If asked to show her vaccination card, Stacey Ricks can choose from three.
Ms Ricks, 49, a kidney transplant recipient who takes immunosuppressive drugs, did not develop antibodies after her first two injections of Moderna.
In June, without revealing that she had already received the Moderna injections, she received a dose of the Johnson & Johnson vaccine before federal health officials approved someone for a third injection.
Getting his fourth and fifth shots was trickier. In July, pharmacy records in the Houston area where she lives finally showed her previous shots. Armed with a doctor’s note explaining that she had not developed antibodies, Ms Ricks convinced a pharmacist to give her two doses of the Pfizer vaccine over the summer.
âShe kept saying, ‘There is no clinical data here,’â recalls Ms. Ricks. âAnd I said, ‘Hey, I got the clinical data. “
Ms. Ricks is one of many people with compromised immune systems in the United States who circumvented government guidelines and received a fourth or fifth unauthorized injection.
The Food and Drug Administration and the Centers for Disease Control and Prevention are responsible for determining when additional doses should be given, but some patients and their doctors believe federal agencies have acted too slowly to protect the most vulnerable.
Israel has already started rolling out fourth injections – Prime Minister Naftali Bennett on Sunday announced the country will offer additional injections to people aged 60 and over, as well as medical staff, becoming the first country to deploy a booster additional as widely.
By comparison, the CDC updated its guidelines in late October to say that immunocompromised groups would be eligible for a fourth dose six months after a third. For those who followed the rules, the first eligibility for a fourth would be at the end of February.
But as new variants like Omicron emerge and vaccination rates continue to be slow in many areas, worrying those with weakened immune systems, many are given additional injections without being certain of their safety. or their effectiveness.
Typically, doctors have the discretion to use approved drugs outside of their recommended uses – so a fully approved vaccine like that from Pfizer could normally be prescribed as doctors see fit.
But, to receive and administer Covid-19 vaccines, providers must sign a legal agreement with the CDC – meaning that if they break agency rules, they risk being kicked out of the vaccination program and could. be prosecuted. The CDC has also previously warned that providers administering unapproved injections may not be protected against legal claims from patients if something goes wrong.
Legal experts say the government has done little to enforce the regulations and seems unlikely to impose penalties on most suppliers.
The people who take the extra hits are not doing anything illegal. They could face civil lawsuits if vaccine suppliers decide to prosecute them for lying, but that is extremely unlikely, according to Govind Persad, an assistant professor at the University of Denver Sturm College of Law.
The FDA and CDC did not respond to questions.
Getting additional photos seems to have worked for some – to some extent. After Ms Ricks’ fifth injection, her doctor sent her a note stating that she had developed a “moderate” antibody response, but “still not a typical response”. She continued to take extra precautions as if she was not vaccinated.
Researchers say that some people who are immunocompromised – depending on their condition and the medications they are taking – may never generate an immune system response, no matter how many injections they receive. Doctors and extra-dose advocates say the United States has a surplus of vaccines, so the alternative is often to let them go to waste.
Higher levels of antibodies appear to correlate with better protection against the virus, but researchers aren’t sure exactly what level of protection different numbers of antibodies provide, and the FDA doesn’t recommend people using tests. antibody to assess immunity.
The CDC estimates that there are around seven million immunocompromised people in the country, but it is unclear who will benefit from additional doses, according to Dr. Robert Wachter, chairman of the department of medicine at the University of California at San Francisco. .
“It’s, at this point, probably more improvisation than science,” he said.
With the blessing of his transplant team, Chris Neblett, who recently moved to Indiana, Pa., Received a third injection in April.
Mr Neblett, 44, was unsure if this might help – the medications he takes for his kidney transplant suppresses his immune system and prevents him from generating antibodies after two injections of the Pfizer vaccine.
âOf course we were bending the rules, but what was the repercussions? There weren’t really any, âhe said.
He generated low levels of antibodies after his third injection of Pfizer, but it wasn’t until his fourth injection in November that his antibody levels matched the response of a normal, healthy individual.
Mr Neblett believes his bet has served the most good – he’s enrolled in a Johns Hopkins Hospital study on organ transplant patients’ responses to the vaccine. His data and that of those who have also acted outside official guidelines helped persuade the CDC and the FDA to allow third injections for vulnerable groups, according to Dr. Dorry Segev, a transplant surgeon at Johns Hopkins University who working on the study. He said hundreds of patients in his study received unauthorized injections.
“They are acting out of desperation,” he said.
“Rather than saying ‘Shame on them’, I would say ‘Shame on the system we have created.'”
While there may be risks for additional injections, such as overstimulating the immune system, Dr Segev said the risks can be watched carefully. Generally, he said his data shows that additional doses of the vaccine should be safe and may work in some cases.
The coronavirus pandemic: what you need to know
The global wave. The coronavirus is spreading faster than ever in early 2022, but the final days of 2021 have brought encouraging news that the Omicron variant is producing less severe disease than previous waves. As such, governments are focusing more on expanding immunization than limiting the spread.
“If three doses didn’t work at all, we should probably be looking at something different for that fourth dose,” said Dr Segev.
One example, he said, is trying to cut back or stop immunosuppressive drugs before giving extra doses if possible. He is one of many doctors to complain that the CDC’s guidelines are too rigid and prevent healthcare professionals from treating patients on a case-by-case basis.
Karen Pearce’s doctor wrote her a note stating that the timing of her recall “MUST be done before her next chemotherapy infusion,” a treatment she needs every six months to control life-threatening inflammatory blood vessel disease.
But Ms Pearce, 69, of Gettysburg, Pa., Will not be eligible for a fourth injection until February, right after she is supposed to receive her next infusion, which she and her doctor said would render her fourth injection unnecessary. This booster injection has taken on increased importance with Omicron, but so far no supplier has agreed to give it a month earlier.
âMore flexibility in their advice could save lives, maybe mine,â she said.
Other experts say there are limits to the flexibility of advice. Getting extra doses too soon could be counterproductive, according to Shane Crotty, a professor at the Center for Infectious Diseases and Vaccines at the La Jolla Institute of Immunology.
This is because the immune system’s long-term memory seems to work better if it can rest between vaccines, he explained, and the body takes months to perfect its antibody-making process after an initial vaccination. .
One potential alternative to multiple injections is to use monoclonal antibodies to protect patients, said Dr. Lianne S. Gensler, rheumatologist at the University of California, San Francisco. Most monoclonal antibody treatments are rare, which means they have only been used as a post-exposure treatment instead of a preventative measure. To make matters worse, Omicron has rendered some existing monoclonal antibody treatments ineffective.
The FDA approved long-term preventive monoclonal antibody therapy specifically for vulnerable populations in December, but doses may initially be limited.
During this time, people with compromised immune systems think about their flawed options.
Patrick VanHorn, 67, of Ventura, Calif., Has chronic leukemia and needs his immunosuppressive drugs to stay alive. He did not produce any antibodies after his fourth dose of Moderna vaccine in August.
He is discussing a fifth shot with his doctors, but he is not sure whether he will.
âRight now my thought is, why bother? Nothing happened in those first four hits, why do I think a fifth hit would do anything different? ” He asked.