Explainer-All U.S. adults qualify for COVID-19 boosters; which is best?
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[November 20, 2021]
By Julie Steenhuysen
CHICAGO (Reuters) - The U.S. Centers for
Disease Control and Prevention on Friday expanded availability of
COVID-19 booster shots to all American adults, hoping to preserve
vaccine protection against the fast-spreading Delta variant.
Previously, the agency had recommended booster shots only for people age
65 and older, or at high-risk from COVID, and said they could choose a
different vaccine from the one they received for their initial
inoculation.
Now, millions more Americans face the choice of which booster to use.
Here is what some experts advise:
THE LATEST GUIDELINES
Prior CDC booster guidance was based on meeting specific age, health or
other risk requirements that left some people confused about whether
they were eligible.
The new guidance aims to clarify that. It says all adults 18 and older
who received their second dose of a Pfizer/BioNTech or Moderna vaccine
at least six months ago are eligible for a booster shot.
Advisers to the CDC also recommended boosters to adults ages 50 and
older. Prior guidance recommended boosters for all ages 65 and older.
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Many people 18 to 64 wondered whether they were qualified for boosters
under prior guidance, which permitted them for people that age with
medical conditions that increase their risk of serious disease, such as
obesity or diabetes. It also included people at greater risk due to
their professions or living situations.
For adults who initially received the single-dose Johnson & Johnson
vaccine, guidance remains unchanged: they should receive any one of the
authorized COVID-19 boosters two months later.
WHICH BOOSTER IS RIGHT?
U.S. booster guidance permits individuals to mix and match, using the
same vaccine as their original series or a different one of their
choosing.
Although the choices may seem confusing, Dr. Monica Gandhi, an
infectious disease expert at the University of California, San
Francisco, tried to break it down simply.
"Fundamentally, you can get whatever you want for your booster, except
for something very particular: Johnson & Johnson should be followed by
an mRNA (from Pfizer or Moderna), period."
The FDA cleared a second J&J shot based on data showing increased
efficacy against COVID-19 to 94%, up from 72% as a single-dose vaccine.
But a U.S.-government study of mixed booster shots found people who
followed a J&J shot with an mRNA booster had significantly higher levels
of protective antibodies.
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![](../images/112021pics/news_e41.jpg)
A woman receives the Pfizer-BioNTech coronavirus disease (COVID-19)
vaccine as a booster dose at Skippack Pharmacy in Schwenksville,
Pennsylvania, U.S., August 14, 2021. REUTERS/Hannah Beier/File Photo
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The mix and match policy gives physicians more leeway
to advise patients at risk for certain side effects to try a
different vaccine. It also allows for the possibility that not every
pharmacy or doctor's office will carry all three types of boosters.
PFIZER OR MODERNA?
For those who got mRNA vaccines, the evidence suggesting a need for
a booster is strongest for older adults who got the Pfizer/BioNTech
shots, said Dr. Paul Offit, an infectious disease expert at the
University of Pennsylvania and a member of the FDA's vaccine
advisory panel.
For younger individuals initially vaccinated with an mRNA vaccine,
the decision is more nuanced. According to data presented on Friday
to a CDC vaccine advisory panel, protection from the Pfizer/BioNTech
vaccine appears to wane more quickly than the Moderna shots, but
both still do a good job at preventing hospitalization and death.
Pfizer's shot contains 30 micrograms of vaccine and so does its
booster. Moderna's original shots were 100-microgram doses, but the
booster is approved as a half dose. It is not yet known whether
Moderna's lower-dose booster will have the same durability as the
original shots.
Kathryn Edwards, a vaccine researcher at Vanderbilt University
Medical Center, said Moderna's lower dose may reduce the short-term
side effects such as fever and body aches associated with the
higher-dose Moderna shot.
Vaccines from both Moderna and Pfizer have been linked with a heart
inflammation side effect known as myocarditis in younger men, but
data presented to CDC advisers on Friday suggests a booster dose
does not increase that risk.
(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and
David Gregorio)
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