Dubai, United Arab Emirates (CNN) – The US Food and Drug Administration allowed, on Tuesday, to add a second booster dose to its license for the “Pfizer” and “Moderna” vaccines against “Covid-19”, for those aged 50 years and over, after the passage of time. Minimum four months after receiving their first booster dose.
Within hours, the US Centers for Disease Control and Control issued a statement saying that the agency would allow receiving a second booster dose in parallel with directing people who initially received the Johnson & Johnson vaccine.
Everyone who received the Johnson & Johnson vaccine and received a first booster dose is also eligible to receive a second booster dose.
These developments follow an updated analysis by the Centers for Disease Control, which shows that the highly rapidly spreading BA.2 submutant has become the dominant strain in the United States.
Now that more people can receive an extra dose of vaccine, should they get it? What factors are they supposed to take into account? And is there any downside to getting more doses? And should I wait for an important event like international travel, or a big wedding to get that booster?
CNN Clinical Analyst Dr. Liana Winn answers these questions.
CNN: Who qualifies now for an extra booster shot?
Dr. Liana Wayne: Prior to this week’s announcement by the Food and Drug Administration and the US Centers for Disease Control and Prevention, people with moderate or severe immunodeficiency were eligible for an additional booster. Now, the group eligible for an additional booster dose is larger, and into two groups:
The first includes people over the age of 50 who have previously received three doses of the “Pfizer” or “Moderna” vaccines, and four months have passed since the last minimum dose of the vaccine, and they can receive a second booster dose with messenger RNA technology, from Pfizer or Moderna.
Second, all adults of any age who received a dose of the Johnson & Johnson vaccine and then a booster dose at least four months ago can receive a second booster dose of one of the two messenger RNA vaccines, Pfizer or Moderna.
CNN: Now that more people are getting a second booster shot, should they do it?
Dr. Liana Win: First, I want to stress the importance of getting the first booster shot.
According to the US Centers for Disease Control and Control, about half of Americans are eligible for their first booster dose that they have not yet received, a surprising rate of 1 in 3 people 65 years of age and older.
There is ample data showing the relevance of the initial booster dose, especially against the ‘omicron’ sub-mutants, including the now dominant BA.2 strain.
While BA.1 was the main mutator, the efficacy of both vaccine doses against severe disease fell to 79%, according to a study by the US Centers for Disease Control and Control.
While the effectiveness of the three doses remained high at 94%.
The data for the second booster dose is less clear, as much of the research comes from Israel, where the fourth has been widely available since the end of January.
One study of adults over the age of 60 found that those who received a fourth dose of the vaccine had a 78% lower risk of death during an omicron wave, compared with those who received a third dose at the minimum four months.
However, the number of deaths was low in both groups.
Another Israeli study, published in the New England Journal of Medicine, found that the fourth dose increased antibodies, but did not greatly enhance protection against infection, and those who were infected had mild symptoms if they received three or four doses.
Complicating matters further, it is not clear how long the enhanced protection from the fourth dose will last.
This cannot be an all-inclusive recommendation, but rather precise guidelines that are tailored to each person’s individual medical conditions.
CNN: What factors should people consider when deciding to get their second booster dose?
Dr. Liana Wayne: First, consider your own medical risk factors, and if you are elderly and have multiple medical conditions, you are more likely to develop severe illness from COVID-19.
Sure, if you are moderately or severely immunocompromised, that should tip the scales in favor of getting an extra booster dose now.
On the other hand, if you are generally healthy, you are still protected from severe illness due to the protection from the vaccine and the first booster dose. So it is not necessary to get the second booster dose, and there may also be benefit in waiting.
CNN: Have there been any negative repercussions after getting the fourth dose?
Dr. Liana Wayne: Extensive Israeli data analyzes did not identify new safety concerns from the fourth dose.
Theoretically, there is a concern that if a person receives boosters on an ongoing basis, their immune system may not activate if exposed to Covid-19 infection, but this has not been proven.
The main downside will be the issue of timing. Is now the best time to receive the fourth dose, or is it preferable to postpone? This will depend on each person’s medical risk factors as well as their risk tolerance, and specifically how important it is for them to continue avoiding the coronavirus.
CNN: Some people may want to wait for a big event like traveling internationally or a big wedding to get an extra dose. Is that a good plan?
Dr. Liana Wayne: not necessarily. If you haven’t received your first booster dose yet, you should receive it now because it is important to maintain strong protection against severe disease.
And remember, there are other tools on hand for better protection during major events, and if you want to be extra vigilant, ordering all guests to be tested and vaccinated for COVID-19 before congregating indoors will significantly reduce risks.
You should also know where you can access treatment in case of injury, and let’s not forget the masks, as a high-quality mask such as the N95 or its equivalent protects you even if those around you are wearing a mask.
Boosters are one important tool that can complement others to help us reduce individual risks.