The FDA has approved second booster shots for people over 50.
Justin Sullivan/Getty ImagesThe Biden administration has given the go-ahead for another COVID vaccine booster for certain people. Four months after their last dose, they can get another Moderna or Pfizer-BioNTech booster.
Do you need an additional booster just because you have one?
The COVID vaccine booster shots provide protection over time, according to health officials. They are concerned about people who are at the highest risk.
The Centers for Disease Control and Prevention did not make it clear how quickly people should line up for second boosters. The agency says these groups are eligible for the shots, but it stopped short of saying they should get them. Some infectious disease experts say that not everyone in this age group needs another shot.
Here are a few key factors to consider if you want to get a second booster.
Older people have the highest risk.
A recent study among people 60 and older in Israel found that people who had a fourth dose of the Pfizer vaccine had a lower incidence of serious illness.
Dr. Eric Topol is the founder and director of the Scripps Research Translational Institute.
Dr. Bob Wachter is the chair of the Department of Medicine at the University of California San Francisco.
The effectiveness of the booster shot has waned considerably six months out from my first shot.
Wachter says that another dose will increase his immunity and decrease the chance of infections.
It is not clear if a second booster is necessary for people under 60.
Monica Gandhi is an infectious disease specialist at the University of California, San Francisco. The younger age group was not included in the study out of Israel.
She points out that other countries are targeting older people. People over 70 can get a fourth shot in Germany. Sweden is giving fourth shots to people over the age of 80, while the U.K. is targeting people over the age of 75. Gandhi says the U.S. is jumping the gun by giving shots to everyone over the age of 50.
The trendline is clear, says Dr. Peter Chin-Hong.
He says that the older you are, the bigger the benefit. Chin-Hong says there is a clear association with age and mortality with COVID.
He wants to protect his mom as much as possible, so he wants to walk a little faster.
Carlos del Rio thinks it is reasonable for people under the age of 60 to wait.
Even for people over 60, the added protection of an additional booster shot is small. People who got the first booster have a low risk of dying. Chin-Hong points out that in the Israeli study, less than 1% of people with a third shot died.
The people who got the fourth shot died at a lower rate than the others.
He says three shots is the magic number so far.
The FDA decided to authorize the additional boosters starting at age 50 because of certain medical conditions that increase the risk of serious illness and death from COVID-19.
About a third of people in the age range of 50 to 65 have significant comorbidities, according to Dr. Peter Marks, director of the FDA's Center for Biologics Evaluation and Research. People with heart disease, lung disease, Obesity and Diabetes are at higher risk for serious illness and death and people over 50 are more likely to have an additional risk factor.
Marks said to consider those at high risk or higher risk by choosing age 50 and up.
Wachter agrees that there is no bright cut off of risk when it comes to age.
Incremental increases in risk are likely as a person ages. A 50-year-old has a lower risk than a 65-year-old.
Wachter says that a healthy 55 year old is probably at the same risk as a healthy 65 year old.
Wachter says many people over 50 may benefit from another dose because of age and underlying conditions.
A booster is recommended for anyone with a serious medical condition, says Dr. Preeti Malani, an infectious disease professor at University of Michigan Health.
Health officials are concerned about people who are immunocompromised because their immune responses to the vaccine tend to wane faster and they are at higher risk of dying from COVID-19.
The Pfizer-BioNTech COVID-19 vaccine can now be given to anyone 12 or older with certain immune-compromised conditions four months after their last dose. The Moderna vaccine can be given to people 18 years of age and older.
This includes people who have undergone solid organ transplants, or who are living with a similar level of immunocompromise.
There is mounting evidence of waning vaccine protection against serious illness in older and immunocompromised people who are at least four to six months past their first booster.
There is evidence of waning immunity from a recent CDC analysis of emergency room visits and hospitalizations. People were protected against hospitalization after a third dose. By four months, that protection had dropped to about 80%.
It means that people who were boosted three, four, five, six months ago probably have limited protection against current infections.
This means a second booster can help shore up that protection, but it is not going to be long lasting.
The rate of viral infections has come down significantly since the peaks in January, but there are signs that infections are rising in some areas. In the U.S., the omicron variant BA.2 is now the dominant variant, and hospitalizations are increasing in some places.
Some people might want to wait to get a booster until the cases start to rise in their community and they need more protection.
There may be more effective vaccines on the horizon. It may make sense for people at lower risk to wait as vaccine makers test omicron-specific vaccines.
You may not want to wait too long if you are high-risk. When the first booster dose became available last year, many people held off. Waiting until you see another outbreak could be dangerous.
It reminds me of trying to time the stock market. Wachter says nobody is good at it. If there is another outbreak on the horizon, it is advisable to maximize your protection.
When deciding on the timing of a fourth dose, there is one more factor to consider: Have you had a recent COVID-19 infection? Wachter says it is reasonable to wait if you have had three shots and have an omicron infection. He says a recent infections puts a person in a similar state as a second booster.
Rob Stein was involved in the report.
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