How to get mRNA after J&J

by jefftkjefftk1 min read5th Aug 20219 comments

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Covid-19
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The viral vector vaccines (J&J, AstraZeneca) are much better than nothing, even against Delta. But they're also substantially worse than what you get from the mRNA ones (Pfizer and Moderna), especially the single-shot J&J (study, NYT). People who got J&J could likely benefit from an mRNA shot, and while the CDC has not recommended it some places like SF General Hospital are offering supplemental doses.

One of my housemates had received J&J and decided to get a supplemental mRNA shot. Here's what worked for them:

  1. Got to the nearest CVS.
  2. Ask what vaccine they have; if they only have J&J, try somewhere else.
  3. Say yes when they verify that this is your first shot.
  4. CVS asked for their name and birthdate, which they gave, but they weren't asked for ID or insurance. Possibly if you are you would need to decline?

This requires lying to the pharmacy, never something to take lightly, and there could potentially be negative medical/legal/financial consequences, but with the information we currently have it seems like something to consider.

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I also did not have to lie. They never asked me if I'd previously been vaccinated against COVID (except to ask whether I'd gotten any vaccines in the last 14 days). 

One alternative: NIH is currently recruiting for a clinical trial to assess the effectiveness of booster doses. Among other requirements, enrollees must not have had a known COVID infection and must have been fully vaccinated at least 12 weeks prior to enrollment. https://clinicaltrials.gov/ct2/show/NCT04889209

In this situation I was asked for ID and insurance and gave them, and there was no problem whatsoever. Record-keeping does not appear to be centralized, even where it ostensibly is? Or at least the pharmacists at CVS aren't checking it when they ask for your ID. Seems like it would be suspicious to decline to give ID?

An aside: I really like to see if there's benefits from receiving J&J after receiving two doses of mRNA.  

Maybe expanded variants protection or quicker immune response leading to lower amounts of shedding.

https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization suggest that primary care doctors have the power to vaccinate in the US. Given that off-label use of medication is generally allowed I would be surprised if you couldn't find a reasonable primary care doctor to give you a second vaccine shot if your first was J&J.

Treating this as a situation where your first sense is to lie, suggests to me that you don't have a relationship with a trustworthy primary care doctor and you should find a trustworthy primary care doctor. 

Even with pharmacies my first approach would be to tell the truth.

I think it's the official policy not to ask for ID/insurance because it's important to also vaccinate the uninsured and undocumented.

Treating this as a situation where your first sense is to lie, suggests to me that you don't have a relationship with a trustworthy primary care doctor and you should find a trustworthy primary care doctor.

My housemate asked their primary care first, and they said no. I don't think that means that the PCP is a bad fit for them; there are lots of things you're balancing when you choose one.

Even with pharmacies my first approach would be to tell the truth.

I've read lots of people trying this and being turned away.

I think it says two bad thinks about the primary care doctor:

  1. They don't think well about treatment evidence. 
  2. They don't support their patient with access to they medical services they want. 

Besides taking time to listen and being easy to access those two seems to me like the main things that are important about a primary care doctor. 

The legal implications are an interesting one. I wonder if we should expect a law to be made against this and should do it before that happens?

I got Mondera, so not sure if I need to worry. But have been thinking about trying to sneak in a third.

It is unlikely that any law that appears to discourage vaccinations will be passed this year.