Is it safe to get a COVID vaccine booster from two brands?

Jordan H. was eager to be vaccinated against COVID-19 when several vaccines were granted emergency use authorization. His wife, a teacher, was a priority. While waiting to be eligible, Provo’s dad, 39, read all he could about vaccines.

When his turn came, he chose a location with the Johnson & Johnson vaccine – not because it was a single dose, he said, but because he tested well in Africa. South where a new variant of COVID-19 was circulating. He thought doing well against Variants was important for the future.

Fast forward six months and Jordan has again lined up for a COVID-19 vaccination. This time, he wanted – and found – the Pfizer-BioNTech vaccine. He had trusted health experts who said it didn’t really matter which vaccine you got, but subsequent reports left him wondering if it was true.

“Things started to spread about other variants, then I learned that there were concerns about the effectiveness of the J&J vaccine. compared to other vaccines available, ”he told Deseret News. “I’m almost 40 years old and healthy, but I have asthma. I realize that I am not invincible.

He had had his first chance in a grocery store. He went elsewhere for the other brand of vaccine. Since he didn’t want to lie, he told an employee that he had lost his vaccination card, but that he was also changing brands. The individual simply handed him a new card and recorded his “first” move.

Jordan is among a growing number of Americans trying to obtain information from a myriad of sources about COVID-19 vaccines – some of which are contradictory – to determine the best way to protect themselves and their families. families as research continues on the need for additional doses of the drug. . Because vaccines are a controversial topic, he asked that his last name and profession not be used.

Recent reports suggest that some people are trying to get a second type of vaccine like it did. Others are anticipating what could be an upcoming recommendation from public health officials to get a vaccine booster around eight months – something the Biden administration supports and hopes regulators will approve.

Some believe that getting two different brands of vaccine could be extra protection. Others would try to replace a J&J shot. Like Jordan, they fear that the vaccine’s effectiveness will be lower than that of Pfizer or Moderna in preventing infections and hospitalizations.

While Jordan used his real name and was outspoken in researching another brand of vaccine, authorities believe there are others who are not telling the truth in order to skip the line or cross the brands . They are taking advantage of the fact that a booster has already been approved for people with immune disorders like a solid organ transplant or cancer. To get the recall, others would have to go to a clinic or pharmacy and lie if asked if they qualify.

Some nursing homes offer a third chance for those who want one, saying older people are particularly vulnerable and their immune systems have likely weakened over time.

But while it apparently isn’t hard to get a callback, the jury is still out on whether it’s a good idea?

Other priorities

Audrey Stevenson, director of the family health division of the Salt Lake County Department of Health, has heard rumors of people trying to play with the vaccination system, but has not seen direct evidence. She thinks most people take advice from public health experts. The cases she’s heard of of people crossing brands are mostly anecdotal in the media, she said.

Questions about the health risks or benefits of an additional vaccine or rebranding have yet to be resolved. Stevenson thinks most people have been patient – and also curious whether studies would address issues such as the need for a booster shot and when is the best time.

She said public health officials were still focused on trying to get individuals to receive their initial vaccine. “But we notice at our awareness events that people show a preference for the vaccine they want.”

More is known about the safety and effectiveness of individual vaccines as they were designed for use, although speculation and some small studies have considered variations. For example, Moderna is testing whether its COVID-19 vaccine and a flu vaccine can be combined in one shot.

The recommendation of public health experts, including the Centers for Disease Control and Prevention and the World Health Organization, is to stick with one brand of COVID vaccine, Stevenson said, and that is the rule for those who are authorized to provide vaccines. “As long as the initial product used is known – and it should be on the vaccination record or in the vaccination register – we should be able to give them the same.”

Go forward

Without regulatory approval, getting an early recall for most people requires misrepresentation. People are asked if they are immunocompromised. We don’t ask them for details. Stevenson said she hadn’t heard of a vaccinator turning someone down because they doubted the answer.

Officials deemed the vaccination so important that they did not need ID. They don’t want to discourage those who don’t have one or are hesitant to show one.

Even if a doctor writes a prescription for this type of vaccine use “off-label” – a term that describes prescribing drugs outside of their directions for use, such as a branded cross-dose or as a reminder for someone. one who is not immunocompromised – the vaccinator is supposed to say no. Stevenson said vaccinators are limited by federal guidelines.

Within 24 hours, COVID-19 vaccinations are supposed to be entered into the Immunization Register, a database that tracks vaccinations like those required to go to school, among others. At least initially, the vendors were so overwhelmed and the pandemic process so novel that some entries were lagging behind.

Among other reasons, the register is important as a means of checking the status if someone loses the vaccination card. This may become more important if employers require workers to present proof of vaccination as part of a new presidential term. The registry could help ensure that the timing between doses is correct. This could potentially show that someone has changed vaccines – or if a provider checks, prevent that from happening.

More to learn

Experts say it’s difficult to get a direct comparison because the efficacy tests used different end points. Pfizer and Moderna both use mRNA technology, and their vaccines test their efficacy in the prevention of symptomatic disease to an average of 90%. But those numbers weren’t generated while variants were circulating. J&J is known to be around 66% effective against moderate to severe infections and 85% effective against more severe infections, including at least some variants. It was also developed using different technology.

Less is known about J&J as it was deployed after Pfizer and Moderna. But studies of all vaccines are ongoing.

The Associated Press reported “J&J presented laboratory data on anti-virus antibodies that indicate that its vaccine protects against the delta variant for eight months and longer. Another small lab study has raised questions about whether a two-dose approach would work better, an option J&J is investigating. “

There are other vaccine-related questions with conflicting early answers. The science is not established, experts say, on how long natural immunity lasts for those who contracted COVID-19 earlier – or whether it is the same in everyone. There is evidence that it is decreasing. Among the questions under consideration is whether a single dose of any of the vaccines is adequate for those with some natural immunity. A study in Israel suggested that surviving COVID-19 is better protection than vaccines. Other research disagrees.

“Giving a single shot of the vaccine to those who had already been infected seemed to strengthen their protection. The long-term benefit of an inoculation booster, which has just started in Israel, is unknown. The data was published as a preprinted article on medRxiv and has not yet been reviewed by other researchers ”, Bloomberg reported.

This study also raised questions about the degrees of immunity according to the variants.

Food and Drug Administration advisers are meeting on Friday to discuss the possibility of recommending an additional injection to boost the Pfizer vaccine. It’s the only one with full FDA approval at the moment, but only for ages 16 and over. It has emergency use authorization for 12-15 year olds and is being studied in young children.

An international panel of scientists including researchers from the FDA and the World Health Organization published a review this week in the medical journal Lancet of all published studies and related clinical trials. They conclude that the general population does not need a booster dose at this time.

“Taken as a whole, the studies currently available do not provide credible evidence of a substantial declining protection against serious disease, which is the primary goal of vaccination,” said lead author Ana-Maria Henao- Restrepo, from WHO, in a Press release on the journal article.

“While the idea of ​​further reducing the number of COVID-19 cases by boosting immunity in those vaccinated is attractive, any decision to do so should be evidence-based and consider the benefits and risks to them. individuals and society, ”she said. “These high-stakes decisions should be based on solid evidence and international scientific discussions. “

The panel said if COVID-19 vaccine boosters were needed, the flu vaccine would likely inform conception. This vaccine formula changes to target flu variants that are expected to circulate during the year. Likewise, COVID-19 boosters would likely be suitable for the variants in circulation.

Jordan had no complications after receiving a second type of vaccine and completed the two-shot series of Pfizer. He used his real name. And he imagines he could be listed in the immunization database as being doubly covered, but he feels good about his decision.

“It seems to me that I had a callback,” he said.

He believes in vaccines and believes COVID-19 vaccines “appear to be among the safest around.” He gets the flu shot every year and has said he will follow future recommendations for COVID-19 vaccination. He just stopped trusting a vaccine. He also thinks he’s probably less at risk from vaccines than from the amount of additives in the foods he consumes each year.