Booster shot rollout against COVID-19 is likely to differ from the first vaccine effort

Although plans are incomplete, people will probably get shots from their doctors and pharmacies

Thousands were vaccinated in the spring at mass sites, such as the Hynes Convention Center, but boosters are likely to be given locally by doctors and pharmacies.John Tlumacki/Globe Staff

The federal government has recommended booster shots for Americans vaccinated against COVID-19, possibly starting as early as next month. But right now, it’s unclear how and where those shots will be administered in Massachusetts.

State health officials and health care providers said they are awaiting guidance from the federal government on the booster program, which was spurred by evidence that immunity wanes some months after the initial vaccination.

But already, one thing seems clear: This new phase of vaccine distribution will most likely bear little resemblance to the initial rollout earlier this year, which was characterized by insufficient and unpredictable supplies, an emphasis on mass vaccination sites, and a state-run sign-up system that initially defeated even seasoned computer users.

Marylou Sudders, the state’s secretary of Health and Human Services, said earlier this month that the state doesn’t plan to reopen mass vaccination sites. Instead, people will probably be able to get their shots at doctor’s offices and local pharmacies. And supplies are expected to be abundant.

The Centers for Disease Control and Prevention recently recommended vaccinated people receive boosters eight months after their second shot of the Pfizer or Moderna vaccines. The CDC proposed a start date of Sept. 20.

But first, the CDC’s Advisory Committee on Immunization Practices, scheduled to meet this week, and the Food and Drug Administration both have to make recommendations on when and for whom booster shots are advised.

Meanwhile, there has been talk of a six-month interval between the second vaccine and the booster, and on Friday, President Biden said that even five months was under consideration — which would mean that those first in line for the vaccine, health care professionals and nursing home residents, are already past due.

Other unanswered questions: Can the booster shot be from a different manufacturer than the initial vaccine? Will boosters be recommended for the Johnson & Johnson vaccine? (Johnson & Johnson recently said a booster at six months would improve immunity, but the federal government has yet to weigh in.)

These questions are especially relevant for the nursing home industry, which relied on CVS and Walgreens to administer the vaccines to patients and staff under a federal contract.

When that arrangement ended, nursing homes In Massachusetts obtained the vaccine from special pharmacies that supply long-term-care facilities, said Tara Gregorio, president of the Massachusetts Senior Care Association, a nursing home trade group.

”Government guidance is important because our pharmacies typically supply Moderna and J&J, but many of our residents received Pfizer,” Gregorio said in a text message.

In the initial vaccine rollout, local boards of health and primary care doctors complained that they were left out of the planning, despite their ability to reach and persuade the most vulnerable and hesitant.

Carlene Pavlos, executive director of the Massachusetts Public Health Association, said that again this time around, she is not aware of any effort yet to involve city and town health officials.

“Local public health needs to be engaged right now,” Pavlos said. “In many jurisdictions the public health staff knows their communities well . . . and would be an important resource for the state if they’re engaged early.”

Likewise, leaders of professional groups representing the state’s primary care doctors said they had not been contacted by the state about the booster shot plans. But many of the problems that occurred in the original vaccine rollout have been resolved.

For the first few months, many primary care doctors wanting to vaccinate their own patients could not obtain doses from the state, which controls the distribution of vaccines. But now there’s a system in place by which doctors who want the shots can order them.

“At this time, finally, physicians who request the vaccine are able to get it,” said Dr. Julie Johnston, president of the Massachusetts Academy of Family Physicians.

That’s important, Johnston said, because patients often want their personal physician, who knows their health history, to provide reassurance that the vaccine is right for them.

“As we eventually get to the younger children, families and parents are going to be having ongoing discussions with doctors who have cared for their children since birth,” she said.

Dr. Lloyd Fisher, president of the Massachusetts chapter of the American Academy of Pediatrics, noted that obstacles have been removed, such as the state’s requirement that doctors buy vaccine in batches of 100, use them up in a short period, and attest that little was wasted. Now doctors can order doses 50 at a time, and won’t get in trouble if they can’t use up every dose in a vial.

“That has made it much more practical for small practices,” Fisher said.

Also the rules on storage have eased. The Pfizer vaccine, once required to have ultracold freezers, can stay in a regular refrigerator for five days.

Dr. Russell S. Phillips, director of Harvard Medical School’s Center for Primary Care, said his internal medicine practice at Beth Israel Deaconess Medical Center started giving vaccines two months ago, and can now offer them to patients when they visit for any reason.

“Many colleagues will be giving boosters through their offices or at nearby sites that the local hospitals will staff and open, so I think we are in good shape,” he said in an e-mail.

But Pavlos, of the public health association, worries that “people are going to assume that supply equals access.”

“Other factors are as important as sufficient supply,” she said, such as the location of vaccination sites, the process for making appointments, and whether people can get paid time off to get their shot and recover from any side effects.

Massachusetts has one of the highest vaccination rates in the country — but more than 2 million people are still not fully vaccinated, and the poorest communities and communities of color tend to have the lowest vaccination rates, Pavlos said.

She fears that such inequities will only widen as the focus shifts to providing booster shots, “and those who haven’t yet received one shot and are not yet fully vaccinated won’t get the attention they need.”

Dr. Rebecca Weintraub, an assistant professor in the Department of Global Health and Social Medicine at Harvard Medical School, shares these concerns. Reaching the unvaccinated must remain a priority, she said. As long as the virus spreads among unvaccinated people, new variants will arise challenging the vaccine’s efficacy.

“If we want to deploy the power of the vaccine, the best booster is vaccinating and accelerating the vaccine for the unprotected,” Weintraub said. “The faster we protect the unvaccinated, it helps mitigate risks for all.”