4th COVID Shot: Who In NJ Should Get It, Will More Need It?

NEW JERSEY — Health officials recommend a fourth COVID-19 vaccine — or a third of the Johnson & Johnson shots — for many people who are moderately or severely immunocompromised. But evolving findings on how quickly each vaccine's effectiveness diminishes may mean that more people around New Jersey will eventually get advised to receive them.

The Centers for Disease Control & Prevention only recommends an extra shot for people with weakened immune systems, who carry an increased risk of severe COVID illness or death. But the Food and Drug Administration began reviewing data that could lead to clearing a second booster dose of the Pfizer or Moderna vaccines this fall, sources familiar with the process told The Wall Street Journal.

Pfizer will soon submit data to U.S. regulators on a fourth dose of its COVID vaccine, CEO Albert Bourla told Bloomberg on Tuesday. Bourla expects the pharmaceutical corporation to approach the FDA with data on how effectively the fourth dose helps restore immunity.

Three million New Jerseyans have received a booster shot as of Friday, according to the CDC. That's 45.7 percent of the 6.6 million people in the state who completed their primary COVID vaccination course. As of Friday, 39,000 people in New Jersey have received a fourth vaccine dose.

State officials have pushed for those eligible to get the booster shot, showing data for hospitalizations and deaths from breakthrough cases in New Jersey. From Jan. 23 to Feb. 19, 0.7 of 100,000 people in the Garden State who received the booster died from COVID-19, while the virus killed 5.4 per 100,000 people within that span.

"The latest numbers on breakthrough cases changes nothing of what we've been saying over the past eight months that we've been bringing you this data," Gov. Phil Murphy said March 4 at the state's last COVID-19 news briefing. "Getting vaccinated and boosted dramatically decreases your chance of severe COVID that could lead to hospitalization or death."

The difference in COVID-19 death rates by vaccination status became clearest during the peak of the omicron wave, according to New Jersey data. The state health department reported the following the following for the week ending Jan. 8:

• unvaccinated: 675 deaths, 25.25 per 100,000 people
• primary vaccination course complete, no booster: 127 deaths, 3.32 per 100,000 people
• fully vaccinated with booster: 41 deaths, 1.82 per 100,000 people

Murphy promised the state would update breakthrough numbers weekly on the New Jersey Department of Health's COVID-19 dashboard (go to the cases and mortality tab and go to "cases by vaccination status").

The state health department sent a memo Feb. 25 to all vaccination partners, alerted them of the CDC's updated guidance for providing additional doses to eligible people.

"The Department actively encourages everyone to receive all doses for which they are eligible, including for people ages 5 and older with immunocompromising conditions to receive an additional dose due to their elevated risks, Nancy Kearney, a state health department spokesperson, told Patch via email. "The Department has also worked to ensure providers are readily offering these additional doses to individuals."

The Pfizer and Moderna boosters lose substantial effectiveness after four months but remain significantly effective in keeping people out of the hospital, according to a CDC study published Feb. 18. The shots were 91 percent effective in preventing people from getting hospitalized the two months after a booster shot, the study found. But after four months, protection fell to 78 percent, according to the research.

Seventy-eight percent is still good protection, according to Dr. Anthony Fauci, the White House's chief COVID-19 advisor. But what remains to be seen is how much potency continues to drop after more time passes.

“There may be the need for yet again another boost — in this case, a fourth-dose boost for an individual receiving the mRNA — that could be based on age, as well as underlying conditions," Fauci said last month.

Who Should Get an Additional Shot

For now, the CDC only advises people who are moderately or severely immunocompromised to get an additional COVID-19 vaccine. Find more details here.

The national push for booster shots has put U.S. health agencies at odds with the World Health Organization. The WHO acknowledges that data indicates the COVID-19 vaccines' waning effectiveness over time. But the organization believes increasing vaccine access for the entire world needs to be the top priority for ending the pandemic.

The CDC considers people moderately or severely immunocompromised if they have the following:

• been receiving active cancer treatment for tumors or cancers of the blood
• received an organ transplant and are taking medicine to suppress the immune system
• received a stem-cell transplant within the last 2 years or are taking medicine to suppress the immune system
• moderate or severe primary immunodeficiency, such as DiGeorge syndrome, Wiskott-Aldrich syndrome
• Advanced or untreated HIV infection
• Active treatment with high-dose corticosteroids or other drugs that may suppress their immune response