Confusion surrounding booster shots could paralyze vaccination efforts. The government must step up


Clinicians across the country are managing three outbreaks simultaneously. The first, of course, is the surge in covid-19 cases due to more transmissible variants. The second is rapidly spreading lies and misinformation about vaccines on social media. And the third outbreak has emerged only recently: The chaos and confusion surrounding the administration of booster shots.

Whereas physicians have become adept at responding to the first two outbreaks, the third has the potential to paralyze vaccination efforts. To mitigate this, we need a centralized information system to verify vaccination administration and clear guidance ahead on how to prioritize doses. And we need it before Sept. 20, when boosters are expected to start becoming available to Americans.

Our current data system to track vaccinations is inadequate. Only a handful of states participate in the Vaccine Administration Management System with most states adopting their own with no cross-communication. As a result, I have no way to access the record of administration of a vaccine given in another clinic or pharmacy and must rely on patients’ paper cards – or worse, their memory if they don’t still have their cards – to determine exactly when they last received a shot so as to administer their booster shot eight months later, as recommended.

Behind the scenes, clinics and pharmacies are trying to understand and anticipate how booster operations will proceed. Many were caught by surprise when the Biden administration announced the Sept. 20 date. The nation’s community health centers and pharmacies, which receive vaccine supplies directly from the federal government, also heard about booster distribution at the same time as the general public.

We need guidance on vaccine allocation and suggestions for prioritization if supply becomes an issue. Should we prioritize people by age or comorbidity? Planning for the fall should start now. For example, our current notification system for patients is designed to send a reminder for second doses, but we are not configured for third doses or boosters. Someone walking in to get a booster when it is available will likely receive a text to schedule a second shot in three or four weeks.

Keep in mind that physicians will have to coordinate booster shots on top of all the other tasks essential to addressing the pandemic. Critical populations remain under-vaccinated, especially people of color and pregnant women. Only 23.8 percent of pregnant women are vaccinated despite mounting data around the clear morbidity and mortality of covid-19 in pregnancy. If administering booster shots disrupts these efforts, it could worsen disparities.

The last time I witnessed so much confusion in the health-care industry was in 1999, when I was still a medical student and we were all trying to figure out what would happen on Jan. 1, 2000, when all computer systems were anticipated to fail. Luckily, none of that ever came to pass. We were also fortunate enough to have well-paid consultants who were able to put bright neon stickers on every surface imaginable marking everything as “Y2K compliant.”

This time around, we don’t have the highly paid consultants or shiny stickers. And the impending day of chaos on Sept. 20 is very real. If history is a predictor, we will weather the inevitable confusion. But in the interest of not allowing a single dose to go to waste, here are two actions that could ameliorate the damage:

First, we need a national vaccine registry. We can allow patients to opt out, but we should have one interoperable system that can track doses and administration. In a manner similar to the Obama administration’s actions to make electronic health records “speak” to each other, the Biden administration must implement a uniform electronic vaccine data standard that functionally enables the meaningful exchange of data related to vaccine administration. This might require new incentives as well as assurances that a national registry will be private, secure and work across multiple settings. If possible, I would love to see this linked to the adverse effect reporting system for vaccines, which has suffered from poor quality and been used to promote anti-vaccination claims.

Second, the federal government should offer transparent clinical guidance around booster prioritization and simple checklists for busy clinicians that keep focus on the goal of getting as many people vaccinated while not wasting precious doses or administering doses earlier than recommended.

The Food and Drug Administration approval of the first mRNA vaccine in history is nothing short of a miracle. But unlike most innovations in medicine, which can take 20 years to diffuse into daily practice, we have precious little time to waste and too much to lose.

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Kavita Patel. Photo: Twitter @kavitapmd

Kavita Patel, a primary care physician, is a nonresident fellow at the Brookings Institution. She was director of policy for the Office of Intergovernmental Affairs and Public Engagement in the Obama administration.




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