Answers to questions about a second COVID-19 booster

The Food and Drug Administration on Tuesday authorized a second Pfizer or Moderna COVID-19 booster for those 50 and over, including people who received the Johnson & Johnson shot, as well as an additional shot for certain immunocompromised individuals. 

The Centers for Disease Control and Prevention followed that news later in the day by recommending the added booster for these groups. Here's what you need to know about the announcement and what comes next.

Who is eligible for an additional COVID-19 booster?

The FDA's amended emergency use authorization means adults 50 and older, and certain immunocompromised people who previously received a second booster, are eligible.

What health conditions lead to eligibility?

"This is a fairly broad group but includes transplant recipients, those with underlying cancers on active therapy, advanced HIV infection and several other conditions," said Dr. David Hirschwerk, medical director of North Shore University Hospital, and an infectious disease expert. "This is a group that has not consistently made a robust response to a standard series of vaccine and even if they do, their protection wanes more quickly."

Dr. Sharon Nachman, chief of pediatric infectious diseases at Stony Brook Medicine, added that "they are youth over age 12 through adults who have high risk for severe COVID due to medications they routinely take — immune suppressants or specific biologic agents — to individuals with cancers or who have had transplants, to elderly populations who routinely lose antibody protection quickly."

Why is the FDA authorizing a booster now?

Protection against the virus may be waning months after the first booster, Nachman said. Medical experts also are concerned as a new omicron subvariant, BA. 2, starts to take hold in the United States. It has already caused surges in Europe.

“For sure the booster will help prevent any serious disease, particularly for new, related variants coming through,” Nachman said.

Dr. Alan M. Bulbin, director of infectious disease at Catholic Health St. Francis Hospital & Heart Center in Roslyn, said data from an Israel study showed a 78% reduction in deaths in people 60 and above who received a fourth shot, compared with those who only had a third. The reduction came amid the omicron surge and Israel will continue a booster program, including a fourth shot for people 60 and above.

According to Hirschwerk, “there is recognition, particularly among the elderly, that there is a waning of immunity and probably some drop in the protection against severe illness compared to the protection very soon after the third dose. A fourth dose restores this protection.”

When should the eligible groups seek out the additional shot?

The fourth dose for adults over 50 and fifth dose for moderate-severely immunocompromised individuals is recommended for four months after the previous shot.

Should adults get a second booster?

“We’ve seen such good results from the vaccination and preventing hospitalizations and deaths,” Nachman said. “If this next booster continues to help us keep people out of the hospital, that’s a great thing.”

Who should be getting the shot first? 

"There is an ample supply of vaccine currently and they should continue to be offered to those who have not received their primary series as well as keeping people up-to-date with boosters," Hirschwerk said.

Nachman said that "ideally anyone who is concerned about their status should start by speaking with their primary care physician. They are in the best position to understand who that patient is and how much their risk is for moderate to severe COVID."

What are medical experts saying about the authorization?

Hirschwerk said that "those who are moderate to severely immunocompromised have had this available already, but expanding the additional dose to older adults, particularly those over 65, offers the ability to blunt the likely uptick in cases we’ll experience in the coming weeks."

Nachman was also supportive of the FDA and CDC actions.

"This approval moves the availability of these boosters one step closer to the populations that need them, specifically elderly and the immune compromised," she said. "These groups have the worst outcomes from infections — and not just COVID — and having an easily available and safe booster to prevent severe COVID is worthwhile."