All Adults Can Now Get a COVID-19 Booster. But Should You?

On Nov. 19, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention (CDC), supported an advisory committee’s advice and expanded the group of people who can now get COVID-19 booster doses to include all adults over age 18.

But just because you’re now eligible for a booster shot, do you need to run out and get one? Is the booster recommendation a sign that your previous vaccination is not protecting you anymore? Is it urgent to obtain a booster?

The CDC has now stated that adults who received Pfizer BioNTech vaccine or Moderna vaccine can get boosters at minimum six months. (The agency had already recommended boosters for all adults initially vaccinated with the Johnson&Johnson-Janssen shot.) Previously, the CDC made a distinction between those over age 65 and with underlying health conditions—who the agency said “should” get a booster shot—and those living or working in high risk settings, who “may” get a booster.
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The CDC spokesperson stated that all adults have the opportunity to receive the most recent expansion.

Many people are interpreting that to mean that the urgency to get a booster isn’t as great as the urgency behind the CDC’s original message to get vaccinated, and some people aren’t quite clear about how necessary the booster is. Studies show that the original doses of all three vaccines currently approved or authorized—two doses of the Pfizer-BioNTech or Moderna shots, or one dose of the J&J-Janssen shot—continue to protect people from getting severe disease and needing to be hospitalized. The agency recommended boosters due to increasing evidence coming from Israel and other countries, such as Israel where vaccines are administered for longer periods of time. This means that it is possible to get infections in vaccinated individuals, some of whom may need to be admitted to hospital.

In fact, this question of how urgently boosters are needed was considered carefully by the CDC’s panel of experts, as well as the Food and Drug Administration’s (FDA) advisory committee. Initially, for example, the FDA committee decided to recommend boosters for adults who live or work in settings that put them at higher risk of getting infected, but the CDC panel opted to limit boosters to those at highest risk for severe disease—people over age 65 and those with underlying health conditions. Walensky expanded the eligibility of those eligible for boosters to include people who work or reside in places where SARS/CoV-2 might be more prevalent, like hospitals, food stores, prisons (prisoners), homeless shelters, and schools. People in the group could choose to have a booster, but they were allowed to do so by the CDC. Walensky established the precedent for current guidelines that recommend boosters to all adults. Otherwise healthy adults now have the option to get a booster, but they don’t have to, though the CDC encourages it.

In a press briefing on Nov. 22, Walensky said “everyone over 18 years of age is eligible to get boosted. So, if you’re 18 years and older, I encourage you to go get boosted.” But that falls short of recommending that people get boosted, says Dr. Leana Wen, professor of health policy and management at George Washington University. “The issue is whether the booster is essential vs. nice-to-have. Right now the guidance is phrased as the original vaccination provides pretty good protection, and if you want to get a little extra protection, get boosted,” she says. “That is not the case. Seeing [studies] that found protection from the vaccines declines from the high 80% to 90% to 40% after five or six months —that is not nice-to-have. The booster is not like topping up the immune protection; it’s more like game-changing.”

Dr. Anthony Fauci, the Biden Administration’s chief medical advisor on COVID-19, is equally adamant about the necessity of booster doses. He tells TIME that in his recent broadcast interviews, “I came down very strongly that I thought saying ‘should’ vs. ‘may’ has done nothing but confuse people,” he says. “If you really want people to get a booster, just tell them what to do.”

Fauci points out that there is growing evidence from many countries including the U.S. supporting the use of boosters. The evidence shows that the number of deaths, hospitalizations, and infections in people who have received a booster vaccine is several times lower than those who had only received the first dose. Early data suggests that booster vaccines may provide greater protection due to higher levels of antiviral antibodies and longer lasting protection than those who received the original dose.

Whether boosters are necessary, or an option is up to you. The original vaccine continues to be effective in preventing serious illness and hospitalizations. However, boosters can be crucial if you wish to avoid breakthrough infections. “Right now we are facing more than 90,000 new infections a day [on average], we are entering the winter season, and people are gathering for the holidays,” says Wen. “We know immunity to symptomatic infection wanes substantially at the six-month mark, and immunity even to severe disease wanes too. It’s mind-blowing to me that we cannot just be straightforward with people at this point, and say it is essential to get a booster. The CDC playing around with ‘should’ vs. ‘may’ wording has further confused people.”

Wen points out that the language choice isn’t just semantics. If the CDC said all adults need a booster then doctors would inquire about their booster status. By making it optional, patients won’t necessarily be asked or reminded about getting a booster. “That makes a huge difference,” says Wen. Leaving the decision up to individuals could diminish boosters’ protective potential, she adds.

You should consider getting a booster. Essentially, it couldn’t hurt. With 29 states currently recording new highs in daily COVID-19 cases—coupled with the winter season of colds, flu and other respiratory infections—having the added protection of a booster makes sense. That’s especially true if you’re planning on traveling over the holidays, and mixing with people who aren’t from your household in airports or on planes, trains or buses, and then mingling with family from different households as well. If you have small children who either aren’t yet vaccinated or are only partially inoculated, there’s even more reason to build up a cushion of immunity to surround those who are less protected.

Getting a booster is your choice, but it’s one that could affect family and friends around you. “Many people think the booster is a luxury, as opposed to something they need to get,” says Wen. “That messaging needs to change urgently.”


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