COVID vaccine boosters for all adults could be recommended by Friday

November 18, 2021
Shyrel Ritter, a certified nursing assistant at the Hebrew Home at Riverdale, receives her COVID-19 booster shot at her workplace in New York on Sept. 27.
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  • The FDA and the CDC are expected to recommend COVID-19 boosters for anyone who wants one and is at least six months past their initial vaccination by the end of the week.
  • California, New Mexico and Colorado are among the states that have already made boosters available to everyone who received earlier doses more than six months ago.
  • The CDC has said it’s safe to mix vaccine brands, and data suggests Pfizer-BioNTech or Moderna would be more protective than a second J&J shot.

COVID-19 vaccines do a great job of preventing hospitalization and death, but their protection against infection starts to fade at about six months – even in young, healthy people. 

That’s why by the end of the week, booster doses may be recommended for all adults – or at least those over 30. 

There’s really no down side to getting a third shot, said Ted Ross, an infectious diseases expert at the University of Georgia in Athens, who recently got a booster shot himself.

Side effects are unlikely to be any different than with the first two. The U.S. government bought so many doses so long ago that many will go to waste if they aren’t used soon, he said. And adding extra protection seems like a good idea when 1,000 Americans are still dying every day from COVID-19.

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“The thing boosters might help with is to help dampen the surge or increase we’re going to see this winter,” as people travel and spend more time indoors, Ross said. “That peak or that slope will hopefully not be as steep.”

His view is consistent among many experts: although the first two shots are probably enough to prevent hospitalization and death, a third will buy extra protection while the pandemic is still a part of daily life. 

“Vaccinations work and boosters optimize vaccination,” presidential advisor Dr. Anthony Fauci said at a Wednesday White House news conference.

By the end of Thursday, the Food and Drug Administration is expectedto authorize COVID-19 booster shots for anyone who wants one and is at least six months past their initial vaccination.

An advisory committee and the director of the Centers for Disease Control and Prevention will likely give boosters for all a thumbs up on Friday, though there is some chance they will restrict to those over 30 because of a rare side effect seen mainly in young men. 

Adolescent and young men have seen rare but relatively high rates of myocarditis, a swelling of the heart muscle, within a week or two of vaccination. Myocarditis, which can also be caused by a COVID-19 infection, is usually mild and short-lived when it follows vaccination.

The Biden administration has said it pre-purchased enough doses for every American to get a booster at no cost. 

For the short-term, only the Pfizer-BioNTech vaccine will be available as booster doses for everyone six months after their initial shots, but the FDA and CDC are likely to add Moderna boosters soon.

Extra doses have been available for several months for people with compromised immune systems, including blood cancer patients and organ transplant recipients who were unlikely to get good protection from their first two shots.

When will everyone be vaccinated for COVID-19? Here’s how the vaccine rollout is going

The federal government also authorized boosters after six months for those 65 and older, younger people with health problems and those with jobs that put them at extra risk for infection with COVID-19.

Those who got the single-dose Johnson & Johnson vaccine are also encouraged to get a second shot at least two months after their first.

Some states, including California, New Mexico and Colorado, and the city of New York, have already made boosters available to everyone who received earlier doses more than six months ago.

The CDC has said it’s safe to mix vaccine brands, getting a Pfizer-BioNTech shot after two Moderna’s or visa versa. Data suggests that either of those vaccines, which are similar, would be more protective than a second J&J shot. 

Boosters of the Pfizer-BioNTech or J&J vaccines are identical to initial shots, while boosters of Moderna are half the size of the earlier dose.

It’s not clear yet whether this will be the last COVID-19 shot people will need – or whether immune protection will continue to fade over time or the virus will change enough that a new vaccine is needed.

With some viruses, three doses provide lifelong protection, while with others, like the flu, annual shots are required to protect against a changing pathogen.

Tracking COVID-19 vaccine distribution by state:How many people have been vaccinated in the US?

Dr. Julie Morita, executive vice president of the Robert Wood Johnson Foundation, said she wants to wait to see the data presented to the CDC advisory committee before deciding whether to get a booster shot herself.

Other experts are already convinced.

“Do boosters work and will they bring cases down? I think it’s a resounding ‘yes,'” said Dr. Vincent Rajkumar, a cancer specialist at the Mayo Clinic, who has been closely following the pandemic.

People – even a small percentage ofvaccinated ones – are still dying of COVID-19 in Minnesota, where Rajkumar lives. But those who’ve been vaccinated are dying at a much lower rate than the unvaccinated, he said. According to current statistics, 5 out of every 100,000 vaccinated Minnesotans over age 65 dies from COVID-19, compared to 89 out of 100,000 unvaccinated people. 

Getting booster shots into older people is imperative to protect them, he said, but getting everyone else booster shots will cut down on infections overall, which will make everyone safer.

Former Surgeon General Dr. Jerome Adams thinks everyone should get a COVID-19 booster as soon as they’re eligible. 

People are getting tired of wearing masks, he said, and if they’re going to take them off, they definitely need to compensate with boosters. 

Pfizer-BioNTech, Moderna and Johnson & Johnson:Comparing the COVID-19 vaccines

“We need to double-down on the other tools in our tool chest that we know can be effective,” said Adams, who served as surgeon general from 2017 to 2021. “We need to recognize that boosters lower spread in the community because they bump back up – to 94%, 95%, 96% – vaccine efficacy against spread.”

Only about 15% of people eligible for boosters have gotten them so far – which Adams blamed on a lack of information about their benefits and who was eligible. Opening boosters up to everyone should help reduce that confusion, he said. And it will be much easier to convince a vaccinated person to get a booster than to convince an unvaccinated person to get an initial round of shots, Adams said.

Infection with COVID-19 provides some protection, but it’s not clear how much or how long it will last, Ross, of the University of Georgia, said. People who are vaccinated develop more antibodies than those who were infected but not vaccinated.

Vaccines won’t eliminate COVID-19, just as polio vaccinations haven’t eliminated that disease despite a half-century of global effort, he said. But they will allow society to live with COVID-19 the way we live with the flu.

“To try and have 100% of prevention of infection of any circulating virus is not a likely outcome, but if you prevent severe disease, you prevent hospitalization, you prevent death, I think that’s a goal that’s achievable,” Ross said.

Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City, said everyone needs a booster regardless of their age, health status or profession.

“The initial thinking that ‘no boosters are needed for all adults’ is undergoing a critical review by clinicians and scientists alike,” Glatter said via email. “In my view, this change in thinking arose not only from clinicians’ experience taking care of patients with breakthrough cases of COVID-19, but alongside recent data demonstrating reduced vaccine effectiveness over time, especially 6 to 8 months after completion of the two-shot series.”

Protecting against infections too mild to notice – as a booster does – will prevent people from unintentionally passing the virus along to others, Glatter said.

“The bottom line is that we need to respect the delta variant, which means getting the third dose should be a priority for all adults, especially as the holidays are closely approaching, the weather is getting colder, and we will be gathering together inside,” Glatter said.

Contact Karen Weintraub at [email protected]

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

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