Leslie Ebersole was so eager to get vaccinated against COVID-19 that she traveled roughly 130 miles round-trip from her home in west suburban St. Charles to get the shot in LaSalle County in March, as soon as she was eligible and could snag an appointment.

       While the two-dose regimen of the Pfizer vaccine made her feel more at ease, Ebersole has rheumatoid arthritis and takes immunosuppressant medications, which could reduce her body’s ability to produce enough antibodies following the initial two doses.

       So once the Food and Drug Administration authorized a third shot for her and others with certain medical conditions last month, she consulted with her physician and got the additional dose.

       “It’s not operating from a position of fear,” said Ebersole, a management consultant in the real estate industry. “It’s operating from a position of doing everything possible to minimize risk. It’s the same reason I buckle my seat belt. I don’t expect to get hit by a truck on my way to the grocery store. But if I do, I want to be protected.”

       Medical experts stress that these third doses — which were cleared in mid-August for a segment of the population with specific health concerns — shouldn’t be confused with the booster shots that health officials say the general public might eventually need due to potential waning immunity after initial vaccination.

       An federal advisory panel on Friday rejected a plan to administer Pfizer booster shots to most Americans, but did support boosters for those who are 65 or older or have a high risk for severe illness, outside of the medical conditions already authorized for a third vaccine dose.

       A Centers for Disease Control and Prevention advisory committee is scheduled to meet Wednesday to debate who should get boosters and when the extra shot should be administered. The CDC has said it is considering boosters for older Americans, nursing home residents and front-line health care workers, as opposed to all adults. A separate process will be needed to determine if the Moderna and Johnson & Johnson vaccines also require boosters.

       The United States had originally raised the possibility of administering those booster shots as soon as this month, though the prospect stirred controversy in the international community. World Health Organization leaders recently called for a moratorium on boosters for healthy individuals in wealthier countries until 2022, as many other poorer nations struggle to get first and second shots in arms due to vaccine shortages.

       “We do not want to see widespread use of boosters for healthy people who are fully vaccinated,” WHO Director-General Tedros Adhanom Ghebreyesus said at a news conference earlier this month, while acknowledging the immediate need for third doses for folks with certain medical conditions.

       As of now, the CDC recommends a third vaccine dose for moderately to severely immunocompromised individuals, including cancer patients, organ transplant recipients, some people with HIV infections and those taking medications that might suppress the immune system. The U.S. has given third doses of the Pfizer and Moderna vaccines to more than a million immunocompromised Americans.

       Other nations seem to be following suit: Spain’s health care regulator earlier this month cleared a third COVID-19 vaccine dose for those with compromised immune systems. Canada’s national vaccine panel also recently recommended third shots for some immunocompromised residents, and Italy earlier this month began permitting third doses for certain higher-risk groups.

       The United Kingdom, Israel, France and Germany have already been administering third doses for folks with some health conditions.

       A young man reads a book in his mandatory wait after being vaccinated to check for immediate side effects on Sept. 15, 2021, in Ibiza, Spain. Last week, Spain's health regulator approved the use of third Covid-19 vaccination shots for immunocompromised people. (Zowy Voeten / Getty Images)

       For Ebersole, the extra shot not only offered more peace of mind for her own health — it also made her a little less worried about potentially catching and spreading the virus to others, particularly people who are more at-risk than she is.

       While the medications she’s taking can reduce her immune response, she’s otherwise very healthy and lives a pretty typical life. But she was concerned about unwittingly passing on the virus to others, particularly those who might be more medically vulnerable.

       “I’ve done everything I can to protect myself and protect the people around me,” she said. “This isn’t just about me. It’s about everyone I value in the general community.”

       ‘Improved response’

       There’s been some promising initial evidence that third doses can be beneficial for certain higher-risk patients.

       Canadian scientists found a third dose of the Moderna vaccine significantly boosted protection for organ transplant recipients in a study in the New England Journal of Medicine last month.

       “In ongoing clinical trials, the mRNA COVID-19 vaccines (Pfizer-BioNTech or Moderna) have been shown to prevent COVID-19 following the two-dose series,” the CDC said. “Limited information suggests that immunocompromised people who have low or no protection after two doses of mRNA vaccines may have an improved response after an additional dose of the same vaccine.”

       Some research has also found that immunocompromised people are at a higher risk of breakthrough infections after vaccination, which suggests they might also have more potential to pass the virus on to close contacts. The vaccines tend to offer these patients less protection, with 90% to 94% effectiveness in the general population compared with 59% to 72% effectiveness in those who are immunocompromised, according to the CDC.

       So far, side effects to third doses have been similar to those experienced after first and second doses, like fatigue and pain at the injection site, the CDC has found.

       The third doses — which are identical to the first two — should be given at least 28 days after the second dose of the Pfizer or Moderna shot for folks with weakened immune systems. This is different from the anticipated schedule for booster shots for the general public, which could start eight months after the second dose, according to the CDC.

       The Illinois Department of Public Health advises sticking with the same brand for the third dose as the two-dose regimen.

       The guidance on extra doses for immunocompromised patients doesn’t apply to the one-dose Johnson & Johnson shot: So far, there isn’t enough data yet to know if recipients of the Johnson & Johnson vaccine who are immunocompromised could benefit from an extra shot, according to the CDC, though more data is expected soon.

       Ebersole said getting the third shot was much easier compared with securing the first dose, when vaccine was less abundant in the U.S.

       She said she received her extra shot on Aug. 16 at a Walgreens near her home, after attesting that she falls into a category authorized for the additional dose. The pharmacy staff didn’t require a doctor’s note or any other documentation but did ask her to name the medications she takes, Ebersole recalled.

       “It was pretty routine,” Ebersole said. “She didn’t grill me, didn’t require a doctor’s note. She was a little cautious, but she should be cautious. You don’t want to go against CDC guidelines.”

       Booster shots for all?

       Even after getting a third vaccine dose, those who are immunocompromised should continue to mask, social distance and avoid crowds, the CDC says.

       While a third dose helps ensure those with compromised immune systems get as much protection as possible, some immunocompromised people won’t respond very well even after a third dose, said University of Chicago Medicine infectious diseases expert Dr. Emily Landon.

       “It will take some time for science to illuminate who should be getting fourth doses or even repeating the initial series — something that is needed for other vaccines given during a time of extreme immunosuppression like chemotherapy or right around the time of a transplant — so everyone who gets a third dose because of immunosuppression should still be very careful to avoid getting COVID,” she said. “In short, the third dose adds an additional layer of protection for immunocompromised individual but isn’t a ‘sure thing.’”

       Emergency medical technician Ethan Hall gives Mark Turney, 66, a kidney transplant patient, his Pfizer-BioNTech Covid-19 booster shot at Hartford Hospital in Hartford, Connecticut, on Aug. 24, 2021. (Joseph Prezioso/AFP Getty)

       This is particularly concerning as the highly infectious delta variant of the virus has spurred a surge in cases nationwide, she said.

       Landon said she received a third COVID-19 vaccine dose in August because she also has rheumatoid arthritis and takes immunosuppressive medication.

       “It did make me feel less anxious about delta variant,” she said. “But I still take more precautions than people who aren’t immunocompromised.”

       She added that it’s important for those with higher risks or medical conditions to keep having conversations with their doctors as “new data trickles in.”

       As for the rest of the public, Landon said healthy people who received two doses of vaccine don’t need to be in a hurry to get a booster shot right now.

       “Healthy adults seem to have terrific immunity from the initial two-dose series but, over time, that immunity may wane, resulting in increased risk of minor breakthrough infection at first and maybe more significant infection later — regardless of a variant driving the need for more variant-specific immunity,” she said.

       She added that the evidence for boosters is best in patients over 70 years old and medically frail individuals, “but we really don’t know much about optimizing the timing of boosters” for those who are generally healthy.

       Much is still unknown about how many COVID-19 shots will be needed in the future. Dosing schedules and formulations and booster shots evolve over time for all vaccines, Landon noted, and the regimens she received as a child were different from the recommendations for her son.

       “Over time, we will learn much more and develop a stable regimen for COVID vaccines,” she said. “Until then, things will probably evolve based on the epidemiology and the new science. Anyone who tells you they know ‘for sure’ exactly what people need or will need in the future is simplifying the situation too much.”

       That doesn’t mean the vaccines aren’t safe or effective, she said.

       “They are excellent,” she said. “We just want to balance ongoing risk and ongoing benefit to make more specific recommendations.”

       The Associated Press contributed.

       eleventis@chicagotribune.com

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