The second booster for Covid-19: Dr. Lina Win weighs

CNN: Who qualifies now for an extra boosting potion?

Dr. Lina Wen: Prior to the announcements this week by the U.S. Food and Drug Administration and the Centers for Disease Control (CDC), people with moderate or severe immunodeficiency were already eligible for an additional booster dose. Now, a much larger group qualifies.

This includes two subgroups of people. First, people over 50 who have received three previous doses of Pfizer or Moderna, and who are at least four months past the last vaccine dose, are eligible to receive another mRNA booster – either Pfizer or Moderna.

Second, all adults — regardless of age — who received an initial Johnson & Johnson vaccine and then a booster dose at least four months ago can receive a second booster dose of the mRNA vaccine, again from either Pfizer or Moderna.

CNN: Now that more people can get a second booster dose, right?

All of this tells me that the question of whether people should receive a fourth dose is not an easy one to answer. This cannot be an all-inclusive recommendation, but rather precise guidelines tailored to each person’s individual medical conditions.

CNN: What factors should people consider when deciding whether to get their second booster vaccine?

Wen: First, consider your own medical risk factors. If you are elderly and have multiple medical conditions, you are more likely to develop severe illness due to Covid-19. Sure, if you are moderately or severely immunocompromised, that should tip the scales in favor of getting an extra booster dose now.

On the other hand, if you are generally healthy, you are still well protected from severe illness due to the protection from the vaccine and the initial booster dose. It is not necessary to have the booster medication, and there may also be an advantage to waiting.

CNN: Why would someone decide to wait on the booster?

Wen: At the moment, the level of Covid-19 in the United States is very low. Experts are closely watching BA.2 in case it causes another spike, but the current transmission rate in most parts of the country is the lowest in months. Since the protective effect of a second booster may not last as long, it may be best to wait until there are clear signs of a sudden increase before getting it.

In addition, there are ongoing studies to develop an Omicron-specific enhancer. If you haven’t received any booster at all, I wouldn’t recommend waiting for this variant-specific booster, but if you’ve already received, and especially if you’re not particularly vulnerable, it might be reasonable to defer for the time being.

Another group of people who may be better off waiting are those who have recently had Omicron. It is unlikely that these vaccinated individuals will be re-infected and re-infected soon. Especially if they are generally healthy, I would also advise them to wait a little longer before getting the extra boost.

CNN: Are there any known downsides to getting the fourth dose?

Wen: Extensive Israeli data analyzes did not identify new fourth-dose security concerns. Theoretically, there is a concern that if someone gets continuous boosters, your immune system may not activate as well if they are exposed to Covid-19, but this has not been proven. The main downside would be the issue of timing – is now the best time to get the fourth dose, or is it better to hold off? It will depend on each person’s medical risk factors as well as their risk tolerance, and specifically how important it is for them to continue to avoid coronavirus.

CNN: Some people may want to wait until a big event like international travel or a big wedding to get an extra shot. Is this a good plan?

Wen: Not right. If you haven’t had the initial booster yet, get it now, because this first booster is important for maintaining strong protection against severe disease. Don’t wait for that first booster. I think it is difficult to time a second boost around an event, and it would make more sense to time it around the expected surge.

Having said that, I can understand why people would like to have better protection for major events. Remember that there are other tools at our disposal to do this. If you want to be extra careful, ordering vaccinations and then testing all the guests before meeting indoors will greatly reduce the risk.

Know where you can access treatment in the event of an infection. And let’s not forget the masks – a high-quality mask (N95 or equivalent) protects you even if others around you don’t hide. Reinforcements are one very important tool that can complement these other tools to help us reduce individual risks.