We're probably vaccinating between 500 and 600 people a day at our vaccination center, and then we also do some vaccinations at our retail pharmacies — there are three of those — and some vaccinations in our hospitals and our clinics.

Herz: With the boosters, do you think it's more of a priority for some patients rather than others?

Blau: We do know that there is waning immunity with all three manufacturers over time. We know that, still, the vaccines are really, really effective against severe disease and hospitalization, but we do know that immunity wanes over time and that the risk of contracting COVID — not necessarily serious COVID — goes up.

So absolutely, I'm recommending boosters to all my patients. The ones that I'm giving the particular nudge to are the people who are most at risk for either not having responded to the vaccine in the first place or for getting severe COVID if they were to contract it. So probably the first group on my mind is that immunocompromised group. ... We know that older people are at higher risk for complicated COVID, and we know that their immunity may be more likely to wane. So that's the second group. Anyone else with a comorbidity that predisposes them to severe COVID or thinks they might be exposed at work, right? So those are the people who are already eligible, they definitely should get the booster.

I think everyone else should get the booster too. I don't think it's urgent, get up at 3 o'clock in the morning to refresh the CVS webpage, you know? I think it's a “When you can get a booster, get a booster” kind of thing. It's definitely worth it, but it's probably not quite as urgent.

Herz: You mentioned comorbidities. What are some of the like?

Blau: There's actually been a lot of research into what makes people more likely to get sick if they get COVID. We know that being older does, we know that being immunocompromised does, but there's other things too. A lot of chronic medical conditions that are really common: diabetes, heart disease, dementia, cancer, history of smoking. And even more recently, there's been a growing body of evidence around people with substance use disorder or people with mental illness having a higher risk for severe illness from COVID.

Herz: What's interesting to me, based on what you're saying, is that they didn't do it in tranches and start working back, as they did when they did with the initial vaccination.

Blau: I think with the holidays coming up, it seems like the more shots we can get into arms, the better. I will also just say that it was very logistically complicated with the slow rollout [the first time around]: it's much easier to say everyone's eligible, so there’s also that.

Herz: You mentioned holiday gatherings, so I'll use myself as an example. I just turned 60 and I'm thinking about waning immunity and that the booster could make group gatherings much more safe. Am I overreacting? Am I not quite aligned with with the medical facts?

Blau: I think what's really challenging now is that it's all gray. It's different people's levels of risk. It's the levels of risk of everybody in the room, and it's the levels of risk aversion of everyone in the room, right? I think the more we can do to protect ourselves, the safer our holiday gatherings are going to be. So, you know, having everyone be vaccinated — preferably boosted — kids who are eligible being vaccinated. Even partially vaccinated, is better than not vaccinated at all.

Rapid testing, probably we underutilize it. It's not perfect, but it is additional data. And I think just being respectful of each other when we do have symptoms. It's not going to be perfect this year, but we're definitely closer than we were last year. I think there's a lot of things we can do to keep each other safe. And obviously, vaccinations are part of that.

Herz: What are your plans, and what are your COVID preparations?

Blau: For Thanksgiving, it'll be my mother who is vaccinated, my child who is partially vaccinated and my partner and I — both of us are vaccinated. We're still keeping Thanksgiving pretty small.

For Christmas, it'll be a little bit bigger. Everyone will be vaccinated, everyone will be rapid-tested, but probably around 10 people. The littlest little kids can't be vaccinated, but we also know the risk is really low. We haven't seen them in a couple of years, and I think with all of us being vaccinated and boosted and tested — I'm feeling pretty comfortable about that.