Vaccine 3rd Dose: Answers

Aug 20, 2021

Who is eligible for a 3rd dose?

The CDC has authorized Pfizer and Moderna vaccine recipients for a 3rd dose if they have a health condition that severely weakens their immune system.  2.7% of the adult population and a small number of adolescents will qualify.  These conditions include the following:

• Organ transplant recipients
• Current treatment for blood and lymph cancers (leukemias and lymphomas) and most other types of cancers requiring chemotherapy
• Stem cell transplant recipients
• Advanced HIV infection
• Active treatment with medications that weaken components of the immune system, including 20 or more milligrams/day of prednisone or comparable steroid medications, TNF blockers, and other medications that impair response of the immune system
• Primary immunodeficiency diseases (e.g., DiGeorge, Wiskott-Aldrich syndromes)
• Severe renal disease

Anyone qualifying for a third dose should already be under the care of a physician.  It is best for you to have a discussion with your personal doctor to decide: 1) if a 3rd dose is appropriate for you, and 2) if any temporary modifications in your treatments are needed to get the greatest benefit from a 3rd vaccine dose.

What if I received the Johnson & Johnson vaccine?

For the moment, there is no authorization to provide recipients of the J&J vaccine with an additional dose.  Questions that need to be answered include the amount of benefit people will get from an additional vaccination and which brand of vaccine will give the greatest benefit.  For every 1 American who received a J&J vaccine, 12 others received an mRNA vaccine.  As a result, evidence has accumulated more quickly regarding the benefits of a supplemental dose in Pfizer and Moderna recipients than for those who received J&J.

The CDC knows that people who have received the J&J vaccine and have high-risk underlying health problems are anxiously awaiting guidance.  Research to answer these questions is currently underway.  The doctors on the CDC Vaccine Advisory Panel have said that they will provide the public with an answer as soon as possible.

I have diabetes or another health condition not listed above that I’ve been told puts me at higher risk of COVID complications.  Why don’t I qualify for a 3rd dose?

The evidence at this point shows that for people with diabetes, chronic hypertension, obesity, severe asthma, etc., 2 doses of Pfizer or Moderna continues to dramatically minimize severe disease from the Delta variant of COVID.  There is no evidence that a third dose will further decrease hospitalizations or risk of death.  Anyone who has only received 1 dose of Pfizer or Moderna should get their 2nd dose as soon as possible.  A single dose of mRNA vaccine does not provide adequate protection against Delta.

I’m 65 or over.  Do I qualify for an additional vaccine dose?

At this time, there is no approval of a 3rd dose solely on the basis of age.  This is another area of active research.  The CDC experts point to continuing evidence of extremely good protection for seniors against severe illness, hospitalizations, and death after 2 doses of Pfizer or Moderna vaccines.  They acknowledge that with the Delta variant, more seniors have been infected, but those infections have rarely led to hospitalizations unless the individual also had one of the health conditions listed above.  Before they recommend additional doses, they want more evidence of significant benefit for those 65 and older.

Our local experience supports this position.  Since the Delta variant began to dominate 1 month ago, most hospitalized Garrett residents have not been vaccinated.

My 14 year-old is undergoing treatment for leukemia.  Can she receive a 3rd dose?

Yes.  Anyone 12 and over who weighs at least 88 lbs (40 kg) is eligible for a 3rd dose.  Just as we recommend for adults, it’s best to contact your child’s doctor to see if any treatment modifications are needed to maximize benefits from a 3rd dose.

What is the timing for a 3rd dose?

The 3rd dose should be administered no sooner than 28-days after you received your second dose, regardless of whether you have been vaccinated with Pfizer or Moderna.  A 3rd dose given 1 month or 6 months after your 2nd dose works equally well, so there is no need to restart your vaccination series.

If I have one of the immunocompromising conditions listed above, does that mean I don’t have to worry about becoming severely ill from COVID if I receive a 3rd dose?

People with severely immunocompromising conditions are likely to be better protected after a 3rd dose than after the standard 2-dose series, but even a 3rd dose, they are still more susceptible to severe illness than the general population.  Infectious disease experts recommend layered protection for everyone who is immunocompromised.  That includes full vaccination, avoiding crowded venues, wearing a mask when out in public, and doing your best to maintain social distancing.  The other key protection is to have everyone in your household receive their vaccines against COVID.  The most common source of transmission is within households.  Once one person has COVID, everyone else in the house will soon be exposed.  Please keep in mind that people are contagious 1-2 days before they develop any symptoms, if they develop symptoms.  The better we protect ourselves, the better we protect others.

I have an immunocompromising health condition.  How do I get a 3rd dose?

If your personal doctor (primary care or specialist) provides vaccines, you can contact her/his office for your dose.  Even if they don’t provide COVID vaccinations, it’s still recommended that you contact them to ensure that a 3rd dose is right for you and whether your treatment protocol needs to be temporarily adjusted to get maximum benefit from the vaccination.

If your doctor doesn’t provide vaccinations, the Garrett County Health Department and local pharmacies should be able to help you.  Our health department anticipated the need for some people to receive 3rd doses, but we never receive advanced notice about policy changes at the federal level or the state level.  As a result, we did not know who would be eligible for 3rd doses or what the timing for approval would be until late last week.  We are making modifications to our electronic health record to properly record vaccinations and updating patient education material.  We should be ready to offer vaccines for eligible people later this week.

Updated August 18, 2021 @ 3:57PM