If you’re still confused about who should get coronavirus booster shots and when, no one would blame you. First, federal regulators squabbled about who should be eligible. Then, once they agreed, they put out guidelines with some pretty subtle differences about who “should” get a shot versus who “may” get one.
And the messaging about the necessity of boosters has been muddy at best. The director of the Centers for Disease Control and Prevention recently urged eligible Americans to “walk, don’t run” to get the vaccines.
All of which means there aren’t clear answers about the ideal timing of the third jab for those who qualify. Wondering when you should roll up your sleeves? Here’s what you need to know.
Here’s a quick primer on who’s eligible right now.
First, people who are severely immunocompromised — like, who are undergoing active cancer treatment, have HIV or have had an organ transplant — are eligible for a third dose of the Pfizer or Moderna vaccines, and they have been since late August. That’s because those people are unlikely to have mounted a strong immune response after their first doses.
In September, the CDC and Food and Drug Administration took up the question of whether everyone should be eligible for boosters, as the Biden administration had previously argued should be the case. Both groups said “no.”
For now, aside from the exception above for immunocompromised people, only adults who received the Pfizer vaccine are eligible for a booster dose at least six months after their second dose.
You must also meet these conditions:
Other people also qualify for a booster, but the recommendation is less emphatic:
If you’re 18-49 with an underlying medical condition, you may receive a Pfizer booster, the CDC says.
And if you’re 18-64 working a job that puts you at increased risk of exposure and transmission, you may receive a Pfizer booster.
Experts say you should go now if you’re in a ‘should get a booster’ category.
Though the CDC and FDA certainly waffled about who should get boosters before their final guidelines came out, both groups agree there is good evidence that people who are 65-plus — or 50-plus with certain health conditions that might increase their risk of serious illness if they get a breakthrough infection — should go get boosted.
Health experts aren’t worried that those people didn’t build sufficient immunity, as is the case in people with really compromised immune systems. But they are concerned that their age or medical conditions put them at greater risk of getting really sick as their immunity wanes over time.
“The CDC’s recommendations are really based on risk of acquiring COVID and risk of having a severe response to COVID,” said Michael Ben-Aderet, the associate medical director of Hospital Epidemiology at Cedars-Sinai Medical Center in California.
But spreading that message — while at the same time reassuring all Americans that the vaccines are continuing to do a really excellent job — is a difficult line to walk. Experts emphasize that all three vaccines approved for use in the U.S. have continued to hold up well against infection, especially Moderna’s vaccine. All three are also really effective at preventing hospitalization and death.
“‘Fully vaccinated’ still refers to two shots of Pfizer, two shots of Moderna, or a single shot of the Johnson & Johnson vaccine. And that still provides a huge degree of protection,” Ben-Aderet said.
Talk to your doctor about your risk factors and health background.
If you fall into the “may” get a booster category, now’s a good time to talk to your doctor about your circumstances.
For example, say you’re under 50 and fall into the overweight category, which the CDC defines as having a BMI greater than 25 but less than 30. (How ridiculous the BMI is as a health measurement tool is a whole different story.) If you’re otherwise young and healthy, and you work from home, your doctor might not advise you to get a booster yet.
But if you work in a really high-risk setting, like a hospital, your doctor’s recommendation might be very different.
“What I’ve been telling people is this is really a personal decision at this point. If you’re already fully vaccinated, and you’re eligible for a booster, that decision of ‘should you get it?’ really kind of depends on your individual risk factors and your individual concerns,” Ben-Aderet said. “It’s a good thing to discuss with your doctor.”
“That’s kind of a cool part of what we do as primary care doctors,” echoed Carl Lambert, Jr., a Chicago-based family physician. “We can be the tie-breakers. We can clarify and guide patients.”
Don’t try to ‘optimize’ the timing of your booster shot.
While it’s definitely a good idea to talk to your doctor about your particular circumstances, do not expect that they’re going to be able to help you optimize your immunity in any way based on your upcoming social calendar. There’s simply not enough data for them to be able to tell you if you’d, say, be better off getting boosted right before the holidays when you might travel or see family.
“I wouldn’t try to time a booster around a certain event,” Ben-Aderet said. If you’re eligible for the booster and it’s something you and your physician decide you should get, then get it when it’s your turn — which again, is at least six months after your second dose.
That said, one scheduling tip to keep in mind is that you might feel crummy for a day or two after you roll up your sleeves again.
Ethically, there’s no reason to wait.
Vaccine inequity is a major global issue, and one reason why many global health groups have been critical of mass boosting. “Most vaccines are being reserved for wealthy countries, while other vaccine-producing countries are restricting the export of doses so they can ensure that their own citizens get vaccinated first, an approach which has been dubbed ‘vaccine nationalism,’” the United Nations has said.
Still, in the United States, there are plenty of vaccine doses available — enough for those who are eligible to get their boosters, as well as for children ages 5 to 11 to get their first shots whenever approval comes through.
So doctors say there’s no individual reason to wait. And they point out there’s a strong moral argument to be made for going now.
“From an ethical perspective, you’re not skipping the line. You’re actually doing something that could help someone else,” Lambert said. “You’re reducing harm to your neighbor if you follow these guidelines.”
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.