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Do You Need a Second COVID-19 Booster?

Last month the U.S. Food and Drug Administration (FDA) authorized a second booster dose for some Americans. Ever since then our primary care doctors in Delray Beach have been getting calls from our patients wondering whether they should get one.

It seems strange to be discussing a second booster dose when only about 47 percent of the U.S. population had received a first booster dose as of mid-March.

Last month we discussed the value of a booster dose (“Latest Recommendations on COVID-19 Boosters”), but the recommendations on whether to receive a second booster are mixed.

Confusing guidance

The FDA authorization okayed a second booster dose of either the Pfizer or Moderna vaccines for all adults 50 and older to be given at least four months after the first booster. For those who received one of the mRNA vaccines, this amounts to a fourth dose of the vaccine.

Unfortunately, the Centers for Disease Control and Prevention (CDC) did not provide guidance as to who should receive the vaccine, only that certain people could receive it.

Instead, it simply said that those who would most likely benefit from a second booster were those ages 65 and older and those ages 50 and older who had underlying medical conditions that put them at higher risk of serious illness if they contract COVID-19.

As The Washington Post recently pointed out, the messaging on booster shots has been confusing, especially when some outside experts questioned whether they were necessary.

“There needs to be a lot more guidance put out for physicians and providers as well,” James Lawler, an infectious-disease physician and co-director of the Global Center for Health Security at the University of Nebraska Medical Center, told The Post.

“It’s a complicated landscape,” he said. “There’s lots of data, the data are potentially all over the map and it’s very hard even for infectious-disease doctors to keep up with all of the latest data.”

Conflicting studies

As if to illustrate his point, CNN reports that a study released earlier this month out of Israel which appeared to show that a fourth dose (i.e., second booster) of the coronavirus vaccine protected against infection with the virus for only about eight weeks.

On the other hand, a fourth dose does seem to help protect against severe infection.

“Overall, these analyses provide evidence for the effectiveness of a forth vaccine dose against severe illness cause by [the] omicron variant as compared with a third dose administered more than four months later,” the study says.

No doubt as a result of the criticism, CDC Director Dr. Rochelle Walensky this month offered more clarity on who did not need a second booster. Those who have already received the two-dose mRNA vaccine series and one booster and have been recently infected with COVID-19 do not need one, she said.

So what to do?

Many experts say there’s not much downside with getting a fourth dose, aside from the typical aftereffects of fever, aches, and a sore arm that many people experience.

“I think this is the right move because there’s minimal downside to getting a booster and they appear to be safe, Albert Ko, an infectious-disease physician and epidemiologist at the Yale School of Public Health, told The Post.

“A lot of the risk is going to have to be decided by individual people given the evidence gap and uncertainty. And having individuals make that decision at this point is the right way to go,” he added.

Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco, told the New York Times that only those who are immunocompromised or older than 65 would benefit from a fourth dose.

“If you’re more than five or six months out from your last booster, and you’re at high to very high risk,” the obvious choice is to get a forth shot, he said, adding that given the advantages of not becoming infected, the studies “are all lining up in a direction that says you don’t want to have this infection if you can avoid it, even if you’re 100 percent confident you’re not going to die.”

The bottom line

And that appears to be the difference between an additional booster or not. Chances are, if you’ve had the initial series and a booster, you’re pretty well protected from dying, but you can still experience a breakthrough infection.

There’s also a timing factor involved. Because the fourth dose appears to offer protection against infection for a couple months, you may want to hold off if you’re planning a cruise, for example, and get the fourth dose three weeks before (the time needed for the protection to take full effect).

Another consideration might be whether caseloads are low at the moment, but then your area experiences a spike later.

“What I would see as a potential downside is if you’re in an area where it’s really, really low and you get the booster now, and two, three months from now, the rate goes up higher,” Richard Besser, a former acting CDC director, told NBC’s, Today Show. A more recent shot, in this case, would offer better protection against infection, explained.

If you’re still unsure, talk to us and we can help you decide whether a fourth booster makes sense for you.