William Miller, MD
Second COVID Booster Approved
The FDA has approved the use of the Pfizer and Moderna COVID vaccines as a second booster last week. The scientific evidence supporting this decision is data from Israel which was the first country to authorize a second booster (fourth shot) at the end of last year. The Israeli Ministry of Health has followed over 700,000 of its citizens who received the second booster and has found no significant negative effects. The evidence also supports that a second booster raises levels of circulating antibody. This is felt to be beneficial in preventing serious illness and death primarily in people over 65 or over 50 who have high risk health conditions. The majority, 85%, of the Israelis in the study were over age 60.
The new guidelines, part of the existing emergency use authorization for both Pfizer and Moderna vaccines, allows for all persons above age 50 to receive a second booster as long as the first was at least four months prior. The eligible age is extended for those with documented immunocompromise, for example after organ transplant, to include age 12 and older for Pfizer and age 18 and above for Moderna.
As I reported in the Miller Report for March 21st, “Booster Confusion”, it remains unclear who will benefit most from the second booster and when to get it. Tackling the first part of that question, “who”, it is clear that the risk of serious illness starts to rise after age 65 and is also influenced by risk factors such as diabetes, kidney failure, heart disease, severe asthma and emphysema regardless of age. If you are otherwise healthy and between age 50 and 65, there probably isn’t much benefit to a second booster. If you are above age 65, your risk increases with age and thus the need for protection also increases. Having said that, regardless of your age the majority of protection comes from the two initial shots and the first booster with the second booster only adding a small additional kick.
Another consideration is the timing. It may make more sense to wait until COVID cases are on the rise again before considering a second booster since the immunity seems to begin to wane after about 4 months. Since the next wave of cases isn’t expected until the fall, then it might be better to wait.
Evidence remains strong that getting the initial series of two shots is very beneficial and that getting the first booster is even more so. The CDC published a report on March 18th showing that during the recent Omicron surge in January people who were unvaccinated and contracted COVID were 12 times more likely to develop serious illness and require hospitalization than those people who contracted COVID but who were vaccinated with the original series followed by a booster. Further, those who only had the original series but were not boosted had a 4 times higher incidence of serious illness and hospitalization than those who were boosted. This supports the strong benefit to getting vaccinated and boosted.
Experts in the field seem to be less behind a push for the second booster. Dr. Richard Besser, former director of the CDC, said on NBC’s “TODAY” show last week, “This is one of those where I don’t think anyone needs to race." And the current director of the CDC, Dr. Rochelle Walensky, when referring to individuals in their 50’s said in an interview following the announcement of the approval of the second booster that getting the second booster shot was “a personal judgment call.”
Fortunately, the booster is available to those who qualify as described earlier. Mendocino Coast Clinics in Ft. Bragg offers the shot to the general public as a drive through from 3:00 to 5:00 on Tuesdays, no appointment necessary. Remember to bring your vaccination card. You can call 707-964-1251 for more information. It is also available at CVS, Rite-Aid and Safeway pharmacies, check their websites for availability and to schedule an appointment.