As you may have read, the FDA has just approved a fourth covid shot for many (or “second booster” if you prefer). Whether and how we call something a “second booster” or “next shot” is confusing, and I’ll try to untangle this for you.
First though, we have to acknowledge that although numbers are down, there’s still plenty of covid out there (along with flu and with “stomach flu”, although we’re finding that some of that “stomach flu” is actually covid).
In order to be effective (another potentially confusing word), everyone should have at least 3 covid shots (or maybe 2 if you had the J&J). The original two-shot series is not very effective against omicron, which is the predominant strain. A third shot, however, has been very good at preventing hospitalization and death from omicron. Regardless of which shots you originally had, the third can be either the Pfizer (which is the same dose for the third shot) or Moderna (which is a lower dose for the third shot).
And while that third shot (or “booster”, although I have some problems with that label) is very effective, that effectiveness decreases with time. We’re also dealing with a new variant of omicron that is much more contagious.
So based on these facts, and early data coming out of Israel, the FDA is “approving” a second booster. This is different than “recommending” which is not something the FDA does. A recommendation will likely come from the CDC shortly. Importantly, the committees of experts who make these recommendations haven’t yet weighed in on this. This second booster is approved for people 50 and over at least 4 months after their last shot. It’s also approved for younger people with certain medical problems.
There are two big questions here: 1) Should you get this second booster, and 2) What will be the future of covid shots?
Trying to answer the first question really depends on you and your perception of risk. It’s likely that another booster will improve your immunity—for a while at least. And many of us would like to get back to something resembling a normal life. I think that it’s reasonable to get a fourth shot in order to reduce your risk for a time, which brings me to the next question.
How long would this shot last me, and will I just keep needing more?
A booster is likely to last several months, but we don’t really know for sure. In fact, given how new this disease is, there’s a lot we don’t know. What we do know is that covid vaccines are very effective at preventing hospitalizations and deaths, and that’s a good thing. The downside is that many people feel ill for a day or two after their shot, so they should plan with that in mind. But that’s the only downside.
Given how rapidly this virus can spread and change, and how early we really are in this pandemic, we are certainly going to need more shots in the future, likely this fall. Eventually we will probably fall into some sort of seasonal pattern to both the illness and our shots (like flu) but we don’t really know yet. And we will need to change our vaccines based on what the virus itself does. We’ll also need to keep researching vaccines that have fewer side effects, and we will need to figure out what timing of shots gives the longest-lasting immunity.
I will likely get a second booster in the next few weeks, and if it looks like I’ll need another in the fall, I’ll get that too. A lot of people have been expressing “vaccine fatigue”, wondering what the end point is of all these shots. Ask a diabetic what the end point of their insulin is. We need to do whatever it takes to survive the pandemic, and a shot really isn’t a big deal. We’ll also continue to improve the shot and the timing as we learn more. Being flexible, changing your behavior and making decisions based on the science is how we get through this.
-pal