6: Preparing for COVID-19 Boosters

ASTHO President Dr. Nirav Shah (SHO-Maine) considers the risks to watch for as states and territories administer COVID-19 booster shots to some immunocompromised people; ASTHO Chief Medical Officer Dr. Marcus Plescia discusses the work to address...

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ASTHO President Dr. Nirav Shah (SHO-Maine) considers the risks to watch for as states and territories administer COVID-19 booster shots to some immunocompromised people; ASTHO Chief Medical Officer Dr. Marcus Plescia discusses the work to address expiring vaccine supplies; and ASTHO rolls out a new dashboard with data about environmental health programs and services.       

CDC: COVID-19 vaccines for moderately to severely immunocompromised people

Environmental health programs and services portal

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This is Public Health Review Morning Edition for Tuesday, August 17th, 2021. I'm Robert Johnson with today's news from the Association of State and Territorial Health Officials.


States and territories are gearing up to provide COVID-19 booster shots to some immunocompromised people who have already received the Pfizer or Moderna vaccines.

Dr. Nirav Shah is ASTHO's president and director of the Maine Center for Disease Control and Prevention.


Any and every policy change or eligibility change, no matter what it's for, entails risks. In this situation, I think there are a few risks that states should be on the lookout for.

Number one are patients who are ready for their additional dose before their provider is ready to offer it. Those patients may be disappointed or upset that they were ready, they were indicated for that additional dose, but their provider wasn't yet set up to offer it. That's a potential risk, one that states can plan for now.

The other is in situations where patients should be offered that additional dose but, for whatever reason, the communication system did not work such that they were not aware of that option for them.

We've got to make sure, too, that we reach out to patients as well as providers. Here in my state, in Maine, we've worked with providers since Friday to make sure they were ready to queue up their EMRs so they could query patients and ping patients to schedule a time to come in and get that additional dose.



The news of booster shots comes as states and territories consider how to use vaccines before they expire.

Dr. Marcus Plescia is ASTHO's chief medical officer. He talks about vaccine supplies in today's morning conversation.

There are reports that COVID-19 vaccine supplies may soon begin to expire. How likely is it, because of that, we'll end up wasting some doses?


Well, the challenge that we have right now is that there is vaccine that's been distributed to states and, in many cases, out to local places, and that vaccine is now out in the field and it can't be sent back to the federal government. So, we need to use what's out there—and there is quite a bit of vaccine out there.

But, you know, let me say, first of all, I know that our leadership is very, very engaged in this and very concerned about the need to get that vaccine used because we don't want to waste the vaccine. And then, there are a couple of factors that are at play that I think are really going to help with this.

First of all, we now have approval to use the vaccine to give a third dose of vaccine to people who are immunocompromised; so, I think that's going to boost up demand, or we're going to see a lot more people who are wanting that third dose that'll help use some of it up.

I also think, unfortunately, that people are becoming more and more anxious about the Delta variant with COVID, and more people who've not been vaccinated are now starting to come in for their first and second dose.

The final thing is it is possible that the FDA will step in and decide that the expiration dates on these vaccines can be moved forward a little bit, and then that gives us a little bit more time as well.


Packaging has also been another issue.

Breaking up big pallets of vaccine and moving it out to offices that only need a small box—will that help?

Are states doing that now to try and address this situation? What's going on there?


Yeah. When I mentioned that I think that state and local public health leaders are really taking this seriously, those are the kinds of things that we hear that make us realize that.

You know, I think—because we're trying to get this used up and not wasted—a lot of states have now just taken matters into their own hands. We were trying to get the manufacturers to put it into smaller batches and we just couldn't get that to happen.

So, a lot of states are taking that into their own hands and they're getting their supply in now, and they’re divvying it up and putting it into smaller packets that can be sent out into smaller primary care practices.

And we know there's good scientific evidence that having your provider talk to you about getting vaccinated is a good way to overcome vaccine hesitancy. So, these are good settings to put vaccine into and we've got the vaccine.

And I just think this is just a great move to be more aggressive.



ASTHO has a new dashboard focused on environmental health programs and services. It's intended to help state and territorial environmental health directors understand the location of various programs in each jurisdiction. The portal is available today by following the link in the show notes.


Finally today, there's still time to register for tomorrow's first Insights and Inspirations conversation with retired Lieutenant General Nadia West, the first African American Army Surgeon General. Her discussion, titled "Leading through Uncertainty," begins at 4:00 PM Eastern time tomorrow—that's Wednesday, August 18th. The event is free to anyone listening.


There's a link to the registration page, along with links to the environmental dashboard and other resources, in today's show notes.


Also, don't forget to follow us on Apple Podcasts and Spotify, or listen on Alexa. And, if you have a moment, please take time to share this show with your colleagues.


Remember to join us tomorrow for more ASTHO news and information. We'll also talk with Dr. Kimberlee Wyche-Etheridge, ASTHO's incoming senior vice president of health equity and diversity initiatives, about her plans for the new role.


I'm Robert Johnson. You're listening to Public Health Review Morning Edition.

Nirav Shah MD JD

Director of the Maine Center for Disease Control and Prevention; President of ASTHO

Marcus Plescia MD MPH

Chief Medical Officer, ASTHO