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HIV physician details who should be getting COVID-19 booster shots

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Dr. Stella Safo, an NYC-based HIV primary care physician, discusses who should be getting COVID-19 vaccine booster shots.

Video Transcript

- All right, well we're sticking with this topic, and bringing in Dr. Stella Safo, NYC-based HIV primary care physician to discuss further. And doctor, thank you so much for being with us. Can you tell us a bit about the conditions that you've been seeing on the ground where you're practicing, and what you're seeing specifically with regard to COVID among patients?

DR. STELLA SAFO: Absolutely. So I'm in the outpatient setting. And I work with patients who have either chronic conditions like HIV, diabetes, hypertension. And because these patients are higher risk, I have found that many are coming in, and they have either gotten their vaccines or they're coming in and they're open to asking questions about what they need to know to be able to then feel comfortable to get their vaccines. What I'm finding, though, in the conversations that I have within the community are people who are feeling pretty entrenched in not wanting the vaccine for different reasons, and not necessarily trusting of the vaccines are safe enough for them to take.

And so myself and others are just trying to have these conversations as much as we can, to answer questions, and have people feel empowered to be able to go ahead and get vaccinated. I will say, the increase in hospitalizations, and the kind of scariness of Delta, has made it so that people who are kind of a no before are coming in and saying, hey doc, actually, tell me more about this vaccine because I am a little nervous of what's happening with Delta. So we're starting to see some people shift just because of how severe COVID is becoming.

- When we hear that people who are immunocompromised should get a booster shot, is that a blanket everybody, whether it be HIV or some other situation with their health? Or are there within those different classifications of immunocompromised points at which you should hold off on getting the booster?

DR. STELLA SAFO: It's a great question. So for the most part, it seems like the studies have classified the normal groups that you go to and think of as immune compromised. So folks who are taking immunomodulators, cancer survivors that are on chemo, et cetera. And you would actually be able to, in most places, self-identify what your immune condition is. You would just kind of, you know, you'd provide an attestation for why you need it, and you'd get the booster. It almost becomes a moot point because by September 20, we'll be talking about third doses for individuals. But I like to think of the third dose for people who are immune compromised as actually just finishing off your vaccine series.

Because the idea there is that perhaps the first two doses you got weren't enough, so you're really helping your immune system to get fully used to what it would look like if it saw COVID for real. That's a little different than the world of individuals who are getting an extra booster shot who have a normal immune systems, and that's not going to be happening after September 20. But I will say that for most people, you can kind of self attest that you have a condition, and they will be able to give you that third dose. And most of those conditions are what you would think of classically like cancer, HIV, et cetera.

- Doctor, I'd love to get your thoughts on the booster conversation. I know that some experts have told me that they would like for it to be a patient-physician conversation for the broader population, and maybe not everyone needs to get those shots. Meanwhile, there are others who, of course, are focused on the global vaccine equity part of it, as well as those under 12 not yet being vaccinated. So there are a lot of parts to this. But what are your thoughts about making it a sort of a doctor decision rather than just broadly seeking boosters.

DR. STELLA SAFO: You know, I think this is a place where the administration and the CDC are trying to be proactive rather than reactive. COVID has been one or two steps ahead of us at every turn. And I think this is a place where they're looking at the numbers, they're looking-- it's going to be a tough fall, and they're saying, what could we do to really protect ourselves and our populations. And it seems like the third shot could be an option for that. The challenge here is that we are protected when we're all protected.

And so to give people who are already vaccinated and have a degree of protection a third shot may actually not help us get to where we want to get, which is to decrease the transmission of COVID within many of these communities. And so this is the point where it really matters, that we think about what we want to do. Because if we take those third shots that we're going to make available for our own citizens and turn it around, and add it to the global market so that other individuals globally are able to get it, you can think about what would happen for future, unfortunately, variants of COVID. We could potentially decrease the mutations that will continue to happen with COVID down the line.

And so there's a really good and important, I think, argument among public health officials and, you know, clinicians about, does it make more sense to give everyone who's already vaccinated a third shot? Or does it actually make sense to get more people who are willing globally to be vaccinated? And I think that that's somewhere where I'd fall more on the end of, let's give our global partners vaccines because it eventually protects all of us down the line, and lets us get ahead of COVID.