The health care industry has been focused on getting as many people vaccinated as possible against Covid-19. The nation's "decentralized" vaccination campaign has created a new challenge—how to monitor people trying to get unauthorized booster shots, Rachel Cohrs writes for STAT News.

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Growing interest in booster shots

According to Cohrs, interest in booster shots has grown in recent weeks, amid increases in Covid-19 cases and hospitalizations, as well as Pfizer's intention to seek FDA authorization for a booster. Moreover, several other nations—including Israel, Germany, and the United Kingdom—have started to allow booster shots, Cohrs writes.

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In the United States, however, federal officials have said it's still premature to consider booster shots, since Pfizer's current two-dose regimen remains effective against severe Covid-19, and vaccines remain in short supply worldwide.

Speaking to this growing interest in booster shots, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical advisor to the White House, said, "We're a long way from that. People are jumping the gun here."

Nonetheless, some patients are trying to get additional vaccine doses, either by asking a health care provider willing to prescribe an extra shot or by lying about their earlier vaccination, Cohrs writes.

Holes in a decentralized system

Because the overall vaccination rollout in the United States has been decentralized, the onus has fallen on health systems to make prescribing policies, vaccination sites to check people's vaccine records, and insurers to decide whether they will cover vaccines outside of FDA's authorization, Cohrs writes.

And while some providers may be willing to prescribe additional doses, Cohrs writes, many health systems—including Mount Sinai Health System, Mayo Clinic, University of Washington Medicine, and Wellforce Health System—do not endorse prescribing booster shots.

"The current surge in numbers of individuals with Covid-19 is directly related to individuals declining to be vaccinated, not the need for more vaccines to those who already have been vaccinated," Judith Aberg, chief of the division of infectious diseases at Mount Sinai, and George Baehr, a professor at Mount Sinai's medical school, said. According to Cohrs, Mount Sinai currently sends a notice to any providers who administer a booster shot and requires that they fill out additional paperwork to monitor safety data.

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Similarly, American Medical Association (AMA) president Gerald Harmon said the group supports the current FDA and CDC position on booster shots—although the group did recently unveil a billing code for a Pfizer booster shot that could help insurers track them. (According to Cohrs, the code will not be active unless FDA authorizes the third shot.)

In addition, many vaccination sites—namely pharmacies such as Walgreens and CVS—have explicit policies not to give additional shots to fully vaccinated people.

How patients slip through

However, according to Cohrs, some people have managed to slip through this decentralized network of vaccination oversight—particularly at pharmacies, where pharmacists don't always check immunization records beforehand.

According to Cohrs, when patients arrive at vaccination sites, they usually are required to attest that they have not yet been vaccinated. Best practice dictates that vaccinators check this information against state registries. But some states don't require providers to confirm this information, so some people who've already been vaccinated can receive another shot.

Rebecca Coyle, executive director of the American Immunization Registry Association, noted that one issue for pharmacists is that vaccines have been in abundant supply in recent weeks. She added, "Reviewing a person's history before administration has been the best practice for many years. It's time for a conversation about, 'Maybe I should do that,' as it hasn't been on everyone's minds yet."

Additionally, Kurt Proctor, SVP of strategic initiatives at the National Community Pharmacists Association, noted that pharmacists likely aren't incentivized to keep an eye out for boosters because, since they are not yet authorized, insurers could deny the claims. "They don't have any incentive to say, 'Hey, come get your third dose,'" he said.

Speaking broadly, Kristine Grow, a spokesperson for America's Health Insurance Plans, said the group is unaware of anyone having trouble receiving coverage for a third shot when it is recommended by a physician. However, according to Cohrs, company policies can vary.

For instance, Aetna does not currently cover additional Covid-19 shots for fully vaccinated patients. Anthem, meanwhile, is "monitoring the situation closely," although Michelle Vanstory, Anthem's VP for external communications, said, "[A]ny claims for COVID shots that we receive would be paid with no cost sharing for the member, just as they have been since the vaccine became available."

Meanwhile, CDC said while it is still not recommending boosters, it is starting to track data on unauthorized booster shots. Director Rochelle Walensky said, "[T]he government…is encouraging people to report safety outcomes if they receive boosters." (Cohrs, STAT, 8/3)