Booster shots are here, after much hoopla from the White House and a great deal of discussion and consideration from the teams of doctors and other experts who advise the US Food and Drug Administration and the US Centers for Disease Control and Prevention.
More than 2 million people have already received third doses of Pfizer’s coronavirus vaccine, but these technically were not booster shots – they were extra doses given to people whose immune systems are compromised and may not have responded fully to the first two doses of vaccines.
But now the CDC and FDA have agreed many Americans need boosters and should start getting them. Here are some important things to know about them:
Who is eligible?
Many adults will be eligible for boosters if they have already received two doses of Pfizer’s vaccine.
“Starting today, if you are six months out from your last dose of the Pfizer vaccine, you are eligible for a booster if you fall into one of three high risk groups,” US Surgeon General Dr. Vivek Murthy told a White House Covid-19 briefing Friday.
“Number one: You are 65 or older. Number two: You have a medical condition that puts you at high risk of severe illness with Covid and these conditions include obesity, diabetes, high blood pressure, chronic kidney disease and others. And Number three: You work or live in a setting where you are at high risk of exposure to Covid. This includes health care workers, teachers, those living in shelters or prisons and grocery store workers.”
The federal government website at vaccines.gov has links to pages outlining who is eligible for a booster shot and has lists of locations where shots are available.
The CDC’s Dr. Kathleen Dooling told the Advisory Committee on Immunization Practices earlier this week there is a wide variety of people who might be included in the high risk groups. “Fully vaccinated persons with underlying medical conditions may be at risk of severe COVID-19 if they become infected with SARS-CoV-2,” she said. They include cancer, stroke, chronic kidney disease, chronic obstructive pulmonary disease or COPD, diabetes, heart conditions, obesity, pregnancy and smoking.
White House Covid-19 coordinator Jeff Zients said up to 20 million Americans fall into these categories as of now.
When and where can people get one?
People have already started getting booster shots.
Zients said there is plenty of supply, and people should be able to get boosters at pharmacies, doctors’ offices and sometimes at mass vaccination sites.
“Boosters will be free for everyone, regardless of immigration or health insurance status. No ID or insurance required,” he said Friday.
“And we’ve worked closely with partners including governors, pharmacies, doctors, long term care facilities and other providers so that eligible Americans are able to get a booster shot at roughly 80,000 places across the country, including over 40,000 local pharmacies,” Zients added.
“CDC contacted tens of thousands of nursing homes, assisted living facilities, and other high-risk settings to ensure that they are ready,” he said.
“Colorado has nine mobile vaccination clinics ready to go to get boosters to where people are. And we’ll double that number to 18 over the coming weeks.”
He said Colorado, New York, Ohio and other states were readying large vaccination centers if there is demand.
What about everyone else—including people who got Moderna or Johnson & Johnson vaccines?
The FDA and CDC will continue to consider widening the recommendations for who should and could get booster shots. Moderna has asked the FDA to consider booster doses for people who got its vaccine. Johnson & Johnson has yet to apply.
CDC Director Dr. Rochelle Walensky said her agency acted quickly on FDA recommendations for Pfizer vaccine recipients.
“We will, with similar urgency, evaluate the available data in the coming weeks to swiftly make additional recommendations for other populations at risk, and people who received the Moderna and J&J vaccines,” she told Friday’s briefing.
Murthy made a similar promise.
“I want to speak directly to those who received Moderna and J&J,” Murthy told the briefing.
“Your health matters just as much as other vaccine recipients, and we want to make sure that your protection against Covid is strong and reliable as well. That’s why the FDA is working with Moderna and J&J to get and process their data as quickly as possible with the goal of making booster recommendations for Moderna and J&J recipients in the coming weeks. This is a high, high priority.”
Why do people need them?
The protection provided by Covid-19 vaccines appears to wane over time, especially for people 65 and older, the CDC’s Ruth Link-Gelles, who helps lead the CDC’s Vaccine Effectiveness Team, said Friday.
She reviewed a series of studies looking at the overall effectiveness of vaccines in various groups between February and August and found similar patterns for Pfizer’s and Moderna’s vaccines, both made using mRNA. Effectiveness started to wane a few months after people were fully vaccinated – defined as two weeks after their second dose of either vaccine.
“For individuals 65 plus, we saw significant declines in VE (vaccine effectiveness) against infection during Delta for the mRNA products,” Link-Gelles told CDC vaccine advisers this past week.
“We also saw declines, particularly for Pfizer, for 65 up, that we’re not seeing in younger populations. Finally there’s evidence of waning VE against hospitalization in the Delta period,” she said.
In a study of 4,000 healthcare personnel, first responders, and other frontline workers in eight places who were tested every week regardless of symptoms, vaccine protection against any infection declined from 91% pre-Delta to 66% during Delta.
A study called IVY looked at hospitalized adults in 18 states between March and August. Efficacy of Pfizer’s vaccine waned from 91%, 14 to 120 days after full vaccination, to 77% three months or more after full vaccination. Moderna’s vaccine effectiveness did not really wane, staying at 92% or 93% in that study.
Pfizer says its studies show booster doses bring people’s immunity back up to what it was right after they got their second shots, or to even higher levels.
Do I need a doctor’s note?
No. People are being asked to “self-attest” as to their eligibility for a booster vaccine.
But people should not cheat– especially when it comes to waiting six months or so before getting a booster, said Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases.
That’s because a longer time period between prime – the first doses of vaccine – and boost helps the immune system mature. The longer one waits, the better the immune response.
“If you allow the immune response to mature over a period of a few months, you get much more of a bang out of the shot, as it were – an enhancement of your antibodies,” he said.