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The Virginia Department of Health (VDH) recently announced Virginia will make third doses of the Pfizer-BioNTech and Moderna COVID-19 vaccines available for moderately and severely immunocompromised Virginians.

This move comes after the Centers for Disease Control and Prevention (CDC) updated its vaccination guidelines to recommend third mRNA doses for people who have significantly compromised immune systems. Vaccines are readily available throughout Virginia. Vaccine providers are expected to make third doses available over the next several days as they adapt their processes.

“This is important additional protection for people who have impaired immune systems,” State Health Commissioner M. Norman Oliver, M.D., M.A. said. “As COVID-19 cases rise across Virginia and the country, everyone who is eligible should get appropriately vaccinated as soon as they can.”

The CDC’s move is the final step in the authorization process for third doses of the mRNA vaccines for some eligible populations. Studies have shown that people with a compromised immune system can have a weak response to the standard vaccine regimen, and that a third dose is needed to strengthen immunity in these persons and protect them from serious COVID-19 complications. The U.S. Food and Drug Administration (FDA) evaluated those studies and recommended the change to the CDC on Thursday.

Only Pfizer-BioNTech and Moderna are mRNA vaccines, and therefore the FDA has not recommended additional doses of the Johnson & Johnson (J&J) vaccine. Additionally, the FDA has not recommended booster vaccines for the general public. Those immunocompromised who have already received two doses of either Moderna or Pfizer-BioNTech should wait at least 28 days after their second dose before receiving their third dose.  The third dose should be the same manufacturer as the previous two doses when possible, but this is not required.

This EUA expansion is estimated to include approximately 3% of people in the United States. Immunocompromised persons are those whose immune mechanisms are deficient because of certain immunologic disorders or immunosuppressive therapy. 

While available evidence shows that a third dose provides a modest benefit to improving the immune response to mRNA vaccination, immunocompromised persons might still not have a strong level of protection against COVID-19, even after receiving a third dose of vaccine. Additional COVID-19 precautions remain important for this population. These include wearing a mask, maintaining physical distance from others outside of the home and avoiding crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider.

Persons who are significantly immunocompromised should also discuss the possibility of monoclonal antibody treatment options with their healthcare provider in case they get infected with or are exposed to COVID-19. Household members and other close contacts of significantly immunocompromised persons should get fully vaccinated to provide increased protection to their loved ones.