- A self-attestation is enough to qualify for the booster dose.
- A third dose appears to increase protection against symptomatic disease.
- It’s not yet recommended to “mix and match” doses
The US Food and Drug Administration and US Centers for Disease Control and Prevention have issued guidance that some adults can receive a third shot of the Pfizer/BioNTech Covid-19 vaccine, reports an article published in CNN.
Who is eligible to get a booster dose?
“I think it’s important to clarify who is advised to get a booster versus who may get it”, says CNN Medical Analyst Dr Leana Wen. An emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health.
- If the person is in this category of people who received an organ transplant, are on chemotherapy for cancer, or have other immunosuppressive conditions
- the FDA and CDC announced that people who are moderately or severely immunocompromised and who received two doses of either the Pfizer or Moderna vaccines should get a third dose of the same vaccine
- The FDA and CDC did not provide guidance for immunocompromised people who received the one-dose Johnson & Johnson vaccine.
- individuals who already received the two doses of the Pfizer vaccine,
- who are at least six months out from their second dose
- who are either 50 years old and above and have an underlying medical condition that makes them more likely to have a severe outcome from Covid-19. Those people are advised to get a third Pfizer dose.
People who are 18 and above and have underlying medical conditions or in occupations that are high-risk for exposure to Covid-19. These individuals aren’t necessarily advised to get the booster but they may, once they weigh their own risks and benefits in consultation with their physicians.
Why make this distinction between “should” and “may”?
People above 65 years old, who reside in nursing homes, with underlying medical conditions are at the highest risk. They should get the third dose and the data is clearest that they would benefit from.
“The advisory panel essentially said that the benefit-risk calculation is a little less clear for those who are in the second, broader group. That’s why they may get the vaccine and can choose to get it, but it’s not yet advised that they do”, Dr Wen.
“It’s clear those in the highest risk group should go out and get the third dose if they are past the six-month mark since their second shot. Then, there are others who should get to choose for themselves. We are at a point in the pandemic when people are making very different decisions about their own risks. I think it’s reasonable to let people decide about their own level of risk and whether they want a booster at this time.”
What if you don’t technically meet the criteria for the booster?
A self-attestation is enough to qualify for the booster dose.
“I believe that people should be allowed to make the decision for themselves, in consultation with their doctor, about what constitutes high risk”, says Dr Wen.
Difference between a third dose of the vaccine and a booster
Someone in the US is considered “fully vaccinated” if they receive two doses of either the Pfizer or Moderna vaccines or one dose of the Johnson & Johnson vaccine.
A “booster” is the term being used for another vaccine dose for someone who is fully vaccinated. For people who got the Pfizer or Moderna vaccines, which is the majority of the American public, that’s the third dose.
There are some experts who have said that this additional dose for those immunocompromised should not be considered a “booster” per se, as they never got the full immune protection to begin with from the first two doses.
“But that’s a very technical response. Practically, for those who got the Pfizer or Moderna vaccines, a “booster” and “third dose” mean the same thing”, says Dr Wen.
Should people get the booster shot?
Those advised by the CDC to do so should get the booster dose. The booster very clearly has benefits in reducing the likelihood of contracting Covid-19 and of severe illness.
In the broader group who are allowed but not yet advised to get the booster, the evidence is clear that immunity to mild Covid-19 does wane over time. Protection still appears strong against severe infection. A third dose appears to increase protection against symptomatic disease.
Some people might look at that data and say that they are protected against disease severe enough to lead them to be hospitalized and do not need a booster right now.
Other people would say the opposite. Something that’s considered mild could still be very uncomfortable to go through. That person may need to miss work or have child care concerns.
There could be long-term consequences to even a mild breakthrough infection. For a lot of people, avoiding hospitalization isn’t the only goal they care about. The only way to avoid Covid-19 is to skew in favor of getting the booster after the six-month mark.
The CDC has a list of underlying medical conditions that make it more likely that a person will have severe consequences as a result of Covid-19.
Getting boosters for those vaccinated is an added plus to increase individual protection, and people should certainly do it if they so choose, but we also cannot lose sight of the importance of getting first doses into people who still remain unvaccinated.
Are there any downsides to getting the booster?
The data from Israel, where there has been an extensive booster program, shows that the side effects from the third dose are comparable to those from the second dose. The most common side effects are local reactions that resolve within a couple of days.
The one concerning side effects is myocarditis, an inflammation of the heart muscle, which appears to have the highest incidence among males of adolescent and young adult age.
It’s important to note that the myocarditis associated with the mRNA vaccines is generally mild and resolves with no long-term harm and that Covid-19 itself can cause myocarditis.
“Still, especially if you are a younger male, but also if you are in the may versus should category, it is always a good idea to have a conversation with your doctor about the risks versus benefits of the vaccine”, says Dr Wen.
What about people who got the Moderna or Johnson & Johnson vaccines ,can they get a booster?
Currently, the only people who got the Moderna vaccine who can get a third dose are those who are immunocompromised. Moderna and J&J are both submitting their booster doses for authorization by the FDA, and it should be a matter of weeks before we get more information.
It’s not yet recommended to “mix and match“ doses, so if you received Moderna, you should wait for the Moderna booster rather than getting the Pfizer booster.
Did you Subscribe to our daily Newsletter?
It’s Free! Click here to Subscribe