Mixing & Matching

Mixing & Matching

Today I went to the local CVS Pharmacy to get my COVID-19 booster shot. Just yesterday the CDC had followed up on the FDA’s prior day approval of the Moderna and J&J booster shot and added the ability (maybe even as much as a suggestion) that we were allowed to mix and match vaccine manufacturers. I tend to think this was mostly done for the people who had gotten the one-shot J&J vaccination, but they threw in those of us who had received the Moderna vaccination in a two-shot process earlier in the year. The one condition was that we of the Moderna crowd had to wait 8 months from our second shot to get the booster. I just so happened to have reached my 8-month point on Wednesday, the day the FDA gave its thumbs-up and the day before the CDC chimed in its AOK.

I had heard that they’ve determined that the Modern vaccine is the best and most protective of the vaccines and so they were spending a good deal of time in deciding how potent to make the Moderna booster. The thinking seemed to be that a half-dose was the likely recommendation. That seemed like a very specific and detailed diagnosis, implying that a full-dose might be too much or at least more than was needed to give the optimal immunity level. Imagine my surprise when they determined with the waive of a medical administration hand that mixing & matching for Moderna vaccinatees as AOK. I had never heard that Pfizer’s booster had any dosage debates and the general sense out there is that a Pfizer booster is pretty much just like Pfizer shot one and/or Pfizer shot two. While I kinda understand the logic of mixing & matching in terms of hedging your immunological bets, what with all the potential viral variants and the fairly short hop the researchers have had for gathering empirical evidence of the effectiveness of the various vaccines on the moving target of the COVID-19 virus, I am bit more stumped by the dosage issue. Why go to all the trouble to externally discuss and debate the advantages of differing doses of Moderna vaccine for the booster only to just decide any old booster will do? And the medical establishment wonders why people are confused and not wholly confident in what’s going on.

My bet is that the dosage issue was an angels on the head of a pin issue at Moderna that was the result of their chest-beating over the determination that their vaccine was so much more effective than Pfizer’s or J&J’s. The cost accounting boys probably figured they could double their margins by saying that half a dose of their magic juice was as good as the other boosters, which would allow them to make twice as much revenue (I am clearly doubting that half a dose of Moderna would cost less than a full dose of Pfizer) on the same stock. After all, isn’t it the capitalist American way to reward excellence? Don’t they deserve a bonus for their good work? It would sound like gouging to charge more for their more effective vaccine, but no one could fault them for giving less for the same price if the impact was as good as other boosters. It was actually a very clever solution and I’m not sure I would have been seriously opposed to it. But then CDC stepped in and used the lowest common denominator approach and said that to induce recipients of the decidedly less effective single-shot J&J vaccine to get a better quality brand booster (namely Pfizer), they had better address the mix & match issue. And if you’re going to allow it for J&J you probably should minimize confusion in the public and go mix & match across the board otherwise its something less than mix & match. In fact, it completely foils Moderna because they either have to carefully prescribe half-dose boosters for prior Moderna vaccinatees and full-dose for the rest, or they better just drop the whole half-dose program.

So today, when it was my turn to go up to the vaccination technician, she asked to see my vaccination card. When she saw it was Moderna she said they were not authorized to give Moderna boosters yet. I corrected her and quoted the CDC/FDA decisions of the prior two days and said that my wife had booked the appointment online with CVS with those specific qualifications. She needed to go see a supervisor. When she came back she said it was all good and that they were indeed authorized to give Moderna vaccinatees a booster shot as of today. I asked her if I was getting a Moderna booster and she said no, that they didn’t have any of those yet, but that the mix & match authorization allowed them to give me a Pfizer booster, which they had in ample supply. I made a command decision to proceed on the belief that I have to trust someone and I’m as well off trusting the CDC and FDA as anything else out there, including and maybe especially cable news (even MSNBC) about what is best. A lesser citizen might have balked and decided to wait for the official Moderna booster to get distributed, but I figured the Moderna factory has to uncork all those half-dose bottles and refill them with full doses and that will likely take a long time. Better to follow the wisdom of the CDC and the logic of mixing and matching than risk getting less vaccine protection while I wait. With UK infections and now hospitalizations surging, who knows where the previously vaccinated will end up if they don’t protect themselves in every way possible.

As the needle pushed into my bare left upper arm I began to wonder if there was any chance that a full-dose vaccine (even the weaker Pfizer variety) would cause me more post-vaccination trauma. I have had some two hours of chills from my second Moderna, but many people I know have gotten much more ill from their second vaccinations and boosters than that. Maybe the debate over at Moderna was more about that than about profitability. Then I stopped myself and asked which would I bet on more, that a big pharma (even a newbie like Moderna) would pause itself over what’s best for the patient or pause itself over what’s more profitable? I allowed the technician to proceed. So, now I am COVID-19 vaccine boosted and sitting here waiting for my hot tub to heat up so I can spend an hour in its warmth. I am trusting that if I do have a reaction to the vaccine, it will be mild enough so that I will be able to get out of the hot tub and not drown in there. Somehow, my non-medical mind wonders whether boiling oneself in hot water does something to the speed of acclimation of a virus in a vaccine. I think I’m getting carried away by all this pondering and will just go in the tub and watch a movie on my iPad. I think at this point it would be best to not watch Outbreak or Contagion.