People with weak immune systems can now get a third COVID-19 shot

After U.S. authorizes additional vaccination, state rolls out recommendation for immunocompromised

By: - August 20, 2021 12:42 pm
Photo contains a COVID19 face mask, needs, shots and vials of the vaccine

Nataliya Vaitkevich | Pexels

As a COVID-19 resurgence drives home how vaccinations are helping prevent thousands of Wisconsin residents from getting sick, one vulnerable group of people is now eligible for some additional protection.

The state Department of Health Services (DHS) is recommending that people with weaker immune systems get an additional shot to help bolster the vaccine’s effectiveness.

The recommendation applies to immunocompromised people who have been vaccinated with either the Pfizer or Moderna vaccine, both of which are given in a two-shot series.

Affected people include transplant patients, some patients with HIV-AIDS, patients with blood cancers and others. Some have poor immune systems because of a chronic condition; others, such as transplant patients, are on medications that suppress the immune system as part of their treatment.

“Individuals with these particular conditions or taking these particular medications or treatments may have had a suboptimal response to the two-dose [vaccine] series and wouldn’t reach the full potential that you or I would, not having those conditions,” said Stephanie Schauer, manager of the DHS vaccination program, in an interview with the Wisconsin Examiner. “This additional dose will help get them up to that particular level, or at least closer to that.”

DHS advanced the third-shot recommendation on Wednesday following Food and Drug Administration approval of the procedure and its recommendation by the Centers for Disease Control and Prevention. Whether recipients of the Johnson & Johnson vaccine, which is given in a single dose, would also benefit from an additional shot hasn’t been determined yet.

The recommendation is separate from another plan that the White House announced Wednesday to offer booster shots to fully vaccinated people starting in September. That plan has drawn criticism from the World Health Organization because of vaccine shortages in less wealthy nations.

The booster program hasn’t yet begun, and DHS has no guidelines yet for it, but Schauer said that as outlined it would be for people with fully functioning immune systems whose vaccine immunity has waned over time.

The current third-shot program, however, seeks to bolster resistance to the virus for immunocompromised people in one of six defined categories identified by state and federal health authorities.

Who is immunocompromised?

Someone who has …

  • Been receiving active cancer treatment for tumors or cancers of the blood.
  • Received an organ transplant and are taking medicine to suppress the immune system.
  • Received a stem cell transplant within the last two years or are taking medicine to suppress the immune system.
  • Moderate to severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome).
  • Advanced or untreated HIV infection.
  • Active treatment with high-dose corticosteroids, alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blockers, or other drugs that may suppress your immune response.

Source: Wisconsin Department of Health Services (DHS)

Pandemic roars again

The third-shot recommendation for immunocompromised people comes as COVID-19 cases, after months of decline, have rebounded, driven by the delta variant that spreads much more quickly than previous versions of the coronavirus.

Federal officials have estimated about 3% of the population has one or more of the immune system conditions that would warrant a third shot under the new guidelines. In Wisconsin, that would be about 180,000 residents.

“Our patients are really excited about this opportunity,” said Jaime Myers, clinical director of the UW Health Transplant Center in Madison.

Transplant patients are prescribed immune-suppressing drugs so their bodies don’t reject the transplanted organ or tissues. “That’s what keeps their new organ functioning,” Myers said.

Recent medical studies have shown that transplant recipients had a weaker antibody response. “It doesn’t mean that they shouldn’t get vaccinated,” Myers said. “It’s just that they’re not getting as much protection. So it’s very, very encouraging to know that maybe we can boost that immunity.”

Another group that will qualify for the third shot is comprised of patients who have an advanced or untreated HIV infection. The human immunodeficiency virus (HIV) can lead to acquired immune deficiency syndrome (AIDS).

“This is a population that has a reduced ability to fight infections,” said Carrie VanZant, vice president of operations for Vivent Health in Milwaukee, formerly the AIDS Resource Center of Wisconsin. That puts people at particular risk for exposure to the coronavirus and the delta variant or other variants, she said.

“We’re excited about [the third shot] and recommending it for those the CDC is suggesting,” VanZant said in an interview.

Outreach to eligible recipients

DHS is passing the recommendation on to health care providers and to advocacy groups for people in the various conditions that qualify for the third shot. People with family members or friends who are in one of the immunocompromised categories can also encourage them to consider the extra shot, Schauer added

In addition, the agency is notifying vaccinators to ensure that when people get their third shot they receive the same vaccine — either Pfizer or Moderna — as they did previously.


Schauer said immunocompromised people who receive a third shot should get it 28 days or later after their second vaccination. DHS is encouraging those people to contact their health providers to arrange for the shot.

They can also use the website, which enables users to search for nearby vaccination providers, including filtering them by the vaccine brand. People who are getting a third shot should bring their vaccination card to the appointment or clinic, Schauer said.

Those who are unsure about getting a third dose should consult their health providers for guidance on whether they would qualify and benefit from it, she said.

How much the third shot helps is likely to vary from one person to another. “It really depends on the individual in terms of what is going on with them — their own health condition and their own immune system,” Schauer said.

Despite their conditions, some immunocompromised people might lack a close connection with a health care provider. DHS is advising people in the affected groups who don’t have regular medical care to call 211 or to text the word “COVID” to 211211, where they can get directed to guidance about whether they would be eligible. “We’re really wanting to make sure that we’ve got that additional capacity for those individuals,” Schauer said.

DHS officials are encouraging immunocompromised people who haven’t yet begun the vaccine to start the process so that they get the first two shots and can schedule the third.

“This is one of the best ways that we have to protect individuals against COVID-19 — and including the delta variant,” Schauer said. “People who have not yet been vaccinated need to talk with their health care providers if they have questions or concerns about the vaccine, but I think it is prudent to go ahead and start on that series.”

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Erik Gunn
Erik Gunn

Deputy Editor Erik Gunn reports and writes on work and the economy, health policy and related subjects, for the Wisconsin Examiner. He spent 24 years as a freelance writer for Milwaukee Magazine, Isthmus, The Progressive, BNA Inc., and other publications, winning awards for investigative reporting, feature writing, beat coverage, business writing, and commentary. An East Coast native, he previously covered labor for The Milwaukee Journal after reporting for newspapers in upstate New York and northern Illinois. He's a graduate of Beloit College (English Comp.) and the Columbia School of Journalism. Off hours he is the Examiner's resident Springsteen and Jackson Browne fanboy and model railroad nerd.