What will the Covid-19 booster rollout look like? Public health groups plan as they await details

Health agencies, providers, and other groups tasked with the herculean effort to vaccinate the public against Covid-19 are readying for the next phase of the endeavor: boosters. But they’re also having to account for an array of unknowns about who will be eligible and when, with just days remaining before the White House originally said the shots would be available.

“They’re planning to plan, because there’s so little information right now about what this is going to look like,” said Lori Tremmel Freeman, the CEO of the National Association of County and City Health Officials.

The Biden administration said last month that booster doses of the Pfizer-BioNTech and Moderna shots would start rolling out the week of Sept. 20, with people becoming eligible eight months after receiving their second dose. But there’s been little clarity since then what the deployment of boosters will actually look like, whether the eight-month timeline might shift to six, or whether additional shots will be recommended for everyone or just certain groups, given that data show the vaccines haven’t lost any significant protection for most people. Even vaccine regulators at the Food and Drug Administration have signaled they don’t think boosters are needed at this point for the general population.

Depending on how widely boosters are authorized and what local demand looks like, providers say there could be some bumps as the shots become available. But nine months into the vaccination effort, they know the ropes. They’re well practiced at scaling their efforts; handling the logistics of getting, storing, and administering doses; and trying to reach as many people as possible. Supply is no longer an issue, and those involved said they’ll be able to adapt to the next stage of the country’s vaccination plan, noting that they’ve already been offering third shots of the mRNA vaccines from Pfizer and Moderna to certain people with compromised immune systems.

“Our members are a little bit on pause right now, because it’s not entirely clear what will happen with boosters,” said Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials. But he added: “The general feeling is we know how to do this.”

Whatever booster plan gets the green light from federal health agencies — which should become clearer in the coming days — the campaign to give additional shots won’t look like the early days of the vaccine drive. Dedicated clinics could spring up in some communities, but unless there’s a massive demand, states likely won’t reopen mass vaccination sites that helped the country administer some 4 million doses a day during its peak.

Similarly, the government isn’t expected to tap national pharmacy chains to deliver boosters at nursing homes and some long-term care facilities like it did last winter. Those facilities instead will largely rely on their existing pharmacy networks to get booster shots once they’re authorized.

“The federal government is changing the way it operated its original long-term care facility vaccination program,” a CVS Health spokesperson wrote in an email. “For facilities interested in working with us for booster shots, we’ll be providing an online resource they can use to contact us directly. We’ll work closely with facilities for the best solution for each of their unique needs.”

Instead of mass vaccination sites, more shots will likely be administered at pharmacies and by health providers. Major pharmacy brands like Walmart and CVS Health have said they’ll contribute to the deployment.

“It’s using the community access points that are there now,” said Mitchel Rothholz of the the American Pharmacists Association.

Primary care offices could play a more prominent role than in the early days of the vaccine roll out, particularly if the government winds up issuing nuanced guidelines about who should get a booster and when. It’s possible, for example, that health agencies initially will recommend boosters only for seniors, health care workers, and residents of long-term care facilities.

“If we’re going to have a lot of complexity around Covid vaccines, I think we really want to be leveraging the primary care platform,” said Ann Greiner, the CEO of the Primary Care Collaborative, noting that people with questions about vaccines often turn to a trusted physician to talk about them.

An FDA advisory committee is meeting Friday to discuss the application for boosters from Pfizer, and the agency could expand its authorization for third shots of the vaccine soon after that. If the FDA green lights boosters, a Centers for Disease Control and Prevention panel will then make a recommendation about who should receive the shots. That group, the Advisory Committee on Immunization Practices, is scheduled to meet Wednesday and Thursday.

Meanwhile, the administration’s original goal of having a Moderna booster available next week has been pushed back. There are also plans to eventually offer a second shot of the one-dose Johnson & Johnson vaccine, but they are not as far along.

If health authorities limit boosters to just certain people, an additional challenge for groups doling out shots could be denying those who thought they would become eligible for another shot, said ASTHO’s Plescia. Already, some people who aren’t yet eligible have finagled their way into getting a third dose.

Providing boosters will also become yet another item on the to-do list of vaccine campaigns that are grinding away on the more urgent task of reaching people who haven’t been vaccinated at all. Freeman, of the county and city health officials’ group, said that boosters are coming as local agencies’ agendas are loaded: school is starting; flu season is looming; and perhaps later this year or early next, children under 12 will become eligible for Covid-19 shots.

“We’ll be at this for quite some time,” Freeman said.