And, the above timeline is already out of date! The latest guidance is
you can get a booster if (emphasis the CDC):
- People 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
- People aged 50–64 years with underlying medical conditions should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series,
- People aged 18–49 years with underlying medical conditions may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks,
People aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.
#4 above was a recommendation initially rejected by a CDC advisory panel but eventually included after a direct overrule by CDC Director Rochelle Walensky. From the New York Times
The director of the Centers for Disease Control and Prevention on Friday overruled a recommendation by an agency advisory panel that had refused to endorse booster shots
of the Pfizer-BioNTech Covid vaccine for frontline workers. It was a highly unusual move for the director, Dr. Rochelle Walensky
, but aligned C.D.C. policy with the Food and Drug Administration’s endorsements over her own agency’s advisers.
Also, no boosters at all for those who received a Johnson & Johnson or Moderna shot (yet).
Further context from the World Health Organization is not to offer boosters
, but these concerns are primarily from an equity perspective. These aren’t baseless, but the fact is the United States is sitting on vaccine doses it could almost certainly not give away, even if it wanted to.
Got it all straight yet?
My Take On Boosters
First, it’s worth a reminder about some underlying facts about vaccination:
What are the different ways a vaccine helps confer protection against a virus?
…vaccines help protect you in two ways. First, you develop antibodies to the virus, which are immediately available to protect you if you’re exposed. Second, you produce memory cells, which remember how to produce antibodies if you need them later. The initial antibodies stick around for a while but not forever, but the memory cells remain.
Are booster doses/shots safe?
By all available evidence, 3rd shots/boosters are safe
. Israel has been offering boosters quite liberally for several months now. However, the CDC does admit
it is not certain how a 3rd dose may impact the rate of myocarditis, a known yet rare side effect of the mRNA vaccines.
So, what are boosters for?
A booster shot — literally, a third dose of the same vaccine — has two possible uses. First, for people who are immune-compromised (say, cancer patients), a third dose of vaccine may be necessary to prompt a strong immune response. There is widespread agreement for using boosters this way; one way to think about it is that this group should have been on a three-dose regimen initially.
For everyone else, who likely had a robust immune response initially, the value of a booster is less clear. The booster will prompt more antibody production, increasing immediate protection, but it isn’t clear that that’s necessary to improve protection against severe disease. Which is the point of the vaccines in the first place. This isn’t a straightforward trade, and reasonable people differ.
Simplified, a booster will increase the baseline level of antibodies in the body, allowing it to better prevent a symptomatic infection of COVID-19. The expected natural outcome of a booster is: boosters will almost certainly reduce the rate of breakthrough infections.
However, there is not much solid evidence booster shots for the general population meaningfully reduce the risk of hospitalizations or death, because the original vaccine dosage already does a phenomenal job at this!
Hence, the debate taking place over the past several weeks.
What are we actually trying to achieve in the United States?
I see two realistic, feasible goals:
If the goal is to prevent as much COVID infection as possible at all costs, then it probably makes sense to give boosters to the general public. But given the inherent fact that boosting those already vaccinated does virtually nothing for the unvaccinated, the actual impact on cases would probably be small. Getting 1 shot in everyone would be far more impactful than getting 3 shots in those with 2.
If the goal is to make COVID a manageable disease (aka, people don’t die or get hospitalized at very high rates), then I don’t see a compelling reason to boost the general public. At least right now, the vaccines are already doing exactly what they’re designed to do.
What I fear, above all else, is the confusing, political, and sometimes hypocritical messaging around boosters undermines confidence in the vaccines overall. Poor messaging could lessen any positives gained from boosters if the unvaccinated group remains unswayed to get shot #1.
This post from Marginal Revolution
(a blog with contributions from Alex Tabarrok and Tyler Cowen) captures the dissonance I feel and the significant downside risk of the confusing messaging. Note, this was written before
Walensky’s reversal of her agency’s recommendations, and responding to that decision, emphasis mine:
My first reaction upon hearing that boosters were rejected was to ask the same thing: would these same “experts” say that, because the vaccines are still effective without boosters, vaccinated persons don’t need to wear masks and can resume normal life? Of course not. They use the criterion “prevents hospitalization” for evaluating boosters (2a) but switch back to “prevents infection” when the question is masks and other restrictions. What about those that are willing to accept the tiny risk of side effects to prevent infection so that they can get back to fully normal life? The Science ™ tells us that one can’t transmit the virus if one is never infected to begin with.
And, emphasis also mine:
The biggest problem with public health professionals continues to be (1) elevation of their own normative value judgements — namely that NPIs [non-pharmaceutical interventions, e.g., social distancing, masking, quarantine, etc.] are no big deal no matter how long they last — which have nothing to do with scientific expertise, (2) leading them to “shade” their interpretation of data to promote their preferred behavioral outcome rather than answering positive (non-normative) questions with positive scientific statements, (3) thus undermining the credibility of public health institutions (FDA, CDC) and leading to things like vaccine hesitancy.
This blog post is angrier than I am, indeed. Still, I tend to agree with its final assertion: public health officials are undermining their credibility with this bungling, a risk far larger than the question of boosting the general public.
Anyway, enough words of mine spilled on the topic. If you’re craving more, I will encourage you to read this excellent op-ed in the New York Times about the topic: