Minnesota set to jump ahead on boosters

Minnesota is set to offer COVID-19 vaccine boosters to all adults in response to the worsening pandemic wave and a state infection rate that remains one of the highest in the nation.

State health leaders said the expansion will address waning immunity in early vaccine recipients that is increasing viral exposure risks. The Advisory Committee on Immunization Practices will consider the expansion Friday, but Minnesota Health Commissioner Jan Malcolm said the state would act this week regardless of federal guidance.

"Given the alarming surge in COVID cases that Minnesota is facing as we head indoors for the winter and gather for the holidays, this protection is important and timely," the Minnesota Department of Health said in a statement.

Another 4,827 infections and 32 COVID-19 deaths were reported Thursday, raising Minnesota's totals to 866,055 infections and 9,125 deaths. While vaccinated people make up a third of new infections since May 2, the rate is increasing amid evidence that immunity wanes six months after vaccination.

The 1,381 COVID-19 hospitalizations on Wednesday included 333 people requiring intensive care in Minnesota, which has the nation's second-highest rate of infections over the past seven days, behind Michigan.

Minnesota's ranking is partly a function of aggressive testing, which has resulted in a positivity rate above 10%. South Dakota has the 16th highest rate of new infections, but its low testing numbers left it as the only state with a positivity rate above 20% last week, according to the Centers for Disease Control and Prevention.

Boosters in Minnesota are recommended for all recipients of the Johnson & Johnson vaccine and recipients of the other vaccines who are seniors or younger adults with health problems or jobs that expose them to increased infection risks. Booster access was expanded to all adults in some other states, including Colorado, though that created initial confusion as some pharmacy chains were still limiting appointments.

Expansion could tighten access to booster doses, which are available at most clinic and pharmacy chains, but with limited times and locations. Not all will respond to a state decision to expand access to the shots. CVS Health said it is part of a federal pharmacy program that precludes it from giving doses to people other than those recommended by the CDC and Food and Drug Administration.

Some groups urged caution in expanding booster access beyond those who are most vulnerable. Minnesota ranks second among states in providing booster doses to 54% of its seniors, according to CDC data. Among residents of 310 skilled nursing homes in Minnesota, 92% were fully vaccinated but only 21% had received boosters through Nov. 7, according to state data.

An editorial in the Annals of Internal Medicine this month argued that a more protective approach than booster expansion could be increasing rapid testing as well as shots for unvaccinated people and those in other nations with lower coverage.

Dr. Natalia Dorf Biderman said her fully vaccinated COVID-19 patients at Methodist Hospital in St. Louis Park are elderly and haven't had boosters. However, she supported broader access to boosters because COVID-19 cases are straining hospitals.

"The more boosters that we can give to the community for those who have waning immunity, the better," she said. "If we had a lack of the vaccine then it would be concerning, but that's not the limiting factor at this time."

Mayo Clinic research this month showed that third doses of Pfizer or Moderna vaccines did not increase rates of severe adverse reactions compared with second shots. Rates of milder symptoms such as fever and chills were elevated in booster recipients.

Dr. Andrew Badley, a Mayo co-author, said the results favor expansion "given the extreme safety of boosters, the unacceptably high prevalence of infection in Minnesota presently, and the number of ongoing hospitalizations for severe COVID disease."

Despite waning immunity, the latest studies show that vaccinated people remain at lower risk for severe illness, hospitalization and death. Only 21 of Sanford Health's 204 COVID-19 patients hospitalized Tuesday in Minnesota and the Dakotas were vaccinated. Among 62 COVID-19 patients in intensive care, just four were vaccinated.

Some adults probably don't need boosters because waning immunity varies and can level off at an amount that remains protective, said Marc Jenkins, director of immunology at the University of Minnesota Medical School.

In theory, antibody testing could identify patients in greatest need of boosters, but nobody has agreed on the "set point" of minimum immunity that is needed, he said.

"The best strategy is just to boost everybody," he said, because the low risk of side effects makes too much protection the better option than too little.

New pediatric Pfizer vaccine doses have been provided over the past two weeks to more than 60,000 children 5-11, or 12% of that age group in Minnesota. Health officials urged more child vaccinations to stem infection risks in schools.

The state on Thursday reported a preliminary total of 1,271 coronavirus infections among pre-K-12 students while they were in school in the week ending Nov. 6. That is down from 3,058 school-linked infections in the week ending Oct. 2, but up from 806 in the week ending Oct. 30.

Gov. Tim Walz on Wednesday called boosters "our best bet" against the latest COVID-19 wave because many vaccinations in Minnesota occurred early last winter and may have lost part of their effectiveness

"The expansion of boosters to everyone will make a difference," he said.

Walz said he doesn't expect legislative support for another peacetime emergency declaration, which would give him authority to issue mask mandates or restrictions on gatherings and businesses like those used earlier in the pandemic. Masks are recommended in K-12 schools and indoor public places in Minnesota, because all counties are above the CDC's substantial or high-risk thresholds for viral transmission.