Third Shot? How dumb am I?
August 23, 2021 2:21 PM   Subscribe

It's estimated that 10% of the population are getting a third shot. Should I go and get it now (regardless if it's a higher dose than the booster might be?) I'm a 54M and a parent of three younger kids. I've shed 80lbs in the last 3 years (currently 185) - BP is normal, resting HR is 50. I'm in good health, but not an athlete.

I got the first dose (Pfzier) in March and the 2nd 30 days later. No side effects.

I have three kids under the age of 10; I'm in a northern state - and while we have masking as a mandate in the schools, between my wife working in a school building and each of the three in a different building, the next four weeks are going to be painful.

I'm stressing the **** out over many other people. Yes, of course, there's a stress sense of what little control I can have over the situation.

But I sat on nails waiting for my (now healthy) number to come up in our state.

It looks like Sept 20th is going to be when the US rolls out their booster shot. Why shouldn't I just walk into my local pharmacy and get it now? This is both an ethical and a best practices question.

It looks like the shots best efficacy is closer to 5 months than 8 when it comes to terms with delta. It also looks like Moderna handles delta better.

I'm due to travel in Oct. And my small business needs the money. It's not work I can turn down. A week in Vegas.

I'm a layman - and I'm hoping the hive mind here will help me with the ethics of this and the best practices if I go down this route.

And if your against vaccination? I'm not interested in your opinion.
posted by filmgeek to Science & Nature (30 answers total)
I'm not sure what ethical questions you have. I don't believe you are suggesting any kind of fraud here or intent to game a system.
posted by archimago at 2:24 PM on August 23, 2021 [2 favorites]

Why are you eligible for a booster? You do not sound immunocompromised. It's time to be patient and wait.
posted by tiny frying pan at 2:25 PM on August 23, 2021 [14 favorites]

Unless you're in an area that's short on doses I would just go get it. If you're concerned you'll be turned away tell them it's your first and you have no insurance. People in the USA are being offered money to get vaccinated and they still refuse to get vaccinated. Doses are being thrown away. I don't think you should feel any ethical qualms about doing this.

In your position I would get Moderna as my third dose. You can go on and search by vaccine type. Be aware that the side effects may be more severe than that of Pfizer.
posted by Anonymous at 2:31 PM on August 23, 2021

You're still in the period of time where you're really well protected by your first two shots! The evidence around boosters points to potentially waning immunity about 8 months after vaccination (and even that is being hotly debated by epidemiologists and public health folks). You have not had 8 months pass yet, so you are still well-protected by your first two shots.

You are not eligible for a third shot at this time. Right now, only people with specific conditions are eligible. If you went to a pharmacy, they might give you a third shot - I don't know your jurisdiction and it varies by the pharmacy - but you would have to lie.

To me, this is not ethical - you're not deriving benefit from the third shot and you're deliberately lying.
posted by quadrilaterals at 2:31 PM on August 23, 2021 [36 favorites]

No. Duh. Do not lie to medical professionals about your vaccination history.
posted by heatherlogan at 2:34 PM on August 23, 2021 [16 favorites]

I would however suggest getting some good-quality N95/KN94/whatever masks to wear during your trip.
posted by heatherlogan at 2:35 PM on August 23, 2021 [3 favorites]

Regarding ethics specifically, I think if there's no shortage in your area it's not unethical, and possibly more ethical than the alternative if you're going to be traveling, and if the vaccine surplus in your area actually shrinks or disappears once people start getting their boosters (i.e., getting a shot later might be delaying someone else's booster, while getting a shot now might just mean one fewer shot thrown away. But it depends on your area).
posted by trig at 2:37 PM on August 23, 2021 [2 favorites]

(Besides the ethical question...this is a bad idea medically. This is not something a doctor would tell you, specifically, to do now.)
posted by tiny frying pan at 2:39 PM on August 23, 2021 [8 favorites]

You sound like me in your reading. I'm also pretty stressed about the Delta variant. You're citing research, I think, but not giving links, so I can't speak to the specifics you're mentioning (10% of the US population is getting a booster? 5 months is better than 8 months?).

I guess I'd say this: if you believe in science so much that you got this vaccine when others were scared, why would you now ignore what science is saying about this? If you think you really need one, then make the case to your doctor. Currently the way to get legal and ethical eligibility for a booster is to have a conversation with your doctor.

I'd also ask if you are doing everything else you need to do to be healthy and have a strong immune system. Are you getting enough sleep each night? Are you exercising regularly? Limiting the consumption of sugar? Are you getting several servings of vegetables a day? Are you taking vitamin supplements for D and anything else where you might be deficient? Are you taking care of yourself and focusing on stress reduction? Are you in therapy to help manage stress?

Here's the thing: a booster shot isn't magic. If you get a booster, you aren't going to feel any differently. Your body won't know. You will still need to be diligent, and you'll probably still be stressed reading about breakthrough cases (I'm guessing you're doing what I'm doing).

Also: World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus on Monday called for a two-month moratorium on COVID-19 booster shots as many low- and middle-income countries still struggle to provide enough vaccine doses for their citizens.

The Associated Press reported Ghebreyesus made these remarks while speaking to reporters in Budapest. The WHO head argued that “vaccine injustice and vaccine nationalism” fuels the risk of more infectious COVID-19 variants emerging.

If you get a booster, it's you, as a relatively privileged American, working the system to benefit in ways you aren't even sure works. It's not based in science but it would be a decision driven by fear and anxiety. That can't be the way to gain a sense of a control in life.

We are all stressed and scared right now. Please don't use stats about others cheating ("10% of Americans") to justify making a decision about medicine without input or approval of medical professionals. A booster shot isn't a cure for stress and anxiety.
posted by bluedaisy at 2:41 PM on August 23, 2021 [21 favorites]

So the OP may not be planning to lie about vaccination history, but instead to fudge the reason for the shot: places like CVS are giving it on the honor system to anyone claiming to be immunocompromised on the web registration form. OP, I have no opinion as of yet as to whether you/anyone should go out and do this now, instead of waiting, but I sympathize as I have a lot of complicated thoughts of my own about this given my own health history and exposure risks (though for now I am firmly in the camp of waiting it out).
posted by blue suede stockings at 2:44 PM on August 23, 2021 [1 favorite]

1. Full FDA approval of the Pfizer vaccine means doctors may be able to administer the shot “off label.” The biggest advantage of this is that it opens up the potential for kids younger than 12 to potentially get it before additional approvals. There will be more people, in a large group at a time who will likely need that stock.

2. Today the WHO asked countries with robust vaccine stock to hold off on booster shots for 2 months to increase vaccine equity. Yesterday’s argument that the shots are just being wasted anyway is out the window. You would be taking away from someone else if you went and got a third shot right now (and you are not immune on promised).

I’m generally a fan of lying to authorities when rules or stupid or unnecessary, but in this case I don’t believe it would lead you to an ethical end.
posted by raccoon409 at 2:44 PM on August 23, 2021 [8 favorites]

Because your immunocompromised community members have been locked in their homes for 530 days and counting, and it is their turn for boosters right now. Please just wait your turn.
posted by twelve cent archie at 2:50 PM on August 23, 2021 [22 favorites]

Mod note: One comment removed. Do not use the racist term “illegals” to describe people, period.
posted by cortex (staff) at 3:02 PM on August 23, 2021 [38 favorites]

Data point: I got a booster last week. They asked detailed questions about why I qualified. I don't think they were cross checking against health records, but still, nurses are saints to whom you shalt not lie.
posted by Dashy at 3:06 PM on August 23, 2021 [2 favorites]

As best I can tell, the question of whether a third dose is actually necessary or wise for people in your risk group is contested by scientists right now. If we take the fact that the wind is blowing toward a third dose in the US as a sign that it actually is necessary, when it comes to the details of your own third dose, I think you should listen to those experts who are making that case. They're the ones best suited to judge when and for whom this makes sense, not us and not you.

Definitely not anti-vax over here, and definitely feeling you on the Delta blues. Mask up, keep your distance, do your best. I imagine your kids are at the front of your mind where your risks are concerned, as my own child is for mine. Apropos of that, do we know that a third dose helps reduce odds of transmission? I feel like I am following this fairly closely for a layperson but I do not know much about actual third dose data at all. I have the sense of events rushing faster than data, which never feels great.

I'm sorry we're all in this.
posted by eirias at 3:49 PM on August 23, 2021 [5 favorites]

I’ll echo what everyone else has said and add another point:
If you do this, it’s is not a one time lie that will go away. This will go on you medical record, and we are possibly moving to requiring proof of vaccination for entrance to public events and places.

Additionally if we are required to get a second booster at some point, because you’ve gotten this one earlier than your group was allowed, you will either have to lie again or be stuck in a timeframe where your vaccination efficacy is waning but cannot get vaccinated and will either have to lie again or live in more fear than you are now.

You have done everything you can to be safe. If you trust the science that vaccines work, please trust them when they say the vaccine you’ve already gotten is still protecting you. I know it’s hard but please wait.
posted by Pretty Good Talker at 4:19 PM on August 23, 2021 [11 favorites]

The third dose that people are taking right now is meant to help make people with compromised immune systems whole in their vaccination, as the standard initial two doses weren't enough to successfully protect for this particular cohort.

And here's how not-enough the initial two doses have been: A recent Johns Hopkins study found that fully vaccinated transplant patients have an infection rate 82 times higher than in the general vaccinated public and the rate of serious illness is 485 times higher (link).

I'm a transplant patient. I wanted to bring this up because some folks think there's not much of a difference between this wave of third dose vaccine recipients and genpop and are perhaps thinking that their vaccination is flagging or ineffective in a similar way. It'll take a few months to see if this works as intended. A sibling is a dialysis patient, a cohort with an estimated 80% effectiveness for the standard doses, and has not yet been invited to take this third dose even though they were part of 1c in my state.

In your place, I'd talk to my doctor and see if they thought I should move ahead. Otherwise, please keep masking, keep distancing, please keep doing your part. I've been isolated though this whole thing, and it's hard not to envy the folks who have that level of liberty.
posted by mochapickle at 4:42 PM on August 23, 2021 [25 favorites]

I got a third Moderna vaccine recently on the advice of my doctor because I have some autoimmune stuff and I've been fully vaccinated for more than six months. I filled out the paperwork myself and was not challenged on the decision. There was no verification process.

My immune reaction to the third one was a lot more intense and long lasting than either of the other two. I'm still pretty sore in that arm and lymph node from the shot three days ago.
posted by answergrape at 5:07 PM on August 23, 2021 [1 favorite]

I got my booster on Saturday. I also live in the North East. You are asked a series of health related questions (general /non specific questions) checking to be sure you met the criteria set by the CDC for a booster. You do not choose what booster you want: its goes along with what vaccine you originally received. I definitely go along with Answer grape---- no reaction to rounds 1 or 2 but round three kicked my butt for 24 hours but it again made me aware that I do not want covid for any length of time! Could you play the system, for sure...I guess that's a personal decision that I would not question anyone's motive at this point!
posted by sunnypup at 5:17 PM on August 23, 2021

My preference is to wait until the special new vaccine that specifically targets the Delta variant becomes available.
posted by metonym at 6:30 PM on August 23, 2021 [4 favorites]

I just want to note that people in this thread who are encouraging you to get a third shot are sharing vaccine misinformation. For example, we have not yet fully tested the efficacy of switching brands. Yet there is someone up thread saying that you should get Moderna as a booster (aka SPIKEVAX) because you got Pfizer for your first two shots. This is not in alignment with current scientific evidence. It's also not okay to tell the pharmacist that it is your first dose and then never show up for your "second," because that messes with scientific evidence. Public health officials are keeping close track of how many vaccines are delivered, and you shouldn't make that data dirtier for personal gain.

One of the really difficult things about this pandemic is experiencing just how little regard people have for evidence-based medicine. This is not just a moral issue. It's why we are in the mess we're in. We cannot individually come up with our own little plans or workarounds to get the vaccine in the way that we want, because we do not have the expertise to know what we are doing. If we've learned anything in this pandemic, it's that public health is not a question of "personal decisions." There are moral and practical reasons to not jump the line.
posted by twelve cent archie at 9:07 PM on August 23, 2021 [23 favorites]

It is my understanding that one reason the delta variant is causing people who have gotten two Pfizer vaccines to get sick is because many of those people had their first two shots really close together. There is a reason why there is a waiting period between many other types of vaccine booster shots, analogous to that of a student cramming for an exam. Two closely spaced study sessions in one morning are going to get the material into your memory less effectively than if you study on two different mornings. Because the next wave of the pandemic was coming in hard and fast they allowed people to get their second shot early. They figured it was better than going into a bad wave of many infections with only one shot. But the price we paid is same as the student who does their studying all in one day, six months later the material is not nearly as likely to stick as if it had been properly spaced.

I think you will want a third shot, but if you get one in the next couple of weeks you are jumping the gun on your own immune system and you'll stay in the situation of the student who has the material only in short term memory and not in long term memory. The longer you can hold off getting your next booster, the more effective it will be.

I am not an epidemiologist. My analogy only goes so far. But I think the protection you get from an additional even-more-too-soon shot will turn out to be a lot less than you hope and could make it hard to get onto a good vaccination schedule later. The vaccine is not more effective if you double dose or triple dose. Your immune system really does need extra time to marshal your defenses.
posted by Jane the Brown at 10:30 PM on August 23, 2021 [1 favorite]

Response by poster: This has helped me quite a bit.

I realize that I'm trying to ascertain if there are any negative biological repercussions in getting the booster early - from both a physiological and bureaucratic point of view.

Along with the grey hat best practice if I were to go down this line.

I've never stopped wearing a mask when indoors, except in my home. And I haven't been to a restaurant, aside from takeout in nearly two years. I'm not doing this casually.

Just for the people asking for "links" - I'm not looking to get into an argument of where I find my data. I know what you're really asking/arguing - how much of an internet pilot am I?

Preprint study of a lesser efficacy of Pfzier Of course, this needs validation and deeper looks into Delta.

Example: Moderna's Press release saying that efficacy at 93% through six months - but caveats about delta (This is a moderna press release)

The Atlantic's Article from four days ago on "Why wait 8 months?"
. Of note: "ABC News revealed that an internal CDC memo estimated that at least 1 million Americans have already gotten a third shot—and that was before either announcement.".

I am not a physician or epidemiologist. I'm watching/listening to more educated people around this field (some are physicians and epidemiologists) as well as the edge research and reaction in countries like Israel. And no, I'm not looking to be an armchair expert. I'm aware of my knowledge gaps - thanks.

I'm watching the trend between various news sources and reading the comments on some places with people's opinions that *are* physicians and researchers.

Yes, I'm discussing this with my physician.

There is (beyond my control) a surfeit of any of the three vaccines available near me. I'm not bribing someone. These will go to waste and are freely available to the community. Nobody is being cut out of a dose if I walk into my local pharmacy. Zero.

Boosters are going to be offered Sept 20th ion the US. And Delta accounts for 98% of new infections.

I'm at 5 months since first jab. My concern is that my trip in October occurs during month 7.

I found out last week that my physician - contracted COVID last week. Normally, I'd involve her as she's been very prescient and accurate over the last 5+ years - and especially recently.

I can wait two weeks until she's back on the job (hopefully for her health and family). Thanks all.
posted by filmgeek at 3:55 AM on August 24, 2021 [1 favorite]

Perhaps a point not worth mentioning since the US will require 8 months between second dose and booster, but Israel required only 5 months and the groups who have gotten boosters are seeing much better protection against Delta, at least in terms of how I am interpreting the data:

Even when trying to follow the science and public health experts, there are a lot of different viewpoints.

I will not be getting the third dose before the US recommends it, but I do think that getting it sooner than 8 months will increase your protection pretty meaningfully against Delta (especially as your initial vaccine efficacy wanes) which will be helpful to reduce risk of catching it and spreading it to your unvaccinated child. Whether doing it at 5 months rather than 8 means it won't last for as long, I am not sure.
posted by NorthCoastRiver at 4:53 AM on August 24, 2021

We all desire much more certainty than is possible right now. Based on available evidence, literally no one knows the answer to your question beyond the hints we have from pre prints etc that you're aware of already. My personal guess (I'm a nurse and read news articles as you do, but have no magical ability to see the results of future, large scale research) is that it likely is of little consequence if you personally get another vaccine today. There may be some benefit, a large benefit, no benefits, and/or harm to you. We don't know. But we do know that you already have much greater protection than the vast majority of earth. And probably a third shot will not provide absolute protection.

While I get the desire to impact our own lives, a big lesson of COVID is that we aren't in a bubble. Honestly the speed at which we can vaccinate the world with even a modestly effective vaccine is more important to each our well being than our personal dosing schedules.

There's lots of stuff that was worth fighting the system about during COVID (shout out to early pro-mask advocates!) but I'm going to sit on my hands on this issue and take a booster if and when I'm prompted to.
posted by latkes at 7:36 AM on August 24, 2021 [6 favorites]

Oh man. I don't think we can understand postmarketing estimates of vaccine effectiveness through a tweet thread, especially one that's half in Hebrew (at least, I sure can't -- probably we have some MeFites who read). Everything depends on how you define the comparison group. It is really, really hard to get that right.

If it's your kids that you're most worried about, can you afford to do a couple BinaxNOW tests and quarantine in a hotel for a week or so after your return? It won't provide absolute protection... but neither would a third dose.
posted by eirias at 8:40 AM on August 24, 2021 [4 favorites]

I will not be getting the third dose before the US recommends it, but I do think that getting it sooner than 8 months will increase your protection pretty meaningfully against Delta (especially as your initial vaccine efficacy wanes) which will be helpful to reduce risk of catching it and spreading it to your unvaccinated child. Whether doing it at 5 months rather than 8 means it won't last for as long, I am not sure.

That is not how I understand the data, though I haven't been able to dig into the source data as much as I'd like. I can't read Hebrew, so I can't confirm what the tweets say. Unless you can read Hebrew and are trained in understanding epidemiological methods, I would caution drawing these conclusions from those tweets. I don't read Hebrew, but I do understand epi methods - I am an epidemiologist and I work on COVID. (All opinions are my own.) I have significant concerns about the interpretation of the Israeli booster findings in terms of confounding variables.

A booster shot has not been shown to work better against Delta. There is not evidence to say that you need a booster shot at 5 months. There is not evidence to say that you need a booster shot at 7 months. There may be evidence to recommend a booster shot at 8 months, but we're still trying to parse the data and get a better understanding.

Boosters at 8 months also hasn't been decided yet - there are still multiple discussions that have to happen with scientific evidence. We're not just waiting for a rubber stamp; we're waiting for the highest trained people to review this material. It is unclear why the WH circulated this information without these discussions having happened, but here we are.

Talking to your doctor sounds like a great idea.
posted by quadrilaterals at 9:16 AM on August 24, 2021 [4 favorites]

"A booster shot has not been shown to work better against Delta."

Meaning protection against Delta with a second dose (that was given 5-8 months ago) and no booster is no different than if you add a booster?

"That is not how I understand the data, though I haven't been able to dig into the source data as much as I'd like"

Can you explain how you do understand the data? Not trying to be snarky and I apologize for how the tone may come across when written on the internet. I am just seeing that, according to those charts, efficacy among the groups who received a booster seems to have improved. And I've seen elsewhere, not just interpreting from this chart, that the effectiveness of the vaccine does wane over time (less so for severe infections or hospitalizions). So thinking about the waning effectiveness, and then seeing the Israeli charts where post-booster efficacy increased, that's how I've interpreted it. So that's why I struggle to understand your comment about the booster not working better against Delta - otherwise, what has suddenly changed the course for these Israelis?
posted by NorthCoastRiver at 9:57 AM on August 24, 2021

And on a related note, from this paper yesterday:

" Our results confirm high effectiveness of BNT162b2 against hospitalizations through roughly six months after being fully vaccinated, even in the face of widespread dissemination of Delta. Reductions in effectiveness against SARS-CoV-2 infections over time are likely primarily due to waning rather than Delta escaping vaccine protection."

That is similar to my point that Delta doesn't seem to be the unique factor here, but more just the waning efficacy over time since second dose (again, just for infection, not severe/hospitalized which that first sentence says remains strong. But that isn't the key point if you're worried about just catching and spreading to a child.)
posted by NorthCoastRiver at 10:05 AM on August 24, 2021

An update in case the original poster is still following this thread:

Biden administration is likely to approve boosters at six months, per the WSJ
posted by NorthCoastRiver at 1:56 PM on August 25, 2021

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