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Happy Thursday, readers.

Can you jump the line for a service that doesn’t technically even have an authorized line yet? Call it whatever you’d like, but more than one million Americans have taken it upon themselves to get a third dose of a COVID vaccine under the shadow of the raging Delta variant and potential concerns over how long currently authorized shots remain effective in warding off a breakthrough COVID infection without a booster, according to Centers for Disease Control (CDC) documents reviewed by ABC News. (There is now mounting data to support some of those fears.) There are no officially Food and Drug Administration (FDA) authorized boosters to date, although the agency is expected to change that by the end of this week for certain individuals.

The actual number is almost certainly higher than one million unauthorized third doses since the CDC data only tracked those who previously received two rounds of the Pfizer/BioNTech or Moderna coronavirus vaccines, but not those who may have received Johnson & Johnson’s single-shot variety, which relies on a different kind of technology. I know from personal experience that some folks worried about the J&J jab’s overall effectiveness and staying power against variants like Delta have gone out to get a booster dose of Pfizer’s or Moderna’s shot. Stay tuned for more on how that looks on the ground and how regulators, insurers, and pharmacies are dealing with it (short answer: uncomfortably and by pointing to a lack of current government authorization for boosters).

Which brings me to my question: Would you get a COVID booster even if you’re not technically supposed to yet? Through conversations with some of the individuals who have done just that, it appears that gaming the system isn’t too difficult if you’re determined to get your hands on a third dose. For instance, if you provided health insurance information when getting your first shots, you might be able to say you don’t have insurance and therefore not be flagged as being fully vaccinated in a pharmacy’s system. And individual pharmacies may not have much they can do to prevent giving someone ineligible a booster if they don’t have that person’s full information. That makes gaming the system easier for those hell-bent on a DIY third dose.

There’s a whole lot of ethical questions wrapped up into the debate and little in the way of easy answers. Once the FDA does authorize booster shots, they will almost certainly be triaged and prioritized for people at high risk for severe COVID illness, the immunocompromised, and the elderly. The likes of Dr. Anthony Fauci have said vaccinated, healthy people, and most of the population that isn’t immunocompromised shouldn’t worry about boosters just yet, although nearly everyone will “likely” need to revamp their immunization down the line.

But given the hundreds of millions of COVID vaccine doses which have been secured by the U.S. government, and the fact that you can be fully vaccinated and healthy but still catch a symptomatic case of the Delta variant, is a free-for-all inevitable or perhaps even the correct practical move for public health? And should we be placing a priority on getting those who remain unvaccinated their shots first, or should people who received their shots as recommended have an opportunity for a booster if they want one? After all, even if these people’s chances of landing in the hospital are dying are quite low, getting sick with COVID-19 can still be cumbersome and debilitating while allowing for wider spread of the Delta strain.

Again, no easy answers from me on this one. But I’m interested to hear readers’ thoughts on how the public should approach COVID boosters, and whether taking it upon themselves to go get one despite lacking eligibility is an acceptable move.

Read on for the day’s news, and see you again next Thursday.

Sy Mukherjee
sy.mukherjee@fortune.com
@the_sy_guy

DIGITAL HEALTH

HIMSS digital health conference goes not virtual. Ok, so it's more accurate to say not purely virtual. But there's a bit of irony to the Healthcare Information and Management Systems Society's (HIMSS) 2021 massive health tech conference going back to its annual live event in Vegas (in conjunction with an online platform) given the event's emphasis on all things virtual. HealthTech Magazine recounts some of the marquee conversations, which hit on classic digital health topics such as bolstering IT security, modernizing electronic health records with more accessible technologies while maintaining privacy, and getting patients to adopt new kinds of technologies when it comes to keep tabs on the health. (HealthTech Magazine)

INDICATIONS

Another sign of the coming need for boosters. One reason that regulators may be feeling increased pressure to give COVID booster shots the greenlight is the continued drip of evidence that mRNA-based vaccines such as Pfizer's and Moderna's start to lose potency anywhere from four to six months to nine months out from someone's initial immunization and are especially vulnerable to the Delta variant. New research from the Mayo Clinic (which has yet to be published in a peer-reviewed journal) finds that Pfizer's shot in particular may be far less effective at preventing breakthrough Delta infections among the fully vaccinated. The Mayo Clinic study finds that between January and July, Moderna's vaccine was 86% effective at preventing new coronavirus infections while Pfizer's was 76% effective. Things look very different once you isolate July, though, with the numbers falling to 76% effficacy for Moderna and 42% for Pfizer, according to the data. (Fortune)

THE BIG PICTURE

Black patients have significantly higher chances of dying after a liver transplant. A new study highlights a longstanding truth of American medicine: Demographics are often destiny in U.S. health care. We see that in life expectancy and quality of life among the underserved and minority populations. Updated figures on survival rates following liver transplants offer a microcosm into the trend. According to the data, discrepancies between Black Americans and other racial groups are only getting worse among liver transplant patients, with Black people 60% more likely to die after the procedure than white Americans. This group also fared worse than Hispanic Americans, raising questions of access and quality of care disparities for those who need a key medical procedure. (ModernHealthcare)