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Emory physician answers questions about new CDC booster recommendations

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On Oct. 21, the Centers for Disease Control and Prevention recommended booster doses of Moderna and Johnson & Johnson’s COVID-19 vaccines in certain populations, expanding booster eligibility to millions of Americans. Along with previously endorsed Pfizer boosters, there are now three types of COVID-19 boosters available in the U.S.

Booster shots, which are different from third doses, can be administered anywhere COVID-19 vaccinations are available. They can also be given at the same time as other vaccines, such as influenza. 

For more information about the CDC’s COVID-19 booster recommendations, we spoke to Dr. Jay Varkey, associate professor of medicine at Emory University’s School of Medicine.

Q: Who should get a COVID-19 booster shot?

A: For individuals over 65 who received Pfizer or Moderna vaccines, CDC recommends a booster shot at least six months after the initial vaccination series. “As we grow older, our immune systems change, so persons over 65 will benefit from the booster to try and ensure that protection continues,” Varkey says.

People who are 50 or older with chronic medical conditions should also receive a booster. “Some of these chronic medical conditions are actually quite common,” Varkey says. “This includes being overweight, having diabetes, having high blood pressure, or having chronic heart disease, kidney disease, or lung disease.”

Those who live in long-term care settings such as nursing homes and are at least 18 should also receive booster shots. “That setting itself is a high risk for COVID,” Varkey says.

For anyone who received a single dose of Johnson & Johnson vaccine, CDC recommends a booster shot at least two months after the first dose. 

Q: Who else may receive a COVID-19 booster shot?

A: CDC has further recommended booster doses for people who are at least 18 and have underlying medical conditions. This includes pregnant individuals, Varkey notes.

People who are at least 18 and work or live in certain high-risk settings, such as schools, health care facilities or homeless shelters are also eligible for boosters.

Q: Do the vaccines still work well?

A: “These vaccines are highly effective at doing what they were designed to do,” Varkey says. “They are very effective at preventing death from COVID, and they are very effective at preventing serious illness that requires people to get hospitalized for COVID.” Unvaccinated people are also five times more likely to get infected with COVID-19 than vaccinated people. 

However, “immunity after vaccination evolves over time,” Varkey says. “This is totally normal; antibodies decrease over time, and we see this with other infections.” Boosters may help enhance protection against COVID-19 infection.

Varkey, who works in a hospital caring for COVID-19 patients, plans to get a booster shot. “I don’t want to actually get COVID, and I am expecting that there will be future waves until there is increased immunity in my community.”

Q: Which brand of vaccine should be used for a booster?

A: Individuals may choose any of the three COVID-19 vaccines currently available in the U.S. for their booster doses. The CDC’s recommendations allow for “mix and match” dosing, meaning people may receive a different vaccine type for their booster dose than their initial vaccination series. People may also stick to the same vaccine type they originally received. 

“There’s flexibility here,” Varkey says. “This is the benefit of having real-world experience of hundreds of millions of these vaccines being administered not just in the United States, but worldwide.” He adds that most people should make this decision with the advice of their doctor. 

Q: Where are booster shots available?

A: Booster shots are available anywhere COVID-19 vaccines are administered. Varkey recommends going to to find COVID-19 vaccination sites near you.

Q: Is there any reason to not receive a booster?

A: Many fully vaccinated individuals remain well-protected from COVID-19 without getting a booster shot. 

“I know many doctors – who are fully vaccinated, young, healthy with no chronic medical conditions, who have PPE at work – who haven’t yet gotten boosted. Not because they don’t believe in boosting, but because they feel protected,” he says. “That’s very different than somebody who is over the age of 65 or with chronic medical conditions, or who maybe resides in a high-risk setting like in a nursing home, where the data for boosting is not only evolving, but actually really much in favor of getting boosted among those groups.”

Varkey recommends that individuals under age 50 with no medical conditions talk to their doctor about the risks and benefits of booster doses.

“If you had a person who was 18 with no co-morbidities and fully vaccinated, their risk of having an adverse outcome from COVID is very, very low. To that same vein, their relative added benefit from getting boosted is somewhat marginal,” Varkey says. “Any medication, any intervention has potential side effects, so it’s important that we use these strategically and not boost people willy-nilly who have no indications to get boosted.” 

Q: How can we prevent future waves of COVID-19 infection and disease?

A: “I want to really emphasize that the key to preventing future waves of COVID isn’t really through boosting,” Varkey says. “It’s through vaccinating the third of the country that have yet to actually get vaccinated, even though they’re eligible. As of today, that’s over 65 million people in the United States. That really is the key in terms of getting to this next phase and learning to live with COVID, and not having it be a pandemic that disrupts our lives.” 

“Another key point is that a pandemic, by definition, is a global issue,” he adds. “I want to make sure that we don’t forget our privilege that in the United States, we can have a scientific discussion about boosting potentially millions of people who have already completed their vaccine series before most health care workers in the world have actually received even a single dose.”

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