Many who feel they need more coronavirus protection have managed to obtain an extra dose. “I did feel bad about it. But I didn’t feel bad enough,” one woman said.
Amy Piccioni is not a doctor or a scientist, but as word of breakthrough coronavirus infections in vaccinated people started spreading this summer, she waded through an array of technical and often contradictory information about the need for coronavirus booster shots. Then she decided for herself: She would not wait for federal regulators to clear them before finding one.
“It takes a long time for scientists to admit that some people need a booster,” said Ms. Piccioni, 55, who received the one-dose Johnson & Johnson vaccine last November through a clinical trial and timed her booster around a visit to her father in July, thinking it would protect her on the plane. She walked into her local Walgreens, asked for a Pfizer shot and got it, no questions asked.
“All I could think about was how low the vaccination rate is in some areas,” said Ms. Piccioni, who lives near Del Mar, Calif., and is in good health. “Those doses don’t last forever, so I felt no guilt about taking one that probably would have expired.”
While tens of millions of Americans continue to decline even a first Covid-19 vaccine, a small but growing number have sought out additional shots even though the Food and Drug Administration has not yet approved them and it remains unclear who precisely needs one and when.
Studies in the United States have found that the vaccines continue to provide robust protection against severe Covid-19, especially for those younger than 65, even as evidence grows that their effectiveness against infection wanes over time. A review published on Monday by an international group of scientists, including two from the F.D.A., found that none of the data so far provided credible evidence in support of boosters for the general population.
Still, many seeking early boosters fear that breakthrough infections could inconvenience or sicken them — or worse, they say, someone they love. Most do not feel they are taking a dose from someone else, as vaccines are widely available in the United States and a local pharmacy is not in a position to shift shots to nations that need them.
The number of Americans who are not immunocompromised but have obtained extra shots is unclear. About 1.8 million people have done so since mid-August, according to the Centers for Disease Control and Prevention, but that count is likely to include many with weakened immune systems. The Food and Drug Administration authorized additional shots for that group last month.
Also last month, the Biden administration announced that it hoped to start offering boosters on Sept. 20 to people who had received a second dose of the Pfizer-BioNTech or Moderna vaccine at least eight months before. But the leaders of the F.D.A. and the C.D.C. then said they needed more time to evaluate safety and other data. Janet Woodcock, the acting F.D.A. commissioner, has urged people not to seek booster shots on their own, but to wait for a regulatory ruling that they are safe and necessary.
For many Americans — particularly those over 65, who were among the first to be vaccinated — the shifting plans were just another case of inconsistent information from the government about the pandemic.
“Frankly, I did not trust the government to act on the science,” said Lynn Hensley, who assigned herself a booster in July, six months after her second shot. “I’m 78 and consider myself at a greater risk. I feel like I can just read what’s out there and make up my own mind.”
She went to a temporary county vaccine clinic in the Fox River Valley area of Wisconsin.
“They did ask me if it was my first or second shot, and I told them it was my first,” she said. “I did feel bad about it. But I didn’t feel bad enough.”
The Maryland Department of Health decided to take action ahead of the F.D.A.: It issued an order last week permitting immediate boosters for all residents 65 and older who live in group settings like nursing homes. Michael Ricci, a spokesman for Gov. Larry Hogan, pointed to the C.D.C.’s recommendation last month that “moderately to severely immunocompromised” people should have extra shots.
“We are relying on that expansive view to deem the seniors in congregate settings as immunocompromised,” he said. “We are directing those facilities to offer the booster shot to anyone who wants one.”
Federal guidance on masks, vaccine mandates, the risk of outdoor transmission and other virus-related issues have shifted often over the course of the pandemic. At times, within both the Trump and Biden administrations, there has been open disagreement among health officials on how to proceed, and confusing guidance that has subsequently been reversed.
As a result, Americans across the political spectrum are relying on pieces of information, like an announcement by Israel’s Ministry of Health in July that the effectiveness of the Pfizer-BioNTech vaccine against symptomatic infection — though not against serious illness — waned over time. Others have trusted their intuition, whether that means taking dangerous livestock medications to “cure” the virus or seeking a booster before it is officially recommended.
“This is a result of poor risk communication and lack of political and scientific transparency over the last 18 months,” said Rachael Piltch-Loeb, a researcher and fellow in public health emergency preparedness and response at the Harvard School of Public Health. “It is also a reflection of people feeling a total lack of control of what is happening in society at this point. One of the things that can do to protect themselves is to take science into their own hands.”
For vaccinated people living in areas where many have shunned shots and masks, proactively grabbing a booster feels like buying insurance on a rental car: They might not need it, but it makes them feel more secure.
Many have found willing partners in pharmacies and health care providers.
Bruni Baeza, 83, walked into a CVS in Miami, flashed the white vaccine card that showed seven months had passed since her last shot and was immediately given a booster, she said in an email from her birthday cruise — the impetus, she said, to get the third shot.
Pharmacies deny that they are knowingly letting people flout the guidelines. “Patients are asked to attest that all information provided, including health status, is truthful and accurate while scheduling a vaccination appointment on CVS.com and when they receive their vaccination,” said Ethan Slavin, a spokesman for the company. Mr. Slavin said that “we can’t speak to anecdotal reports” that CVS is giving boosters to customers like Ms. Baeza, who shared a record of her third dose with a reporter.
Public health experts generally take a dim view of booster self-selection. Like vaccine refusal, they say, it does not take into consideration the broader fight against the pandemic, which they believe should be focused on vaccinating the 25 percent of Americans who are eligible but unvaccinated, or on vaccinating people in poor nations.
“This flies in the face of what is required in a pandemic,” said Dr. Kirsten Bibbins-Domingo, an epidemiologist at the University of California, San Francisco. “The challenge is, particularly in a pandemic, individual choice is important but the entire strategy has to do with our collective choices and responsibility.”
Isabella, an healthy 18-year-old freshman at Colorado College, decided to get a second Moderna vaccine in order to protect immune-compromised friends and others.
“I feel like I can’t put the responsibility of being safe on anyone else,” said Isabella, who asked to be identified only by her first name because she had been dishonest about her health status, telling a pharmacist that she was immunocompromised. “I don’t want to contribute to illness in my community. Maintaining my immunity status is something I can do to protect my peers and myself, across all political views, so the legality of my booster shot isn’t important to me.”
Dr. Bibbins-Domingo saw another downside in this method: “With everyone out there lying about being immunocompromised, lying about their status, this will just wreak havoc with the data. We want public health decisions to be based on good data. It is a disserve to treat medicine like a restaurant where we go in and order from a menu.”
Still, people like Ms. Piccioni, the California woman who supplemented her Johnson & Johnson vaccination with a Pfizer one, feel it is better to be safe than sorry, even if the evidence has been mixed. “I was nervous,” she said, but concluded, “For someone like myself, someone who had an old vaccine, it was OK to boost with two.”
She got her second Pfizer shot last month.
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