Hawaii residents who are over 50 or immunocompromised can now receive a second Covid booster shot, with the Hawaii Department of Health following the Food and Drug Administration decision Tuesday to authorize additional doses of the Moderna and Pfizer vaccines for those groups.

This comes as the BA.2 omicron subvariant is now responsible for the majority of new infections in the U.S., according to Centers for Disease Control and Prevention data released Tuesday, stoking fears of a new wave of cases.

“Those now eligible for a second booster should determine the right time to get the extra protection another dose will provide,” state Health Director Libby Char said in a press release Tuesday.

Moderna COVID-19 vaccine elderly vaccinations Craigside Place.
The Hawaii Department of Health has adopted federal guidelines recommending second boosters to immunocompromised people and residents 50 and older. Cory Lum/Civil Beat/2021

This jab is the fourth dose of the mRNA vaccines approved for older Americans and the fifth dose authorized for people living with immunodeficiencies, the FDA said in a press release.

People aged 50 and older will now become eligible for a second booster four months after their first booster dose, which, in turn, is administered at least five months after recipients complete their two-dose primary series.

For immunocompromised people, the two boosters come after a CDC-recommended three-shot primary series, which was increased based on evidence that a two-shot regimen was not enough to trigger a comprehensive immune response. Adults with immunodeficiencies can choose between either mRNA booster, while kids aged 12-17 are only eligible for the Pfizer booster.

Pfizer had originally applied this month for FDA approval of a second booster dose for adults aged 65 and older, while Moderna requested fourth dose authorization for all adults, to give federal regulators “flexibility” to decide which age groups to include, Moderna CEO Stephane Bancel told CNBC at the time.

The federal government ended up splitting the difference, as about a third of adults between the ages of 50 and 65 years suffer from “significant medical comorbidities” placing them at high risk for severe disease, FDA Center for Biologics Evaluation and Research director Peter Marks said in a press call Tuesday.

“By choosing age 50 and up, which is often something we use for other respiratory viruses like influenza to consider those at high risk or higher risk, we felt like we would capture the population that might most benefit from this fourth booster dose,” Marks said.

Federal regulators largely based their decision on Israeli data, which found “no new safety concerns” after approximately 700,000 Israeli adults received a second booster shot, 600,000 of whom were aged 60 and up, according to the FDA press release.

While the nation has largely opened up as the original omicron wave subsided, with Hawaii ending its indoor mask mandate and vaccine-or-test requirement for incoming travelers Saturday, signs are mounting of a coming surge driven by the BA.2 omicron subvariant.

The subvariant now accounts for 55% of new infections nationwide, CDC data showed Tuesday.

For the federal government’s region nine, which Hawaii shares with California, Arizona, Nevada and much of the Pacific, proportions were even higher, with BA.2 responsible for over 60% of new cases.

So far, infection counts in-state and nationwide have remained on a downward trend. However, cases of the BA.2 subvariant are surging across Europe, which has acted as a harbinger for America in the past.

Hawaii recorded a seven-day average of 87 cases in the latest numbers released last Wednesday. Twenty-six patients were hospitalized with Covid, while the state had logged five more deaths.

Cases of the subvariant have been on the rise in Hawaii, with infections due to BA.2 recorded in every county but Kauai. Wastewater testing has indicated that the subvariant has arrived even on that island, Kauai Deputy District Health Officer Lauren Guest said in a briefing last week.

“It is not known yet how the variant will affect case rates or hospitalizations in our community,” Guest said.

Whether or not the second booster will effectively blunt a future surge is hotly debated, with an Israeli study finding the second booster was not enough to prevent breakthrough omicron infections.

There are also signs residents are losing appetite for repeated Covid shots – despite constant state messaging on the importance of booster shots, Hawaii’s booster rates linger around 38%, rising only about 3% in the past two months, according to state vaccination data.

Even if second boosters don’t prevent all infections, they still offer an extra layer of protection from severe disease for the most vulnerable, FDA official Marks said.

“If it were my relatives, I would be sending them out to (get the second booster),” Marks said. “Think just about people 65 years and older. One in one hundred of them are not with us today, who were with us before the pandemic, because of COVID-19.”

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, Cooke Foundation and Papa Ola Lokahi.

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