At the end of March became US Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) gave it okay for people over 50 and certain immunocompromised individuals to receive another COVID-19 booster shot to boost the declining immunity.
That CDC says the second booster is particularly important for people 65 and older and those 50 and older with underlying medical conditions (such as obesity, hypertensionor diabetes) that increase their risk of severe COVID-19 disease.
While many public health experts welcome the decision of the federal agencies, others argue that the evidence is still too preliminary to recommend a fourth dose – equivalent to another booster of a Pfizer or Moderna vaccine – in such a wide range of people.
“There is currently no clear evidence that vaccine protection against serious illness is declining significantly [enough] in adults between the ages of 60 and 79 with a normal immune system to support the need for a fourth dose, ”said Andrea Ammon, a German physician and director of the European Medicines Agency and the European Center for Disease Prevention and Control, in a declaration.
The controversy has led many Americans to wonder whether they should get shot or not.
Why the CDC decided to recommend another booster
The CDC made its decision based on early evidence suggesting that the second booster (fourth shot) increases protection against severe COVID-19 for people at higher risk of becoming very ill, without posing any safety concerns.
Looking at the results of more than 180,000 participants, an Israeli study was published in New England Journal of Medicine (NEJM) found that another booster of the Pfizer vaccine was extremely effective in people over 60 years of age. The researchers with Clalit Health Services (the largest health organization in Israel) noted that 14 to 30 days after the administration of a fourth shot, COVID-19 infections fell by 52 percent, hospitalizations fell by 72 percent, and deaths fell by 76 percent compared with those who had received three shots.
A separate study published in NEJM found that persons receiving a new booster remained defended against serious illness six weeks after receiving their shots; their protection against breakthrough infection decreased markedly in the eighth week.
The authors of the paper concluded that more follow-up is needed to evaluate the effectiveness of the second booster against serious illness over longer periods.
So who should get another booster?
“We have seen serious breakthrough infections in a much higher number among those 65 and older, and if it’s been five or six months since your first booster, your protection is likely to have diminished,” he says. Jennifer Horney, Ph.D., professor of epidemiology and core faculty member at the Disaster Research Center at the University of Delaware in Newark. “If an extra booster significantly reduces your risk of hospitalization or death, it’s a good idea.”
Public health experts generally agree that people with weakened immune systems can benefit from an extra shot. These people may receive treatment for cancertaking immunosuppressive drugs or high doses corticosteroidsor have impaired renal function, for example.
“People who are immunosuppressed are more likely to get seriously ill because their immune system has a hard time fighting infections,” he says. William Schaffner, MD, Infectious Diseases Specialist and Professor of Preventive Medicine and Health Policy at Vanderbilt University School of Medicine in Nashville, Tennessee. “These people should get the second booster because they need all the help they can get.”
People who are severely immunocompromised and their relatives fall into a special group
Protecting organ transplant recipients from the virus can be particularly challenging. Research has shown that many organ transplant recipients do not develop antibodies to SARS-CoV-2, the virus that causes COVID-19, after receiving a primary COVID-19 vaccine regimen. ONE National Institutes of Health (NIH) study found that even after a third dose of a Pfizer or Moderna mRNA vaccine, many transplant recipients still failed to produce an antibody response.
The organization is currently investigating whether kidney and liver transplant recipients can provide a better antibody response to vaccination if their immunosuppressive drugs are temporarily reduced.
“In cases where vaccination and boosting do not help, they need other forms of protection, including more stringent isolation from potential infection, as well as frequent testing and easy access to antiviral drugs,” he said. David Lo, MDa prominent professor of biomedical sciences at the School of Medicine at the University of California at Riverside.
If you are 50 years of age or older and are caring for someone who has a severely compromised immune system, you also have a good reason to get a fourth dose of a Pfizer or Moderna vaccine.
“One of the reasons to get a fourth is if you are the primary caregiver for someone at high risk and they live in your home,” says Dr. Schaffner. “You want to create a cocoon of protection around that person so you’ll say to yourself, ‘I want to go the extra mile to protect my relative who lives with us and receives cancer chemotherapy,’ or something like that. I know more. , who have received their fourth dose on behalf of someone they care about. ”
For healthy people aged 50 to 60 years, the decision can be more difficult
While the benefits of a second booster for people aged 60 and up are more apparent, evidence supporting a fourth shot for those between 50 and 60 is less clear.
“The age category 50 to 60, especially in those without health problems, is right now a gray area,” according to Columbia University Irving Medical Center in New York City. “The data on the effectiveness of another booster in this group is limited, so it’s hard to say what the benefit is. These individuals can do well with just one booster if they do not have additional comorbidities.”
Schaffner suggests that for Americans in this age group, it comes down to a personal decision, adding that some may choose to wait to get a new booster until closer to fall or winter in anticipation of a predicted seasonal COVID-19 rise . Plus, a new formulation of the vaccine that is specifically tailored to handle new variants may be available thereafter.
Another factor to weigh may be if you have had COVID-19 recently. Dr. Horney says vaccinated individuals with breakthrough infections due to omicron appear to have an additional measure of natural immunity which will help protect them from the omicron sub-variant BA.2 and the more recently discovered variant XE.
“If you’ve just had COVID, then maybe postpone your second booster for the summer,” Horney says.
If you are not sure, talk to your doctor
For those struggling to decide whether to get the fourth shot, the American Heart Association recommends consulting your doctor.
“People eligible for the second booster should call their clinical care office to discuss the need for another booster,” said the American Heart Association president. Donald Lloyd-Jones, MD, a professor of cardiac research at Northwestern University’s Feinberg School of Medicine in Chicago, in a statement.