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What might happen if people skip the second dose of the COVID vaccine

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The success of America’s massive COVID-19 vaccination program now underway depends on people receiving two doses, three to four weeks apart. But a recent study suggests that many people may not get their second injection, which is necessary to build maximum immunity.

The research, published December 14 focused on a vaccine to prevent the viral skin disease known as shingles. He found that one in four Medicare patients missed their second dose within six months of the first.

Recipients of the two COVID-19 vaccines currently approved for use may be more likely to complete their vaccination than those in the study, for reasons including an increased health risk if they do not. But the authors of the new study warn that many of the same obstacles will be at work: not only patient neglect, but also poverty, age and isolation.

A high number of incomplete vaccinations could make it more difficult to contain the coronavirus and end the pandemic, which is spread out of control in most states. It could also lead to more deaths and hospitalizations than there would otherwise be.

To make matters worse, the study found that follow-up vaccination rates for shingles were much lower for some groups. Only 58% of Hispanic patients, 61% of black patients, and 69% of Asian patients received a second dose. Meanwhile, only 64% of low-income patients and 66% of disabled patients returned for their second doses.

“This obviously has troubling implications for the COVID vaccine,” says Juliette Cubanski, one of the study’s authors and deputy director of Medicare policy at KFF, formerly the Kaiser Family Foundation. “These groups are among the hardest hit in terms of serious illness and death from COVID.”

There are some important differences between Shingrix, the shingles vaccine, and the coronavirus vaccines. Obviously, while shingles can be extremely painful and even debilitating, it is rarely life threatening. And with the coronavirus in the news every day, patients will be less likely to simply miss their second dose.

Another factor that points to higher second dose rates for COVID vaccines is timing. Patients could wait up to six months for their second dose of Shingrix, but the two COVID vaccines currently being administered – one from Moderna and the other from Pfizer-BioNTech – require a second injection within three to four weeks. According to Cubanski, Shingrix’s longer delay may have made it easier for patients to forget their follow-up injection.

But other factors that kept patients from going through their full Shingrix treatment will still be in effect when it comes to COVID vaccines.

One is the complex and often unpredictable payments that are inextricable in American health care. The Shingrix vaccine required a co-payment for each dose, which Cubanski said may have discouraged some people from getting a second. In contrast, the coronavirus vaccine is not expected to require any payment from U.S. beneficiaries, even for the 29 million Americans without health insurance. But Cubanski fears people may not realize they can get the vaccine for free.

“People’s concern that they have to pay for something out of their own pockets can be a problem, even if there is no real cost,” she says. “They may not know that the vaccine is really free.”

Transportation is also likely to be a problem. Disabled, low-income or rural Americans in particular may have difficulty reaching a vaccination site not just once, but twice. Rural areas have some of the lowest influenza vaccination rates– as low as 25% in some cases – partly because of the distance.

Finally, Cubanski is concerned that some vaccinated against the coronavirus may be discouraged from taking their second dose after an adverse reaction to the first. Although reactions do not appear to be common, Pfizer and Moderna vaccines can cause mild muscle pain, fatigue, or low fever.

“These side effects are a sign that the vaccine is working, not a sign that you have been infected with the virus and now have the disease,” Cubanski says. “It’s an important message to get across.”

In fact, it is medically impossible for Pfizer or Moderna vaccines to transmit the virus behind COVID-19. While some vaccines use weakened versions of the virus they are protecting against, new COVID vaccines use new technique to trigger immunity without using viral material.

Meanwhile, there is no single system in the United States to ensure that patients receive their second dose. This responsibility will fall on the individual recipients and the various health providers administering the vaccine.

A major vaccination site should be outpatient clinics, including those run by Walgreens and CVS. Walgreens says it will use a variety of techniques to keep track of doses, including scheduling an appointment for a second dose when the first is given and sending reminders to patients via mail, email and Voice Messaging.

As with most aspects of the coronavirus pandemic, these challenges have implications beyond the individual who misses their second dose. Test data indicates that a single dose of Moderna or Pfizer vaccines provides significant protection of the coronavirus, but a second dose makes this protection much higher and probably more durable. If enough people miss their second dose of the vaccine, it could take much longer to achieve the level of population-wide immunity needed to prevent the virus from circulating and end the pandemic.

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