Patients picky about which brand of booster? Here's what to tell them

Pharmacists in Ontario are reporting that patients are walking away from COVID-19 vaccine booster doses when only the Moderna COVID-19 vaccine (Spikevax) is available instead of Pfizer-BioNTech’s COVID-19 vaccine (Comirnaty). Justin Bates, CEO of the Ontario Pharmacists Association told CBC news said that half the people who want a Pfizer-BioNTech COVID-19 vaccine are turning down a Moderna COVID-19 vaccine when they are offered that instead. “They may cancel their appointment. They may walk out,” Bates told CBC News on January 7. There is currently a limited supply of Pfizer-BioNTech COVID-19 vaccine in Ontario, and the availability varies by region, said Jen Belcher, a pharmacist-owner and vice-president of strategic initiative and member relations at the Ontario Pharmacists Association. The Pfizer-BioNTech COVID-19 vaccine is preferred for the booster dose in those 18 to 29 years old due to a lower risk of myocarditis and pericarditis compared to the Moderna vaccine, according to the National Advisory Committee on Immunization (NACI)’s new recommendations on December 3, 2021. While most regions in Ontario should have enough supply to provide the 18- to 29-year-old age group with Pfizer-BioNTech COVID-19 vaccine for a booster dose, there may not be enough for people in older age groups who wish to have that vaccine over Moderna, Belcher said. Here is some advice on how to communicate with patients who are hesitant to accept the Moderna COVID-19 vaccine booster dose. 1. Be proactive with information Use the communication tools at your disposal to inform patients what vaccine they will be getting, said Belcher. This might be an automated message on the answering machine, a text to confirm appointment, an email to your patients, a notice on your pharmacy’s website or even posted signs in your pharmacy. This will help bring the message to a wide audience and may help avoid cancelled appointments. “Really use some of your technology to take pressure off your staff,” Belcher said. Read: Skin reactions to mRNA vaccines tend to be mild, transient 2. Acknowledge the complexity of available information There’s a lot of information (and mis-information) floating around. Add personal anecdotes from friends and relations, not mention Facebook posts, and no wonder patients are concerned. Kelly Grindrod, an associate professor at the University of Waterloo School of Pharmacy said that she often begins conversations by acknowledging the complexity of the information available. 3. Stress that the two mRNA vaccines are basically interchangeable Both Belcher and Grindrod said there’s a lot of brand recognition with the Pfizer-BioNTech COVID-19 vaccine, which may be why people are requesting it. It is also what many people received as their first COVID-19 vaccine. Yet Pfizer-BioNTech and Moderna COVID-19 vaccines are both effective in preventing hospitalization and death from the virus. “They are in essence interchangeable because they produce the same immune response whether you give one or the other,” Belcher said. Some pharmacists use the Pepsi and Coke analogy. Belcher said pharmacists can find a comparison that resonates with their patients. For example, she likes to tell patients it is like the Chevy Silverado and the GMC Sierra: same chassis, same mechanics, but different symbols on the hood. Both get you where you want to go. Some patients have anecdotes of friends or relatives who felt ill after receiving one of the vaccines, noted Belcher. Pharmacists can reinforce that any vaccine can provoke an immune response at any point in a vaccine series and these immune responses vary from person to person. Some studies don’t differentiate between the two mRNA vaccines. For example, a recent study published in the NEJM examining neutralizing antibody titres against the Omicron spike proteins combined the data from plasma specimens of people who had received the Pfizer-BioNTech and Moderna vaccines. Spoiler: neutralizing antibody titres against Omicron were substantially higher in persons who had three doses of an mRNA vaccine compared to those with two doses. Read: Moderna: Initial booster data shows good results on Omicron 4. Talk about dosages While some patients may be satisfied with an explanation that the vaccines are interchangeable, others with more concerns might benefit from understanding more about dosages. The Moderna COVID-19 booster dose is a half dose, at 50 mcg. People receiving the Pfizer-BioNTech COVID-19 vaccine booster dose get the full dose, which is 30 mcg. “A half-dose Moderna is actually more mRNA than Pfizer,” Grindrod said. “This is important because we dose vaccines based on age,” she said. “It’s not the size of your body but the age of your immune system.” A young person with a robust immune system responds well to the lower dose of the vaccine, which together with the reported lower risk of myocarditis and pericarditis is why the under 30s receive the lower dose provided by the Pfizer-BioNTech COVID-19 vaccine. “Once you’re over 30 and you don’t have that risk in the same way, and your immune system isn’t as strong and robust as it was in your teens and twenties, it does make sense to, if you can, get the Moderna booster that’s just a bit more and might evoke a slightly stronger response,” Grindrod said. Note, of course, that people older than 70 years and immunocompromised people receive a full 100 mcg dose of Moderna COVID-19 as a booster. 5. Cite real-world results While evidence on the effectiveness of mRNA vaccines against the Omicron variant are still emerging, some real-world data suggest the Moderna COVID-19 vaccine may provide more durable protection against previous variants of concern compared to the Pfizer-BioNTech. The NACI noted this in its Dec. 3, 2021 recommendations. For example, a study from the Centres for Disease Control showed the Moderna vaccine was 93% effective in reducing adult hospitalizations in the U.S. between March and August 2021, where the Pfizer-BioNTech vaccine was 88% effective. 6. Reinforce the danger of foregoing a booster dose Waiting for a different vaccine while COVID-19 cases climb puts patients at risk. Belcher suggests “being firm on the value of accepting Moderna.” Whatever mRNA vaccine is available for a booster dose is the best vaccine. Depending on supply issues, this may mean some patients between the ages of 18 and 29 will receive Moderna COVID-19 vaccine. Communicate clearly to patients the risk of pericarditis and myocarditis. In Canada, it's 1.44 events per 100,000 following a Pfizer-BioNTech vaccine and 2.55 events per 100,000 following a Moderna vaccine, according to a November 2021 report from Public Health Ontario. Make sure you communicate that the cases are mild and responded well to treatment and rest. Note this slight increased risk with Moderna is based on 100 mcg primary doses and not the 50 mcg booster dose, according to the NACI. Also, of course, the risk of myocarditis and pericarditis is higher with COVID-19. Asking for a certain brand of vaccine is “a phenomenon unique to COVID-19,” Belcher said. Grindrod said that with each dose of COVID-19 vaccine, the conversation gets easier. Educating patients now will help later if additional doses are required. “These are long-term investments in educating the public,” she said. Read: Ontario to offer fourth COVID-19 vaccine doses to immunocompromised Ontarians

Patients picky about which brand of booster? Here's what to tell them

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