Most Immunocompromised People Have Gotten the 4th COVID-19 Vaccine Dose, But Want More Information About Its Effectiveness

Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.

In October 2021, the U.S. Centers for Disease Control and Prevention (CDC) made an important change to its COVID-19 vaccine recommendations. Under this guidance, people who are immunocompromised and received three doses of the mRNA COVID-19 vaccines (Pfizer or Moderna) could now get a fourth shot as a booster dose.

At the time of our poll, the CDC had been recommending the booster shot to be given at least five months after the third shot. However, the CDC plans to revise this guidance to recommend for immunocompromised to get the booster after three months instead.

The booster shot is intended “to enhance or restore protection against COVID-19 which may have decreased over time,” according to the CDC.

The recommendation for the fourth COVID-19 vaccine dose came as COVID-19 numbers had been on the rise for weeks across the U.S., due to the spread of the Omicron variant and an increase in breakthrough cases.

In our latest poll, the Global Healthy Living Foundation’s COVID-19 Patient Support Program aimed to gain insight into our community’s experience receiving or plan to get this extra layer of protection.

The poll was conducted from February 3-7, a few weeks after immunocompromised became eligible for the fourth shot (if they received their third shot when it was first authorized in August 2021).

Of the 2,384 poll respondents (93 percent reported they are immunocompromised), the majority (96%) had the two-dose mRNA vaccines as well as a third shot for the original series.

Similarly, 96 percent reported having received a fourth COVID-19 vaccine dose.

Here are some other key learning and insights from the poll.

For the most part, immunocompromised people have had little difficulty accessing the fourth shot, but many are forced to explain their eligibility

In the days before our poll was conducted, some immunocompromised people reported getting turned away from receiving a fourth shot, as this Kaiser Health News story reported. The CDC even had to reach out to pharmacists to remind them that immunocompromised people are eligible for fourth shots. Wanting to know more about how this was impacting our community, we asked if people had any difficulties when trying to get the fourth shot. Participants were given five options and able to select all that apply:

• 59% said no difficulties
• 20% said I was initially turned away at the vaccination site
• 7% said I was not able to make an appointment at first
• 5% said there weren’t many available appointments
• 5% said I did not initially know where to go for a fourth dose
• 4% said my health care provider initially advised me not to get an additional vaccine dose
• Less than 1% said I did not initially have time to get a fourth dose

In a free response section of the poll, it became clear that there is confusion around the fourth dose among vaccine providers.

One person wrote, “there seems to be confusion at most pharmacies about whether it’s approved to give a fourth dose. This confusion creates doubt and makes me feel a little nervous about getting the fourth dose, but I prefer the protection given my condition, age and general health.”

Another shared this story: “I am a nurse, and it is my 14-year-old daughter who is Immunosuppressed. We went to a small clinic run by a doctor I work with to receive the fourth dose. Initially they said, ‘oh she has already had her third dose.’ I had to explain the newest recommendation. We were promptly cared for then, but I also had to name drop the doctor who runs the clinic. I don’t believe many people would have had the resources and ins that we had.”

Others similarly begged for better awareness claiming they had to wait while pharmacists determined what to do. “The pharmacy didn’t know anything about the fourth dose and didn’t know it was authorized, how much to give me, etc.” and another shared “I was able to schedule a fourth dose. When I arrived, the clinician was unclear whether I should receive a full or half does (of Moderna). After 15 minutes of discussions with peers and experts, I received a half dose.”

Many are planning to get a fourth shot when the time is right

For those who reported not yet having received a fourth COVID-19 vaccine dose, we wanted to learn more about this decision. The most common reason people mentioned was that it was too soon for them to get a fourth dose (43%). Others said they have an upcoming appointment (11%).

Other reasons included:

• 12% said I’d rather receive a booster that is made for recent variants
• 7% said my health care provider advised me not to get an additional vaccine dose for now
• 6% said I’m nervous about side effects
• 4% said I don’t want to get a fourth vaccine dose
• 4% said I was turned away at the vaccination site
• 3% said there weren’t available appointments

Those who haven’t got a fourth COVID-19 vaccine dose are worried about the lack of information

In a free response section where patients could elaborate on their answers, some people wrote that they didn’t even know a fourth shot was available until they received this poll. “I didn’t know about it until right now, so will have to read up on it,” was a common sentiment.

Many respondents also expressed their concerned over a lack of data about the safety and effectiveness of the fourth dose, specifically for those who are immunocompromised. “Concerned about immune system going into overdrive from all of these vaccines,” one respondent said. Another wrote, “concerned that too many shots will overwhelm my health and work against my system. Not enough info.”

More information on how often immunocompromised people will need additional vaccine doses would be comforting, as one person wrote, “I am concerned about getting so many vaccines in such a short time. I have six autoimmune conditions and several other chronic conditions that are flaring about a week after each vaccine. More info and reassurance along these lines would be so helpful.”

And another shared how despite trusting the science, it’s hard to keep getting more shots: “I am a believer in and a staunch advocate for the vaccine, but I must admit, finding out that the efficacy only lasts for a few months in my group — the immunocompromised — is disconcerting.”

But for the most part, respondents reported being thankful for having this extra layer of protection available in the U.S., as one person wrote, “grateful that I have access to a fourth dose when many people throughout the world are still awaiting primary/booster doses.”

The Global Healthy Living Foundation is committed to providing ongoing education about COVID-19 vaccines for the chronic illness and immunocompromised community.

To stay informed about the latest COVID-19 vaccine news for people who are immunocompromised, take immunosuppressant medications, or have autoimmune conditions, follow all of our COVID-19 vaccine coverage here.

Get Free Coronavirus Support for Chronic Illness Patients

Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety.

About the Patient Support Program Quick Poll

Members of our program have underlying health issues — such as inflammatory arthritis and other autoimmune conditions, heart disease, lung disease, diabetes, and more — that may increase their risk for COVID-19 complications. They are interested in understanding the best ways to stay safe during the pandemic and to be part of a community of people with similar concerns, questions, and fears.

We regularly poll members, who live in the U.S. as well as around the globe, about a variety of topics, including how the pandemic is affecting their lifestyle, mental health, chronic disease management, medication adherence, and more.

We use this information to inform the educational resources we provide and to inform other stakeholders — such as public health experts, policymakers, advocacy groups, health care professionals, and pharmaceutical companies — about chronic illness patients’ needs and concerns. You can participate in ongoing polls by joining the support program here.