5 key considerations as 'mix and match' boosters roll out

By Pamela Divack

The authorization and upcoming rollout of boosters creates many new opportunities and challenges for health care leaders. Be sure to keep these five things in mind as you prepare your vaccine strategy moving forward. 

1. Communication and education still matter—fully boosting all eligible people will require proactive efforts from all parts of the health care industry. 

   It's possible that the initial booster rollout may be slow, as people may struggle to understand what the boosters do, why it's important to boost immunity, and whether there are potential side effects.  as well as hesitance to take off work or dedicate time to getting the additional shot. Aside from the clinical concerns patients may have, there may also be confusion surrounding eligibility and different mix-and-match regimens. 

   Additionally, reaching originally hesitant and hard-to-reach populations and convincing them to take a booster—especially for those who originally opted for the J&J one-dose vaccine due to simplicity and convenience—may be a challenge. As we've seen before with initial vaccine doses, there are many 'unvaccinated but willing' individuals who fall short of receiving a shot for various reasons outside skepticism. We anticipate a continuation of this challenge, even with boosters. Successful booster rollout will require proactive outreach efforts and other key steps from all parts of the health care industry.

   Despite the positive booster news and authorizations, our best tool to fight the virus is still getting as many people vaccinated as possible. Efforts to roll out boosters should not detract from trying to improve vaccine uptake overall. 

     

2. Booster rollout will be complex for administers and distributors—it is essential to develop clear protocols. 

   The vaccine supply chain is about to get much more complex with Moderna's half-dose booster shot (and full third dose for immunocompromised people), J&J and Pfizer's full third dose, varying dosing interval schedules, the impending authorization of different-dose vaccines for kids, and complexities around mixing-and-matching. 

   Leaders must develop and implement ways to organize this complexity and track various protocols, account for unpredictable supply and demand of different shots, prepare for an influx of demand if eligibility widens in the coming weeks, and prevent potential waste. They should also prepare for the potential need to dedicate space, resources, or staff to booster clinics, to help more efficiently and easily distribute boosters to those eligible, and clearly communicate what boosters they have available with patients (who may actively seek out specific shots.)  

    

3. Mixing and matching makes the vaccinator's job both easier and harder.
   

   This future complexity presents a challenge for individual vaccinators, too. Organizations must ensure their staff are equipped to handle varying dosing regiments, timing intervals, and eligibility criteria for different populations – and keep up with potential eligibility expansion in the future. Tracking various protocols will increase the mental load on vaccinators to ensure they're giving the right dose to the right patient at the right time (especially if booster doses are not shipped in different vials), and staff must be trained and prepared to manage this complexity.   

    

4. Providers and regulators must continue to track data on the vaccines, even after booster rollout.

   As we push forward in the quest for immunizing the population, we need to keep tracking data to understand a myriad of questions: whether we will need yearly boosters, which vaccine regimens are most effective, optimal timing of vaccination, effectiveness against different variants, and risks associated with different populations, among others.The answers to these questions will likely determine long-term vaccination strategy and pandemic response. The more data available, the less room there is for confusion and misinformation. 

    

5. Equity efforts will always be important, especially if we hope to vaccinate the world

6. We've said this before and will say it again: equity must be embedded into every aspect of the battle against Covid-19. Providers, pharmacies, and clinics must not lose sight of lessons learned during the initial phase of rollout—such as offering boosters at convenient hours, so people don't need to take off work or bringing the shots directly into the community. Review key takeaways from an organization that led a successful and equitable Covid-19 response with the initial vaccine rollout—the lessons still apply to the booster rollout. 

While there are more than five considerations in the booster rollout, these are important to think about right now. As we await CDC's final recommendations on boosting and mixing-and-matching, health care leaders need to start preparing for the complexities involved with boosting patients. 

Andrew Mohama contributed to this piece