No eligible Californian should be denied booster, officials say

A woman gets a booster shot at a McDonald's.

Nov. 11, 2021 Updated 9:24 AM PT

No fully vaccinated adult should be denied a COVID-19 booster shot, the California Department of Public Health says.

The move comes as health authorities are trying to increase the number of Californians getting the booster shots, fearing that slow early demand could increase the chances of another winter coronavirus wave.

“Do not turn a patient away who is requesting a booster,” Dr. Tómas Aragón, the state health officer and public health director, wrote in a letter. Booster patients must be adults, and at least two months must have passed since receiving a Johnson & Johnson vaccine or six months since getting the second dose of the two-shot Pfizer-BioNTech or Moderna vaccination series.

The U.S. Centers for Disease Control and Prevention has said for weeks that any adult who has received any of the three vaccines should get a booster shot if they live or work in settings that put them at increased risk for exposure to the coronavirus, such as hospitals, schools, grocery stores, factories, farms, jails, the Postal Service and public transit.

But as concerns grow about the potential threat of a fifth wave of COVID-19, health officials in California — at both the state and local levels — are increasingly encouraging all residents to consider getting the booster.

There is increasing evidence that the immunity provided by shots received months ago weakens over time. Without a booster, vaccinated people will be at greater risk for breakthrough infections, which can lead to hospitalizations and death among the most vulnerable.

Officials are suggesting it would be tragic if those eligible did not get a booster ahead of the winter holidays. According to the CDC, only about 34% of fully vaccinated seniors in California 65 and older have received a booster shot; among all fully vaccinated adults in the state, only 14% have received one.

“If you think you will benefit from getting a booster shot, I encourage you to go out and get it,” said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency. “It’s not too late to get it this week. Get that added protection for the Thanksgiving gatherings that you may attend. Certainly, going into the other winter holidays, it is important.”

Authorities are already noticing more coronavirus cases among the first group of vaccine recipients last winter, Ghaly said.

Scientists and doctors say vaccinated seniors or those who have weakened immune systems are at greatest risk of having to be hospitalized from a breakthrough infection. And, while younger, healthier people are more likely to survive a breakthrough infection without severe illness, they can become a source of viral transmission that could sicken elderly family members and friends.

In the state’s letter, Aragón directed vaccine providers to allow patients themselves to determine whether they’re at risk — which would qualify them for the booster, according to the CDC’s criteria.

He offered a host of explanations that would fit the CDC’s eligibility criteria and cover essentially all California adults. People at increased risk may include those “who live in geographic areas that have been heavily impacted by COVID,” those who “reside in high transmission areas,” “who work with the public or live with someone who works with the public,” or “live or work with someone at high risk of severe impact of COVID.”

The bottom line? Vaccine providers should take the position that “nobody will be turned away who wants a booster,” Dr. Marty Fenstersheib, the COVID-19 vaccine officer for Santa Clara County, Northern California’s most populous county, told reporters this week.

“If you look at the CDC guidelines, and you drill down to the various groups, what you end up with is the recognition that pretty much everybody is eligible,” Dr. Sara Cody, the public health director and health officer for Santa Clara County, said.

The California Department of Public Health went even further, offering more ideas of who could be eligible under CDC criteria. In a statement, the department said: “In general terms that everyone can understand, we urge Californians to get a booster if someone in their home has a medical condition or if they work around other people.”

The list of qualifying medical conditions is expansive — including being overweight, pregnant, a current or former smoker, or having high blood pressure, diabetes, asthma, depression, anxiety or an alcohol- or drug-use disorder.

California’s official recommendations for people who should get the vaccine, last updated Oct. 22, is already slightly more permissive than what the CDC suggests. The state recommends the following people receive booster shots:

• Adults who received a Johnson & Johnson shot at least two months ago; and,
• Adults who received their second Pfizer-BioNTech or Moderna shot at least six months ago who have an underlying medical condition, live in a long-term care setting, work or live in a setting at high-risk of exposure to the coronavirus, or are at increased risk to COVID-19 due to social inequity.

Times staff writer Melissa Healy and the Associated Press contributed to this report.