Back when the White House announced that booster doses would be available in late September, there was a huge asterisk on that plan—the FDA and CDC would have to go through their usual process examining the data and making recommendations. That process has finished, and boosters are now available for some people who have had Pfizer vaccines.
Who can get a booster?
Right now, COVID-19 boosters are authorized and recommended only for people who had Pfizer for their initial series. If that’s you, the CDC says you should get a booster if you fall into one of the following categories:
People over age 65People who live in long-term care facilities, like nursing homesPeople over age 50 who have underlying medical conditions that mean they are at greater risk of severe disease if they were to get COVIDThose are the “shoulds.” Then there are groups of people who the CDC says “may” choose to get a booster if they feel the benefits outweigh the risks:
People aged 18 to 49 with underlying medical conditionsPeople aged 18 to 64 who are exposed to COVID often “because of occupational or institutional setting”When can I get a booster?
Boosters are intended to be given six months or more after your second dose. So if it’s been, say, three months since you got that dose, it’s still too early for you. But if it’s been longer, like say eight months, you can go ahead and get the booster as soon as you’re ready.
The Pfizer boosters are the same formulation and same dosage as the original vaccine, so any place that can give the regular doses should be able to administer a booster.
What are the underlying medical conditions?
The CDC has a list of conditions where people are at risk of developing severe disease if they contract a COVID infection. These include pregnancy (including people who have been pregnant in the last 42 days), people with heart conditions, current and former smokers, people with a BMI over 25 (which is a lot of us), diabetes, lung disease, and cancer, just to name a few.
You don’t need a note from your doctor, or any other documentation, to get a booster at most pharmacies or clinics. Just let them know you have one of the conditions.
Who actually needs a booster, though?
Okay, that’s a trickier question. The FDA’s and CDC’s advisory panels looked at data that showed immunity seems to wane for older people (65 and over) in a way that could put them at greater risk of severe disease. Both groups agreed that boosters made sense for people over 65.
The CDC has also previously recommended that people who have weakened immune systems due to reasons like cancer or taking medication for autoimmune diseases should get a third dose as part of their initial vaccination with Moderna or Pfizer. That was based on data showing that two doses is not always enough to trigger a lasting immune response.
(If you got the Johnson & Johnson vaccine, there isn’t enough data yet for these panels to discuss the booster question, but that may be coming soon.)
What about everybody else? Here’s where it gets messy. The vaccine’s protection against severe disease doesn’t seem to be fading in younger and middle-aged adults. The only thing fading, according to the (admittedly limited) data, is protection from mild disease, including asymptomatic disease that could lead to transmission. And that protection was never perfect in the first place, so even if we can boost that protection a smidge, we get very little benefit from doing so.
The CDC’s advisory panel actually voted 9-6 against recommending boosters for people 18-64 in occupational settings with exposure risk, and the vote for people 18-49 with underlying conditions only passed narrowly, again 9-6.
The CDC overturned its own advisory panel’s ruling to make the recommendations we reported above. To me, as an observer, this smacks of political pressure. The White House has been trying to make boosters for everyone happen for months now, but the science just doesn’t seem to be there to support casting such a wide net. Recall that the FDA’s advisory panel, which met last week, voted “no” on the question about authorizing boosters for everybody age 18 and older. They narrowed the authorization down to people age 65+ and people at high risk, before passing the question to the CDC panel for their turn.
All of that suggests to me that the decision to recommend boosters to younger people has possibly gotten ahead of the science, but that doesn’t mean that you shouldn’t get a booster. You get to decide. There just isn’t a lot of data to make that decision with. We don’t know if side effects of the third dose will be different than those of the first two doses (though they seem to be fine). And we don’t know how much a booster will actually boost your protection. If you have a doctor you can talk with, you may want to discuss it with them.
