Omicron boosters: Do I need one, and if so, when?
The Centers for Disease Control and Prevention is recommending updated COVID boosters, for people ages 12 and older.
These newly authorized shots are reformulated versions of the Moderna and Pfizer-BioNTech COVID-19 vaccines and they're available at pharmacies, clinics and doctors' offices around the country.
The boosters target both the original strain of the coronavirus and the two omicron subvariants which are causing most of the current infections. Vaccine makers have scrambled to rejigger the vaccines as they've become less effective against new variants.
"This virus has been mutating so quickly over the past two years," says Judith Guzman-Cottrill, an infectious disease specialist at Oregon Health & Science University. "I feel like we've been playing catch up and finally we have caught up," Guzman-Cottrill says.
Pfizer's updated booster is available for anyone 12 and older. The Moderna booster is available for anyone 18 and older.
"If you are eligible, there is no bad time to get your COVID-19 booster,'' CDC Director Rochelle Walensky told NPR. "I strongly encourage you to receive it," she says.
But after talking to several infectious disease experts, we found there's a whole range of opinions on who needs to boost and when. So, if you are navigating this decision, here are some things to consider:
Who needs a booster as soon as possible?
"I would recommend this booster shot for those who are immunocompromised or those who are 60 years [old] and above," says Monica Gandhi, an infectious disease expert at the University of California, San Francisco. Gandhi says people in these groups are at highest risk.
According to CDC guidance, people are eligible if it's been at least two months since they received their last COVID shot, either a booster or an initial vaccine, but some vaccine experts say it would be better to wait at least four months.
"I will get it," says Physician Bob Wachter, who's in his mid-60s and in good health. "I'm about eight months out from shot number four. And so my immunity has waned significantly," Wachter says. He plans to get an updated booster as soon as it's available as a hedge against serious infection, given COVID is still circulating widely with about 400 deaths per day.
"There's no question that getting a booster increases the likelihood that you'll have a benign case," if you do get infected, he says.
Wachter also agrees with the CDC recommendation that younger adults get the booster. Boosting can protect against the risk of long COVID and helps protect the community at large by reducing transmission, if there's another surge, he says.
"There are good reasons to get it, even for people that have a low chance of a super severe infection," Wachter says.
When does it make sense to wait?
If you've had a recent COVID infection, it makes sense to wait.
Guzman-Cottrill and her children had mild infections in August, so she says she'll wait until November to get boosted.
"Our natural antibody response will protect us against COVID for another few months. So I do think it makes sense to wait and get the updated booster about three months after our positive COVID test," she says.
This is in line with the recommendation from CDC vaccine advisers — people who recently had COVID-19 may consider delaying a booster shot by three months. That's what the country's top infectious disease expert, Dr. Anthony Fauci says he plans to do. Fauci tested positive in mid-June and says he'll wait three months before he gets his updated booster.
Guzman-Cottrill says both her teenagers will also get the new booster "to protect us from COVID this winter so we can avoid sick days from work and from school," she says.
Can I time my shot for maximum protection at the holidays?
It won't be a surprise if there's another COVID surge this coming winter. Since the protection from boosters may only last several months, some people say they plan to wait to get the new booster in order to have maximum protection when the risk of infection is higher. "You can make a rational argument to wait until case rates are higher," says Wachter.
If you're trying to time it for the period of highest risk, he says, there are likely to be a ton more cases in December and January than there are in September and October.
However, Wachter says, this strategy is a bit like trying to time the stock market. It's hard to predict exactly when the surge will happen, so there's a risk in waiting.
"You are basically accepting a period of vulnerability that you don't need to have," he says. "And as I weigh all that, my thinking is I'd rather not do that."
Another argument against waiting is that the protection from a booster shot is not instantaneous. "It does take a few weeks for our immune systems to be primed," says Dr. Aniruddha Hazra, an infectious disease specialist at the University of Chicago. He says it could be risky to wait until a surge is already underway.
Hazra points out the vaccines can activate our immune systems in a few ways. Immune cells, known as B cells, help produce antibodies that fight off the virus in the short-term. Research shows COVID vaccines boost antibodies for several months, but then they begin to fade. After that, B cells and another type of immune cell, known as T cells, which can destroy infected cells, stick around to build a deeper immunity.
He says this deeper immunity was triggered and primed from the initial vaccines, so everyone who's been vaccinated should have some protection against COVID But given the omicron subvariants circulating now are so different. "This [new] booster will definitely provide you with higher levels of antibodies, which are short term and short lived. It may also provide more deep-seated immunity," he says.
Will the new booster shots prevent COVID infections completely?
No. There's lots of enthusiasm for the updated boosters, but they are not a magic bullet
As SARS-CoV-2 has evolved, it's become more transmissible, which is why delta and omicron led to such large surges, despite widespread vaccination in the U.S.
"The goal of this vaccine is to prevent severe illness," says Paul Offit, directorof the Vaccine Education Center at the Children's Hospital of Philadelphia. He argues that many people who've already received three doses of vaccine remain well protected, so he doesn't see a clear benefit to giving the new boosters to everyone 12 and up.
According to CDC data, people who have had one or two boosters have a 0.024% chance of being hospitalized with COVID-19. For people under 50, it's even lower — 0.014%
Offit agrees that certain groups should receive the new booster including elderly adults, people who are immunocompromised and those with chronic conditions that put them at higher risk of serious illness. But he questions the value of another booster for healthy, younger people.
Offit says he had a mild infection in May that lasted a few days. He's decided against getting the new booster. "I think I'm protected against serious disease."
The new boosters offer a few months' protection against infection, he says, but there's no clear evidence of benefit beyond that.
Copyright 2022 NPR. To see more, visit https://www.npr.org.
RACHEL MARTIN, HOST:
A new kind of COVID booster is now being distributed around the country. Pharmacy chains and doctors' offices are now receiving and administering the doses. These new shots target the variants circulating that are still causing thousands of infections a day. So who is eligible for this new booster? And is there any case to be made for holding off on getting one? NPR's Allison Aubrey joins us to answer these questions. Hey, Allison.
ALLISON AUBREY, BYLINE: Good morning, Rachel.
MARTIN: All right. First off, who's eligible, and how is the shot different?
AUBREY: Sure. Well, the CDC now recommends these boosters for people 12 years and up. And the big difference is that the new boosters are designed to fend off BA.4 and BA.5. These are the sub-variants of omicron that are now dominant. There are two boosters authorized, a Pfizer shot, recommended for people 12 and up, a Moderna shot for those 18 and up. People are eligible as long as it's been at least two months since their last booster or COVID vaccine. I spoke to an infectious disease expert, Judy Guzman-Cottrill. She says there's a lot of hope that the new boosters will offer improved immunity.
JUDY GUZMAN-COTTRILL: We finally have a booster that matches the currently circulating COVID variant in the United States. This virus has been mutating so quickly over the past two years that I feel like we've been playing catch-up. And finally, we have caught up.
AUBREY: A lot of the infectious disease experts I talked to say, though the booster is open to most of the U.S. population, those who can benefit the most from getting it sooner rather than later are elderly people, people with compromised immune systems or chronic conditions that put them at higher risk.
MARTIN: So then, in light of that, is it worth it for healthier, younger people to get this booster?
AUBREY: Yeah, I think there's less urgency to get the booster right now if you're young and healthy. But there is a consensus that there's still a benefit. Studies show protection wanes over time. Even though, at this point, most vaccinated people get only mildly sick from COVID, there are still risks and inconveniences. You may have to miss work, interrupt travel, stay away from others. You could get symptoms of long COVID. And, of course, there's a chance of passing it on to vulnerable people at a time when there's still about 400 COVID deaths a day. Now, I spoke to Bob Wachter. He's a physician at UC San Francisco. He says he's getting his as soon as possible. He says he got his last booster about eight months ago.
BOB WACHTER: My immunity has waned significantly. My immunity against getting infected has waned almost completely. So there's no question that getting a booster of some sort increases the likelihood that you'll have a benign case if you get one and will lower the probability you'll get a case of COVID.
AUBREY: He says it's pretty clear to him that the benefits outweigh the risks.
MARTIN: So forgive what may be a self-serving question, but what if you've already had COVID?
AUBREY: Right. Well, if you've had COVID in the last several months, it's pretty certain you've been infected with BA.4 or BA.5. So you've got some time before you need a booster. Generally, about three months after an infection is when you should think about getting the new booster. Judy Guzman-Cottrill says she and her two teenagers are just getting over COVID now. They had it at the end of August.
GUZMAN-COTTRILL: Our natural antibody response will protect us against COVID for another few months. So I do think it makes sense to wait and get the updated booster about three months after our positive COVID test. We had COVID in August, so getting a booster in November will then protect us from COVID this winter so we can avoid sick days from work and from school.
AUBREY: At a time when the virus is likely to be on the uptick again. It will not surprise anyone at all to see a surge coming this winter.
MARTIN: OK. I get that. But what's the advice for those who haven't had a recent COVID infection but they still want to wait until late fall or early winter to get a booster?
AUBREY: I think many people will want to wait a while, given that full protection of a booster may only last several months. I'd say there's mixed opinions from infectious disease experts about trying to kind of time the vaccine. I spoke to Dr. Anu Hazra of the University of Chicago about this. He says he, too, has heard people say, oh, I'll wait until Thanksgiving or Christmas or some big event that I'm going to to try to time the booster to my time of highest exposure.
ANU HAZRA: It's a very reasonable approach to think about - what's your own risk? - and trying to potentially calculate or try to think about when is the best time to get your booster. I think it's also important to know, though, when you get a booster, it's not immediate protection, right? It takes time for your body to create these antibodies.
AUBREY: It takes a few weeks, two or three weeks, until the full protection kicks in. So it's a little bit like trying to time the stock market. In theory, it's not a bad idea. But Dr. Hazra says, in practice, it may be tough to pull off an exact timing.
MARTIN: And exactly how powerful is this new booster? I mean, is it going to prevent people from getting infected at all?
AUBREY: Well, no. People could still get infected. It will help prevent severe infections...
AUBREY: ...But it's not a magic bullet. I think that's part of the reason why there are some respected voices within the infectious disease community who don't agree with the CDC that everyone needs the new booster right now. I spoke to Paul Offit. He heads the Vaccine Education Center at the Children's Hospital of Philadelphia. He told me he agrees with the CDC recommendation to give the booster to high-risk folks, so elderly people, people with immune - compromised, people with chronic conditions. But he does not agree that everyone 12 and up should get it now.
PAUL OFFIT: My thinking on this is that the goal of this vaccine is to prevent severe illness. For those who already received three doses, I think that they don't fall into one of those three high-risk categories. They are protected against severe illness, so I don't think they benefit from a booster. So I'm not going to be getting this vaccine. I think I'm protected against serious disease.
AUBREY: Among people who've already been vaccinated and boosted, the risk of being hospitalized with COVID remains very low. So Dr. Offit says he'd like to see data from trials on people to show that another booster dose is really beneficial.
MARTIN: NPR's Allison Aubrey. Allison, we always appreciate your reporting. Thank you.
AUBREY: Thank you, Rachel.
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