Maryland health officials weigh expanding eligibility for booster shots

State health officials are entangled in a debate over expanding eligibility for COVID-19 booster shots. 

Health officials in Maryland note a growing number of reported cases in recent days and concerns about waning protection against the COVID-19 virus among larger groups of people. Maryland’s health secretary told a Senate Vaccine Oversight Work Group Monday that the state is wrestling with again going out on its own, separate from federal guidance, as some other states have already done. 

“Definitely anyone who is over two months for J&J should go get a booster,” said Dennis Schrader. “For Pfizer and Moderna, we’re having those conversations. We’re not ready to make an announcement today but we are looking closely at that issue.” 

Schrader’s comments and the advice given by at least one Maryland county highlight a growing tension between the federal government and public health experts on the ground in state and local governments.

Some states have expanded access to booster doses on their own. 

On Monday, New York joined California, Colorado and New Mexico in expanding access. New Jersey officials announced the same day that they were also close to widening access. 

“We are having the very conversation internally about what’s next and that is a debate we’re hearing is happening around the country,” Schrader said. 

At least one county — Anne Arundel — is already encouraging all adults 18 and older who got their second dose six months ago to get a booster.

“As we’ve talked about, with some vaccines your immunity decreases over time and you need a booster shot like we do with the flu vaccine or tetanus,” Anne Arundel County Health Officer Dr. Nilesh Kalyanaraman told reporters during a briefing Tuesday. “As we’re entering the thick of cold and flu season it’s important to make sure you’ve got that good protection.”

Under federal guidelines, all people 65 years and older are eligible for a booster six months after their second dose. Those who are 18 or older and have an underlying condition or have compromised immune systems or who work in a high risk job are also eligible. 

“When we first started our response in vaccinations at the beginning of the year, we had to make tough decisions as to who is first and second,” Kalyanaraman said. “Right now, there isn’t those tough decisions. Everyone can get access to one.”

“Just to be clear, we are within the CDC guidelines,” he said. “We’re not going outside either the CDC or the state guidelines.”

Kalyanaraman acknowledged that the county is expanding the CDC’s definition of risk.

“What we’re trying to do is clarify that people really don’t have to exclude themselves from getting a booster,” said Kalyanaraman.

“We’re finding that people are thinking about that first January, February kind of moment and that’s how they define risk and only at the highest possible risk are they getting (boosters),” he said. “What we’re saying is we’ve opened up a lot. People are back at work. people are going about doing their activities and there’s a lot more risk and so we want people to recognize their activities will put them in that higher risk category.”

Some lawmakers on the Senate oversight panel expressed frustration at changing health guidance and delays in making booster shots available to more people.

“One of the things that has been most frustrating to ordinary people through this pandemic has been the changed advice from public health authorities,” said Sen. Jim Rosapepe, D-Anne Arundel and Prince George’s counties. “Put your mask on, take you mask off. Get a shot now, get a shot later. Get a test in this situation, get a test in another situation.” 

Rosapepe called for the state to expand eligibility to all adults. He said he was “mystified” as to why that had not already happened. 

“Why are we saying that people under 65 shouldn’t just get a booster shot? What’s the downside? I don’t get it. “Schrader said, agreeing with Rosapepe. 

“The debate on that, senator, I don’t disagree with you, actually,” said Schrader. “We do not have the greenlight yet from the CDC to do that. So the debate is whether or not do we make our own policy.” 

Schrader told the Senate panel that the three vaccines “have a limitation in their durability. Over time, the protection from these vaccines that we’ve been given, including delta and other variants, is naturally going to wane. This does not mean that individuals lose protection from the vaccine. What it does mean is that you may need a booster to maintain the highest possible immunity. And many eligible Marylanders are now at this stage.” 

Nationally and in Maryland, there are upticks in reported cases as colder fall weather sets in. 

In Maryland, the rolling seven-day average for new cases was 815, 16% higher than the week before. But hospitalizations are lower even as the state positivity rate ticks back above 35 and the state’s cases per 100,000 people approaches 14. 

Even with waning immunity, anecdotal evidence shows that vaccines are providing a benefit. 

So far, the state has administered about 718,000 boosters — about half the population eligible under current federal rules. Schrader said the state has an ample supply of vaccines. 

“We actually kept supply in state when others were giving it back,” said Schrader. “We kept it. We’re in very good shape for supply going forward.” 

Monday’s seven-day case average is more than 52% lower than the same time a year ago, before vaccines. Deaths are also lower than a year ago. 

Gov. Larry Hogan earlier this year broke with federal guidance on boosters for people living in congregate facilities, including nursing homes. He also expanded eligibility for the immunocompromised. Federal health officials later revised their guidelines to include those categories. 

But Hogan’s announcement came after the state conducted a small study of immunity levels among nursing home patients. That study suggested declining levels of antibodies. 

“We wanted to make sure that we had some science behind making that decision,” Schrader told the panel. “You’re right, we’d like to move faster.” 

But even after expanding eligibility, there were problems getting the shots. 

Schrader said doctors and others administering the doses are looking for assurances “that they’re going to be OK” following state advice that differs from the federal government.  

The health secretary said people can also self-attest if they believe they are eligible for a shot. Officials have acknowledged previously that those sworn statements are not verified. 

“Part of the challenge too is that providers are hesitant to give shots because we gave them the green light to give additional doses to people at one point who are immunocompromised, and we still had providers in the state who were a little nervous about that.”