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UPMC: New patients priority

Health system aims to get more people first-time vaccines before boosters

In the ongoing campaign against COVID-19, getting unvaccinated people vaccinated is more important than getting vaccinated people boosters, according to UPMC experts in a virtual news conference Friday.

Likewise, getting a full course of shots with one of the three vaccines available should be the focus — not whether Moderna, Pfizer or Johnson & Johnson is better — because all do an excellent job protecting against serious illness and death, said Donald Yealy, chief medical officer for UPMC, and Graham Snyder, medical director of infection prevention and hospital epidemiology.

“I don’t want people to get lost in some of the scientific nuance of the duration of immunity and the strength of immunity.” Snyder said. “We know in our daily lives the most important outcome — staying well — (is something) all three do really well.”

The differences between them are “fairly trivial,” according to Yealy.

While in general, boosters are less important than initial vaccination courses, and while most people eligible for boosters can take their time scheduling those, boosters can nevertheless be critical for people who are immunocompromised, including people with HIV/AIDS, cancer and transplant patients who are taking immunosuppressive drugs and those with congenital diseases that affect the immune system, according to Yealy and the Centers for Disease Control and Prevention.

If you’re qualified for a booster but healthy, “you can walk” to get the additional shot, but if you’re immunocompromised, you might want to “run” — metaphorically, Yealy said.

The availability of boosters for some who’ve received the Pfizer vaccine doesn’t mean people are “all of a sudden” unprotected, Yealy said.

Rather, their immune systems may need a “reminder” on how to respond to the coronavirus — one that the presence of the virus itself can actually provide, he said.

The Food and Drug administration has approved Pfizer boosters for people who completed their initial series of shots at least six months ago and are 65 or older or over 18 living in a long-term care setting or who live or work in a high risk setting or who have an underlying medical condition, according to the CDC.

An advisory panel of the Food and Drug Administration has recommended that the FDA approve boosters for some who’ve received Moderna and J&J shots.

Boosters can serve as a “reminder” to our immune systems of how to respond to the coronavirus, Yealy said.

The big obstacle to getting the remaining 30% of the eligible population in Pennsylvania vaccinated seems to be hesitancy, and one reason for hesitancy is concern about long-term side effects, according to one of the questions at the news conference.

Vaccination side effects, however, aren’t a legitimate concern, according to the doctors.

The vaccines have been “incredibly well-studied,” Snyder said.

These vaccines have been subject to “the most intense scrutiny,” and have been used on hundreds of millions of patients, Yealy said.

Despite their relative newness — about a year of use — experts have learned more about them than about almost any other vaccine, Yealy said.

The vaccines are “absolute winners,” Snyder said.

“One of the safest bets possible,” Yealy said.

Moreover, long-term side effects generally begin to announce their existence relatively early, and the history of the COVID-19 vaccines has not been worrisome on that account, according to Yealy.

Finally, a COVID-19 infection is far more dangerous for someone who’s unvaccinated than any side effect might be for someone who gets a shot, Yealy said.

Despite UPMC’s promotion of vaccines, the organization doesn’t hesitate to provide monoclonal antibody treatment to help unvaccinated people recover from COVID-19 infections, Yealy said.

“We treat people based on what they need,” he said. “We don’t decide to give or withhold medical care based on any previous decision (of the patient).”

That’s “not how we want to be,” he added.

Nevertheless, that sort of situation can serve as a reminder that “choices have consequences,” he said.

It can also provide leverage for encouraging unvaccinated loved ones of recovering patients that getting a shot is “an earlier and better choice,” Yealy said.

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