As Delta variant rises, so do second-dose skippers

BOSTON — It’s something Americans have been hearing since last December when Pfizer’s first shipment of COVID-19 vaccine went out.

“You need both shots to be sure you’re fully protected,” said Dr. Daniel Kuritzkes, the chief of the Division of Infectious Diseases at Brigham and Women’s Hospital, repeating, once again, the recommended dosing regimen for the two mRNA vaccines on the market.

But increasingly, it seems, that regimen is falling on deaf ears. Through mid-June, the Centers for Disease Control and Prevention confirmed some 15 million Americans seem to have skipped the second dose of the Pfizer and Moderna products. That amounts to a non-compliance rate of 12%.

The agency told Boston 25 News it will be updating the figures later this week.

“I’m sure a lot of it just has to do with the convenience factor, the hassle to have to go in and make that second appointment,” Kuritzkes said. “Some people may have had, you know, fevers and felt crummy for a day or so and not want to do that again.”

Kuritzkes said that seems a small price to pay for the durable immunity to COVID-19 one gets from vaccination.

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“There may just be some people who think the caseload is going down,” he added. “There are just so few cases happening now in many parts of the country, why should they bother to get fully vaccinated?”

One recent study, funded by Public Health England, suggests there’s ample reason to get two doses of the Pfizer vaccine. It found effectiveness against the Delta variant climbing from 35.5% after a single dose to nearly 88% after two doses.

Dr. Jeremy Kamil, an associate professor of microbiology and immunology at LSU Health in Shreveport, Louisiana, calls the two-dose data very clear and very strong. And suggests it sends a message to those who have skipped dose two.

“You can control your behavior and go back and get that second shot and do your part to protect our community and to protect our country from the pandemic having another big wave here,” Kamil said. “But the fate’s sort of in our own hands to do the right thing. So if you’ve only gotten one shot, unfortunately with these new variants, especially, you’re not likely to be fully protected.”

Oddly, some with just one dose of Pfizer or Moderna on board may have better protection than those fully vaccinated. But they paid an entry fee most would rather avoid: they were previously infected with COVID-19.

“There are now at least five or six robust studies to suggest that people who’ve had COVID-19, a single dose of vaccine would provide an excellent response, probably comparable to or even better than getting a two-dose vaccine,” said Dr. George Abraham, the chief of Medicine at St. Vincent Hospital in Worcester. “So, therefore, in that category of people, I would be less worried.”

The one worry is if that category assumed they had a COVID-19 infection instead of actually finding out they did. Last spring, Kamil got sick twice with symptoms that resembled those of the coronavirus.

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“I worried because I had a bad cold, I was laid out in bed, got like five PCR tests, all negative,” he said. “And that happened twice. I thought I had it. So a lot of people think that they’re immune and they’re not.”

And that could be a deadly mistake. While COVID-19 remains more of a mortal threat to those over 65 and those with pre-existing conditions, younger people have also succumbed.

What concerns some, long-term, is first whether dose-skipping will continue to grow. And second, whether it will impact the uptake of that possible third, or booster shot, if it’s ever needed.

“It worries health care workers like us because we fear we will see a repeat of 2020 and we all have a bit of COVID-19 fatigue,” Abraham said.

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