I am a physician and public health expert over 50 years old, in good health, and I have not yet received my second reminder.
I know this decision is surprising to some, given that the Food and Drug Administration (FDA) recently authorized a second booster dose in my age group, as well as those who are 12 years and older with certain conditions that compromise their immune system. The Centers for Disease Control and Prevention (CDC) has also authorized a second booster shot for people over age 50 and those at risk for severe disease.
I’m not opposed to the idea of a second booster dose — I think it’s an important public health tool. But for most older people with relatively healthy immune systems, I don’t think it’s time for a second booster.
“I’m not opposed to the idea of a second booster dose – I think it’s an important public health tool.”
The argument in support of the second booster is quite simple: an additional injection will bolster individuals’ waning immunity four months or more after their first booster, and thus increase the effectiveness of the vaccine in protecting against COVID infection. -19 and subsequent diseases.
For people whose immune systems don’t respond well to the COVID vaccine, or for those who have other conditions that make them more vulnerable to serious illness, this logic makes sense. But I don’t think that makes sense for anyone over 50 who isn’t immunocompromised.
We are still learning about COVID and the best strategy for administering vaccines. Our understanding of the benefits of second boosters comes from research in Israel, but this understanding is constantly evolving. And there are potential downsides to getting a callback now. For one thing, we don’t know how long the protection of this second booster dose will last. If we apply the experience with the first booster, the protection against the second could decrease in as little as three to four months, especially against the omicron variants, which would imply that we would need a third booster and who knows how many others later. We don’t know what kind of protection we would get from a third or more booster dose, especially if they had the same formulation targeted at the original SARS-CoV-2 virus strain in current vaccines.
READ MORE: People 50 and older will soon be eligible for a second COVID-19 booster dose. But is it necessary?
An argument for further strengthening now is to pre-empt a possible COVID surge due to a new variant. But the first booster shot appears to provide long-lasting protection against serious illness. Additional injections would make sense if we experienced a large increase in disease, especially severe disease, leading to a rapid increase in hospitalizations, ICU admissions and mortality. Although cases are slowly rising in Pennsylvania and elsewhere with the increase in the BA.2 form of the omicron variant, I wouldn’t call it a “push”.
Why is this important? Boosting immunity and the effectiveness of vaccines now, when we don’t particularly need them, can “waste” the benefits, leaving us with less immunity in future surges. An imperfect analogy is the flu vaccine: Since the effectiveness of the vaccine fades over time, the CDC recommends scheduling it at the start of flu season. (And the EU agrees with my assessment, saying recently that it’s “too early” for a second booster for people with healthy immune systems under 80.)
To decide when it’s time for me to get a second reminder, I look at the data. Research shows that people who have been vaccinated against COVID and who are relatively healthy would likely have significant protection against a second booster in about one to two weeks. I watch how the number of cases and hospitalizations during BA.2 climbs; if there is a significant and consistent surge I will get my second booster and expect to be in good shape in a few days. I will also be following the FDA’s ongoing discussions on the appropriate vaccine strategy to prepare for a possible surge in the fall. In the meantime, I will continue to wear masks in dense public places and take home COVID tests when appropriate. And as a public health physician, I will continue to encourage others to get vaccinated and receive their first booster, if eligible.
Another consideration: As the virus evolves, manufacturers are working on variant-specific and universal COVID vaccines. I don’t know how repeated boosters with the same vaccine strain could impact how we respond to these future modified versions of the vaccine.
COVID vaccines are safe and effective and have undoubtedly saved millions of lives so far. I believe reminders are important and will continue to help save lives, but timing is important.
Eddy Bresnitz is a physician and former deputy commissioner for the New Jersey Department of Health, where he was also the medical advisor for the COVID-19 response team.