Residents of long-term care facilities will be the first to receive additional Covid-19 booster vaccinations, after the Biden administration announced Wednesday that a third shot is needed to fight off waning immunity in fully vaccinated people.

The Biden administration is also set to mandate vaccinations among nursing home staff as a condition to continue receiving Medicare and Medicaid funding, The Associated Press reported.

The administration is developing plans to offer the booster shots after three separate reports published this week in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR) revealed a decline in the vaccines’ ability to protect against less serious infections, and that more protection is needed to stave off the delta variant as well as the chance of contracting more serious infections.

News of the booster shots was lauded by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

“We will continue to engage with public health officials to help advise and hopefully streamline the process for administering booster shots considering the diversity of the long term care profession. In the meantime, we must remain vigilant, especially in the face of Delta, and continue to promote uptake among currently unvaccinated staff and residents,” AHCA/NCAL President and CEO Mark Parkinson said in a statement.

The association pushed back on the plan to mandate vaccines for nursing home workers, saying that the mandate should apply to all health care workers. 

LeadingAge echoed AHCA/NCAl’s sentiments about mandating vaccines for nursing home staff, arguing that doing so would compound an already tough labor environment and place further strain on already tight margins for facilities in financial distress.

“To penalize nursing homes by withholding or withdrawing funding is not the right way to increase vaccination rates. Without Medicaid and Medicare funding, nursing homes cannot provide the quality care that our nation’s most vulnerable older adults need,” LeadingAge President and CEO Katie Smith Sloan said in a statement. 

The booster shot rollout will begin on Sept. 20, meaning that the first people to receive additional vaccinations will be higher risk demographics including health care workers, the elderly, and long-term care residents, the administration announced.

Positive Covid-19 cases have risen significantly over the past two months, from a trailing seven-day average of 11,133 cases on June 20, to 139,872 cases on Aug. 17, the New York Times reports.

The plans for booster shots will apply to people who received the Pfizer-BioNTech and Moderna vaccines. Scientists are still gathering data on the Johnson & Johnson vaccine, which rolled out in March. But authorities expect booster shots will be required for recipients of the J&J vaccine, as well.

One of the studies, centered on the effectiveness of the Pfizer and Moderna vaccines before and after the delta variant became the dominant strain of Covid-19, reported a 22% decrease in effectiveness from March to July among nursing home residents.

The Pfizer vaccine’s effectiveness decreased from 74.2% for the pre-delta variant period between March 1 and May 9, to 52.4% from the period between June 21 and Aug. 1 when the variant accounted for the majority of new cases. The Moderna vaccine’s effectiveness decreased from 74.7% to 50.6% during that span.

“An additional dose of COVID-19 vaccine might be considered for nursing home and long-term care facility residents to optimize a protective immune response,” the report read, adding that safety measures to mitigate the spread of the virus among staff and visitors, including vaccinations, is critical.