booster shots

What to Know About Booster Shots for All

Photo-Illustration: Intelligencer; Photos: Getty Images

This week, the nation’s top health officials unveiled plans for all Americans to get COVID-19 booster shots. The plan would see the extra doses rolled out starting September 20, going first to nursing-home residents, health-care workers, and others vaccinated early. (All of it is pending expected authorization from the FDA.)

The current crop of vaccines available have been shown time and time again to be effective at preventing severe illness, and officials were previously quick to say they didn’t see a need for boosters for the fully vaccinated. But that equation has changed with the Delta variant, which has infected and sickened some of the vaccinated; waning immunity; and an unevenly vaccinated public.

Here’s everything you need to know about the Biden administration’s plans of booster shots for all:

What does the data say?

According to health officials, mRNA vaccines by Pfizer and Moderna continue to be highly effective in reducing risk of hospitalization and death. But immunocompromised individuals, such as transplant recipients on drugs to prevent organ rejection, tend to develop weaker or suppressed immunity to the disease from their initial vaccination, compared to the general public. A study from March showed that only about 17 percent of immunocompromised people built sufficient levels of protection against the coronavirus after the first dose and 56 percent did after the second jab. As a result, experts agree that those who didn’t develop a robust immune response from a full immunization should get another shot. Last week, the CDC officially advised a third dose for people with compromised immune systems.

For everyone else, experts are divided about whether such a boost is needed, even if immunity from vaccination was shown to fade over time. According to preliminary data out of Israel, the vaccine was just 39 percent effective at preventing infection in July, compared to 95 percent for those vaccinated in January; though most cases are not serious, some people require hospitalization. Additional research from drug maker Pfizer also found that its vaccine’s efficacy declined to 84 percent after six months. This worrying drop in immunity coincided with a resurgence in cases driven by the more contagious Delta variant and suggests an increased risk of severe disease among those who got vaccinated early.

This is also reflected in preliminary data from the CDC, which shows that vaccine effectiveness declined from 92 percent to 64 percent as Delta became the dominant variant in the U.S. As a result, a booster shot may provide a greater degree of protection, but it is unclear how much. Still, other countries have begun administering booster shots: Israel is offering a booster to people over 50 who were vaccinated more than five months ago, and France and Germany plan to offer boosters to some people in the fall.

Others are more skeptical about boosters as an effective intervention against breakthrough infections.

“The thinking was, because there seems to be erosion in protection against infection, let’s get ahead of the game,” Dr. Paul Offit, professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, told Intelligencer. “But for protection against serious illness, really all you need is immunological memory — meaning memory B cells and memory T cells — which generally are longer lived than, say, the level of neutralizing antibodies in the bloodstream.” He added that the data is not quite there in terms of how much immunity against serious illness dampens over time.

How will it work?

Per the new plan, agencies are preparing to offer booster shots in September to all eligible Americans starting eight months after their second dose of Pfizer’s or Moderna’s vaccine. The first people vaccinated would likely be first in line for boosters too. But for the 14 million Americans who received the Johnson & Johnson vaccine, approved in the U.S. later than Moderna or Pfizer, officials are continuing to collect information to determine when to recommend boosters. Vaccinated people between the ages of 12 and 17 are also not included in the booster plan.

Should people “mix and match” shots?

Studies on whether to use vaccines from the different manufacturers available have been ongoing. A U.K.-based study that looked at following up AstraZeneca’s viral vector vaccine with Pfizer’s mRNA shot found that the booster was tolerated well. Other countries, such as Chile, have used the mix-and-match vaccination approach and have not reported problems with that strategy. Still, the World Health Organization has warned against individuals mixing vaccines on their own.

Is there a right time to get the booster shot?

When you should get a booster depends on when you got your initial shots. The recent blanket recommendation for boosters suggests people get an extra jab beginning eight months after their second shot. It’s likely that time frame was based on studies that showed the vaccine’s efficacy dipped after about six months.

Will your booster take away someone else’s shot?

Earlier this month, the WHO called for a moratorium on booster shots in order to focus on getting at least 10 percent of the population of every country vaccinated. (Only 1.3 percent of people in low-income countries have received at least one dose, according to Oxford University’s Our World in Data.)

“The problem isn’t giving a third dose to people who are already vaccinated. The problem is giving any doses to people who are unvaccinated,” Offit said. “It’s the equivalent of, when the Titanic was sinking, giving a second life preserver to people who are already in a lifeboat rather than giving one life preserver to people who are in the water.”

Meanwhile, the Biden administration points out it’s already donated just over 115 million doses abroad. “Our wartime effort will continue doing everything we can to get more people vaccinated, both here at home and around the world,” White House COVID-19 task force coordinator Jeff Zients said Wednesday, according to the Guardian. “We can and must do both at the same time, because that’s what it’s going to take to end this pandemic, and we will not stop until we get the job done.”

What to Know About Booster Shots for All