Alaska health care providers, facing an intense surge of COVID-19 that’s overwhelmed the state’s hospitals, say they’re relieved and grateful for a decision by Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, that allows them to get vaccine booster shots.
Some experts have questioned Walensky’s decision last week that said healthy people in high-risk jobs, in addition to the elderly and at-risk groups, can get the boosters if they want to.
Critics said Walensky’s move, which overruled a divided CDC vaccine advisory panel, gave Americans too much leeway to seek third shots before residents of poorer countries could get their first ones, and created confusion over who qualifies.
But in interviews, many Alaska health care providers said Walensky’s decision fit with the demands and risks they’re taking on in the middle of the nation’s most intense, delta variant-driven surge in coronavirus cases and hospitalizations. Some remote clinics also had doses nearing their expiration dates.
“It’s like your parents telling you to finish your dinner because there’s kids starving in Africa,” said Dr. Megan Sarnecki, medical director at the clinic on the Aleutian island of Unalaska. “You’re not sending your leftovers to kids starving in Africa. And we’re not sending a vial that we only used half of to a third-world country.”
A national debate has been playing out over booster shots for more than a month, since President Joe Biden announced that every adult would qualify for one eight months after their original two-dose vaccine.
Afterward, federal expert panels charged with evaluating the vaccines recommended them only for certain groups, with members voicing concerns about giving unnecessary shots and a lack of data showing clear benefits from authorizing boosters for a larger group.
While the Food and Drug Administration’s panel agreed to offer the shots to people in high-risk jobs, like health care workers and teachers, the CDC’s expert panel disagreed, in a 9-6 vote Thursday. Members said they were concerned that the move would distract from the nation’s focus on giving out shots to the unvaccinated, which has a much higher public health benefit, and they also questioned whether the recommendations were too vague and undermined public confidence.
“We might as well just say give it to anyone 18 and over,” the Washington Post quoted one expert on the CDC panel, pediatrician Paul Sanchez, as saying. “We have a really effective vaccine, and it is like saying that it is not working, and it is working.”
Walensky, the CDC director, announced her decision to break from the panel on Friday, a day after its vote.
The agency’s final statement said people 65 and older, nursing home residents, and people 50 and over with at-risk conditions “should” get booster doses, while younger people with underlying medical conditions and people in risky workplaces “may” get the third shots.
The recommendations only apply to the Pfizer-BioNTech vaccine; the expert panels have not yet considered the question of broad-based boosters for the vaccines made by drug companies Moderna and Johnson & Johnson.
While Walensky’s move set off criticism from some academics and health care administrators, there was little backlash in Alaska, where the current surge is placing the state’s hospital system under intense strain.
Administrators, with their workforces already stretched, said they did not want risk losing more employees to breakthrough COVID-19 cases. In Unalaska, when an employee had to quarantine at one point, the chief executive spent a week answering phone calls, Sarnecki said.
Then there were the personal risks.
A recent shift working in the intensive care unit at Anchorage’s Native hospital was the “hardest, most, grueling, most depressing and overall most sad period I’ve ever been through,” Dr. Thomas Kelley said in an interview this week, outside a clinic where dozens of hospital employees had received their third shots.
“We were just watching people die, regardless of what we did,” Kelley said. “My reaction to the recommendations to have the booster was, ‘I just want the booster.’ I’m terrified of what I see, I remain terrified of what I see, and I don’t scare easy.”
There’s data to suggest that the boosters are safe, effective and can minimize the risk of COVID-19 either for people with health problems or who face repeated exposure, said Dr. Anne Zink, Alaska’s chief medical officer. She said the CDC’s “permissive language” addresses concerns about legal protections and liability around the booster doses and “allows individuals, in combination with their health care provider, if needed, to make that risk-benefit decision.”
“I just think it really recognized the variety of clinical scenarios and situations that we see, the variety and diversity of human experience and what we’re seeing with COVID overall,” Zink said in an interview. “There are very few health care workers that I work with on a regular basis who were not anxiously anticipating this information from the CDC, simply because they’re seeing so much COVID right now and really wanting to do everything in their power to keep themselves, their family and their community healthy and safe.”
Zink said Alaska’s health department had been debating whether to release its own recommendations breaking from the CDC’s expert panel, though that’s no longer necessary after Walensky’s decision, she added.
Many Alaska hospitals and health care systems had already started moving forward with booster doses for staff members before the CDC’s announcement.
In the rural Western Alaska hub town of Nome, the tribal health organization, Norton Sound Health Corp, started giving out boosters to staff two weeks ago, after a previous CDC recommendation that immunocompromised people should get them.
“We are an incredibly rural, austere medical environment. It takes us a long time to get people in and out of here,” said Tim Lemaire, an NSHC doctor. “It will be interesting to see what the evidence shows in the long run. But for us, we felt like it was the right call to at least offer it to everyone.”
This story has been updated: The Unalaska clinic employee had to miss work due to a quarantine, not COVID-19 infection.