Sorting Out the COVID Booster Shot Recommendations

There is frustrating variability in COVID booster recommendations emanating from the FDA, the CDC, HHS and the White House. As of the third week of September, 2021, 2.16 million Americans have received a booster shot, 181 million have been fully vaccinated and 385 million have been “half-vaxed.”

I’ll attempt to bring some temporary clarity to the booster discussion and then I’ll talk about what we are doing at Texas Family Medicine.

• In August, President Biden announced that boosters would begin September 20, 2021 pending approval of that plan from the FDA and the CDC. As of this point, neither agency has promoted widespread booster shots.

• Also in August, the CDC approved COVID boosters for a group they describe as moderate to high-risk, about 3% of Americans. These folks have blood cancers such as leukemia, are receiving chemotherapy, immunosuppressive drugs, or have poorly controlled HIV or other immune deficiency diseases.

• Last week, an FDA sub-committee recommended the FDA approve boosters 6 months after the second shot (Pfizer only) for folks aged 65 and up, healthcare workers, and those at higher risk such as people with diabetes, heart disease, or kidney disease. This recommendation will likely become official within 1-2 weeks. I’m not sure if they will include Moderna vaccine recipients.

• In the same announcement last week, the FDA sub-committee recommended against boosters for everyone 16 and up. So, unlike the first two doses for Moderna/Pfizer and the single dose for J&J, the booster recommendation would be only for higher risk folks, not the entire population.

• On September 20, 2021, Johnson and Johnson announced the results of a study that looked at a booster 2 months after the first shot (J&J has the single-dose COVID vaccine). The second dose increased protection from symptomatic disease from 75% to 94%. More importantly, it protected recipients 100% from hospitalization. Although I’ve only read the study summary, it was rather large and should receive close attention from the FDA and CDC vaccine experts.

Ok, that’s a lot of information to sort through. Our clinic is taking the following approach:

• If you are in the moderate to severe category (cancer or immunosuppressive drugs, poorly controlled immunocompromised disease, or blood cancer), we recommend the booster now if you received the Pfizer or Moderna vaccines.

• If you are 65 and older, a healthcare worker (or other vocation that puts you in frequent exposure situations), we recommend holding off on the booster until the FDA gives approval. That should come in 1-2 weeks (by the first week of October).

• If you are high risk and received the J&J shot, it is likely the FDA and CDC will recommend a booster at some point but that will likely not come for another 1-2 months.

• Everyone else should hold off on a booster.

Folks have asked some great questions regarding the boosters:

1. Does the recommendation of a booster mean the vaccines aren’t working? No. They are remarkably successful at preventing hospitalization and death, but there is evidence that their efficacy is waning. In addition, bumpiing the levels of antibodies in our immune systems by taking boosters should prevent surging COVID variants.

2. Why are there such varying recommendations? Part of the answer is that there is more than one federal agency working on these recommendations. The other is good news. The vaccines have been effective. Experts are seeing persistently elevated antibody levels in those who are vaccinated, and that fact is causing them to be slower in recommending a booster.

3. Will the boosters cause side effects? Probably, especially for those who experienced symptoms from the first two shots. I have had lengthy conversations with folks who had rather unpleasant side effects from the first shots. There will be some difficult decisions for people.

4. Do the boosters contain the same serum as the first two shots? Yes.

5. Rather than take a booster, shouldn’t I just take the monoclonal antibody infusion if I get COVID? No. Generally speaking, the antibody infusion is not as safe as the booster, and is significantly more expensive. Plus, as we all know, an ounce of prevention is better than a pound of cure.

A parting note on the vaccine discussion.

Good people can disagree on COVID vaccines, but let’s disagree without being disagreeable. Within our recommendations as physicians, we support our patients regardless of what they decide personally regarding COVID vaccinations. We give advice, but our patients ultimately make decisions about their health.